以神經功能檢查定義末期病人之探討—以「安寧緩和醫療條例｣為核心

有鑑於我國逐漸進入老人化的社會，再加上｢無效醫療｣的資源浪費，政府對於人民醫療保健的態度必須由被動改為主動，消極轉為積極。將相關醫療疾病種類與有關的醫療法制相結合，建立無縫隙的醫療網。預防疾病的發生，治療疾病的惡化，提高生活的品質，不僅可以減少家庭社會的問題產生；亦可加強職場的勞動力與增進國家的競爭力。國家有限的醫療資源，必須充分的利用，我國每年醫療花費大約309億元於病人死亡前一年，而80%皆用在病人死亡前半年，而這些許多是｢無效醫療｣。如果省下來的錢，應用在疾病的控制，與須要長期照顧失能失智的病人，就可以解決去年通過的｢病人自主權利法｣與｢長期照顧服務法｣在財務方面的需求。儘快貫徹兩法，使我國在病人自主與社會福利兩方面更向已開發中國家邁進一大步。安寧療護已是普世價值，醫療界針對｢末期病人｣，逐漸的改變治療觀念，已從｢治癒｣轉為｢療癒｣，注重病人的生活品質，從身、心、靈三方面著手。我國｢安寧緩和醫療條例｣主要是為了照顧｢末期病人｣所特別制定的。但其對｢末期病人｣之定義，模糊不清，易令廣大民眾混淆，不易為醫事人員所遵循。所以本文建議利用在神經內科行之多年的｢美國國衛院腦中風評估表｣（NIHSS），檢查身體神經功能，將病況因疾病影響的程度，以分數具體呈現出。｢末期病人｣的定義清楚之後，病人的生命權與自主權的界限也因而釐清。當病人進入末期病況的時候，就以病人｢自主權｣為主；而尚未達到｢末期病人｣的標準之前，國家還是要以維護病人的｢生命權｣為主。｢末期病人｣的定義，過於狹隘，會影響病人的權益；過於寬鬆，會造成國家觸犯｢國家不得違反保護不足禁令原則｣。其同時亦涉及｢安寧緩和醫療條例｣與｢病人自主權利法｣，不可謂影響不大。本文建議｢末期病人｣的定義宜授權中央主管機關做適當的修訂，以符合民意的需求。

關鍵字

病人自主權利法；長期照顧服務法；安寧療護；末期病人；美國國衛院腦中風評估表；安寧緩和醫療條例

並列摘要

Owing to becoming aging society of my country and over expenditure of futile medical care, Central Institute of Health should change attitudeof people health care. We have to set up seamless medical network by combining different kind disease with related medical law. Therefore, it not only decrease social problem but also increase manpower and country competition. It is essential for our country to make the most of limit medical resource. It costs 309 hundred million Taiwan dollars for dying people（ one year before death ）each year. Among 80% of that, it is for patient in half a year before death. Much of money is for futile medical care. As if all of money were saved for preventing disease, taking care of disability and dementia patient, financial problem of “Patient Self-Determination Act”and “Long-Term Care Act” could be solved. Hospice and palliative care has already been recognized in the whole wide world. The idea for managing terminal illness patient has gradually been changed from cure to healing. It should emphasize patient’s quality of life from body and soul. The “Hospice Palliative Care Act”was enacted only for taking care of terminal illness patient. But the definition of terminal illness is not clear and easily makes people confused, medical doctor also have difficulty to abide by the law. The thesis suggests that National Institute of Health Stroke Scale （NIHSS）could be useful to evaluate neurological function affected by disease .The self-determination right is priority for patient in the terminal stage. On the contrary, right to life should be protected by government as patient is not compatible with the definition of terminal illness. The definition of terminal illness is too narrow and will influence benefit of the patient. The government could offense the law of protection of right to life if the definition of terminal illness becomes very relaxed. Both “Hospice Palliative Care Act”and “Patient Self-determination Act” are related to terminal illness patient so that it is very important to have clear definition of terminal illness. Hence, the thesis recommends that Central Institute of Health makes some proper modification of terminal illness definition to satisfy with most of the people.

並列關鍵字

Patient Self-Determination Act ； Long-Term Care Services Act ； Hospice Palliative Care ； Terminal Illness ； National Institute of Health Stroke Scale ； Hospice Palliative Care Act