病人自主與預立醫療照護計畫：英國經驗

Patient Autonomy and Advance Care Planning: The United Kingdom Experiences

台灣於民國105年1月6日三讀通過亞洲首部「病人自主權利法」，旨在透過預立醫療照護計畫(advance care planning, ACP)及早與個人和其家屬討論未來醫療照護的選項，以作為未來當個人因疾病或意外喪失意思能力時，提供符合其意願之生命末期照護之指引。藉此落實尊重病人醫療自主、保證病人善終權益、以及促進醫病關係和諧的願景。然而台灣ACP相關發展與經驗尚不足，筆者分享在英國留學時之研究與臨床見習經驗，以期提供台灣未來政策、法規以及臨床實務之參考。英國依據意思能力法2005(Mental Capacity Act 2005)發展了ACP迄今將近15年，透過以個人為中心之介入措施及早討論與澄清其生命末期照護偏好與意願，提供符合個人意願之生命末期照護。透過全國性政策與教育資源支持，加上慈善非營利組織與基層第一線醫療人員的協同合作，使ACP的概念得以普及，進而增加安寧緩和療護的使用率，並藉此改善病人與家屬的生命末期照護歷程。彈性的相關紀錄表單設計與ACP醫療人員配置是其特色，然而困難的跨科別之資訊傳遞與缺乏統一共享平台，卻是提供連貫且一致性生命末期照護之一大挑戰。英國捍衛個人醫療自主權並協助意思能力受損之個人行使最大程度的自主權利，值得台灣借鏡。

Taiwan adopted the‘‘Patient Right to Autonomy Act’’on January 6th, 2016, where is the first in Asia to employ legislation to honour an individual’s medical autonomy. Through applying advance care planning (ACP), an early end-of-life care discussion among an individual and his/her family members could be initiated in order to achieve concordance with preferred care provision. Such discussions respect the patient’s medical autonomy, ensure their good death and improve the clinician-patient relationship. However, the relevant experiences in Taiwan is sparse. The authors shared their experiences on ACP in the United Kingdom while studying abroad. The UK developed ACP based on the Mental Capacity Act 2005 for almost 15 years, aiming to provide a person-centred end-of-life care which is aligned with an individual’s wishes and preferences. The nationwide policy and educational resources support and the collaboration with charities and clinicians in all settings successfully promote the concept of ACP and increase the usage of palliative care, which potentially improve the patients and families end-of-life care experiences. Flexible recording documentations and ACP facilitators are their advantages, however, the inefficient information hand-over through different care settings and the lack of an information sharing platform could potentially compromise the care quality, which is challenging to concordance with preferred end-of-life care provision. The UK experiences of honouring an individual’s medical autonomy and assisting a person with impaired mental capacity to maximise their ability for decision-making are worth learnings to inform future Taiwanese ACP development.