從醫療自主權觀點檢驗我國預立醫療決定制度

Abstract

本文檢討病人自主權利法（下稱病主法）規範之預立醫療決定制度，以保護個人醫療自主權之規範目的為基礎，釐清病主法在立法與適用上之疑義，並比較英國心智能力法之制度設計，以修正病主法過度限制醫療自主權之規範，最後提出本文認為我國病主法預立醫療決定制度之樣貌。 在成立層次上，應放寬病主法適用範圍，也減少作成程序中的要式規定，並更具體規範意願人應具備之預立醫療決定能力；效力層次上，應認為預立醫療決定於作成時即生效，只是直到特定臨床條件發生，且個人喪失決定能力時，才有施行預立醫療決定之必要，若有不確定預立醫療決定效力之情形，病主法應使法院有權判斷其有效性。 整體而言，由於預立醫療決定之效力爭議必然存在，因此病主法不應為了避免效力爭議，而將程序複雜化，反而應使個人能夠更容易地為預立醫療決定，且即使效力發生爭議也有適當的因應之道。

The thesis delves into the analysis of the advance decision within the Patient Right to Autonomy Act, focusing on safeguarding individuals' right to make medical decisions. The primary objective of this study is to identify the shortcomings within the current Patient Right of Autonomy Act in Taiwan. To achieve this, a comparative analysis is conducted by juxtaposing it with the Mental Capacity Act in the United Kingdom. Finally, the thesis proposes amendments to advance decisions. A wider application of the scope of advance decision in the Patient Right of Autonomy Act should be adjusted. Moreover, it is crucial to reduce the legal requirements involved in the decision-making process and establish well-defined standards concerning medical decision-making capacity. The documentation of an advance decision should be immediate, but it should only be enacted when specific clinical conditions arise and the individual is lacking the competence to make medical decisions. In cases where doubts arise regarding the validity of an advance decision, the court should possess the authority to determine its legitimacy. In summary, although the disputes surrounding the validity of advance decisions are inevitable, the Patient Right to Autonomy Act should not complicate the decision-making process to avoid such conflicts. Instead, individuals should be empowered to easily make advance decisions, and the validity of their decisions can be confirmed when disputes arise.