自主善終的臨床觀點－從病人自主權利法與ACP談起

The Clinical Perspective on Good Death-Starting from Patient Autonomy Act and ACP

10.29494/LN.201903_20(1).0002

馬瑞菊(Jui-Chu Ma)；林佩璇(Pei-Xuan Lin)；蕭嘉瑩(Chia-Ying Hsiao)；蘇珉一(Min-I Su)；曾令君(Ling-Chun Tseng)

善終 ； 病人自主權利法 ； 預立醫療自主計畫 ； good death ； patient autonomy act ； advance care planning

領導護理

20卷1期（2019 / 03 / 01）

16 - 27

繁體中文

病人自主權利法（簡稱病主法）的立法目的為尊重病人醫療自主、保障其善終權益，促進醫病關係和諧，其精神乃是保障病人之知情、選擇與決定權。此法實施後將對病人、醫療人員及醫療院所產生極大之影響，故本文除以文獻查證綜觀國內、外推動預立醫療照護計畫如何守護病人善終權提出說明外亦針對病人自主權利法上路後的臨床觀點提出建議。藉此專題協助醫療人員推動預立醫療自主計畫時有所依循，並能提供病人善終、家屬無憾之全人照護。

The purpose of legislating Patient Autonomy Act is to respect the patients' autonomy when receiving medical treatments, to protect their right to good death, and maintain a harmonious relationship between the medical officers and the patients. The principle of this Act is to protect the patients' right to enlightenment, selection and determination. The implementation of this Act will have a great impact on the patients, the medical officers, as well as medical institutions. In addition to the supplements of useful references as the evidence describing how ACP has been nationally and internationally promoted to protect the patients' right to good death, this study also claims a clinical perspective after Patient Autonomy Act comes into enforcement. Ultimately, this study intends to assist the medical officers in employing it as fundamental principles when promoting ACP and hence provide the holistic care to the patients towards good death and grant the families of them peace of mind with no regret.

