建置病人自主權利法之預立醫療照護諮商決策輔助工具

Abstract

預立醫療照護諮商 (Advance Care Planning, ACP) 在病人自主權利法中的推動是提 供民眾簽署預立醫療決定書前正確、對等的知情，協助民眾充分瞭解五款特定臨床條件、 維持生命治療與人工營養流體餵養等各種醫療選項的內涵。除了法定意義外，其目標也在 於提升死亡識能以進行善終準備。在民眾進入預立醫療照護諮商程序前提供決策輔助工具 (Decision Aid, DA)，可預先協助民眾對自我生命價值的探索與思考，獲得相關資訊以促進與 諮商團隊的討論。本文蒐集四個發展預立醫療照護諮商 (ACP) 輔助工具具有經驗的國家，並 融合本國的法規精神，以臺北市立聯合醫院決策輔助工具為例，探討臺灣以病主法為基礎 - 預立醫療決定決策輔助工具的發展重點，俾使提供各界對於發展相關醫療決策輔助工具之 參考。

Patient Right to Autonomy Act(PRAA) in Taiwan promotes consultation of Advance Care Planning (ACP) to provide people with correct and equivalent knowledge about life-sustaining treatments, artificial nutrition and hydration, and assist them express their preferences to accept or refuse certain kind of medical treatments when diagnosed with the specific clinical conditions by the documentation of Advance Decision. Hence, ACP is much wider in scope than a written advance decision. An ACP discussion might include the people`s concerns, important values or personal goals for care. Therefore, it is important to develop Decision Aids for Advance Care Planning to improve clarity of personal values, provide adequate information about the legal procedure, and facilitate effective communication with ACP team. This article will review the most popular tools for ACP decision aids among four experienced countries and discuss how to integrate the legislative procedures of PRAA into the structures of ACP decision aid in Taiwan. More evidence is needed to evaluate the impact of current ACP decision aids.