- 研究生：林淑婉
- 論文名稱：簽署預立醫療的社會學分析： 以某區域醫院醫療行政科室人員分析為例
- 指導教授：葉欣怡
- 關鍵字：醫療自主、預立醫療決定、預立醫療照護諮商
- 論文中文摘要
研究結果顯示，在醫療行政場域政策影響下，對於預立醫療表達認同與支持，本研究醫療行政單位的群體意識，對於死亡品質的價值觀，一致認同善終為最終目標，但對於預立醫療政策仍在保留與觀望的態度。本文也實證臺灣文化社會的家族觀念，以家屬為優先，故資訊不對等是社會學的研究重點，不論是醫護人員及民眾應加強生命教育及死亡識能的再教育。
- 論文英文摘要
A hospital is a modern-society labor workplace made of a double-track, bureaucratic system, which provides products and services. While it offers us sick-relieving and healing functions, it meets our needs of seeking medical solutions. With the advancing medical technologies and national health insurance programs, Taiwan’s average lifespan has been on a rising streak for the past years, with the people on the island having greater expectations on the health and care providers. To extend our livespan and improve life-sustaining treatments, we have to consider life quality under life-sustaining treatments. With the enactment of Patient to Autonomy Act on January 6, 2019 in Taiwan, people with behavioral capacity could sign and choose if they would like to receive further medical attention once suffering from incurable illnesses that jeopardize their life quality and self-respect, a law designed to allow patients to make appropriate decisions ahead of time and reduce suffering before death. To make people fully understand the advance care planning (ACP) they choose, the new law requires them to take ACP advisements before making their own advance decisions (AD). Since the law was enacted, some 20,000 patients have signed. The study was conducted through personal participation and observation, semi-structural focus group, patients’ agonal experiences, their relatives’ experiences, and the medical solutions under our national health insurance program in my workplace of medical administration, in an attempt to break through the bottleneck of promoting ACP in Taiwan.
The study demonstrated a great approval and support for the ACP from people under the efforts of official promulgations made by medical regulators. Based on group consciousness of medical administration staff and their perception towards quality of death, we found good quality of death is widely considered an eventual goal. However, people remain some dubious about ACP policy. The study also proved the patients’ family is always given priorities before patients themselves in Taiwan’s culture and society. Thus, information asymmetry is an issue needed to be addressed in social science. Both health care providers and people should be further educated for life value and death consciousness.
