2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/644286摘要：根據統計目前台灣健保體系每年花費在「慢性呼吸治療」及「洗腎」服務的支出約佔健 保總支出之10〜15%，對健保造成沉重負擔，導致財務危機，也引發醫療資源配置是否符合社 會正義的質疑。尤其是台灣的末期腎病(ESRD)罹患率與洗腎(hemodialysis)之比率皆是全世界 最高，而過去十年於社區快速成長的呼吸治療中心(respirator care center, RCC)及呼吸治療病房 (respiratory care ward, RCW)，更是發展出新的醫療照護與給付模式，產生許多新問題。與這 兩類病患有關的許多醫療照護決策、病患治療與住院標準、給付標準、健保政策之制定…， 都牽涉到醫療資源分配與社會正義問題，衍生許多倫理與法律難題。本研究將以「慢性呼吸 治療」及「洗腎/器官移植」為例，針對醫療資源分配所涉及之倫理議題進行深入分析與探討。本研究預計執行二年，首先將針對分配正義之主要理論、醫療資源分配機制進行研究分 析與理論建構，並據以檢視、反省我國相關醫療資源分配現況。接著從組織倫理之層面切入， 探討並建構醫療機構進行資源分配決策的架構與機制，並以慢性呼吸治療及洗腎/器官移植為 例，應用所建立之理論與架構，探討其所涉及之各種醫療照護決策、病患治療與住院之標準， 與醫療及健保政策等倫理與法律議題，包括「如何妥善分配器官」、「活體/屍體器官指定捐 贈」、「合併移植之器官分配」、「不給予及終止洗腎」、「不給予及撤除呼吸器治療」等兩難倫 理決策，並彙整前述各項研究成果後，建置可供參考依循之臨床倫理處置指引及相關建言， 以協助醫療機構、專業人員、患者及家屬，在遭遇相關倫理難題時，能有所參考依循，做出 適切有益的決策及處置。<br> Abstract: The case numbers and health care cost for “chronic ventilator dependent patients” as we as “renal dialysis patients” has increased rapidly in the last 10 years and was estimated to cost more than 10〜15% of the total national health insurance budget in Taiwan. This has made the “already overburden and in financial crisis” national health insurance system even more critical. Moreover, such fact also raised serious doubt of whether such practice fulfils a fair distribution of scare health resource and quality end-of-life care for patients.This research is intended to investigate the ethical and legal issues arising from the health resource allocation and priority setting, using the examples of health care delivery for the chronic ventilator dependent patients and renal failure/organ transplantation patients. We will firstly investigate the major ethical theories in distributive justice and mechanism for resource allocation. Then we will adopt an institutional level approach to examine organizational ethics in terms of framework and mechanism for resource allocation and priority setting. The cases of chronic ventilator dependent and renal dialysis patient care will be used as examples. More specific problems including treatment decision makings, admission and discharge standards, organ distribution, designated organ donation, combined organ transplantation, withholding and withdrawing dialysis, withholding and withdrawing ventilators... and etc will be examined and analyzed. These researches are aimed for articulating these common and critical health care ethics dilemmas especially involving priority setting and resource allocation, and then setting up solutions or processes for problem solving, which mostly likely will include the establishment of clinical ethical guidelines for health care professionals and institutions to follow.醫療資源分配分配正義器官勸募政策終末照護倫理不給予/撤除維生治療洗腎器官移植呼吸器依賴resource allocationdistributive justicepriority settingend-of-life care ethicswithholding/withdrawing life-sustaining treatmentrenal dialysisorgan transplantationventilator dependent