失智症患者預立醫囑相關議題探討

Explore the Issue of Determining the Advanced Directives in Patient with Dementia

失智症為21 世紀的重症之一，其複雜多變的臨床症狀需要持續的照護，亦表示須長期支出醫療費用，對家庭與社會經濟造成沉重負擔。失智症病程發展過程中，患者會逐漸喪失決策能力，為考量患者之自主及最大利益，鼓勵其在尚具自主決策能力時，即預立醫囑以表達個人對自身未來的醫療照護期望與意願，能使家屬及醫護人員尊重患者自主權並顧及醫療決策倫理，及早準備相關因應措施，讓患者獲得最適切的醫療照護。然何時是失智患者預立醫囑的最佳時機及相關的限制，值得深入探討。本文奠基於臺灣現存之臨床情境，統整相關文獻並提出論述，期能提供醫療人員在面對失智症患者的醫療自主抉擇時之參考。

Dementia has become one of the severe diseases of the 21st century. With its complex clinical symptoms, patients with dementia need continuous care which accompanied by long-term medical expenses and economic burden of family and society. Patients with dementia gradually lose their capacity to make medical decision in the course of disease. In considering patients’autonomy and best interest, patients with dementia are encouraged to make the advanced directives before losing the ability for self-determination, so that their own personal expectations and wishes toward future medical care plan can be noted. As a result, family members and health care providers are able to respect for the autonomy while taking into account the ethical medical decision which facilitate early preparation and plan for the appropriate medical care. However, when is the right time for patients with dementia to determine the advanced directives and what limitations associated with it needed to be explored. Based on Taiwanese current medical situation, we reviewed literature related to ethical dilemmas of care for patients with dementia and provided discussion and comments. Such information can be references for healthcare providers when facing medical decisions for patients with dementia.