失智症照護與成年監護制度之跨域結合

Cross-domain Integration of Dementia Care and Adult Guardianship System

失智者之認知功能退化為漸進式，其因意思能力出現瑕疵至喪失的過程可能為時多年，以致失智者在漫長病程中因判斷力下降而被詐騙、身分遭盜用、或是不動產被不法轉移的案例時有所聞，但因失智者及其家屬常因未事先在法律上採取必要保護措施，以致訴訟上常處於特別不利的地位。監護制度是保障失智者權益的重要設計，我國成年監護制度設計上含括監護宣告及輔助宣告，一旦經法院宣告後，受監護人之行為能力將瞬間全部或部分被剝奪，由於該制度無法完全尊重失智者本人之決定權與其自主性，施行上恐有侵害人權之可能性。因應高齡社會的到來，我國在原有的監護制度外，增訂成年人意定監護制度，本文倡議醫法跨域結合對推動以人為本的失智照護至關重要，醫事人員若能主動提供失智者及其家屬關於我國監護制度的相關資訊，提醒失智者宜善用其仍具意思能力之黃金時間，為自己日後的護養療治及財產管理預為安排，除能尊重失智者本人之決定權外，亦能發揮其身為失智者之照顧者、諮詢者、及代言者之角色。此外，司法人員若對失智症的進程與影響有進一步的認識，未來將能適時審酌有無施以監護之必要性，同時合理運用法律授權之手段，確保失智者能在司法訴訟程序中得到充分保障。

"Persons with dementia（PWD）experience declining cognitive function that can make it difficult to make meaningful judgments. PWD may encounter many problems such as becoming victims of fraud, misuse of identity and improper transfer of their real estate. They may be particularly disadvantaged in situations requiring litigation due to the absence of laws providing legal protection. One important safeguard in Taiwan to protect the rights and interests for PWD is the guardianship system. The Taiwanese system of guardianship includes guardianship and assistantship over adults. If guardianship and assistantship is determined by the courts, the PWD will no longer have partial or complete rights for decision making. Some may view this as a violation of human rights. With a rapidly increasing aging society, adult guardianship by agreement was implemented in order to provide better protection of basic human rights for PWD. The purpose of this study is to encourage frontline health care workers taking an active approach of sharing information about adult guardianship system while providing integrated care for PWD. If PWD can make such arrangement before the onset of declining cognitive capabilities, this will not only promote self-determination but also protect a person’s dignity and rights for healthcare, financial and property support in later years. The frontline health care workers can also achieve their roles of being the care provider, counselor, and advocator of their clients. In addition, if judicial personnel have a better understanding of the process and impact of dementia, they will be able to review the necessity of guardianship in a timely manner in the future, and at the same time use legally authorized means to ensure that the dementia can be fully protected in the judicial proceedings."