論人工流產配偶同意條款對女性生育自主權之影響

Abstract

根據國民健康局人口與健康調查研究中心於2008年針對全國20至49歲之育齡婦女懷孕及生育狀況所進行的「第10次家庭與生育力調查報告」，在抽樣調查所得之2706份已婚婦女之樣本中，發現具人工流產經驗者佔34.82%。由此可知，我國三位已婚女性中即有一位曾進行人工流產，此一比例凸顯人工流產相關法規與女性權益保護具有密切關係。

目前我國人工流產法制係以優生保健法為主要法源，在符合特定構成要件情況下，女性可援引優生保健法之規定，作為實行人工流產時阻卻刑法墮胎罪成立之阻卻違法事由。此等阻卻違法事由固然有以人口優生目的為考量者，亦有概括賦予婦女以影響心理健康及家庭生活為由者，似有意給予婦女對於是否實施人口流產一定程度的自由決定空間。然而，依據優生保健法第9條第二項規定，若是已婚婦女欲以「懷孕或生產將影響其心理健康或家庭生活」為由實行人工流產，必須取得配偶同意，此一規定無疑妨礙已婚婦女自主決定是否接受人工流產手術。為此，本文欲從女性生育自主權角度，分析檢討配偶同意條款在法律上之正當性。

本文首先藉由分析優生保健法之立法歷程、相關法院判決及國內學說等文獻，探究女性生育自主權於我國法體系下之定位，本文認為，女性的生育事項涉及個人生涯規劃以及自主決定，透過行使生育自主之權利，方得展現個人價值，故生育自主權與人格權具有密不可分之關聯性，此等人格權之保護已多次透過大法官解釋及學理加以充實，而被納入憲法基本權利之保障範圍中，因此生育自主權應為憲法第22條所保障之權利。此外，本文試圖於立法歷程、學理論述與法院判決脈絡中，透過不同的法學解釋方法，針對現行優生保健法中「人工流產配偶同意條款」之規範目的及權利依據進行研究。本文發現，由於優生保健法立法當時之整體社會氛圍欠缺對女性權利之意識與尊重，且參與立法之人士亦多具傳統父權思想，該等同意條款被視為監督女性行使權利之工具。遍尋相關法院判決，發現我國實務對於配偶同意之法律性質並無一致且明確之定位；而學理見解對於配偶同意條款之正當性亦有所質疑，認為此等規定將會加深女性在婚姻關係中不平等之地位而陷女性於不利處境，在不具備正當合理的規範依據情況下，本文認為現行配偶同意條款應有修改之必要。

除了法理基礎之探討外，本文亦嘗試藉由深度訪談之方式進行實證研究，從醫學臨床工作者之角度，探討此等同意條款在執行面上對女性生育自主權之實質影響力，包括是否構成女性在人工流產決定上之不當負擔，並檢視執行面是否與法律規範產生落差。本文發現，優生保健法之配偶同意條款除了在法律上構成對女性生育自主權利之限制外，實際上，許多醫療院所為避免紛爭、甚至成為墮胎罪被告，在認定婦女是否取得配偶同意一事上採取嚴格作法，實質上等於提高了已婚婦女接受人工流產手術之門檻，導致已婚女性除了必須面臨法律上之要求與限制外，更要擔心被醫療院所拒於門外、不得不產下子女或尋求密醫協助的困境，此等情形實屬對女性生育自主權之壓迫。本文認為，即便修正草案將配偶同意條款修正為僅需告知，並提供例外免除告知義務之保護，目前實務上的運行狀況顯示，仍不足以保護婦女之生育自主權，本文主張應將現行配偶同意條款刪除，方能充分保障女性生育自主之權利。

Taiwan’s Bureau of Health conducted “The Tenth Family and Fertility Survey” in 2008 to find out the pregnancy and fertility condition of married women who aged from 20-49 in Taiwan. The results show that out of the 2706 samples, around one-third (34.82%) of respondents had experiences of induced abortion. This high ratio highlights the close relationship between abortion regulations and protection of women reproductive rights.

Under the Criminal Code of the Republic of China, abortions are considered as criminal offences. However, women may be exempted from criminal liability if exception clauses provided in Article 9 of the Genetic Health Act are met. Exceptional clauses provides in the Genetic Health Act are out of the concerns of either population quality or women’s mental health and family life. Although the law takes women’s freedom of making decisions for their own bodies into consideration, spousal consent requirement is imposed on married women who seek for abortion with the reason of “pregnancy or childbirth is likely to affect their mental health or family life.” The legal requirement of spousal consent is undoubtedly a constraint on women’s reproductive rights. Therefore, this study aims at analyzing and reviewing the legitimacy of the spousal consent clause from the perspective of women’s reproductive rights.

The first part of this thesis reviews the legislative history of the Genetic Health Act, relevant judicial decisions and academic articles in order to find out the legal status of women’s reproductive rights under Taiwan’s legal system. Secondly, the study discusses the statutory purpose for the establishment of the spousal consent clause. This study finds that due to the lack of awareness of and respect for women’s rights, the legislators with patriarchal ideology regarded this provision as a means to oversee women’s abortion decision-making. This study argues that there’s no sufficient legal basis to justify the existence of the spousal consent clause. This legal requirement may deepen gender inequality in Taiwan and as a result should be changed.

This study also conducted an empirical study to explore how the spousal consent clause is implemented and to what extent women’s reproductive rights may be affected by the spousal consent requirement. Totally 13 semi-structured depth interviews were conducted, including 11 health care workers (5 physicians, 6 nurses) and 2 advocators for women’s rights. Interview results reveal that the spousal consent clause constitute a de jure obstacle impinging women’s reproductive rights; moreover, due to fear of getting sued for malpractice or charged with criminal offence, clinicians are not only hesitated to provide abortion medical but also inclined to strictly interpret the law. The actual practice of the spousal consent requirement reflects the existence of de facto restriction for women seeking for abortion. Even if the proposed law requires informing women’s spouses before receiving abortion instead of getting spousal consent, this study argues that the actual practice may remain the same and women’s reproductive rights may still be undermined. The legal requirement of spousal consent must be abolished to protect women’s reproductive rights.