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  • 學位論文

精神衛生法保護人制度與民法監護人制度之比較評析

A Comparative Study of the Guardianships between the R.O.C. Civil Code and Mental Health Act

指導教授 : 黃詩淳

摘要


本文旨在探討我國精神衛生法保護人制度與民法監護人制度之關聯,並分析其異同優劣,另藉由比較法之觀察,嘗試提出我國法制上之芻議。本文之問題意識在於,若一意思能力不足之人,同時符合嚴重病人(精神衛生法第3條第4款)與受監護人(民法第14條第1項)之定義,此際應如何認事用法?我國現行法制就此並無明文,相關文獻論述亦為罕見。 首先,從歷來有關身心障礙者之國際公約可發現,現今立法思潮已不再將身心障礙者視作單純之保護對象,而係協助彼等能基於自主意願參與社會活動,易言之,應尊重身心障礙者身為權利主體之本質,俾其能運用餘存之能力經營日常生活。復次,由於精神疾病之原因與狀況多樣且難以逆料,兼之病患之治療與復健均相當仰賴家屬與社群之支持,故在制定精神衛生相關法律時,應將病患之支援系統一併納入考量,以實質減輕家屬之負擔,同時益於病患有效復歸社會。 其次,藉由瞭解我國精神醫療之發展趨勢與法制沿革,得以一窺我國自日治時期至今,針對精神疾病政策之遞嬗與演變,進而明其制度之闕失。蓋我國雖已大幅提升相關專業人力與社會福利資源,然就法規內容而言,與國際公約所強調之「正常化」與「權利主體化」,仍有一段不小之落差。 另一方面,比較我國現行保護人制度與監護人制度後可發現,二者之設置目標均係保護、增進意思能力不足者之權益,並作為替代彼等意思決定之機關;惟在設計上,立法者係將精神醫療事務自人身照護領域分離,以特別法形式交由保護人負責處理。但就規範密度以觀,保護人制度遠不及監護制度,不僅未完整審酌嚴重病人之最佳利益、甚至忽視其意願(例如緊急處置),亦欠缺客觀有效之監督機關。再者,監護制度雖業經修正,但從其內容以觀,我國實仍未脫離「上對下監護」之父權陰影,除未能充分尊重個人之餘存意志,針對人身照顧之規定亦有不足,導致需借助其他特別法加以補充。整體而論,我國針對意思能力不足者,仍未能擺脫將之視作「保護客體」之代理色彩。 針對精神衛生法與民法之競合適用,日本與英國法制各自發展出一套切合國情之體系,亦可供我國參考借鏡。以日本而論,其與我國類似,亦面臨高齡化與少子女化之嚴峻衝擊,爰催生成年監護制度之修正;而依現行精神保健福祉法之規定,保護人主要在協助病患接受治療,而其出任有法定順序。然保護人制度於日本遭受批評已久,主要係因其無法因應高齡化與少子女化之社會趨勢,且將協助送醫治療等責任課與私人,不無迴避國家責任之虞,故日本訂於2014年4月正式廢止保護人制度。反之,英國則採取一相異之路徑,大幅體現所謂「國親思想」,除亟為重視意思能力不足者之最佳利益,對於限制彼等自由權之要件與方式亦設有詳細規範。此外,英國係由許可精神衛生專業人員擔任類似保護人之角色,該人員需經國家審認具備充分之法律與精神衛生專業學能,在病患之評估或治療程序上扮演重要角色。值得注意者,英國、日本及我國,均允許保護人於特定情況下,得違反受保護人意願給予強制性處分。 我國現行法將精神醫療事務自人身照顧領域獨立,並劃歸保護人負責之方式是否妥當,實不無疑問。首因保護人並非嚴重病人之法定代理人,卻得無視其意願,替之意思表示或受意思表示,就法理而言難謂妥適;其二,現行保護人制度具備諸多缺失,對其資格、任期、注意義務如何均未置一詞;其三,我國目前並未就保護人制度設置一般性監督機關,其出任之過程亦僅由家屬決之即可,似過於草率。 綜上而論,本文主張應廢除保護人制度並修正嚴重病人之定義,改由監護人統籌負責精神醫療事務。又,基於便民之考量、避免無人即時為監護宣告之聲請,一旦精神障礙者被認定為嚴重病人,醫院即應依法提出上開聲請;在法院決定監護人人選前,則先由家屬擔任暫時之意思決定代行者,便於醫院進行聯繫與治療。如是將能避免保護人、監護人制度雙軌並行致生之矛盾與疑慮,嚴重病人之法定權益亦得經由法院之監督得以獲致保障。

