| 摘要: | 癌症近來已躍為台灣十大死因之首，平均每四人中即有一人死於癌症，癌末病人瀕死過程極為辛苦，飽受疼痛的折磨，醫學治療（cure）宣布無效，代之以安寧療護的照護（care）緩和病情為主。「安寧緩和醫療條例」中定義的末期病人，「指罹患嚴重傷病，經醫師診斷認為不可治癒，且有醫學上之證據，近期內病程進行至死亡已不可避免者。」而「瀕死病人」則在增列條文中出現，意味著瀕臨死亡的病人。只是，在某些案例中，由疾病引起的劇痛不是竭盡全力的照護就能安撫的，因此數年來醫助自殺的呼聲四起。 在醫療無效的情況下，痛苦難以解除，故基於尊重病人自律原則，本文就不傷害和仁愛原則、自律與諮詢同意權，討論醫助自殺的道德理據。醫助自殺的用意，立基於同情病人受苦，結束無意義延長的生命，在尊重病人自律原則之下，由病人主動請求醫助自殺的權利。就病人而言，每個人都想有個「好死」（善終），一些意外固然難以抗拒，然而因病而亡的結果往往也不是什麼善終，病人在病魔、醫療技術折磨之下，形影削瘦，起居也需他人扶持，個人尊嚴喪失，生命意義頓然失去，若是因病而亡也可以成為「好死」的一種，則能成全更多希望「好死」的人的心願。 就家屬而言，最大的希望就是陪伴病人度過困難時期，然而在自然的死亡過程中，死亡的時刻常難以確切掌握。若死亡是計劃中的，病人能完善地將後事交代完畢，家人也就能在重要的關鍵時刻，全程陪伴走完其人生旅程。 然而，因為學理上沒有令人滿意的支持論據，醫助自殺到目前仍有許多爭議，無法進行立法。醫助自殺是醫護人員協助自殺行為，不像自願主動安樂死是涉及第二人或第三人的他殺行為，故醫助自殺道德性上比自願主動安樂死較具優先性，因為自願主動安樂死涉及他殺的道德爭議，挑戰「不可殺人」的禁令，所以情況困難棘手。在有些情況下癌末病人生不如死，假設病人自願請求，醫助自殺是否能成立呢？如果醫助自殺不能成立，那麼安寧療護將是唯一出路，但安寧療護是否可以涵蓋在道德上只有醫助自殺才能解脫的所有案例呢？ 本文就癌末病人醫助自殺的道德性進行探討，並提出其所可能導致的好或壞結果，在充分的諮詢同意下，為痛苦無法被減輕的病人提供一條出路，並為學術界提供一個思考的方向。 Recently cancer disease becomes no1. of the top 10 reasons of death in Taiwan, by average one of the four patients’ death due to cancer. Terminal cancerous patients die tough, and exhausted with unbearable pain. When health medication doesn’t work to dying people, professionals suggest alleviating “care” instead. By the definition of The Alleviation Medication of Law, “terminal patient” means that patients getting serious disease, diagnosed cureless by their doctors, and proof in medicine tells the dying course in approaching is unavoidable. “Dying patient” presented in added laws means the one who is going to be death. However, in certain cases, pain caused by cancer disease can’t be diminished by endeavoring in care, so for several years claims of physician-assisted suicide have arisen everywhere. Cause of medication useless, pain unresolvable, by the basis principle of respecting patients’ autonomy, this thesis will discuss the morality of physician-assisted suicide, on according to rights of nonmalevolence, beneficence, autonomy and informed consent. On ground of sympathizing patients’ suffering, physician-assisted suicide’s purpose is to end meaningless proceeding lives while patients actively ask, to respect patients’ autonomy. On the perspective of patients, everyone wants a “good death”, but some accidents are originally unresisted, otherwise death cause of diseases is always not a good result. Patients’ everyday living needs others’ help, under illness and medical techniques, shaped weak, and loses their individual dignity, life meanings. If “good death” compasses death of illness, then it can reach the degree that “good death” of more people will be available. On the perspective of families, their biggest hope is to be accompanied with patients during their tough dying, nevertheless in the course of natural death, it is often hard to control the death time exactly. If the death planned, patients can perfectly arrange things and finish them completely, families otherwise can be accompanied with patients’ dying trips at that key moment. However, because there are no pleasing support arguments in literature, until now it is still many fighting in physician-assisted suicide, but can’t proceed to legislation. Physician-assisted suicide means professionals help patients to suicide themselves, while voluntary active euthanasia concerns about second or third homicide so the morality of physician-assisted suicide gives priority to voluntary active euthanasia. Because the moral issue of voluntary active euthanasia concerning homicide, challenging the prohibition of “you must not kill”, therefore the condition is thorny in dealing with. In some kind of condition terminally cancerous patients don’t want be kept alive but die, supposed patients voluntarily ask at his free will, then physicians-assisted suicide can be justified? If it can’t be justified, then alleviation medication will be the only access, but if it can compass all the cases where morally only physician-assisted suicide can get rid of? This thesis explores the morality of terminally cancerous patients’ physician-assisted suicide, giving all the possibilities of good or bad results caused by that, under fully informed consent, to suggest an entry to patients whose sufferings may not be decreased, and give a reference direction to the bioethics community. |
