| 研究生: |
郭兆昕 Kuo, Chao-Sin |
|---|---|
| 論文名稱: |
國家干預未成年醫療決定規範之比較法研究 State Intervention in Minors’ Medical Decision-Making: A Comparative Perspective |
| 指導教授: |
江浣翠
Chiang, Wan-Tsui |
| 學位類別: |
碩士 Master |
| 系所名稱: |
社會科學院 - 法律學系 Department of Law |
| 論文出版年: | 2026 |
| 畢業學年度: | 114 |
| 語文別: | 中文 |
| 論文頁數: | 217 |
| 中文關鍵詞: | 未成年人 、醫療決策 、親權 、醫療自主決定權 、國家干預 、醫療倫理 、國家監護原則 、醫療倫理諮詢委員會 、未成年最佳利益 |
| 外文關鍵詞: | minors, medical decision-making, parental authority, medical autonomy, state intervention, medical ethics, parens patriae, clinical ethics committee |
| 相關次數: | 點閱:4 下載:0 |
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本論文探討國家介入未成年醫療決策的法律規範與制度操作。現行我國法制雖對特定醫療處置設有未成年人得同意之條文,但大多以年齡與行為能力為判準,並保留法定代理人之介入權,未能充分反映未成年人心智成熟程度與自主判斷能力。此種依賴法定代理或協助決定之規範設計可能忽略了在不同情境下父母或法定代理人未必皆遵守未成年人最佳利益,或其所認為對子女最佳利益與醫療提供者所認為者有所落差,甚至有可能剝奪未成年人對於涉己醫療決策為參與並決定之機會,此時即有可能產生紛爭。而國家基於法治國原則及社會國原則對於人民權利之保護與保障程序之建置,應承擔解決未成年醫療決策可能衝突之第三方。可能之解決方法係預先制定相應之法規範,再進一步即透過裁判方式為干預之決定,就前者而言可能產生之問題已如前述,就後者而言,如何干預、遵守之程序、干預決定之考量及為何種干預之決定等問題,我國對此並非如此清晰,因此本文擬透過他山之石作為借鏡。
就針對法定代理或協助醫療決定之法律規範而言,相較於我國之情況,美國法已透過判例及各州自行立法之方式,對於未成年人於何種情境下、或具備何等能力即可自行為特定醫療決策之穩定見解,而英國、澳洲亦如是。就針對國家如何干預未成年醫療決策而言,美國實務則係透過所謂國家監護原則作為介入權源,並經以損害原則調和後之最佳利益標準判斷國家是否能作成強制治療之決定。此外本文亦指出,倫理諮詢機制可在進入司法程序前扮演溝通橋樑,協助緩解意見及價值上衝突,希冀如此比較能對我國對未成年人醫療自主的認識納入不同思考,建立依能力與風險層級調整之介入標準,實現未成年病患自主、父母責任與國家保護之三方平衡。
This study examines the legal framework governing state intervention in minors’ medical decision-making. Although Taiwanese law permits minors to consent to certain medical treatments, the current regulatory structure largely relies on age and formal legal capacity while preserving broad parental authority over medical decisions. This design fails to adequately reflect minors’ cognitive maturity and their capacity for autonomous judgment. As a result, conflicts in medical decision-making are often framed as disputes between parents and physicians, which marginalises minors as decision-making subjects and leaves the state without clear standards for legitimate intervention.
To address these issues, this study adopts a comparative legal method and analyses the legal approaches of the United Kingdom, the United States, and Australia. The analysis focuses on how different legal systems recognise minors’ decision-making capacity and how the state may intervene when disagreements arise between minors, parents, and medical professionals.
The comparative analysis shows that different jurisdictions increasingly recognise minors’ developing autonomy while maintaining mechanisms for state protection when serious health risks arise. These systems incorporate standards that assess minors’ capacity and balance parental authority with the protection of the child’s welfare.
This study concludes that Taiwanese law should develop a more nuanced framework that recognises minors’ evolving capacities and establishes differentiated standards for state intervention based on decisional competence and medical risk. Such an approach would better balance minors’ autonomy, parental authority, and the state’s protective responsibility in medical decision-making involving minors.
