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題名:醫務社會工作者於預立醫療自主計畫之經驗研究
作者:蔡長穎
作者(外文):TSAI,CHANG-YIN
校院名稱:東海大學
系所名稱:社會工作學系
指導教授:呂朝賢
學位類別:博士
出版日期:2023
主題關鍵詞:病人自主預立醫療自主計畫醫務社會工作者Patient Self-DeterminationAvance Care PlanningMedical Social Worker
原始連結:連回原系統網址new window
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尊重病人的「自主權」是末期照顧的核心價值之一,我國立法院於2015年12月18 日三讀通過《病人自主權利法》,並於2018年1月6日正式施行,成為全亞洲第一部維護病人善終自主權的專法。此法賦予具完全行為能力的民眾,於意識清楚時可預立醫療決定,選擇在生命末期的「特殊情況」,享有拒絕醫療的權利。並註記於健保卡,一旦符合末期病人等五大狀況時,就能依照這個決定走完人生最後一程。該法規定,20歲以上且具完全行為能力,就能預立醫療決定(AD),且簽署後可隨時以書面撤回或變更。預立醫療決定的內容指涉,考量未來面對生命末期、不可逆轉昏迷、永久植物人、失智程度極嚴重無法自理、或符合其他中央主管機關公告的重症之時,事先立下之書面意思表示,指明處於特定臨床條件時,希望接受或拒絕之維持生命治療、人工營養及流體餵養或其他與醫療照護、善終等相關意願之決定。而要預立醫療決定,得先至提供預立醫療照護諮商的機構進行預立醫療自主計畫(ACP)。
其中醫務社會工作者於《預立醫療自主計畫》中扮演著至關重要的角色,本研究之探討重點乃在醫務社會工作者對於《預立醫療自主計畫》及《病人自主權利法》之相關看法與態度,並試圖以醫務社會工作者為主體,藉由深度訪談法,並將訪談內容整理與分析,本研究主要為瞭解醫務社會工作者於預立醫療自主計畫服務過程之實際經驗,並瞭解醫務社會工作者參與預立醫療自主計畫之問題與困境,最後希望探討醫務社會工作者對病人自主權利法、預立醫療自主計畫及預立醫療決定之整體態度,以回應醫務社工人員參與醫療團隊之角色與功能定位。
To guarantee the medical autonomy and good death toward the patients' right. The Legislature passed the "Patient Autonomy Rights Act" on December 18, 2015, and was officially implemented on January 6, 2018, becoming the first country in Asia. A special law to maintain the patient's autonomy. This law gives people with full capacity to make medical decisions when they are conscious, choose a "special case" at the end of their lives, and enjoy the right to refuse medical treatment. And note on the health insurance card, once the five conditions of the final patient are met, you can follow the decision to complete the last journey of life. The Act provides that a medical decision (AD) can be pre-established if you are over 20 years of age and fully capable, and can be withdrawn or changed at any time after signing. The content of the advance medical decision refers to the written meaning of the future when considering the end of life, irreversible coma, permanent vegetative, extremely debilitating, unable to take care of themselves, or meeting the serious symptoms announced by other central competent authorities. To determine the life-sustaining treatment, artificial nutrition and fluid feeding or other decisions related to medical care, hospice, etc., that are expected to be accepted or rejected in certain clinical conditions. To pre-establish a medical decision, you must first go to an institution that provides pre-established medical care consultations to conduct an Advance Care Care Planning (ACP).
Among all, medical social workers play an important role in Advance Care Care Planning (ACP). Therefore, this study attempts to focus on medical social work, through in-depth interviews, and collating and analyzing interviews.This study is mainly to understand the actual experience of medical social workers in the Advance Care Care Planning medical service process, and to understand the problems and difficulties of medical social workers participating in the Advance Care Care Planning. The overall attitude of the law of rights, Advance Care Care Planning, and advance medical decision-making in response to the role and functional orientation of medical social workers participating in the medical team.
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