高齡者參與善終課程後善終觀點轉化之探討

The Exploration of Good Death Perspective Transformation for the Elders Who Participated in Good Death Course

羅耀明(Lo, Yao Ming)

指導教授 ： 胡夢鯨

國立中正大學/教育學院/成人及繼續教育學系/碩士(2013年)

摘要

隨著我國高齡人口所占總人口比率提高，未來所占的死亡比率將更高。善終是高齡者的期待，然而我國目前的醫療環境存在許多善終障礙，且據研究發現高齡者的善終權常被忽略，而簽署DNR（預立選擇安寧緩和醫療意願書）、接受安寧及交代遺囑有助善終。國內高齡教育機構極少提供死亡教育課程，且相關研究不多。本研究為探討高齡者參與善終課程後善終觀點轉化，以DNR、安寧與遺囑為善終課程內容，綜合Mezirow與Brookfield的轉化學習理論為立論基礎，研究目的為探討(1)高齡者的善終概念與經歷親人的死亡經驗；(2)高齡者對善終課程的認識與需求；以及(3)高齡者參與課程後的觀點轉化情形。研究對象為參與研究者於樂齡中心開設的善終課程之56歲至74歲的7位高齡者，本研究採質性研究法，以半結構式深度訪談蒐集資料，輔以觀察筆記進行資料分析。
　　本研究發現參與課程有助增長高齡者向親友分享的信心；分享DNR對象以年齡相近者為主；分享內容會整合課程學習與個人經驗；高齡者的孩子不簽署DNR可能與缺乏生命經驗有關；對於假設癌末時以安寧做為末期照護選項的接受度高；對環保葬的接度高，2位高齡者往生後不希望後代祭拜；對告別式的安排有自己的想法；單身獨居的高齡者，若能簽署DNR並向其他人交代臨終與後事內容，有助其對善終的放心；和家人談論善終的議題要有輕鬆的氣氛；高齡者若願向高齡父母討論善終議題，可能引發父母為個人善終採取準備的行動；課程安排分組討論與同學分享，有助高齡者對善終課程更多元的認識與反思；團體學習有助高齡者達到觀點轉化。
本研究獲致3項結論：(1)高齡者的善終概念與經歷親人的死亡經驗有關，其善終概念相較於過去研究應增加不要拖延、不要拖累家人、往生時要有人知道、在期待的地方往生、善有善報的因果觀；(2)受訪者對善終課程的認識與個人的生命經驗有關，但認識深度普遍不足；在參與課程後一致認為高齡者有接受善終課程的需求（要）；(3)受訪者參與善終課程後DNR皆達到觀點轉化，遺囑有4人、安寧則無人達到觀點轉化。
　　最後，依據本研究結果提出5項建議：(1)針對一般家庭：正視高齡者的善終權，鼓勵家人敞開談論善終的議題以減少死亡恐懼；(2)高齡教育機構的課程規劃：應主動且積極規劃相關課程，課程需有連續數週的安排，將有助疑惑得到解答；課程規劃同儕互動活動，有助反思與行動；高齡教育機構可主動向安寧推廣單位接洽師資；(3)政府主管機關：建議衛生署、醫療相關單位及殯葬主管機關，前往高齡教育機構推廣DNR、安寧與環保葬之理念；(4)對未來研究的建議。

關鍵字

安寧 ； 遺囑 ； 不施行心肺復甦術 ； 死亡教育 ； 觀點轉化

並列摘要

As the elder population ratio is getting higher, the death ration of elders is getting higher too. Elders expect to have “good death”, however there are still many systematical obstacles in current medical environment for the elders to achieve this goal. The right of good death for the elders is often neglected, and good death can be better fulfilled by signing DNR and accepting Hospice care and prearranging will. This study is based on the transformative learning theory proposed by Mezirow and Brookfield and the research purposes include : (1) exploring the good death concept and the experience of expiring relatives’ death of elders; (2)exploring the elders’ understanding and need regarding Good Death course; (3)exploring the perspective transformation of elders after attending the Good Death course. The research objectives are seven elders age from 56 to 74 who attended the Good Death course in the Senior Active Learning Center. Qualitative methodology was applied and semi-constructive depth interview was conducted for data collection, and observation note was used for data analysis.
　　It was found that attending the Good Death course increases the elder confidence to share DNR with others, especially people in the same age. The sharing content consists of course learning and personal experience. It was also found that the elder’s children refuse to sign DNR due to the lack of related life experience. Most of the elders accept Hospice care at the final stage of cancer, and choose tree bury which is a more environment friendly way to bury themselves. Two interviewers do not want their later generations to offer sacrifices to memorize the elders, and have certain ideas about their memorial services. The live alone elder can ensure their good death confidence by signing DNR and explaining his after death arrangements to others. This study suggests that it will be better to discuss good death issue with family in an easy atmosphere. If the elder could discuss good death issue with their parents can intrigue their parents to start preparation actions for their own good death. The Good Death program was conducted by group discussion and peer sharing which help the elders to absorb multi-viewpoints and self-reflection, and group learning facilitates viewpoint transformation.
Three major conclusions in this study are: (1)the elders’ good death concept is related to their experience of experiencing relative death, and concepts such as no postpone, do not bring troubles to family, someone should know while the elder experiencing death, die at the wanted place, good action has good return should be added to the traditional good death concept. (2)The understanding to the Good Death course is related to the elders’ personal life experience, however the knowing is not enough in general, and it was found the elders have the need to attend Good Death course. (3)The interviewers all reported that they achieve perspective transformation after attending the Good Death course, four were shown in their wills but no one was shown in Hospice care.
　　Five suggestions were proposed based on the research result: (1) the good death right should be paid attention seriously, and people should be encouraged to discuss the good death issue to decrease the fear of death in every ordinary family. (2)The continuing education institutes should plan Good Death course for the elders, and the course should be designed to conduct certain peer discussions and sharing to help the attendants to act and self-reflection. (3) The professional lecturers can be recruited from the related organizations of Hospice care. (4) The government should promote the ideas of Good Death in the continuing education institutes. (5) providing suggestions to future studies.
Keywords：transformative learning, death education, do-not-resuscitate (DNR), hospice care, will

並列關鍵字

will ； hospice care ； do-not-resuscitate (DNR) ； death education ； transformative learning

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