一、中文部分
1.書籍
史尚寬(1964),親屬法論,作者自版。
王澤鑑(2018),民法總則,作者自版。
司法院(2003),美國聯邦最高法院憲法判決選譯(IV),司法院發行。
司法院(2005),美國聯邦最高法院憲法判決選譯(V),司法院發行。
李宜琛(1946),現代親屬法論,國立編譯館。
李宜琛(1944),日耳曼法概說,商務印書館。
沈冠伶(2024),民事訴訟法(上),台北:新學林。
林菊枝、吳煜宗(2017),臺灣親屬法新論,台北:新學林。
林秀雄(2022),親屬法講義,台北:元照。
高鳳仙(2019),親屬法:理論與實務,台北:五南。
胡長清(1946年),中國民法親屬論,商務印書館發行。
陶匯曾(1928),親屬法大綱,商務印書館。
屠景山編(1931),親屬法原論,上海世界書局。
梁光耀(2012),圖解實用倫理學,香港:非凡出版:香港聯合書刊物發行。
陳棋炎、黃宗樂、郭振恭(1993),民法親屬新論,台北:三民。
陳聰富(2018),民法總則,台北:元照。
陳聰富(2019),醫療責任的形成與展開,修訂版,臺北市:國立臺灣大學出版中心。
黃丁全(2000),醫事法,台北:元照。
鄭冠宇(2021),民法總則,台北:新學林。
戴炎輝、戴東雄、戴瑀如等合著(2021),親屬法,台北:元照。
2.期刊論文
史尚寬(1969),我國民法上之親權,法令月刊,20(3),頁3-5。
小林貴典(2018),未成年子女之父母拒絕醫療同意時的法律因應,月旦醫事法報告,第21期,頁156-176。
王志嘉(2011),生育自主權──兼論未成年人醫療決策,台灣法學雜誌,173期,頁45-49。
王泰升(2017),臺灣的繼受歐陸民法:從經由日中兩國到自主採擇,法令月刊,第68卷 第4期,頁1-20。
王澤鑑(2006),人格權保護的客體與展望(一)-人格權、人格尊嚴與私法上的保護,月旦法學雜誌,第80期,頁105-120。
江浣翠(2021),未成年人之醫療決定與自主--台灣規範現況與評析,月旦醫事法報告,53期,頁24-39。
李立如(2007),婚姻家庭與性別平等:親屬法變遷的觀察與反思,政大法學評論,95期,頁174-227。
李立如(2008),司法審查之表述功能與社會變革:以性別平等原則在家庭中的落實為例,臺大法學論叢,37卷1期,頁33-78。
李立如(2012),親屬法變革與法院功能之轉型,國立臺灣大法學論叢,41卷4期,頁1639-1684。
李立如(2019年),憲法解釋中的家庭圖像與其規範地位,國立臺灣大學法學論叢,第48卷第3期,頁967-1021。
李震山(2004),憲法意義下之「家庭權」,國立中正大學法學集刊,第16期,頁61-104。
李震山(2025),生命權保障的憲法詮釋路徑-簡評憲法法庭 113 年憲判字第 8 號判決,月旦實務選評,第5卷第4期,頁82-90。
林欣柔(2016)。未成年人醫療自主權-以愛滋檢測為中心。法律與生命科學,5卷1期,頁11-27。
林秀雄(2003),我國親權法之現狀與課題,月旦法學雜誌,第 100 期,頁42-53。
林秀雄(2022),父母對未成年子女之扶養義務-評析最高法院 109 年度台抗字第 120 號裁定,月旦實務選評,第 2 卷第 8 期,頁72-79。
吳全峰、黃文鴻(2007),論醫療人權之發展與權利體系,月旦法學雜誌,第148期,頁128-161。
吳振吉(2021),醫療契約立法之比較研究(一):典型化契約考量因素及早期荷蘭立法之介紹,月旦醫事法報告,53期,頁128-146。
范嘉紋(2020),淺談未成年醫療及身體自主權,司法新聲,第133期,頁56-86。
侯英泠(2022),醫師保密義務之原則與例外──論病人個人隱私保護與揭露之倫理難題,月旦醫事法報告,頁7-23。
許育典、陳碧玉(2009),論憲法限制親權的憲法正當性,台北大學法學論叢,69 期,頁1-38。
許育典、陳碧玉(2014),國家公權力介入家庭後的衝突關係:以兒少保護為核心。東海大學法學研究,42期,頁1-52。
張兆恬(2018),審議民主於生醫法上之運用:我國法之觀察。法律與生命科學,7(1),1-16。
黃舒芃(2005),比較法作為法學方法:以憲法領域之法比較為例,月旦法學雜誌,120期,頁183-198。
陳心怡、何堯凱、唐宜楨(2021),從醫療人員觀點來看兒童醫療決策參與權利,醫學與健康期刊,10卷2期,頁61-72。
陳俊榕(2019),醫療上之知情拒絕權,高大法學論叢,第14 卷第 2 期,頁83。
陳惠馨(2014),親屬法的理論與實務,月旦法學雜誌,第233期,頁21-41。
楊秀儀(2007),論病人之自主權---我國法上「告知後同意」之請求權基礎探討,台大法學論叢,36卷2期,230-268。