1. 李欣慈,鄭淑貞,黃川芳,吳郁梅,胡文郁(2015)。華人儒 、 釋 、 道文化觀點探討台灣護理之家老年住民簽署自身預立醫療指示文件的現況與困境。安寧療護雜誌，20(2)，154-165。
   連結：
2. 林艷君,胡文郁(2016)。社區高齡者預立醫療自主計畫之介入與推展。護理雜誌，63(4)，13-18。
   連結：
3. 張婷(2018)。臺灣與美國預立醫療照護諮商特色之比較研究。法令月刊，69(5)，59-74。
   連結：
4. 張麗卿(2016)。病人自主權利法－善終的抉擇。東海大學法學研究，50，1-47。
   連結：
5. 陳瑞娥,林秋菊(2016)。慢性腎臟病患預立醫療自主計畫模擬情境溝通訓練方案之建構。護理雜誌，63(3)，105-111。
   連結：
6. AMA. (2016). AMA Code of Medical Ethics. Accessed https://www.ama-assn.org/ about-us/code-medical-ethics/
7. American Bar Association. (2017). My Health Care Wishes. Accessed App https://www.americanbar.org/groups /law_aging/MyHealthCare WishesApp.html
8. Bravo, G.,Dubois, M. F.,Wagneur, B.(2008).Assessing the effectiveness of interventions to promote advance directives among older adults: a systematic review and multi-level analysis.Social Science & Medicine,67(7),1122-1132.
9. Brinkman-Stoppelenburg, A.,Rietjens, J. A.,van der Heide, A.(2015).The effects of advance care planning on end-of-life care: a systematic review.Palliative Medicine,28(8),1000-1025.
10. Brown, B. A.(2003).The history of advance directives. A literature review.Journal of Gerontological Nursing,29(9),4-14.
11. Fulmer, T.,Escobedo, M.,Berman, A.,Koren, M. J.,Hernández, S.,Hult, A.(2018).Physicians' Views on Advance Care Planning and End-of-Life Care Conversations.Journal of the American Geriatrics Society,66(6),1201-1205.
12. Hajizadeh, N.,Uhler, L. M.,Pérez Figueroa, R. E.(2015).Understanding patients' and doctors' attitudes about shared decision making for advance care planning.Health Expect,18(6),2054-2065.
13. Harder, R.(2005).Advanced directives: the conversation we all must have.Nursing management,36(5),4.
14. Hsiung, Y. F. Y.,Ferrans, C. E.(2007).Recognizing Chinese Americans' cultural needs in making end-of-life treatment decisions.Journal of Hospice & Palliative Nursing,9(3),132-140.
15. Lorenz, K. A.,Lynn, J.,Dy. SM,Shugarman, L. R.,Wilkinson, A.,Mularski, R. A.,Morton, S. C.,Shekelle, P. G.(2008).Evidence for improving palliative care at the end of life: a systematic review.Annals of Internal Medicine,148(2),147-159.
16. Lum, H. D.,Brown, J. B.,Juarez- Colunga, E.,Betz, M. E.(2015).Physician involvement in life transition planning: A survey of community-dwelling older adults.ВМC Family Practice,16(1),92.
17. Robinson, L.,Dickinson, C.,Rousseau, N.,Beyer, F.,Clark, A.,Hughes, J.,Exley, C.(2012).A systematic review of the effectiveness of advance care planning interventions for people with cognitive impairment and dementia.Age and Ageing,41(2),263-269.
18. Sabatino, Charles, P. (2013). Eight advance care planning lessons that took me thirty years to learn. Accessed https://www.americanbar.org/public ations/bifocal/vol 34/issue_6_augus t2013/8 lessons in 30 years.html.
19. Shepherd, J.,Waller, A.,Sanson-Fisher, R.,Clark, K.,Ball, J.(2018).Knowledge of, and participation in, advance care planning: A cross- sectional study of acute and critical care nurses' perceptions.International Journal of Nursing Studies,86,74-81.
20. Sullivan, S. S.,Dickerson, S. S.(2016).Facing Death: A Critical Analysis of Advance Care Planning in the United States.Advances in nursing science,39(4),320-332.
21. Ulrich, L. P.(2001).The Patient Self- Determination Act: Meeting the Challenges in Patient Care, Washington.Georgetown University Press.
22. Walker, R. M.(2001).Physician-assisted Suicide: the Legal Slippery Slope.Cancer Control,8(1),25-31.
23. 吳振吉,蔡甫昌(2016)。簡評 「 病人自主權利法 」 及其影響。醫院雙月刊，49(1)，6-10。
24. 林妙穎,羅月雲,黃秀美,陳鳳裕,謝伶瑜(2010)。末期腎病病人之預立醫療計畫。安寧療護雜誌，15(3)，331-341。
25. 柯莉珊,王筱珮(2012)。住院老人接受預立醫療照護計畫介入之成效 － 系統性文獻分析。安寧療護雜誌，17(1)，48-61。
26. 胡文郁,楊嘉玲(2011)。從癌症晚期病人進行末期醫療決策的經驗一反思 「 預立醫療照護計畫 」 之推展。2011 第七屆生命教育學術研討會 《 生命意義與臨終關懷 》，台北:
27. 張惠雯,顏啟華,林鵬展,劉立凡(2011)。病人對預立醫囑的看法 － 以彰化某醫院家庭醫學科門診病人為例。安寧療護雜誌，16(3)，296-311。
28. 陳世宜(2016)。簡談病人自主權利法。台北市醫師公會會刊，60(8)，45-49。
29. 蔡甫昌,郭蕙心(2017)。病人自主權利法之倫理觀點與實務挑戰。台灣醫學雜誌，21(1)，62-72。
30. 衛生福利部 ( 2018 ) . 病人自主權力法明年上路 , 衛福部公布配套辦法 , 取自 https://www.mohw.gov.tw/cp- 16-44221-1.html •
31. 衛生福利部 ( 2018 ) . 病人自主權利法施行細則條文 , 取自 https://www.mohw.gov.tw/cp-16- 44221-1.html •
32. 謝至鑑,王淑貞,王英偉(2013)。符合社區民眾預立醫療自主計劃文化觀點之介入模式 － 台灣花蓮地區之經驗。安寧療護雜誌，18(1)，1-13。
33. 謝至鑑,黃家琪,王英偉(2012)。以團隊導向學習運用於預立醫療自主計畫。續教育之教學安寧療護雜誌，17(3)，249-260。
34. 羅光(1994)。中國人的生死觀。哲學與文化，21(7)，578-583。
35. 羅耀明(2011)。克服善終障礙 ～我國高齡者之善終教育現況與因應策略。安寧療護雜誌，16(3)，361-370。

1. 嚴美華,蔡佩勳,陳資錞,胡靜文(2023)。照顧一位末期腎臟病個案選擇安寧緩和療護之護理經驗。新臺北護理期刊，25(2)，130-139。
2. 楊惠卿(2022)。後疫情時代探討病人自主權利法對個人與家庭心理的影響。輔導季刊，58(3)，33-42。
3. (2024)。衛教介入對社區長者預立醫療照護諮商知識與態度之成效。新臺北護理期刊，26(1)，6-17。