台灣老人醫療自主權的省思

The Medical Autonomy of Elderly in Taiwan

台灣老年人口增長迅速，伴隨平均餘命的延長，老年人已成為醫療體系主要的消費族群。尊重自主為醫學倫理的重要核心價值，然而其意涵，卻會受到家庭、社會與醫療文化的影響；而針對高齡病人，因老化所帶來身、心、社會各方面能力之衰退，如何在我國特殊文化背景：下，維護高齡者的醫療自主權，實值得深思。本文將彙整相關議題之文獻論述，由老人的弱勢情境、華人文化及現行醫療決策情境等面向，闡述高齡者面對醫療決定之處境，進而對如何實踐高齡病人醫療自主之照護理想提出建言。

The elderly population is increasing rapidly in Taiwan. With the average life expectancy on the rise, the elderly have become major consumers of healthcare products and services. Factors that influence respect for autonomy, a core value of medical ethics, may be related to family, society, and the medical culture. Especially in patients who are already elderly, aging causes declines in physical, mental and societal capacities. Practicing a respect for patient autonomy is particularly challenging for healthcare professionals in Taiwan due the unique culture background of elderly Taiwanese patients. This article reviews and integrates the literature related to the issue of patient autonomy and elaborates on medical decision-making among elderly patients in Taiwan in the contexts of: the disadvantages faced by the elderly, the background of Chinese culture, and the current medical decision-making environment. A few suggestions are proposed to help preserve the medical-decision-making autonomy of elderly patients in Taiwan.