An Educational Need to “Natural Death Act” in Taiwan

台灣於民國89年6月通過安寧緩和醫療條例之立法，此不僅代表國內末期病人自主權 受到重視，也促使末期醫療決策更能符合倫理精神。本研究目的在探討醫護人員針對 末期病人施行不施予心肺復甦術（DNR）的現況以及推展本條例之態度，以利未來規 劃推展本條例策略之參考。研究對象為某醫學中心三個癌症照顧相關病房的醫護人員 共69名，以半結構式問卷調查法進行資料收集。在所有受訪醫護人員中九成以上(95. 7%)曾有DNR經驗，超過一半(53.0%)在執行DNR時，僅得到家屬的同意，三分之一(31. 8%)受訪者會質疑過去執行DNR的合法性。約有八成(79.7%)受訪者支持本條例之制定 ，但不及二成(17.4%)醫護人員認為已完全了解條例內容，同時超過九成(97.1%)受訪 者有意願更進一步瞭解條例之內容。研究結果也發現，緩和醫療工作人員對條例制定 的支持程度及按條例執行DNR的程度均較非緩和醫療病房工作人員為高，且達統計上 顯著差異（p<0.01, p<0.01），研究對象對條例內容的了解程度與該條例的執行程度 呈正相關（r=0.442, p<0 . 01）。因此，安寧緩和醫療條例相關內容宜列入醫學院 核心課程，並對臨床醫療人員提供醫學倫理在職教育課程，方能落實本條例，達成此 立法目標以謀末期病人之福祉。 The Natural Death Act was enacted in Taiwan in June 2000. The legalization not only represents respect for the dignity of the terminally ill. But also facilitates ethical decision-making in end-of-life care. The present study was designed to investigate the current status of DNR (Do Not Resuscitate) orders and to understand the training requirements for further Natural Death Act educational initiatives. A total of 69 medical professionals working in oncology wards and a palliative care unit were interviewed with a semi-structured questionnaire. Sixty-six respondents (95.7%) had been involved in DNR situations, and around half (53.0%) had consent from the families. One third (31.8%) of respondents were unsure of the legal status of DNR orders . Although only a small proportion (17.4%) fully understood the contents of the Natural Death Act, the majority (79.7%) of respondents supported the legislation. Nearly all respondents (97.1%) expressed a willingness to learn more about the contents of the Act. Staff in the palliative care unit scored higher in their support of the newly enacted legislation and in practicing in accordance with its regulations (P<0.01, P<0. 01). Understanding the Act and practicing in accordance with its regulations were positively correlated (r=0.442, P<0. 001). Incorporation of the Natural Death Act and related issues into medical school curricula and provision of appropriate training for medical professionals appear to be the most useful educational strategies at this early stage. (Full text in Chinese)