協助同性伴侶參與末期愛滋病患不施行心肺復甦術之自主決定

Experience Assisting an AIDS-Infected Homosexual Patient and His Same-Sex Partner Make a Do-Not-Resuscitate Decision

同性戀愛滋病病人在臨終時，期待委託他們的同性伴侶或是親密友人擔任醫療決策的代理人。雖然我國的民法定義中，同性婚姻不是合法的，但同性戀之愛滋病病人可經由「預立指示」的過程，委任同性伴侶為醫療代理人，完成預立醫囑。此篇案例報告為描述一位末期同性戀愛滋病患者合併肝衰竭，護理人員在病人意識清醒時透過預立醫療指示之過程，尊重並協助病人完成其委任同性伴侶為醫療代理人之護理經驗。護理人員透過認可同性伴侶的角色並給予情感支持外，同時與醫療團隊召開家庭會議，協助個案完成委任同性伴侶成為醫療代理人的心願，藉由個別性及完善的護理措施給予個案及同性伴侶情感支持，並在個案病程變化的同時，給予同性伴侶支持及協助其與個案父親的溝通，摒棄痛苦且無意義的急救過程，共同陪伴個案走過臨終期。臨床護理人員具備臨床專業知識外，更需同理同性戀伴侶在社會的處境，透過相關法律的協助，才能化身為病人的「代言人」，完成病人臨終自主決定的心願。

Family members play an important role in the process of writing advance directives. Homosexual men infected with HIV often wish to authorize their intimate same-sex partner or friends rather than immediate family members to make medical decisions on their behalf. Although same-sex marriage is currently illegal in Taiwan, HIV infected homosexual patients are able to write advance directives appointing their same-sex partner to be their surrogate decision maker for end-of-life medical decisions. This case report describes an experience assisting a homosexual patient with HIV to write his advance directives. The nurse assisted the patient and his partner to make a self-determined decision not to resuscitate. Family conferences held to discuss the patient's decisions regarding resuscitation helped legitimize his partner's primary role in making end-of-life healthcare decisions on his behalf. As an advocate for patient rights, nurses should understand the law as it relates to homosexuality and end-of-life decision making, inform patients on the durable power of autonomy, and help execute their advance directives.