失智症病人之預立醫療照護諮商探討

Advance Care Planning for Patients with Dementia

10.6200/TCMJ.201910/SP_16.0012

楊君宜(Chun-Yi Yang)；田恩慈(En-Tzu Tien)；林欣儀(Hsin-Yi Lin)；李洧慈(Wei-Cihg Li)；邱筱芸(Hsiao-Yun Chiu)；劉建良(Chien-Lian Liu)

心智能力 ； 心智能力缺損 ； 最大化能力協助 ； 預立醫療照護諮商 ； 失智症 ； 醫療決策 ； 醫療人員 ； 以人為本的照護 ； Mental Capacity ； Mental Impairment ； Maximizing Capacity ； Advance Care Planning ； Dementia ； Medical Decision Making ； Healthcare Professionals ； Person-Centred Care

北市醫學雜誌

16卷附冊（2019 / 10 / 31）

110 - 119

繁體中文

預立醫療照護諮商（Advance Care Planning, ACP）主要是為了讓病人有醫療自主權、保障病人善終權益、促進醫病關係和諧，除了保障個人進而擴及家庭、社會性的權益。接受預立醫療照護諮商應該是每個人都可以享有的權利，但對於部份疾病導致心智能力缺損者，如失智症者、精神疾病者、智能障礙者常會因意思表達及理解能力問題而被質疑是否可以自行做決定，因此往往會影響了他們的權益。依2006 年聯合國所訂之「身心障礙者權利公約」及英國2005年所制定之「心智能力法案」，心智能力缺損者仍然可以接受預立醫療照護諮商以表達自己的想法及價值理念並訂定自己的醫療決策，惟須要醫療人員運用“最大化能力協助”原則來協助，包括能力的評估、輔助工具的運用、專業人員的訓練等，以最符合他們能力的方法，並結合以人為本的照護理念提供支持和社會關懷以保障他們醫療與善終的自主權益。

The main purpose of Advance Care Planning (ACP) is to enable patients to gain medical autonomy, protect the rights of a good death, and promote harmonic doctor-patient relationship, and further extend from personal rights to the family and society. Accepting ACP should be a right that everyone should have. However, those who suffer from certain diseases that cause mental impairments - such as dementia, psychiatric disorders, and mental retardation, are often questioned of being unable to make decisions by themselves due to their disability to express and apprehend. According to the Convention on the Rights of Persons with Disabilities implemented in United Nation in 2006 and the Mental Capacity Act enacted in the United Kingdom in 2005, people who lack mental capacity can still acquire ACP, express their thoughts and values, and make their own medical decisions. Only that the healthcare professionals are required to use the principle of maximum capacity to assist the patients including the assessment of competence, use of assistive tools, provide training courses for healthcare professionals, etc, in a way that best suit the remaining cognitive abilities, and to provide support and social care based on person-centered nursing so that the autonomic medical and good death rights are protected.