在醫療現場，常發生高齡長者，為了要進行特定法律行為，被要求來申請醫療證明，抑或法院為了某些民事糾紛需要醫院出示病歷資料或說明病患病情。是以本文欲探討成年人因年齡增長所衍生之心智功能下降，是否影響其行使法律行為之能力，進而檢視民事法律行為與醫療之關係。本文將透過文獻探討與司法實務案例之實證分析，探討我國民法中執行各式行為所需能力之規範現況，精神鑑定以及醫療與高齡及疑似失智者於能力爭議之關聯性。
我國民法關於「意思能力」之規範，主要落實於民法第75條後段，旨在保護行為時處於無意識或精神錯亂而欠缺認知能力的表意人。然而，目前的法規內容於實際運作時產生之諸多問題，仍待進一步討論。而民法上判定各類型意思能力的方式，包括決策、財務及結婚能力等，主要之心證來源係透過個別認定，醫療紀錄、心智評估與精神鑑定參判以及法院以職權調查各方資料及證人證詞而成。
透過對高齡者所為民法上多項法律行為之案例分析後發現，司法判決在高度倚重民法75條下所生之問題，於精神鑑定及醫療紀錄作為判決主要證據來源，各有其優缺點，以及法院對於意思能力的判斷標準仍舊分岐而有待整合。在醫學實證研究分析後亦已證實，於失智症前期之決策及財務處理能力已開始出現問題，對於高齡者行使法律行為前發掘問題，適時介入能力評估實有其必要性。
由於心智狀態之改變進而發展成失智症，是步入高齡後必然要面對的問題，其除了是生理疾病以外，更涉及財務安全、法律與人權等社會議題，從而幫助醫界強化能力評估意識，法界提高對醫療邏輯的認識，進而在旁觀者介入機制、分級精神鑑定及民法第75條之適用性修改作出制度性的改革，透過醫界與法界的跨域合作將是穩定社會持續進行之重要關鍵。

In clinical settings, elderly individuals often seek medical certificates to undertake specific legal actions, or courts require hospitals to provide medical records or clarify a patient's condition in the context of civil disputes. Consequently, this article examines whether the decline in cognitive function associated with aging affects an adult's capacity to engage in legal acts, thereby exploring the intersection of civil legal actions and medical practice. Through a review of existing literature and an empirical analysis of judicial precedents, the article investigates the current regulatory framework regarding the capacity required for various legal acts, the role of psychiatric evaluations, and the relationship between medical issues and disputes over the capacity of the elderly and those with suspected dementia.
In Chinese civil law, the regulation of "capacity to form intent" is primarily embodied in the latter part of Article 75; its purpose is to protect a declarant who, at the time of an act, lacks cognitive capacity due to unconsciousness or mental derangement. However, the practical application of current regulations gives rise to numerous issues that warrant further discussion. Regarding the determination of various types of capacity—such as decision-making capacity, financial capacity, and capacity to marry—the court forms its judgment based on case-by-case assessments that incorporate medical records, mental health evaluations, and psychiatric appraisals, alongside information and witness testimony gathered through the court's own investigative authority.
An analysis of cases involving various civil legal acts performed by the elderly reveals issues arising from the heavy reliance of judicial rulings on Article 75 of the Civil Code; specifically, while psychiatric evaluations and medical records serve as primary sources of evidence, each has distinct advantages and drawbacks, and judicial standards for assessing mental capacity remain inconsistent and in need of harmonization. Furthermore, empirical medical research confirms that impairments in decision-making and financial management capabilities emerge during the prodromal stages of dementia; thus, it is essential to identify potential issues before the elderly engage in legal acts and to intervene with timely capacity assessments.
The progression to dementia resulting from changes in mental status is an inevitable challenge of aging. Beyond being a physiological condition, it encompasses social issues such as financial security, legal matters, and human rights. Consequently, fostering greater awareness of capacity assessment within the medical community and enhancing the legal sector's understanding of medical logic, thereby driving institutional reforms regarding bystander intervention mechanisms, tiered psychiatric evaluations, and amendments concerning the applicability of Article 75 of the Civil Code. Through interdisciplinary collaboration between the medical and legal professions is crucial for maintaining social stability.

