预先医疗决定中患者自主权与医师自由裁量权的冲突与解决
Conflict and Resolution of Patient Autonomy and Physician Discretion in Advance Care Decisions

本文以法院案例研究为基础，探讨了在预先医疗决定范畴下患者自主权与医师自由裁量权之间的关系与解决权利冲突的价值指引和路径构想。解决冲突的价值指引包括立法原则需优先保护高位权利、明确权利边界、重视患者利益至上、规范权利行使；路径强调医疗决策应真实反映患者意愿、明确患者自主权与家属替代决定的边界。法院在调解冲突中扮演重要角色，需要多方合作解决。以期此文对医患关系进行更为全面和深入的法律分析，更好地适应我国老龄化社会需求，促进医疗服务的公平、公正和高效。
Based on court case studies, this article discusses the relationship between patient autonomy and physician discretion in the context of advance medical decision-making, and the value guidelines and paths for resolving the conflict of rights. The value guidelines for resolving the conflict include legislative principles that prioritize the protection of superior rights, clarify the boundaries of rights, emphasize the supremacy of patients’ interests, and regulate the exercise of rights; and the pathway emphasizes that medical decision-making should truly reflect the patient’s wishes, and clearly define the boundaries between patient autonomy and family members’ substitute decision-making. Courts play an important role in mediating conflicts, and need to cooperate with multiple parties to resolve them. We hope that this article will provide a more comprehensive and in-depth legal analysis of the doctor-patient relationship, better adapt to the needs of China’s aging society, and promote the fairness, justice and efficiency of medical services.