推動預立醫療照護諮商之經驗──以臺北市立聯合醫院為例

The Implementation of Advance Care Planning in Taipei City Hospital

2019年1月6日病人自主權利法正式施行，臺北市立聯合醫院延續2016年至2018年試辦期間的耕耘，持續推動預立醫療照護諮商(Advance Care Planning, ACP)的服務，2019年全院投入逾230位諮商團隊成員，提供超過2,300位意願人進行ACP，辦理逾110場社區宣導活動，發現前來進行ACP的意願人年齡大多數介於50-69歲之間，半數以上表示自己並未罹患疾病，諮商動機以預先進行生命及善終的安排為大宗，而在意願選擇上近乎9成選擇不希望接受維持生命治療與人工營養；並發現現今社會環境並非不能討論生死議題，但仍需要專業人員走出既有框架，運用多元的互動方式提升民眾的死亡識能。此外臺北市立聯合醫院並嘗試將預立醫療照護諮商服務延伸至缺乏家庭社會支持的街友、溝通困難的重度帕金森氏症病人、人類免疫缺乏病毒感染者（HIV感染者）、失智症者、慢性精神疾病以及智能障礙者等特殊族群。

On January 6, 2019, Patient Right to Autonomy Act was officially implemented. Taipei City Hospital continued its efforts during the trial period from 2016 to 2018, continued to promote the services of advance care planning(ACP), and invested more than 230 members of the ACP team to provide more than 2,300 participants to ACP, handle more than 110 community outreach activities. Among the participants, most aged between 50-69 years old, more than half have no disease, most consultation motives were life and good death prearrangement, almost 90% of the participant chose not to receive life-sustaining treatment and did not wish to receive artificial nutrition. And we found that today's social environment is not incapable of discussing issues of life and death, but professionals still need to step out of the existing framework and use multiple interactive methods to improve people's death literacy. In addition, Taipei City Hospital try to extend services to homeless people who lack family and social support, patients with severe Parkinson's disease who have difficulty communicating, and persons with HIV, mentally retarded dementia, chronic mental illness, and mentally disabled people.