一、 本國文獻
(一) 中文書籍
1. 邱銘章主編，失智症診療手冊，三版，2017年。
2. 施啟揚，民法總則，7版，2007年。
3. 陳聰富，民法總則，5版，2025年。
(二) 中文專書論文
1. 吳建昌，意思能力與成人監護，收錄於：周煌智主編，司法精神醫學手冊，一版，頁277-328，2017年。
2. 陳自強（主席）/黃詩淳/詹朝傑/李莉苓/陳文通/李昆霖/郭躍民，「監護宣告之實務與課題」座談會紀錄。收錄於：黃詩淳、陳自強編，高齡化社會法律之新挑戰：以財產管理為中心，頁365-425，2019年。
3. 黃詩淳，從身心障礙者權利公約之觀點評析臺灣之成年監護制度，收錄於：黃詩淳、陳自強編，高齡化社會法律之新挑戰：以財產管理為中心，頁79-106，2014年。
4. 戴瑀如，由聯合國身心障礙者權利公約論我國成年監護制度之改革，收錄於：黃詩淳、陳自強編，高齡化社會法律之新挑戰：以財產管理為中心，頁55-78，2014年。
(三) 中文期刊
1. 吳建昌，王宗揚，民事司法精神鑑定的介紹（一），月旦醫事法報告，73期，頁121-134，2022年。
2. 吳建昌，王宗揚，民事司法精神鑑定的介紹（二），月旦醫事法報告，74期，頁139-155，2022年。
3. 吳建昌，精神疾病患者之意思能力，護理雜誌，57卷6期，頁5-10，2010年。
4. 李立如，成年監護制度與法院功能的演進—以受監護人權益保障為中心，東海大學法學研究，45期，頁99-170，2015年。
5. 林克能、劉秀枝，臨床失智評量表，Acta Neurologica Taiwanica，12卷3期，頁154-165，2003年。https://doi.org/10.29819/ANT.200309.0007
6. 段彥慈、黃詩淳，專業人士參與失智者財產剝削事件之研究，國家發展研究，24卷2期，頁31-67，2025年。
7. 翁國彥／黃致豪／廖福源／黃嵩立／賴又豪／韓宜臻／黃怡碧，「障礙行不行？心智障礙者法律能力的各種兩難」座談會，台灣人權學刊，3卷4期，頁93-120，2016年。
8. 郭乃文、劉秀枝、王珮芳、廖光淦、甄瑞興、林恭平、陳祖裕、徐道昌，「簡短式智能評估」之中文施測與常模建立，中華民國復健醫學會雜誌，16期，頁52-59，1988年。https://www.airitilibrary.com/Article/Detail?DocID=10253009-198812-x-16-52-59-a
9. 陳聰富，自然人的行為能力及住所，月旦法學教室，129期，頁42-51，2015年。
10. 湯文章，精神醫療鑑定與刑事審判－以現行鑑定制度的缺失為中心，真理財經法學，17期，頁37+39-94，2016年。
11. 黃聿斐，法律變更對成人監護制度之精神鑑定實務的影響，月旦醫事法報告，59期，頁47-60，2021年。
12. 黃詩淳，無意識或精神錯亂中所為之意思表示，月旦法學教室，153期，頁15-17，2015年。
13. 精神醫學部主治醫師彭啟倫（口述／資料提供），精神醫學與正義的距離了解司法精神醫學，公共事務室管理師梁世箴（採訪／撰稿），台大醫網，221期，頁811，2024年。https://health.ntuh.gov.tw/health/Ntuh_e_Net/eBook/no221/9/
14. 劉春堂，無行為能力人之法律行為及事實行為，台灣法學雜誌，244期，頁117-123，2014年。
15. 鄭懿之，精神鑑定實務面面觀【實務講座】. 月旦醫事法報告，66期, 頁143-168，2022年。
16. 戴瑀如，初探德國成年輔助法－兼論我國成年監護制度，月旦法學雜誌，167期，頁137-150，2009年。
(四) 研究計畫
1. 江綺雯、林雅鋒，有關失智症人權維護及促進等之權益調查報告，監察院專案報告編號：107內調0039，2019年。
2. 何建志，失智病人民事行為能力與責任能力研究—法律與醫學之對話，（編號：MOST 109-2410-H-038-017），臺北醫學大學醫療暨生物科技法律研究所，2021年。
3. 黃詩淳，民法總則編監護及輔助宣告規定有無修正必要之研究，法務部委託計畫，國立台灣大學，2020年。
(五) 圖表
1. 圖一：監護宣告事件流程簡圖。引自司法院全球資訊網，司法院>業務綜覽>家事>監護宣告與輔助宣告，三、監護宣告事件流程簡圖。https://www.judicial.gov.tw/tw/cp-107-58173-364a9-1.html
2. 圖二：生物標記異常程度與疾病發展關係圖。取自莊宜芳，退休老師外表如常，竟因「這件事」發現失智！1方法揪出「阿茲海默症」，及早因應仍有希望。幸福熟齡。2023年5月16日。https://thebetteraging.businesstoday.com.tw/article/detail/202305160016

二、 外文文獻
(一) 英文書籍
1. J. Moye, Guardianship and Conservatorship, in EVALUATING COMPETENCIES (T. Grisso ed., 2d ed. 2003).
2. S.Y.H. Kim, Instruments for Assessing Treatment Consent Capacity, in EVALUATION OF CAPACITY TO CONSENT TO TREATMENT AND RESEARCH (2010).
3. T. Grisso & P.S. Appelbaum, Using the MacArthur Competence Assessment Tool - Treatment, in ASSESSING COMPETENCE TO CONSENT TO TREATMENT: A GUIDE FOR PHYSICIANS AND OTHER HEALTH PROFESSIONALS (1998).
(二) 英文期刊論文
1. A. Glezer & J.J. Devido, Evaluation of the Capacity to Marry, 45 J. AM. ACAD. PSYCHIATRY & L. 292, 296 (2017).
2. B. Reisberg et al., The Global Deterioration Scale for Assessment of Primary Degenerative Dementia, 139 AM. J. PSYCHIATRY 1136 (1982).
