臨終病人善終之爭議- 病人自主權利法之分析與探討

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Title:	臨終病人善終之爭議- 病人自主權利法之分析與探討
Authors:	吳素娟;Wu, Su-Chuan
Contributors:	哲學研究所在職專班
Keywords:	自然死;醫助自殺;安樂死;終極鎮靜;善終;安寧療護法;natural death;physician assisted suicide;terminal sedation;good death;Hospice Care Act;Patient Right to Autonomy Act
Date:	2021-10-26
Issue Date:	2021-12-07 12:08:37 (UTC+8)
Publisher:	國立中央大學
Abstract:	全球已邁向高齡化的趨勢，臺灣將在2025 年成為老年人口占比大於20%的國家之一，並進入「超高齡社會」，根據衛生福利部健康署的「癌症登記報告」，自民國 71 年起，癌症高居十大死因之首，因此，從這些資料反映出大規模人口老年化和癌症病人逐年的增加，醫療照護的需求也相對地增加，而臨終準備與權利的保障也愈加受到重視。醫療科技的日新月異，為許多無法痊癒的臨終病人，提供了許多解決的治療方式以達成延長生命為目的，但相對地也延長了死亡的過程，這期間病人不僅要承受著難以忍受的病痛折磨，雖延續了生命的長度，但生活沒有了品質，存在對於生命價值又有何意義？因此，如何面對死亡是一生最大的考驗，終究當生命走向謝幕的階段，每個人都希望能有個善終、圓滿的結局。台灣社會對於死亡議題這幾年有更多地關注，其實死亡有許多複雜的情境題，關於死亡的議題有的道德兩難，時至今日歧見仍然持續不斷地在辨明著。本文分析臨終病人死亡方式的選項包括自然死、醫助自殺、安樂死、臨終鎮靜，及《安寧緩和醫療條例》和《病人自主權利法》所提供的方法。而亞洲第一部《病人自主權利法》已在台灣正式上路。這是以病人為主體，是一部保障病人自主權利的法案，因此本文對於《病主法》分析與探討，並且提出修訂建議。期盼能支持並提供臨終病人更多的選項，對於化解臨終病人善終所面臨的醫療困境所幫助。生命總會有走向終點的一天，如果有機會死得有尊嚴，平靜、安詳而圓滿地結束，能達到「養生送死無憾」，就是一種善終。關於善終的詮釋是涵蓋身、心、靈與社會的層面，涵意甚廣，本文意指的善終，只是狹義臨終病人的善終權，因此本文認為善終的意境，如同印度詩人泰戈爾《飛鳥集》的詩句：「生，如夏花般絢爛。死，若秋葉之靜美。」。;The world has been moving towards an ageing trend. Taiwan will become one of the countries with an elderly population of more than 20% by 2025, and will enter a "super old society". According to the "Cancer Registry Report" of the Department of Health and Welfare, cancer has been among the top ten causes of death since 1971. Therefore, these data reflect the massive aging of the population and the yearly increase of cancer patients, and the demand for medical care has increased correspondingly, and the preparation of end-of-life and rights to die have become more and more important. The rapid advancement of medical technology has provided many solutions for many terminal patients who cannot be cured to achieve the goal of prolonging life, but it also prolongs the process of dying. Therefore, how to face death is the biggest test of life. In the end, when life comes to an end, everyone hopes to have a good and satisfactory ending. In fact, there are many complex issues regarding death, and some moral dilemmas regarding death are still unsolved today. This thesis treats in details the options for terminally ill patients today including natural death, physician assisted suicide, euthanasia, terminal sedation and the solutions provided by the Hospice and Palliative Care Act, and the Patient Right to Autonomy Act. The first Patient Autonomy Act in Asia has been officially launched in Sixth January 2019 in Taiwan. This thesis gives a more or less complete analysis of the Act and proposes some amendments for it. It is hoped that it can support and provide more options for terminally ill patients and solves some of the issues of medical dilemma faced by hospice patients. If one has to die with dignity, to end peacefully, quietly, and satisfactorily, and to achieve "no regrets for those alive as well as those died", and this is a good death. The meaning of good death covers issues including the body, mind, spirit and society, and has a wide range of meanings. In this paper I deal only with the good death for the terminally ill in a narrow sense. This is why we believe that the meaning of a good death is like the poem of Tagore′s Stray Birds: ?Let life be beautiful like summer flowers and death like autumn leaves.
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