變更預立醫療決定臨床情境之探討

Exploring the Clinical Situations of Advance Decisions Change

10.6537/TJHPC.202006_24(2).03

陳若伊(Jo-I Chen)；吳政航(Cheng-Hang Wu)

變更預立醫療決定 ； 病人自主權利法 ； Advance Decisions Change ； Patient Autonomy Act

安寧療護雜誌

24卷2期（2020 / 06 / 01）

127 - 136

繁體中文

本文探討之預立醫療決定，依據2019年1月6日開始施行之病人自主權利法規定，意願人得隨時以書面撤回或變更，意願人如欲撤回或變更先前已決定之預立醫療決定之內容，法律規定應向醫療機構為之，並完成掃描上傳及健保卡註記等程序，始得生效。雖然法律放寬醫療機構在完成變更程序前得依意願人變更之書面意思表示執行其醫療意願，然卻又明定如意願人如係變更為「拒絕」維生醫療、人工營養及流體餵養時，必須待完成健保卡註記始能生效。本文對病主法之規定所衍生出可能的多種臨床情境，做一個深入的探討，期望能提供預立醫療照護諮商之醫療人員及簽署預立醫療決定之意願人一個更明確之參考依據。

Based on the Patient Right to Autonomy Act that had been enforced since January 6 2019, the person who signed the advance decision (AD) before may withdraw or change it at any time in writing. The law stipulates that it should be made to the medical institution, and the procedures such as scanning upload and health insurance card note must be completed. The law allows medical institutions to perform the patient's medical wishes in accordance with the written meaning of the change of the patient before completing the change procedure. However, the law restricts the person who wishes to change to ＂reject＂ life-sustaining treatment (LST), artificial nutrition and hydration (ANH), it must be executed after completing the health insurance card note. This article makes an in-depth discussion on the various clinical situations that may arise from the law. We hope that a medical staff who can provide advance care planning and a willing person to sign an advance decision will have a clearer reference.

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