依類型 族群 主題   
 
 
2021.07.14
經濟社會及文化權利國際公約健康權對原住民族保障之規範與實踐研究—兼評我國原住民族健康法草案
族群: 跨族群  
主題: 法律政治、學術研究、醫療保健  
作者 林澂
學校系所 國立東華大學法律學系
地點 全臺 全部  
研究內容

健康權為健全人性尊嚴之重要人權之一。1948年世界人權宣言提出人人有享有健康之權利後,經濟、社會及文化權利公約對於健康之內容與定義,定有更全面之基本規範和義務,並逐步實踐與追求可達到最高水準之健康內涵。我國雖未將「健康權」一詞明文於憲法基本權利章中,卻透過憲法解釋,以及基本國策賦予國家應積極推展公醫制度及衛生保健等相關措施,以維護國民健康之意旨,肯定對健康權之保障,其後更經由大法官解釋,確認了健康權屬於憲法第22條之基本權利性質,且國家對之負有相當之保護義務。
於原住民族健康權方面,自聯合國通過原住民族權利宣言,承認並揭示原住民族因其文化、傳統生活與社會結構等原因,所生之集體權利特性與保障決心,故於原住民族健康之保障,除了公平的享有可達最高標準之身心健康外,亦須以原住民族文化和語言之角度,理解其文化中健康之內涵,提供具文化敏感度之衛生醫療服務,並尊重及考量到其傳統醫學知識與照護方法,以充分實現原住民族之健康權利。我國對於原住民族健康權之實踐,亦係基於憲法尊重多元文化之精神,且政府有積極協助原住民族發展其語言及文化之義務,是以,制定原住民族基本法,以尊重並協助發展原住民族文化及語言之原則,做為保障其基本權利之基礎,條文中亦清楚明示,應依原住民族特性制定相關公衛醫療政策、尊重其傳統醫療保健方法並推廣研究,且應寬列預算,補助其在獲得醫療資源或參與國家規劃之健康保險等相關措施時,可能遇到之困難,對於非居於原鄉之原住民族,在健康、安居、融資、就學、就養、就業、就醫和社會適應方面,亦須給予適當的協助及保障,以促進原民族之健康發展。
惟研究發現,至今原住民族平均之健康水平,以公衛基準指標之平均壽命與嬰兒死亡率觀之,皆低於基準族群之平均水準,呈現健康不平等之狀態。臺灣原住民族亦存在上述情況,鑑於現今諸多公衛政策皆無法完全解決此種問題,故有了原住民族健康法之立法聲浪出現,以促進原住民族健康發展,消弭健康不平等之情事為目標,並達成原住民族健康自決。本文即透過國際人權法及國內法對於原住民族健康權之相關保障內涵,檢視目前尚未立法之原住民族健康法草案,是否能夠實現此權利內容之相關基準,期以對原住民族健康法之草擬及立法方向有所助益,以落實我國對於原住民族健康權之保障。

The right to health is one of the human rights that complete human dignity. According to the announcement of the Universal Declaration of Human Rights in 1948, everyone has the right to health. This announcement prompts the International Covenant on Economic, Social, and Cultural Rights to propose a more comprehensive definition of fundamental norms and obligations, also gradually fulfilling the highest attainable standard of physical and mental health for human beings. In Taiwan, the term “right to health” is not recorded directly in Chapter II (the Rights and Duties of People) of the Constitution of The Republic of China. However, the implications of the term “right to health” are expressed through Constitutional interpretation and Fundamental National Policies. Therefore, the State should actively promote the public medical and health care system to protect people’s health. Furthermore, the Constitutional Court of Judicial Yuan confirmed that the nature of the right to health presents within the scope of Article 22 of the Constitution in the Interpretations Nos. 785, and the State is obligated to protect the right to health.

As to the right to health of indigenous peoples, the United Nations recognizes the characteristics of collective rights and reveals the determination to protect indigenous peoples due to the differences in their culture, traditional life, and social structure by publishing the Declaration on the Rights of Indigenous Peoples. Therefore, to assure indigenous peoples’ health, the State should provide the resources to achieve the highest attainable standard of physical and mental health and guarantee the maintenance of cultural differences of indigenous people. The cultural differences would be maintained by understanding culture, language, the perspective of health, traditional medical practice, and medicine of the indigenous people, then provide culturally appropriate health care services. Moreover, the Constitutional spirit of respecting multiculturalism and the fact that the government must actively assist indigenous peoples of their linguistic and cultural development shaped the practice of indigenous people’s right to health in Taiwan. Therefore, Taiwan acknowledges the Indigenous Peoples Basic Law to protect indigenous people’s fundamental rights concerning their culture and language expansion. The Indigenous Peoples Basic Law clearly stated that the government should formulate the public health strategies according to indigenous people’s characteristics, also promote and research their traditional medical knowledge. Also, the State should broadly set a budget to subsidize the difficulties that might encounter when indigenous people are obtaining medical resources or participating in related measures such as health insurance plans by the State. For those who move out from the original indigenous living area, the government should also provide appropriate assistance and protection regarding their health, housing, financing, education, support, employment, medical treatment, and social adjustment to promote healthy development in nations.

Still, indigenous people’s right to health has potential problems. For example, studies discovered that the average health level of the indigenous people reveals a condition of health inequality. The studies observed two of the public health indicators, the average life expectancy and infant mortality rate; the findings indicated that the health of indigenous people is lower than the average of the benchmark group nations. Taiwan is one of the countries that are encountering the above situation. The fact is that current public health policies could not solve the health inequality of indigenous people. Therefore, the thought of the legislation on the Act of Indigenous Peoples Health emerged, intending to promote healthy development, eliminate health inequalities, and achieve the indigenous people’s healthy self-determination. This paper aims to study the content of indigenous people’s right to health and review the draft of the Indigenous Peoples Health Law, which has not yet been enacted, through the international convention of human rights and domestic laws. Furthermore, this paper provides insights that are helpful to the drafting of the legislative direction regarding the Indigenous Peoples Health Law, which will enhance the government’s protection of the health rights of indigenous people.