並列摘要


This thesis aims at analyzing the relationship between the guardianships of R.O.C. Civil Code and Mental Health Act, and proposing suggestions for incumbent legal systems via comparative studies. It attempts to answer the following vexing question: how to apply law if a person, who lacks adequate capacity, fits in with both the definitions of “severe patient (Article 3 of Mental Health Act)” and “person under guardianship (Article 14 of Civil Code)”? At present, there are no instructions under current law and relative studies are surprisingly few. Firstly, recent international conventions have been repeatedly addressing the rights of people with disabilities. Instead of merely providing protection, it is more pivotal to help them make the best of their lives on their own. We must respect their roles as the master of their lives, and assist them to attend social activities with residual capacities. Symptoms of mental health disorders sometimes are considerably variant, and some of their causes still remain as myths until now. Also, support and companion from families and communities are greatly significant for patients’ recoveries. Therefore, as for policy-making, we should take patients’ supporting systems into account. Only by this method can we substantially lighten the burdens of family members and facilitate patients’ rehabilitation. In the second place, through understanding the transformation of psychiatry developments dated back from Japanese-ruled period, we can comprehensively analyze the pros and cons of related policies. Although Taiwan has increasingly invested in professional personnel and social welfare resources, we are still far behind from the goal of “normalization” which has been strongly advocated by international conventions. On the other hand, after comparing current frameworks of guardianships between Civil Code and Mental Health Act, we can conclude that both systems are established to protect and reinforce the interests for those who lack capacity, and also act as their representative to make or receive the expression of intent. Separated from the duties of guardians under Civil Code, the guardian of Mental Health Act is literally in charge of mental health affairs. Nonetheless, Mental Health Act is far less comprehensive than Civil Code. It lacks complete consideration for patients’ best interests and even permits some mandatory actions against their wills. Most importantly, there are no objective supervisory entities under the Act. As to the guardianship under Civil Cede, despite the modification in 2008, its contents are still shadowed by paternalism. The system is not only deficient in respect for people’s residual capacity, but also regulate too little over body-caring affairs (which leads to numerous subsidiary regulations). As a whole, under current legal structures, Taiwan still treats those who lack capacity as an object of protection. Regarding the application of Civil Code and Mental Health Act, Japan and UK has developed their own models. For Japan, challenged by severe impacts of aging population and low birth rates as Taiwan, has revised its civil law. On the other hand, like Taiwan, its guardians under mental health regulations are mainly responsible of medication and hospitalization assistance. However, the mental health guardianship has long been criticized in Japan, since it fails to respond to the changes in population trends, and enable government to get away from its duty. Therefore, Japan has announced the abolishment of this structure in April 2014. On the contrary, UK took another approach by embodying the spirits of “parens patriae”. It has delicate regulations over the definition and application of “best interests”, while examines strictly about the restrictions of one’s liberty. Besides, regarding mental health issues, UK has adopted the role of “approved mental health professionals”, who are certified with adequate ability and knowledge, to shoulder the similar responsibility of mental health guardians in both Taiwan and Japan. Separating mental health parts from body-caring affairs is actually worthy of debates. First of all, if the mental health guardian doesn’t necessarily serve as the legal representative, we should not grant him/her the limitless power as conferred by Mental Health Act. Secondly, current Mental Health Law is materially incomplete in various parts. Last but not least, people cannot seek remedies from any supervisory entity concerning mental health guardianships. Generally speaking, this thesis proposes the abolishment of mental health guardianships and the modification to the definition of severe patients. The civil guardian should take charge instead. Furthermore, once the patient is diagnosed as “severe patient”, hospitals are obliged to file for the application of guardianships. Prior to the decision made by court, family members should act us temporary guardian and the contact person. Thus, we can prevent the dilemma and potential problems caused by these two regulations, and defend the legal rights and best interests for those in need.

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被引用紀錄


胡珮琪(2017)。我國成年監護制度之實證研究〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU201701410
陳冠穎(2017)。身心障礙者信託法制之比較研究〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU201700583

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