楊秀儀(2017),追求善終的自主:論病人自主權利法之法律性質與定位,萬國法律,第212 期,頁11-19。
楊崇森(2022),羅馬法對現代法之貢獻(羅馬法伴讀)(下),全國律師,第26卷第1期,頁91-104。
劉宏恩(2025),再生醫療立法及產業發展的倫理與社會基礎──以利益衝突、審議會多元性、病人救濟措施與權益保護為例,月旦法學雜誌,358 期,頁 110-126。
廖宗聖(2018),醫生也該懂國際法:殘缺的兒童醫療自主權利,台灣國際法學刊,第15卷第1期,頁129-134。
廖建瑜(2019),生不由己!?──談病人自主權利與優生保健法之規範競合,法官協會雜誌,20卷,頁140-157。
鄧學仁(2013),子女福利與親權法之課題,月旦法學雜誌,216期,頁102-118。
戴正德(2011),醫學倫理諮詢及其在台灣之應用,台灣醫學,15(5),頁518-524。
薛智仁(2003),論人工流產同意權(上),台灣本土法學雜誌,48期,頁143-155。
蔡甫昌、陳侃倫(2011),臨床倫理諮詢之理論與實務。台灣醫學,15(6),638-650。
蔡曉榮(2023),中國傳統家長權到近代親權之演變:一個比較法律史的考察,當代法學,6期,頁136-145。
戴瑀如(2010),從親屬法上父母子女關係論未成年人之醫療決定權,生物醫學,3 卷 4 期,頁 504。
魏伶娟(2023),從比較法觀點談未成年病人之醫療自主決定權—兼論未成年病人為預立醫療決定之可能性,政大法學論叢,第172期,頁233-289。
鄺承華(1998),澳大利亞安樂死法律之探討—病患「權利」之行使?醫療行為之規範?臺大法學論叢,第 27 卷第 4 期,頁293-333。
3.專書論文
陳聰富(2023),醫療契約法典化之研究,收於:契約成立與締約過失,頁350-412,台北:元照。
李震山,家庭權,收於:多元、寬容與人權保障—以憲法未列舉權之保障為中心,台北:元照,頁159-175(2007年)。
李震山(2020),人性尊嚴之憲法意義,收於:人性尊嚴與人權保障,頁1-31,台北:元照。
4.學位論文
李冠儀(2018),醫療法上得未成年人同意與親權濫用,臺灣大學法律研究所碩士論文。
張雅珮(2005),父母子女關係於未成年人醫療決定中之地位-以未成年人之醫療自主權及最佳利益為中心,台北大學法律研究所碩士論文。
陳璿羽(2012),醫學倫理於法律上適用之地位,國立臺灣大學科際法律研究所碩士論文。
黃建秋(2018),醫療倫理、醫療常規與醫療過失,國立成功大學法律研究所碩士論文。
劉珊妮(2025),從文化看病人拒絕治療權之自主性實現,成功大學法律系碩士論文。
鄭瑜亭(2013),未成年人自主決定與父母意見相衝突之法律問題—以子女身體自決為中心,國立成功大學法律學系碩士論文。
蔡政華(2019),兒童最佳利益與醫療決定,政治大學法律研究所在職專班碩士論文。
鍾惠平(2017),從未成年子女最佳利益觀點探討親權行使之限制,國立成功大學法律研究所碩士論文。
謝宛婷(2025),以脆弱性理論修補意思能力制度為醫療自主的實踐模型,國立成功大學法律學系博士論文。
5.其他
台灣癌症基金會,要化療了,你準備好了嗎? https://www.canceraway.org.tw/page.php?IDno=1944 (最後瀏覽日:2025年12月11日)
法務部,主管法規查詢系統,https://mojlaw.moj.gov.tw/LawContentReason.aspx?LSID=FL001351&LawNo=1086 (最後瀏覽日:2026年4月24日)。
ETtoday新聞雲,耶和華見證人信徒拒輸血,車禍不治長庚判賠,https://www.ettoday.net/news/20140911/399900.htm (最後瀏覽日:2026年4月14)。
蔡甫昌,「臨床倫理委員會」之理論與實務,衛生福利部,頁164,2002年5月https://service.mohw.gov.tw/MOHW_Upload/dmc_history/UpFile/Period10 (最後瀏覽日:2026年4月28日)。
二、英文部分
1.書籍
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Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
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Hasday, J. E. (2014). Family law reimagined. Harvard University Press.
