預立醫療照護諮商與諮商倫理

Advance Care Planning (ACP) and Ethics in Counseling

病人自主權利法 （Patient Right to Autonomy Act, PRAA） 於 2019 年 1 月 6 日正式實施，該法透過簽署預立醫療決定（Advance Decision, AD），尊重病人自主決定醫療權。該法規定簽署前，需經 過預立醫療照護諮商 （Advance Care Planning, ACP），並由醫療院所 評估後於預立醫療決定上核章，該決定始能生效。本文作者透過自 身於安寧醫療照護場域之工作經驗，提出國內目前實施預立醫療照 護諮商常見議題，包括：（一）華人文化下親屬意見與病人自主間 的兩難。（二）醫療委任代理人的權利與身份擬定。（三）預立醫療 照護諮商的次數與時效性。以及可能面臨的諮商倫理相關議題， 如：（一）預立醫療照護諮商專業能力與相關專業知能。（二）各方 意見之權衡。（三）預立醫療照護諮商的相關資源轉介。本文作者 也建議相關單位能提供訓練、認證與服務，提供意願簽署人與其家 屬資源上的支持，使病人自主權利法能更體現其初衷與本意，減少 家庭及社會之糾紛，以及提升醫療資源使用之效能。

Patient Right to Autonomy Act (PRAA) of Taiwan is officially implemented on January 6, 2019.By signing the Advance Decision, patients can determine to accept or refuse treatments in their end of life. PRAA rules that people would accept the Advance Care Planning (ACP), and be approved by the hospital on their applications, before making the Advance Decision. This paper thus aims to present difficulties and ethical issues throughout the experience of the proposer who worked in situation of Hospice Care. The difficulties include (a) The dilemma of patients and families in Eastern Culture. (b) The appointment of Health Care Agent. (HCA) (c) The times and persistent of Advance Care Planning. The ethical issues include (a) The related abilities and knowledge of ACP. (b) The balance of the opinions across the different aspects. (c) Transferring patients to the related resources. This paper then suggests that the related departments can provide trainings and certifications, including hospitals and universities. The related departments can also provide more services to support patients and families. Thus, the Advance Decision of PRAA can reduce disturbances in families and society and waste of medical resources.