誰決定善終－《安寧緩和醫療條例》中最近親屬的探討

Who determines death with dignity: An exploration of the close relatives in the Hospice Palliative Care Act

陳偉熹(Wei-Hsi Chen) ； 侯弘偉(Hung-Wei Hou) ； 黃仁慶(Lin-Keng Ng) ； 陳琮華(Tsung-Hua Chen) ； 林宏昇(Hung-Sheng Lin) ； 尹莘玲(Hsin-Ling Yin)

《安寧療護雜誌》 25卷1期 (2020/12) Pp. 27-38

https://doi.org/10.6537/TJHPC.202012_25(1).03

摘要

《安寧緩和醫療條例》奠定我國醫療自主拒絕權，但是當病人未預立醫療意願書或醫療委任代理人，在達到末期且意識昏迷或無法清楚表達意願時，醫療決策仍然仰賴最近親屬替代決定。因此，本條例第七條關於最近親屬的規定，深深影響病人醫療和善終權益。但是，在研究領域裡少有正式報告探討最近親屬的影響情形。本文分析《安寧緩和醫療條例》中最近親屬的規範，並舉出臨床案例探討對末期病人安寧緩和醫療品質的影響。吾人認為目前的條文雖然無法囊括所有狀況，但是符合法律通用性，倘若要修訂人選範圍、適格性、同居事實或其他方式，建議以但書來規範適用在特殊情況。無論如何，預立醫療意願書和醫療委任代理人才是順利讓自己善終的最佳方法。醫療團隊在依法行事之同時，亦應協助最近親屬了解末期病況、醫療最佳利益和無效醫療帶來的痛苦及傷害。

關鍵字

安寧緩和醫療條例 ； 最近親屬 ； 安寧醫療 ； 緩和醫療 ； 家庭文化

並列摘要

The Hospice Palliative Care Act (HPCA) founds the right of refusal in medicine in Taiwan. However, the medical strategy is depended on family when patient who is diagnosed terminal illness under official procedure, do not have advance directives or health care agent, and becomes unconscious or fails to express clearly own's will. Therefore, the Article 7 of HPCA, that designates the close relatives who make substituted judgement for patient, greatly impacts the right of medicine and good death of patient. In this study, we analyzed the extent of close relatives in HPCA, and applied some clinical cases as examples to highlight the negative impact. We Suggested that the current version of HPCA competes the legal principle although it cannot cover all aspects of conditions, that can be regulated by proviso if the extent and eligibility of close relatives are enrolled for change. Nevertheless, advance directives and health care agent are the best methods promising for good death. Medical team should aid close relatives to understand the terminal status, best interest and pain and suffering of futile treatment of patient in addition to merely following the laws.

並列關鍵字

Hospice Palliative Care Act ； close relatives ； hospice and palliation ； palliative medicine ； family and culture

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