街友進行預立醫療照護諮商之探討－個案報告

Advance Care Planning for Homeless People: A Case Report

林欣儀(Hsin-Yi Lin) ； 璩大成(Dachen Chu) ； 劉靜女(Ching-Nu Liu) ； 邱筱芸(Hsiao-Yun Chiu) ； 曾士恩(Shien Zeng)

《北市醫學雜誌》 17卷附冊 (2020/01) Pp. 33-41

https://doi.org/10.6200/TCMJ.202001/SP_17.0004

摘要

依據文獻指出，街友在預立醫療照護諮商（Advance Care Planning, 簡稱ACP）的參與遠低於一般人口群，弱勢處境限制了街友為自己醫療自主與選擇發聲的意願和機會。本文透過回顧一位66歲男性街友的預立醫療照護諮商過程，探討20多年街頭生活經歷，對其在生命末期照護的想法、需求和資源之影響，並透過文獻回顧，探討街友進行預立醫療諮商之阻礙與關注議題。綜合彙整建議如下，促進街友參與ACP需敏感其特殊需求，包括思考諮商時機與場域、與醫療照護團隊之信任關係，以及透過其對死亡議題之關注，討論潛在委任代理人或通知重要他人之重要性，和對後事處理之期待與選擇，以協助發展與其偏好相符之照護計畫，落實以人為本的末期照護處遇和善終目標。

關鍵字

病人自主權利法 ； 預立醫療照護諮商 ； 預立醫療決定 ； 街友 ； 醫療委任代理人 ； 末期照顧 ； 家庭關係

並列摘要

According to the literature, persons experiencing homelessness engaged in advance care planning (ACP) is far lower than that of the general population. The disadvantaged situation has limited willingness and opportunities of homeless people to speak for their medical autonomy and choice. This article explores the impact of a 66-year-old male experiencing homeless more than 20 years on his value and perspective of end-of-life care through discussion of ACP, and analysis obstacles and concerns regarding homeless people in implement ACP through literature review. Based on the above discussions, engaged homeless people in ACP needs to be sensitive to their special needs, including considering the timing and field, and the trust relationship with the medical care team while initiating the issue of ACP, and discussing the potential health care agent, as well as the preferences and choices after death, to help develop care plans that are consistent with their preferences, and to implement people-center care for palliative and end-of-life care.

並列關鍵字

patient right to autonomy act ； advance care planning ； advance decision ； homelessness ； end-of-life care ； health care agent ； end-of-life care ； family relationship