論病人自主之法制—以失智症病人為例

當病人生命走到盡頭，死亡已是無可避免的，醫護人員難道還要遵守天職，將那些無意識、身上充滿管路的病人救活嗎？失智症的病人可以自行決定自己的生死嗎?這是一個值得討論的議題。臺灣在2018年已經邁入高齡社會，高齡社會衍生的健康議題逐漸受到重視，其中失智症就是一例。失智症在認知、語言、記憶等領域會發生障礙或退化等問題，受影響的不僅僅是病人自己，更加重照顧者及其家庭的嚴重負擔。鼓勵病人在尚具自主決策能力時，表達個人對未來的醫療照顧意願與期望，即早訂定預立醫療決定以使家屬及醫事人員尊重病人自主權並顧及醫療決策倫理，及早準備相關因應措施，讓病人獲得最適切的醫療照護。「病人自主權利法」主張每一個人都有自主善終權利，是一部以病人為主的法律，對不予或撤除維生措施的條件（及或人工營養及流體餵養），已擴大至「五大類的病人」，不再限縮於末期病人，而和「安寧緩和醫療條例」針對末期病人的「維生醫療」是指「只延長瀕死過程的醫療措施」有所區別，這對於病人人性尊嚴與自決權的保障將更為周全。病人經預立醫療照護諮商後，簽定預立醫療決定等步驟，在五大類特定的臨床條件下，可以撤除，不施行或終止人工營養或流體餵養及維持生命治療之一部或全部。為了避免病人在資訊不足的狀況下作出錯誤決定，病人行使醫療自主權，須以掌握充分資訊為前提，故規定病人必須先經過一定的諮商過程，藉由醫療團隊、病人及親屬之充分討論，瞭解完整的醫療資訊。讓病人及早做好準備，當身體突然不能由自己做主、行為不能由自己支配的時刻到來，就可以讓親友知道你早已經做好了決定，不要違反你的意願，增加不必要的痛苦，用自己想要的方式，跟這個世界道別。

關鍵字

失智症；病人自主權利法；預立醫療照護諮商；預立醫療決定；自主權

並列摘要

When the patient's life comes to an end.Death is inevitable.Do medical staff also obey their duties? Will those unconscious patients who are full of pipelines be saved?Can dementia patients decide their own life and death? This is a topic worth discussing. Taiwan has officially entered an advanced society in 2018. The health issues derived from the aging society are gradually paid attention to. One example is dementia. Dementia can cause problems such as degeneration or disorders in the areas of language, memory, cognition, etc. Not only the patient is affected.More serious burden on caregivers and patients' families.Encourage patients to make advance medical decisions when they still have independent decision-making ability. Express your personal expectations and wishes for your future medical care. Enable family members and medical staff to respect patient autonomy and take care of medical decisions ethics.Prepare relevant measures early. Let patients get the most appropriate medical care. 「Patient Self-Determination Act」is a law that takes patients as the main body.Advocate that everyone has the right to self-determination.And the Ministry of Health and Welfare should issue clear rules of the definition of the special terms, standardize medical procedures and selection criteria of evidence of the Five Special Clinical Categories of patients, in order to help patients in making decision under specific clinical situations for the appropriate medical or palliative care.In order to prevent patients from making wrong decisions in the absence of information. Patients exercise medical autonomy. The premise is to have sufficient information. Require patients to go through the consultation process first, through the full discussion of the medical team, patients and relatives to understand the complete medical information. So you can prepare early. When the moment of "involuntary self" comes suddenly. Let relatives and friends know that you have made a decision long ago, do n’t go against your wishes, and exert unnecessary pain. Say goodbye to the world the way you want.