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Simpson, A. H. (1909). A treatise on the law and practice relating to infants (3rd ed.). Stevens and Haynes.
Virtue, T., & Rainey, J. (2015). Chapter 2 – Healthcare industry. In T. Virtue & J. Rainey (Eds.), HCISPP study guide (pp. 5–31). Syngress.
2.專書論文
Francis, L., Botkin, J., & Diekema, D. (2020). Decision-making on behalf of children in the research and clinical context: A United States perspective. In I. Goold, C. Auckland, & J. Herring (Eds.), Medical decision-making on behalf of young children: A comparative perspective [eBook edition]. Oxford: Hart Publishing.
Kang, M., & Sanders, J. (2013). Medico-legal issues in adolescent health care. In M. Kang, R. Skinner, L. Sanci, & S. Sawyer (Eds.), Youth health and adolescent medicine (pp. 107–119).
3.期刊
Abrines-Jaume, N., Midgley, N., Hopkins, K., Hoffman, J., Martin, K., Law, D., & Wolpert, M. (2016). A qualitative analysis of implementing shared decision making in child and adolescent mental health services in the United Kingdom: Stages and facilitators. Clinical Child Psychology and Psychiatry, 21(1), 19–31.
Auckland, C., & Goold, I. (2019). Parental rights, best interests and significant harms. Cambridge Law Journal, 78, 287–323.
Aulisio, M. P., Arnold, R. M., Youngner, S. J., et al. (2000). Health care ethics consultation: Nature, goals, and competencies: A position paper from the Society for Health and Human Values–Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation. Annals of Internal Medicine, 133, 59–69.
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Austin, A. W. (2007). Medical decisions and children: How much voice should children have in their medical care? Arizona Law Review, 49, 143–169.
Bieber, E. D., Edelsohn, G. A., McGee, M. E., Shekunov, J., Romanowicz, M., Vande Voort, J. L., & McKean, A. J. S. (2020). The role of parental capacity for medical decision-making in medical ethics and the care of psychiatrically ill youth: Case report. Frontiers in Psychiatry, 11, 559263.
Chen, Y.-R., & Huang, S.-C. (2019). Family law in Taiwan: Historical legacies and current issues. National Taiwan University Law Review, 14(2), 157–218.
Cyr, B. (2024). The mature minor doctrine and COVID vaccination in Connecticut. Connecticut Law Review Online, 56, 1–20.
Dailey, A.C., & Rosenbury, L.A. (2021). The New Parental Rights. Duke Law Journal, 71, 75–160.
de Winter, J. P., Toelen, J., & Milani, G. P. (2024). Empowering young voices: navigating the complexities of minors in healthcare decisions. European Journal of Pediatrics, 183, 2515–2516.
Diekema, D. S. (2004). Parental Refusals of Medical Treatment: The Harm Principle as a Threshold for State Intervention. Theoretical Medicine and Bioethics, 25(4), 243–264.
Drabiak, K. (2021). Resolving physician-parent disputes involving pediatric patients. Houston Journal of Health Law & Policy, 20, 353–402.
Dwyer, J. G. (2025). Clarifying parens patriae. Journal of Ethics & Social Philosophy, 30, 339–378.
Ehrlich, J. S. (2000). Minors as Medical Decision Makers: The Pretextual Reasoning of the Court in the Abortion Cases. Michigan Journal of Gender & Law, 7(1), 65-108.
Ehrlich, J. S. (2023). The abortion rights of teens in the post-Dobbs era. Cardozo Journal of Equal Rights and Social Justice, 30, 1–53.
