安寧緩和醫療條例回顧與探討

Deliberations and Review on the Hallmarks of the Hospice Palliative Care Act in Taiwan

臺灣自1973年民間團體便開始推廣安寧緩和醫療，1990年馬偕醫院成立安寧病房；政府自1995年開始規劃安寧療護，2000年6月正式立法通過「安寧緩和醫療條例」，並陸續於2002年、2011年及2013年等3次修法使其更臻完備。安寧緩和醫療目的是為尊重末期病人之醫療意願及保障其權益，賦予其選擇在生命末期醫療處置的權利。該條例中對心肺復甦術、維生醫療、末期病人等名詞給予明確定義，讓病人在臨終前做意願表達時能有所依據。2011年修法加入撤除維生醫療，使「不施行心肺復甦術」與「撤除維生醫療」適用相關規定，本文將就其倫理與法律之意義上做進一步的探討。該條例也界定末期病人行使「不施行心肺復甦術」與「撤除維生醫療」的同意要件及醫師判定流程。然而在臨床實務上仍有認定困難與不一致的情形，包括醫界及社會大眾仍須更加了解，藉由對話以形成共識，安寧緩和醫療條例才能達到立法初衷的目的。

In Taiwan, hospice palliative care was initiated by a private association in 1973. The first hospice ward was established at MacKay Memorial Hospital in 1990. The government officially took charge of the national hospice programs and administration of palliative care in 1995. In June of 2000, the Hospice Palliative Care Act was enacted by our government and further amended in 2002, 2011, and 2013. The aim of hospice palliative care is to respect the will of the terminally ill patients and to protect their right to decide on the treatment near end of the life. The Act clearly defines the meanings of cardio-pulmonary resuscitation (CPR), life-sustaining treatment (LST) and the designation of terminally ill patients, and also allows the terminally ill patients to express their willingness with regard to receiving these treatments. The will to receive non-applying LST was added into the Act in 2011. The requirements were the same as those for not receiving CPR. This article discusses the use of these applications from the perspective of ethics and law. Currently the Act consists of strict guidelines to help terminally ill patients decide when not to undergo CPR or receive LST, and at the same time provides standard protocol that clinical specialists should follow when helping terminally ill patients make the most suitable treatment or non-treatment decisions. However, conflicts and inconsistency remain in the application of the clinical practices outlined in this Act. Both physicians and the population as a whole need to explore the Act further and discuss it thoroughly in order to reach a better consensus on the meaning and application of palliative care practices. In this way, the aims set forth in Hospice Palliative Care Act can make more concrete and complete. (J Med Health. 2016;5(1):25-34)