醫療預立指示

Advance Directives

楊嘉玲(Chia-Ling Yang) ； 陳慶餘(Ching-Yu Chen) ； 胡文郁(Wen-Yu Hu)

《安寧療護雜誌》 13卷1期 (2008/02) Pp. 30-41

https://doi.org/10.6537/TJHPC.2008.13(1).3

摘要

「醫療預立指示」係指個人爲其未來可能失去決定能力的情況，預先在其仍具清楚意識及自主決策能力時爲自身的醫療照護做規劃，表達個人的期望與意願並完成口頭或書面的陳述。醫療預立指示的精神是在尊重個人自主權與顧及醫療決策倫理下，提供病人最適切的醫療照護。我國於2001年通過安寧緩和醫療條例之立法，其中「拒絕心肺復甦術」及「接受安寧緩和醫療」同意書皆屬醫療預立指示的一部份，但立法迄今民眾及醫療人員均不甚清楚，而落實情況不佳，在現今醫療體系尚未將生命末期醫療及照護方式納入醫療照護計畫中與病人討論，導致病人沒機會參與自身的末期醫療照護方式的決策，最終未能得到符合個人意願或不適當的醫療照護。本文嘗試就國內外文獻整理「醫療預立指示」的概念、重要性、優點與限制、執行方式與障礙及影響簽署與否的相關因素等予以探討，期能增進醫療人員對「醫療預立指示」相關議題的了解與重視。

關鍵字

醫療預立指示 ； 生前預囑 ； 進階醫療計畫

並列摘要

The word ”advance directive” can be defined as that people can give instructions about what they wish to be done after they lose the capacity to decide for themselves by oral or written statement. The spirit of advance directives is that under the situation of respecting the personal autonomy and taking medical decision ethics into account to offer patient most appropriate medical care. ”Natural Death Act” was legally issued and executed in May of 1990 in Taiwan. ”Hospice and Palliative care” and ”Do not Resuscitate (DNR)” are two forms for advance directives. Unfortunately, peoples and medical personnel do not understand it clearly and it is not done well since legislation. Have not brought medical treatment and care of latter stage of life into the plan of medical care and discussed with patient yet in the medical system now. Patients have no chance to participate in the decision of the way of medical care in one's own latter stage. The medical care is not proper to people and cannot adapted to the personal will finally. This text tries to discuss the concept, importance, advantage and restriction, execution, obstacle and the factor of influencing signing of advance directives to promote the medical personnel to the understanding and attention of the advance directives.

並列關鍵字

advance directives ； living will ； advanced care planning