老龄化时代生前预嘱制度的困境与出路

The Challenges and Solutions of Living Will in the Aging Era

摘要: 生前预嘱旨在赋予临终患者更多的医疗决策自主权。随着全球多个国家和地区对生前预嘱进行立法实践，我国亦在逐步探索和推进生前预嘱法律制度的建设。然而当前我国现行法下，生前预嘱制度面临着诸多法律与实践困境，严重制约了生前预嘱制度的有效实施和发展。其中，生前预嘱的权利主体争议、形式要件模糊、权责分配不明、撤销制度空缺与患者自主权限制标准模糊等问题亟待解决。为此，需要进行相关探讨与解释，并建立与完善生前预嘱制度。应当明确主体资格能力与同意能力的界定标准，完善生前预嘱订立的授权代理制度，建立配套的形式审查程序，完善撤销制度的程序，明确效力限制性规定，确定三方权责分配。这对我国法治建设和社会文明进步具有重要意义。

Abstract: The system of living will aim to give terminally ill patients more autonomy in medical decision-making. With the legislative practice of this advance directives in many countries and regions around the world, China is gradually exploring and promoting the construction of relevant legal systems. However, the current system of living will in China faces many legal and practical difficulties, which seriously restrict the effective implementation and development of the system. Among them, there is an urgent need to address issues such as disputes over the rights holder of advance directives, ambiguous formal requirements, unclear allocation of rights and responsibilities, vacancy in revocation systems, and vague standards for limiting patient autonomy. Therefore, it is necessary to conduct relevant discussions and explanations, and establish and improve the system of living will. It is necessary to clarify the criteria for defining the qualifications and consent abilities of the subject, improve the authorization agency system for the establishment of living will, establish supporting formal review procedures, improve the procedures for revoking the system, clarify restrictive provisions on effectiveness, and determine the allocation of rights and responsibilities among the three parties. This is of great significance for the construction of the rule of law and the progress of social civilization in our country.