Good-Death Appointment：A Gaze on Taiwan’s Advance Care Planning Practice from an ER Perspective

• Main Authors: Shu-Yin Lin, 林書因
• Other Authors: Yih-Ren Lin
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/4ru269

碩士 === 臺北醫學大學 === 醫學人文研究所 === 106 === The draft of 3rd revision of Taiwan’s “Hospice and Palliative Care Act” announced on May 15th, 2013, enacted the advance directive document in five a letter of intent. On December 18, 2015, the Legislative Yuan finally passed the 3rd reading of the Taiwan’s “Patient Self-Determination Act”. It allows patients to have their rights to sign a letter of intent independently, and to refuse any treatments and terminate Advanced Hospice Palliative Care and Life Sustaining Care Choices of Intent. This difficult but well-intentioned case is based on the right to the best interests and respect of life. The current Hospice and Palliative Care Act is to set into action of “Advance Care Planning （ACP）”, which give us, as a human being, a hospice chance to make decisions for facing our ending of life. Though, is it true that the current ACP program regarding has covered all aspects of people’s choices for their ending stage of life? In this research, two main topics will be further discussed. The first is to discuss patient self-determination at his/her life ending stage, and 2) to explore the differences between making a pre-medical decision and care for life. The main method that was used in this research was either to review historical medical records or to have patient participate this research directly. The statistic result presents in this research was retrieved from an Emergency Room in a Teaching and Learning centre in North Taiwan. A retrospective approach was used to the collection of historical medical records from the 55 patients who were at their life ending stage, activating the discussion, signing, or doing business related to the social and cultural influences of the DNR or the pre-medical decision. Results show: 1) the rates of signing a pre-medical decision and DNR had an increasing trend when people age up, 2) the insufficiency and incompleteness from the current medical treatment in the final life of medical treatment provided by the ER team 3) unnecessary invasive medical care could be reduced if a pre-medical decision is signed at earlier stage, which could have the quality of life the patient pictures during their final stage, 4) a well-established relationship between family, spouse, and friends would increase willingness and motivation for arranging medical planning, and 5) when a disease has a clear development to death, the more you know about your own medical situation, the more likely it is that the patient will sign a pre-medical decision. 6) The issue of DNR is not to be limited to the life-conscious of the senior citizens, but to the life-self-determination of all different ages. The emphasis of care for life in this study is to be achieved through the life of the individual. The current pre-medical decision program is a good practice for the life-self-determination, and further to be able to maintain the life quality of the individual. This conclusion is expected to be an extension of the study of Life education in the days to follow.