醫療上之知情拒絕權


陳俊榕

中文摘要

對於一切事物都能清楚知悉,並不能保證我們生活的安定或 改善我們的生活;相反地,對於事物的無知有時反而可以讓我們 擁有更多的選擇或行動的機會。對於病人來說也是如此,因為就 心理上的影響而言,特定醫療資訊的取得可能會造成病人沈重的 心理負擔,因而可能使病人陷於長期的憂慮或恐慌。據此,對病 人而言,擁有拒絕知悉特定醫療資訊的權利,顯然就有其必要 性。而不論是從醫學倫理四原則中的各項內容,或是憲法所擔保 的一般人格權中的病人自主原則,都可以推導出病人擁有知情拒 絕權的正當性。 德國學界對於將知情拒絕權應用於一般醫療事件的討論,是 由基因診斷法的規定而來,因為該法明確地賦予當事人就基因檢 測的內容擁有知情拒絕權。儘管如此,若要將這項權利套用到一 般醫療事件中來加以適用時,就會產生一些問題。由於病人的主觀期待是判斷醫師說明義務範圍的標準之一,因此,為了使病人 的知情拒絕權之行使成為可能,或許可以透過對於醫師說明義務 範圍的限縮來實現。當醫師在向病人履行說明義務時,可以先透 過詢問的方式去瞭解病人對於相關醫療資訊的主觀態度。病人藉 由醫師的初步提示與詢問後,可以自己決定是否主張知情拒絕 權。當病人明確地表示不願知悉特定的醫療事實時,在與該事實 有關的內容方面,就應一併地排除醫師的說明義務。

 

Discussion on the Right Not to Know in Medicine

Chun-Jung Chen

abstract

Knowing everything clearly does not guarantee the stability of our lives or improve our lives. In contrast, ignorance of things sometimes allows us to have more choices or opportunities for action. It is the same for patients who may have a heavy psychological burden after knowing special medical information and then get into long-term anxiety or panic. Due to this reason, it is obviously necessary for patients to have the right to refuse to know specific medical information. Both the content of the four principles of medical ethics, or the principle of patient autonomy in the general right of personality guaranteed by the Constitution, can all be used to derive the justification for patients' right not to know. The discussion by the German academic circles about the right not to know comes from the rules about genetic diagnosis, which clearly gives the concerned person the right to reject the content of genetic testing. However, some problems arise when applying this right to general medical incidents. Since the subjective expectation of the patient is one of the criteria for judging the scope of the doctor's obligation to inform, the right not to know may be exercised through the limitation of the scope of the doctor's obligation to inform. When a doctor is performing his duty to inform the patient, he can ask questions and understand the subjective attitude of the patient to relevant medical information at first. Following the initial indications and enquiries made by the doctor, the patient can decide whether to assert the right of rejection by himself. When the patient expressly indicates that he is unwilling to know a particular medical fact, the doctor’s obligation to explain should be excluded in the context of the fact.