徒法尚不足自行：從「病人自主權利法」反思善終政策【本期企劃】 試閱
Do Right Things at the Right Time: Policy Reflections on Patient Right to Autonomy Act and Hospice in Taiwan
本文從公共衛生出發，評析「病人自主權利法」（下稱病主法）的實施現況。本文主張如何善終有理論上的應然，但對於病主法作為衛生政策，特別是生死素養的實然，其內涵與挑戰的討論還有空間。本文分三節，首先討論病主法在政策推動上的挑戰，特別是政策宣傳的效果、預立醫療照護諮商的運作，與政策成效的設定。其次，從歷史制度論的視角本文回顧善終制度的政策路徑，側重政策的關鍵契機、法律政策的配套建立，與安寧專業的發展。基於以上理解，本文最後以強化安寧專業、確認病主法政策定位，與調整生死素養宣導策略，對病主法在現階段的落實提出建言。
From the viewpoint of public health, this paper offers policy reflections on Patient Right to Autonomy Act (PRAA), the first of such legal achievements in Asia. With high expectation of how good death can be achieved through this law, its implementation, nonetheless, have been facing challenges. Therefore, in this paper I summarize the problems that have obscured PRAA’s policy goals, including vague priority setting of PRAA effects, inappropriate communication channel on hospice, and confusing legal frames on the facilitation of good deaths. I also briefly review the legal and professional development of hospice care in Taiwan in light of historical institutionalism. Only with these understandings, I argue, can we capture how PRAA can be improved, by revising the law or beyond, to serve as the guidance toward good death for everyone that deserves it.
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