樂齡學員善終觀念與病人自主權法實踐初探

A Preliminary Study on Concepts of a Good Death and Patient Autonomy Act Practice

周祖佑(Chou, T.-Y.) ； 王政彥(Wang, C.-Y.) ； 吳明隆(Wu, M.-L.)

《福祉科技與服務管理學刊》 9卷3期 (2021/09) Pp. 314-332

https://doi.org/10.6283/JOCSG.202109_9(3).314

摘要

邁入高齡社會的臺灣，高齡者之健康與善終需求，將逐年上升。原為推行善終觀念之病人自主權利法，因許多民眾對其內容不甚了解，簽立時點又常迫近死亡，反無助於醫療爭議的降低。本研究目的為探究樂齡學員善終觀念，以瞭解其生命末期之權利與義務之健康與法律識能。本研究以台灣南部地區年齡55歲以上、230位樂齡學員為對象，以中文版Miyastita等人之短表善終量表題項及另加上病人自主權立法實踐題項共計25題問卷，採Likent7點量表為研究工具，收案期間2020年10月至12月，有效問卷213份，以SPSS.24版及AMOS.22分析，採取一階的驗證性因素分析，善終觀念建構出「知情同意」、「安詳離世」、「死亡認知」以及「病人自主權利法之實踐」等四個構面，整體模型評估均符合模型適配度指標。顯示樂齡學員其「安詳離世」、「死亡認知」、「知情同意」、對於「病人自主權利法之實踐」的因素負荷量皆達高標且其解釋力亦強，而本研究為臺灣樂齡學習者之善終觀念與病人自主權法實踐之初探，結果發現二者有正向關係。希冀成果得以提升各界對生命、健康、死亡等三類識能，落實「尊重醫療自主、保障善終權益、促進醫病和諧」，為未來長照政策與醫療糾紛提供建言。

關鍵字

善終 ； 知情同意 ； 安詳離世 ； 死亡認知 ； 病人自主權

並列摘要

Taiwan will become a super-aged society by 2026 and the needs of good death will increase among the elderly. Although the Patient Right Autonomy Act has been implemented for two years, conflicts still arise between doctor-patient relationships. An elder dying from a natural cause of death is apparently a risk factor in disputes. The study aims to understand the causal relationship between the concept of good death and meet the Patient Right Autonomy Act accordingly. The Chinese short version of the good death questionnaire (GDI) is authorized by Dr. Fang. The questionnaire consisted of Likert scale questions with a 7 points scale. The GDI includes 18 items in addition to 5 items that include the practices of Patient Right Autonomy Act. The study recruited 230 elderly individuals as the subjects from a senior citizens learning center in Southern Taiwan from October to December in 2020. In total, 213 questionnaires were collected. Firstly, we conducted a confirmatory factor analysis to construct the ＂informed consent＂, ＂concept of peaceful death＂, ＂cognition of death＂, and ＂the practice of patient autonomy＂. Secondly, a construct validity was applied. The results of the analyses showed that the concept of peaceful death, cognition of death, and informed consent significantly influences the practice of Patient Autonomy Act. With Advance Care Planning (ACP), the elderly can live with dignity in the last moments of their life instead of medical futility. Our study shows that a good death communication between patients and doctors can meet the Patient Right Autonomy Act, protect patients' rights, promote doctor-patient relationships, and reduce or avoid medical disputes.

並列關鍵字

concepts of good death ； cognition of death ； informed consent ； peaceful death ； Patient Right Autonomy Act