在孝道和家庭主義文化脈絡的影響下，對於華人社會中的老年族群而言，特別是與生命末期自我決策有關的議題，如預立醫療照護計畫（advance care planning），對於老人本身和家屬都是困難的事。本文首先說明目前長照機構執行預立醫療照護計畫的現況與瓶頸，並闡述東、西方對於自主權之異同，再進一步探討華人孝道與家庭主義如何影響台灣長照機構老人之自主權。最後，以居住於長期照護機構下台灣老年族群為例，說明與自主權相關之議題，如遷移與住民於機構中的治療決策。期望未來能提升台灣長期照護機構長者晚年有關生命末期照護決策之自主權性。

Under Chinese filial piety and familism culture, self-determination for the Chinese elderly at the end of life, such as advance care planning, is difficult for both older people and their family members. The purpose of this article is to explore the implementation and barriers of developing advance care planning or advance directives in long-term care facilities. We would present the different way to think about the notion of autonomy between the Western and Eastern. Otherwise, we would also explain how the cultural issues, such as filial piety and familism, affected the elderly autonomy in Taiwanese long-term care facilities. Finally, the issues about self-autonomy among institutionalization of residents, such as relocation to institutions and the use of advance directives, would be discussed. We hope the percentage of elderly autonomy in Taiwanese long-term care facilities to increase, especially for the issues at the end-of-life care.