3. C.P. Hughes et al., A New Clinical Scale for the Staging of Dementia, 140 BR. J. PSYCHIATRY 566 (1982).
4. D.C. Marson et al., Clinical Interview Assessment of Financial Capacity in Older Adults with Mild Cognitive Impairment and Alzheimer's Disease, 57 J. AM. GERIATRICS SOC'Y 806 (2009).
5. D.C. Marson, Clinical and Ethical Aspects of Financial Capacity in Dementia: A Commentary, 21 AM. J. GERIATRIC PSYCHIATRY 382, 385 (2013).
6. D.C. Marson, Loss of Financial Competency in Dementia: Conceptual and Empirical Approaches, 8 AGING, NEUROPSYCHOLOGY & COGNITION 164 (2001).
7. E. Widera et al., Finances in the Older Patient with Cognitive Impairment: "He Didn't Want Me to Take Over", 305 JAMA 698, 700 (2011).
8. F.O.T. Yu et al., Assessment of Capacity to Make Financial Decision in Chinese Psychogeriatric Patients: A Pilot Study, 19 HONG KONG J. PSYCHIATRY 82 (2009).
9. J. Karlawish et al., Cognitive Impairment and PD Patients' Capacity to Consent to Research, 81 NEUROLOGY 801 (2013).
10. J.Moye & D.C. Marson, Assessment of Decision-Making Capacity in Older Adults: An Emerging Area of Practice and Research, 62 J. GERONTOL B PSYCHOL SCI SOC SCI 3 (2007).
11. J.C. Morris, The Clinical Dementia Rating (CDR): Current Version and Scoring Rules, 43 NEUROLOGY 2412 (1993).
12. J.M. Lai et al., Everyday Decision-Making Ability in Older Persons with Cognitive Impairment, 16 AM. J. GERIATRIC PSYCHIATRY 693 (2008).
13. John C. Morris, Clinical Dementia Rating: A Reliable and Valid Diagnostic and Staging Measure for Dementia of the Alzheimer Type, 9 INT'L PSYCHOGERIATRICS (suppl. 1) 173 (1997).
14. L.E. Harrell et al., The Severe Mini-Mental Status Examination: A New Neuropsychologic Instrument for the Bedside Assessment of Severely Impaired with Alzheimer's Disease, 14 ALZHEIMER DISEASE & ASSOCIATED DISORDERS 168 (2000).
15. M. Dymek et al., Factor Structure of Capacity to Consent to Medical Treatment in Patients with Alzheimer's Disease: An Exploratory Study, 1 J. FORENSIC NEUROPSYCHOLOGY 27 (1999).
16. M. Gallegos et al., 45 Years of the Mini-Mental State Examination (MMSE): A Perspective from Ibero-America, 16 DEMENT. NEUROPSYCHOL. 384 (2022).
17. M.M. Kershaw & L.S. Webber, Dimensions of Financial Competence, 11 PSYCHIATRY, PSYCHOL. & L. 338 (2004).
18. O. Kusoro et al., Time to Diagnosis in Dementia: A Systematic Review With Meta-Analysis, 40 INT'L J. GERIATRIC PSYCHIATRY e70129 (2025).
19. P.A. Lichtenberg et al., A Person-Centered Approach to Financial Capacity Assessment: Preliminary Development of a New Rating Scale, 38 CLIN. GERONTOLOGIST 49, 59 (2015).
20. P.A. Lichtenberg et al., A Short Form of the Lichtenberg Financial Decision Rating Scale, 43 CLIN. GERONTOLOGIST 256 (2020).
21. P.S. Appelbaum & T. Grisso, Assessing Patients' Capacities to Consent to Treatment, 319 N. ENGL. J. MED. 1635 (1988).
22. Paul S. Appelbaum, Clinical Practice: Assessment of Patients' Competence to Consent to Treatment, 357 N. ENGL. J. MED. 1834 (2007).
23. RM Crum et al., Population-Based Norms for the Mini-Mental Status Examination by Age and Educational Level, 269 JAMA 2386 (1993).
24. T.N. Tombaugh & N.J. McIntyre, The Mini-Mental State Examination: A Comprehensive Review, 40 J. AM. GERIATRICS SOC'Y 922 (1992).
25. Tsuo-Hung Lan et al., Validation of Chinese Version of the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) in Patients with Schizophrenia Spectrum Disorders, 210 PSYCHIATRY RES. 634 (2013).
26. V. Ajluni, Enhancing Decision-Making Capacity Assessments in Primary Care: A Practical Guide for Family Physicians, 26 J. GEN. FAM. MED. 379 (2025).
(三) 英文網路文獻
Kaycee Sink & Svenja Wacker, The Clinical Dementia Rating (CDR): Advantages, Challenges, and Considerations, Cogstate Blog (Sep. 26, 2025), https://www.cogstate.com/blog/the-clinical-dementia-rating-cdr-advantages-challenges-and-considerations/.