家屬代理維生醫療決策之道德基礎、標準與決策形成模式：對台灣安寧緩和政策的反思

Moral grounds, standards, and decision-making models for surrogate life-sustaining treatment decisions by family members: a reflection on Taiwan’s hospice and palliative care policy

當老化或病情影響而無法為自己做醫療決定，需由他人代為進行，此即醫療上之代理決策。維生醫療抉擇是生命最後一哩路上，關涉個人尊嚴與生活品質之重要決策。鑒於預立醫療相關文件（預立安寧緩和醫療暨維生醫療抉擇意願書、預立醫療決定書）之簽署率偏低，當無決定能力病人需進行維生醫療抉擇時，仍以家屬代理決策最為常見。本文回顧其他國家關於家屬代理決策之道德基礎、標準與決策形成模式之相關文獻，藉以檢視我國現行規範，並對相關安寧緩和政策與未來研究提出建議。

Individuals experiencing old age or advanced-stage diseases may be insufficiently lucid and thus require surrogate decision-makers. The decision to use life-sustaining technologies is a crucial one for such individuals because prolonged life may lead to suffering in some cases, implicating the individual’s ability to die with dignity. When it comes to making life-sustaining medical decisions for incapacitated patients, in practice, family members often function as surrogate decision-makers in Taiwan because of the low uptake of written documents about advance care plans, including“The Letter of Intent for the Choice of Hospice Palliative Care and Life-Sustaining Treatment”and“Advance Decisions.”This article reviews the literature, mainly on studies outside of Taiwan, on the moral grounds, standards, and decision-making models for life-sustaining treatment decisions made by family members. This article also examines Taiwan’s current regulations, offering suggestions for researchers and policymakers. (Taiwan J Public Health.