特殊醫療的病人自主及其刑法爭議

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Title:	特殊醫療的病人自主及其刑法爭議
Other Titles:	The criminal law Disputes about Patient Autonomy in the Special Medical Treatment
Authors:	韓政道 HAN, CHENG-TAO
Contributors:	張麗卿 CHANG, LI-CHING 法律學系
Keywords:	特殊醫療;病人自主決定權;人體器官捐贈;重症新生兒;人體臨床試驗;末期病人;被害人承諾 Special medical treatment;Patient right of autonomy;Organ transplantation;Critically ill neonates;Human clinical tial;Terminal illness patients;Victim's promise
Date:	2019
Issue Date:	2019-12-16T03:20:52Z (UTC)
Abstract:	本文以特殊醫療為題，由病人自主決定權開展，從刑法評價衍生的爭議為角度，思索我國現行醫療相關法制度就特殊醫療情境中的病人權益，是否已有完善的規範與保障。對於特殊醫療，本文是從一般醫療中，劃定四向具體的醫療情境，分別從中探究病人自主決定權與所面臨的刑法爭議。首先，關於人體器官捐贈，本文將其視為一種特殊醫療的原因是，不同於醫學的本質是以追求回復健康為目的，器官捐贈手術本身僅僅是對受術者造成純粹傷害的惡害影響，以此種利他型的醫療行為，除了顛覆了醫療行為的本質與目的，關於捐贈者的自主權益與保障，就有必要進一步的思索與探討。其次，關於人體臨床試驗的特殊性是，臨床試驗在無法確切預知與掌握風險的情況下，受試者是否願承擔這項風險，應取得受試者本人同意，相較於一般醫療，臨床試驗更應重視病人自主決定權的保障。諸如，試驗前應取得受驗者的真摯同意，其中有關醫師的告知說明義務與取得病人同意等要件與程序，無論在法規範或解釋上都應更加嚴謹。再者，談到重症新生兒醫療的爭議問題，主要聚焦於這些特殊醫療的決策與衝突上。而重症新生兒的醫療特殊性在於，新生兒自始欠缺自主權利，也無法藉由他人推測釐清其意願，是以，當發生父母拒絕重症新生兒接受常規性治療的情況下，該如何保障其最佳利益。應從刑法理論探討醫師治療義務的界線，並從中尋求醫師或第三方等意見來共同維護新生兒病人的醫療權益。最後，末期尊嚴醫療的病人自主直接挑戰的是刑法規範的容許性。隨著社會價值觀念的轉變，人類借助醫療科技無限度的延長生命，反倒促使人民省思，毫無意義的延長痛苦的生命，是否符合醫療倫理中的行善要求。在此特殊情境下，人民是否享有拒絕醫療的自主決定權利，本文將會從我國目前立法現況來觀察，檢討末期醫療於刑法評價上的容許性與合法空間。 This thesis takes special medical treatment as the topic, and the patient decides to carry out the right, from the perspective of the disputes derived from the criminal law evaluation, and considers whether the current medical related legal system in China has perfect norms and guarantees for the patient rights in special medical situations. For special medical treatment, this article delineates the four-way specific medical situation from general medical treatment, and separately explores the patient's discretion and the criminal law disputes. First of all, regarding the donation of human organs, the reason why this article regards it as a special medical treatment is that, unlike the essence of medicine, the purpose of pursuing recovery of health is that the organ donation surgery itself is only a harmful effect on the pure injury caused by the subject. In order to use this kind of altruistic medical behavior, in addition to subverting the nature and purpose of medical behavior, it is necessary to further think and discuss about the independent rights and protection of donors. Secondly, the specificity of human clinical trials is that if the clinical trial is unable to accurately predict and grasp the risk, if the subject is willing to bear the risk, the subject should obtain the consent of the subject, compared to general medical, clinical trials. More attention should be paid to the protection of patients' discretion. For example, the true consent of the subject should be obtained before the trial, and the requirements and procedures for the notification of the physician and the consent of the patient should be more rigorous in terms of legal norms or interpretations. Furthermore, when it comes to the controversy of severe neonatal care, it focuses on the decision-making and conflicts of these special medical treatments. The medical speciality of severely ill newborns is that newborns lack autonomy at the beginning and cannot clarify their wishes by others. Therefore, how to protect their parents when they refuse to receive routine treatment from critically ill newborns? Best interest. The boundaries of physicians' treatment obligations should be explored from the theory of criminal law, and opinions from physicians or third parties should be sought to jointly safeguard the medical rights of neonatal patients. Finally, the patient's autonomy in the final dignity of medical care directly challenges the permissibility of the criminal law. With the change of social values, human beings use medical technology to prolong life indefinitely, which in turn encourages people to think about it, and it is meaningless to prolong the painful life, and it is in line with the requirements of doing good in medical ethics. In this special situation, whether the people have the right to decide on the right to refuse medical treatment, this article will observe from the current state of legislation in China, and review the admissibility and legal space of the final medical treatment in the evaluation of criminal law.
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