生前预嘱的法理基础与制度构建——以生命安全与生命尊严的冲突与平衡为视角  

Legal basis and institutional construction of living will:from the perspective of the conflict and balance between life safety and life dignity

作　　者：黄永镇 HUANG Yongzhen(School of Marxism,University of Chinese Academy of Social Sciences,Beijing 102488,China)

机构地区：[1]中国社会科学院大学马克思主义学院,北京102488

出　　处：《中国医学伦理学》2025年第4期490-499,共10页Chinese Medical Ethics

摘　　要：医疗自主权虽于法无据,但《中华人民共和国民法典》第一千零二条规定的生命尊严为生前预嘱制度提供了法律支撑。因保障生命安全与维护生命尊严之间可能存在冲突,因此在构建和实施该制度时应当在二者间寻求平衡。生前预嘱制度应遵循尊重患者自主、患者最佳利益及不加速不拖延的基本原则。在具体规则方面,订立主体原则上只能是完全民事行为能力人;适用范围应通过疾病类型、存活期限和尊严贬损程度进行限定;内容可包括拒绝延长痛苦的维生治疗、拒绝增加痛苦的有创治疗及接受减缓痛苦的安宁疗护;形式上须采用书面或录音录像的方式并经过公证或见证程序;预嘱人具有完全民事行为能力时可通过明示或默示方式撤回生前预嘱;生前预嘱在预嘱人无法自主作出医疗决策且处于生命末期时生效;为提高执行率并避免不必要的医疗纠纷,应规定违反生前预嘱的法律责任与免责条款。Although medical autonomy lacks a legal basis,the life dignity stipulated in Article 1002 of the Civil Code of the People’s Republic of China provides legal support for the system of living will.Given the potential conflict between ensuring life safety and maintaining life dignity,a balance should be sought between the two when constructing and implementing the system.The system of living will should adhere to the basic principles of respecting patient autonomy,the best interests of patients,and neither accelerating nor delaying death.In terms of specific rules,the subject of the establishment can only be a person with full civil capacity in principle;the scope of application should be limited by the type of disease,survival period,and degree of dignity degradation;the content may include refusing life-prolonging treatments that prolong suffering,refusing invasive treatments that increase suffering,and accepting palliative care to alleviate pain;the form must be in writing or in audio or video format,and must undergo notarization or witnessing procedures;living will can be revoked by the declarant explicitly or implicitly while testators have full civil capacity;living will take effect when testators are unable to make their own medical decisions and are in the end-of-life stage;legal responsibilities and exemption clauses for violating living will should be stipulated to improve execution rates and avoid unnecessary medical disputes.

关 键 词：卫生法 生前预嘱 医疗自主权 生命尊严 生命安全 

分 类 号：R-052[医药卫生]