從天主教倫理之普通與特殊維生方法再思《病人自主權利法》之拒絕人工營養與流體餵食

Revisiting the Refusal of Artificial Nutrition and Hydration in the Patient Right to Autonomy Act from the Perspective of Catholic Ethics on Ordinary and Extraordinary Means of Conserving Life

《病人自主權利法》（以下簡稱《病主法》）讓末期及符合特定臨床條件的非末期病人可以拒絕人工營養與流體餵養（ANH）。然而，天主教會台灣地區主教團認為除非臨終或身體無法吸收，否則就有持續提供的義務，故反對《病主法》。本文從傳統天主教倫理神學所闡述的普通與特殊維生方法，審思《病主法》之拒絕ANH。本文指出，普通與特殊維生方法與《病主法》均重視病人的經驗與意願，而ANH在《病主法》規定的臨床條件下，有可能帶給病人超過利益的負擔，不盡然是普通方法。《病主法》若能衡量病人整體利益與負擔，即可與天主教傳統教導趨向一致。預立醫療決定（AD）有助於了解末期階段病人的療護意願，天主教徒若根據《病主法》輔以衡量普通與特殊維生方法簽署AD，當處於非臨終而無法從ANH獲得持久效益時，拒絕成為特殊方法的ANH不致淪為安樂死，同時可合法表達自身的醫療意願。

The Patient Right to Autonomy Act allows terminal and non-terminal patients who are under specific clinical conditions to refuse artificial nutrition and hydration (ANH). The Chinese Regional Bishops’ Conference opposes this Act, arguing that ANH is an ordinary method of care and, that unless the patient is dying or unable to absorb, there is an obligation to provide it. This article examines the refusal of ANH in the Patient Right to Autonomy Act from the perspective of traditional Catholic teaching on “ordinary and extraordinary means of conserving life.” It points out that both “ordinary and extraordinary means” and the Patient Right to Autonomy Act value the patient’s experience and wishes. When a patient is faced with the clinical conditions specified in the Patient Right to Autonomy Act, providing ANH may bring more burden than benefit, and hence it is argued that ANH is not necessarily an ordinary means. In addition, this paper proposes that instead of only using medical standards to assess whether one can refuse ANH under this Act, an analysis of benefit and burden from a patient’s perspective should also be included. This would make the Act more consistent with Catholic moral teachings. Finally, this paper recommends that Catholics be allowed to sign advance directives under this Act, as it is the only way one can legally express one’s wishes on such an important healthcare decision and be able to refuse ANH when it becomes an extraordinary means.