https://scholars.lib.ntu.edu.tw/handle/123456789/545077
標題: | The practicalities of terminally ill patients signing their own DNR orders - A study in Taiwan | 作者: | Huang C.-H. WEN-YU HU TAI-YUAN CHIU Chen C.-Y. |
公開日期: | 2008 | 卷: | 34 | 期: | 5 | 起(迄)頁: | 336-340 | 來源出版物: | Journal of Medical Ethics | 摘要: | Objectives: To investigate the current situation of completing the informed consent for do-not-resuscitate (DNR) orders among the competent patients with terminal illness and the ethical dilemmas related to it. Participants: This study enrolled 152 competent patients with terminal cancer, who were involved in the initial consultations for hospice care. Analysis: Comparisons of means, analyses of variance, Student's t test, χ2 test and multiple logistic regression models. Results: After the consultations, 117 (77.0%) of the 152 patients provided informed consent for hospice care and DNR orders. These included 21 patients (17.9%) who signed the consent by themselves, and 96 (82.1%) whose consent sheet was signed only by family members. The reasons why patients were not involved in the discussions toward the consent (n = 82) included poor physical or psychological condition (44.9%), concerns of the consultant hospice team (37.2%), and the family's refusal (28.2%). On a multivariate analysis, patients' awareness of their poor prognosis (odds ratio = 4.07, 95% confidence interval = 2.05 to 8.07) and their understanding of hospice care (2.27, 1.33 to 3.89) were two independent factors (p<0.01) that influenced their participation in the discussions or their personal signature in the informed consent. Conclusion: The family-oriented culture in Asian countries may violate the principles of the Patient Self-Determination Act and the requirements of the Hospice Care Law in Taiwan, which inevitably poses an ethical dilemma. Earlier truth-telling and continuing education of the public by hospice care workers will be helpful in solving such ethical dilemmas. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-55449135002&doi=10.1136%2fjme.2007.020735&partnerID=40&md5=6de9a95cd98ccfdcdc2fcf3d5b2afdde https://scholars.lib.ntu.edu.tw/handle/123456789/545077 |
ISSN: | 0306-6800 | DOI: | 10.1136/jme.2007.020735 | SDG/關鍵字: | adolescent; adult; aged; article; ethics; ethnology; family; female; human; informed consent; interpersonal communication; legal aspect; male; mental capacity; middle aged; organization and management; psychological aspect; regression analysis; resuscitation; right to die; Taiwan; terminal care; terminally ill patient; Adolescent; Adult; Aged; Family; Female; Humans; Informed Consent; Male; Mental Competency; Middle Aged; Regression Analysis; Resuscitation Orders; Right to Die; Taiwan; Terminal Care; Terminally Ill; Truth Disclosure |
顯示於: | 醫學系 |
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