- 期刊
預立醫療照護諮商過程中常見的法律疑義分析
Analysis of Common Legal Disputes during Advance Care Planning Process
摘要
目的：西元2015年12月18日經立法院三讀通過「病人自主權利法」，2016年1月6日經總統公布，並於2019年1月6日正式施行，開啟臺灣首部針對病人為主體的法案，讓具完全行為能力之人，可以透過預立醫療照護諮商的程序，事先簽署預立醫療決定書，以維護其在更多特定臨床條件下，行使醫療自主、拒絕醫療的權利。臺北市立聯合醫院配合法令開辦預立醫療照護諮商服務，民眾藉由諮商程序，與親友、醫療團隊經由討論和共融諮商，並簽署預立醫療決定，但仍難免因法律素養或認知不足而遭遇一些諮商過程的法律適用是否適當或正確問題。本文將整理諮商過程中針對病人自主權利法和相關子法可能產生的一些疑義，完成諮商程序有關法律公共議題的探究。方法：透過不記名問卷詢問和統計預立醫療照顧諮商團隊，包括:醫師、社工人員、護理人員和心理師在諮商過程可能的法律爭點和實務施行的困境。結果：諮商人員在諮商的過程中最常遇見的法律疑義問題，前五名依序為二親等內親屬參與、諮商費用、執行AD時家屬的妨礙、意願人的心智能力和執行AD的啟動要件，另有其他重要的法律爭議等等。結論：本文從文獻探討和醫院預立醫療照護諮商執行現況透過問卷整理，統計參與諮商團隊成員之諮商過程的法律爭議面向的分布並研析討論結果及改進芻議，可為未來諮商實務和推廣提供良性和正確的法律適用提供建議，以做為未來諮商執行和推廣順遂之所循。
並列摘要
Objective: On December 18th, 2015, the Third Reading of the Legislative Yuan passed the Patient Right to Autonomy Law. It was promulgated by the President on January 6th, 2016, and was officially implemented on January 6th, 2019. I t opened Taiwan’s first bill for patients as the main body and gave the tools that a person with full capacity can sign an advance decision through the advance care planning to maintain his right to exercise medical autonomy and refuse medical treatment under more specific clinical conditions. Taipei City Hospital cooperated with the decree to launch an advance care planning service. Through the consultation process, the declarant with relatives or friends, consulted medical consultation teams through discussions and communications, signed an advance decision. The medical consultation teams may meet some insufficient or inappropriate applications of the law during some consultation process. There are often some doubts about the Patient Right to Autonomy Law and related sub-laws. This article will try to understand the possible legal issues and difficulties in the implementation and to complete the inquiry into the legal public issues in the consultation process. Method: We use the anonymous questionnaires to explore the legal problems and opinions of the Taipei City Hospital’s consultation teams including physicians, social workers, nurses and psychologists during the consultation process. Results: The most common legal doubts encountered by consultants during the consultation process are the top five, which are the participation of the second relatives, the consultation fee, the family member’s obstacles during the execution of AD, the mental capacity of the declarant, and the start of execution requirements. The other important legal disputes are also noted in the questionnaires. Conclusion: To understand the opinions of participating consultation teams on legal disputes in consultation, this study could be discussed from the literature and the implementation status of advance care planning consultants through questionnaires, and also we will perform statistics on the distribution of legal disputes in the consultation process of members participating in the consultation team, analysis of the discussion results, and suggestions for improvement. We believe that this study will provide excellent and correct resolutions for future consultation practice and also will promote the amendment of the law as a guideline for future consultation and implementation.