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

Implementation and barriers for elderly nursing home residents in signing their own advance directives in Taiwan: from culture perspectives of Taoism, Confucianism, and Buddhism

10.6537/TJHPC.2015.20(2).5

李欣慈(Hsin-Tzu S. Lee)；鄭淑貞(Shu-Chen Cheng)；黃川芳(Chuan-Fang Huang)；吳郁梅(Yu-Mei Wu)；胡文郁(Wen-Yu Hu)

文化觀點 ； 護理之家 ； 預立照護計畫 ； 預立醫療指示 ； 拒絕心肺復甦術 ； culture perspectives ； nursing home ； advance care planning (ACP) ； advanced directives (ADs) ； do-not-resuscitate (DNR)

安寧療護雜誌

20卷2期（2015 / 07 / 01）

154 - 165

繁體中文

立基於儒、釋、道信仰的中華文化，是人類四大古文明碩果僅存，有其延續華人生存至今的優勢。對於死亡準備議題，過去學者將大部分老年住民把疾病末期照護相關的自主權交由家屬決定的原因，多歸因於儒家的孝道思想和家族主義或道家順其自然的想法；然而，作者近來在臨床上發覺除上述儒家和道家的觀念影響外，其實也與佛家「因果輪迴」的想法有關。由於受到上述文化影響，在長照機構執行預立醫療指示計畫時常面臨的困境是，機構老年住民對於簽署自身預立醫療指示(ADs)文件的態度多半抱持消極甚至不願簽署。故，本文對於在長期照護機構推行預立照護計畫(ACP)時的建議如下：1.醫療人員須主動詢問及聆聽老年住民對目前疾病是如何影響其生活品質。2.醫療人員必須以儒、釋、道文化觀點合併善終概念向老年住民及其家屬介紹ADs文件。3.醫護人員應扮演中間協調和傳達的角色，分別與住民和家屬討論末期生命照護相關議題。4.推行ACP前，應協助長輩確認是否真正了解ADs文件和安寧緩和照護對他們真正的意義。5.機構住民簽署ADs文件的同時，應協助他們能夠以居家安寧的方式獲得安寧照護以減少不適症狀，並在生命末期得以善終。

Chinese culture, which has developed from Confucianism, Buddhism, and Taoism, is one of the few greats extant of four ancient civilizations and has its advantage to keep Chinese people survival until today. For issues related to prepare for the death, previous researchers thought that most of elderly residents wanted to transfer their autonomy of end-of-life care decision making to their family because of the notions of filial piety and familism from Confucianism and the idea of allowing nature to take its course from Taoist. However, lately in clinical situation, authors found that it was not only by the influence of the notions from Confucianism and Taoism, but also by the thought of Karma from Buddhism. Due to the cultural influences as above, the difficulty for the long-term care facility to implement the advance care planning (ACP) was that the attitude of most of the elderly residents toward signing their own advance directives (ADs) was passive or even turned it down. Therefore, our suggestions for carrying out ACP in long term care facilities are: 1.Health professionals must actively ask and listen to residents about how their diseases affect their quality of life. 2. Health professionals need to introduce ADs documents with the notion of good death from culture perspectives of Taoism, Confucianism, and Buddhism to the elderly residents and their families. 3. Health professionals should discuss end of life care with older residents and their family separately by playing a mediating role in coordinating and communicating between them. 4. Before implementing ACP, health professionals must help elder residents understand what the true meaning for them to have ADs documents and hospice palliative care. 5. When elder residents sign their own ADs documents, health professionals must assist them to have the hospice home care to manage their uncomfortable symptoms to have the good death at the end of life.

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