Ehrlich, J. Shoshanna. (2024). Turning Women into Girls: Abortion Regret and the Erosion of Decisional Autonomy. Women’s Rights Law Reporter, 329-356.
Gerdes, H., & Lantos, J. (2020). Differing thresholds for overriding parental refusals of life-sustaining treatment. HEC Forum, 32(1), 13–20.
Griffith, R. (2016). What is Gillick competence? Human Vaccines & Immunotherapeutics, 12(1), 244–247.
Halley, J., & Rittich, K. (2010). Critical directions in comparative family law: Genealogies and contemporary studies of family law exceptionalism. American Journal of Comparative Law, 58, 753–775.
Hamilton, V. (2006). Principles of U.S. family law. Fordham Law Review, 75, 31–73.
Hill, B. J. (2015). Constituting children’s bodily integrity. Duke Law Journal, 64, 1295–1362.
Huntington, C. (2014). Restating childhood. Brooklyn Law Review, 79, 525–549.
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4.判決資料
Bellotti v. Baird, 443 U.S. 622 (1979).
Cruzan, 497 U.S. at 280.
Custody of a Minor, 379 N.E.2d 1053 (Mass. 1978)
DeGrella, 858 S.W.2d at 709.
Gillick v West Norfolk and Wisbech Area Health Authority [1986] 1 AC112.
Ginsberg v. New York, 390 U.S. 629
Glenn H. v. Hoskins, 419 P.3d 567, 571 (Ariz. Ct. App. 2018).
In re. Agar-Ellis, Agar-Ellis v. Lascelles
In re Cabrera, 552 A.2d 1114 (Pa. Super. Ct. 1989)
In re Cassandra C, 112 A.3d 158.
In re D.G., 970 So.2d 486 (Fla. Dist. Ct. App. 2007).
In re D.R., 20 P.3d 166 (Okla. Civ. App. 2001).
In re E.G., 133 Ill. 2d 98, 549 N.E.2d 322.
In re Eric B., 189 Cal. App.3d 996, 1003 (Cal. Ct. App. 1987).
In re Hamilton, 657 S.W.2d 425 (Tenn. Ct. App. 1983)
In re Jensen, 633 P.2d 1302, 1303-04 (Or. Ct. App. 1981).
In re Matthew V., 68 N.Y.S.3d at 802
In re Quinlan, 70 N.J. 10 (1976)
In re Swan. Atl Report. 1990 Jan 23; 569:1202-6
Jensen v. Cunningham, 250 P.3d 465, 679 Utah Adv. Rep. 18, 2011 UT 17 (Utah 2011)
Matter of Cabrera, 552 A.2d 1114, 1115-17 (Pa. Super. Ct. 1989).
Meyer v. State of Nebraska, 262 U.S. 390
Mueller v. Auker, 576 F.3d 979, 983 (9th Cir. 2009).
Muhlenberg Hosp. v. Patterson, 320 A.2d 518 (N.J. Super. Ct. 1974)
Novak v. Cobb Cty., 849 F.Supp. 1559 (N.D. Ga. 1994)
People v. Pierson, 176 N.Y. 201, 68 N.E. 243 (N.Y. 1903)
Pierce v. Society of the Sisters of the Holy Names of Jesus and Mary, 268 U.S. 510 Planned Parenthood v. Danforth,428 US 52 (1976)
Prince v. Massachusetts, 321 U.S. 158 (1944).
Rasmussen, 741 P.2d at 689.
Re Jamie (No. 2) (2013) 278 F.L.R 155.
Raqeeb v Barts NHS Foundation Trust [2019] EWHC 2531 (Admin) and [2019] EWHC 2530 (Fam).
Re R (A Minor)( Wardship: Consent to Treatment) [1992] Fam 11.
Re W (A Minor) (Medical Treatment: Court’s Jurisdiction) [1992] 3 WLR 758.
Santosky v. Kramer, 102 S.Ct. 1388, 1414 (1982).
Secretary, Department of Health and Community Services v JWB and SMB (Marion’s Case) (1992) 175 CLR 218 (High Court of Australia).
State v. Perricone, 181 A.2d 751 (N.J. 1962)
Troxel v. Granville, 530 U.S. 57
United States v. Toviave, 761 F.3d 623
Wyatt v Portsmouth Hospital NHS Trust [2005] EWCA 1181.
Younts v. St. Francis Hospital & School of Nursing, Inc., 469 P.2d 330, 205 Kan. 292
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