無最近親屬者之生命末期醫療抉擇

End-of-Life Decisions in Patients without Relatives and Surrogates

謝雅琪(Ya-Chi Hsieh) ； 蔡佩渝(Pei-Yu Tsai) ； 楊鈺雯(Yu-Wen Yang) ； 林益卿(I-Ching Lin) ； 黃馨葆(Sin-Bao Huang)

《安寧療護雜誌》 19卷1期 (2014/03) Pp. 33-46

https://doi.org/10.6537/TJHPC.2014.19(1).3

摘要

《安寧緩和醫療條例》第三次修法於2013年1月9日公布施行，為解決末期病人未預立醫療指示，在意識昏迷或無法清楚表達意願且無親屬的情況下之無效醫療困境，經安寧緩和醫療照會後，醫師考量病人最大利益，可代替病人決定終止心肺復甦術或撤除維生醫療。然而，醫師在下此決定時，難免會質疑此舉是否符合倫理標準，或擔心是否觸犯法律。本文由生命倫理原則為經緯，兼及探討國外相關法規，以闡明本次修法之宏旨，期望減少國內醫界基於倫理與法律考量之困境。如今台灣的法律，在無代理人患者的末期醫療上已提供了基本的保護。然而，為了減少醫師開立不施行心肺復甦術及維生醫療醫囑之阻礙，建議各醫療機構應該要制定處理流程及設計書面的檢視表單，以制度與團隊力量減少阻力，也要協助無親屬之病人於意識清楚時及早預立醫療指示。期待台灣在病人自主權提升的同時，醫師的專業也能在法律保障下為病患提供最合適的醫療。

關鍵字

安寧緩和醫療條例 ； 無家屬及代理人 ； 不施行心肺復甦術 ； 撤除維生醫療

並列摘要

The third revision of Taiwan’s ＂Hospice and Palliative Care Act＂ was effective from January 9th, 2013, which resolved the problems of futile medical treatment in terminally-ill and unconscious patients without advanced care planning (ACP) and relatives. According to the 2013 amendment and based on the best interest of patients, physicians in charge can withhold and/or withdraw futile medical treatment from incompetent patients who do not have relatives or surrogates after consultation with hospice team. However, while physicians decide to withhold cardiopulmonary resuscitation or withdraw the futile life-sustaining treatment for patients’ best interest, they may hesitate because of fear of against moral rules or legal regulations. This article is a discussion about the principles of medical ethics and legal consideration in western world. We expect to reduce the plight of end-of-life care in such situation in Taiwan based on the amendment and above discussion. Now, in Taiwan, we have legal protection in dealing with end-of-life care of patients without relatives and surrogates. We also suggest medical institution should have stipulated procedural approach and a written check list to smooth the way for physicians to withhold cardiopulmonary resuscitation or withdraw life-sustaining treatment. More important, we must help patients without relatives to have their advanced care planning while they are still competent. As patients’ autonomy getting more important, we hope physicians can also provide adequate medical treatment under legal protection.

並列關鍵字

Hospice and Palliative Care Act ； without relatives and surrogate ； withhold CPR ； withdraw life-sustaining treatment