醫師與律師對於家屬代理醫療決定之態度分析

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Title:	醫師與律師對於家屬代理醫療決定之態度分析 The attitudes of physicians and lawyers on surrogate's decision making
Authors:	黃雅君
Contributors:	醫務管理學系碩士班
Keywords:	倫理;法律;代理權;態度 ethics;law;surrogate;attitude
Date:	2011-07-15
Issue Date:	2011-10-17 16:57:17 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	背景與目的：我國醫療法規中，除了保護病人自主權，也賦予病人家屬受病情告知及代替無決定能力之病人做決定的權利，然而這樣的代理權行使，卻可能衍生出負面問題。因此，本研究希望瞭解醫師與法律專家在面對病人代理權出現兩難決定時之觀點，以及探討實際倫理面與法律面的規範是否存有互相違背的情形。研究方法：為橫斷面問卷調查，對象為中部兩家醫院之醫師及法律專家，總回收樣本數分別為120份及26份。問卷內容是以三件臨床案例情境為主軸，所發展出的結構式問卷，用來探討醫師及法律專家在不同情境下之態度。以SPSS12.0版統計軟體進行描述性、卡方檢定及邏輯斯迴歸等資料處理。研究結果：三件案例情境中，在面對病人代理權出現兩難決定問題時，醫師與法律專家皆多數不贊成遵從家屬代理決定而執行醫療處置，兩者態度有一致性的結果，而「臨床年資」及「宗教信仰」為醫師是否贊成遵從家屬代理決定而執行醫療處置的主要影響因素；醫師多數不同意家屬有代理病人意願，法律專家多數不認為家屬代理人所行使的同意權在法律上具有效力，兩者態度有一致性的結果，而「宗教信仰」及「醫院權屬別」為醫師是否同意代理人的做法有代理病人意願的主要影響因素；醫師與法律專家皆多數認為遵從家屬代理決定而執行醫療處置後，違法的可能性較高，兩者態度有一致性的結果，而「是否曾經發生過醫病糾紛」為醫師認為哪一種決定比較會引起醫療糾紛或訴訟的主要影響因素。三件案例情境中，多數醫師與法律專家在面對病人代理權出現兩難決定時之態度已有一致性的共識，但是仍有少部分醫師及法律專家持不同觀點，這表示少數醫師在臨床工作中，可能會因對法律規範缺乏深入瞭解，而做出有觸法風險的醫療決策，而法律專家之間的態度差異性，亦可瞭解到現行法律制度對於病人代理權的規範，仍有部分尚未明確定義與界定。結論：本研究成果期望可提供醫師在臨床決策上的依據，以及成為未來醫學倫理教育、醫療政策、法律代理權規範方面的制定參考，進而保障病患安全與最大權益，讓代理權的行使發揮作用力。 Background：In our country, the medical laws and regulations protect patient's autonomy, as well as give family the rights to substitute decision-making for incapacitated or unconscious patients. In some circumstance, families' decision may violate or limit patient's autonomy since they don't make decision on behalf of patient's best interests. Therefore, we want to realize and compare the opinions of physicians and lawyers about controversial decision-making of surrogate. Methods：This study is a prospective cross-sectional survey study. We develop self-administrated questionnaire and recruit 120 physicians in two hospitals and 26 lawyers from some law firms to this study. This study provides three real scenarios regarding dilemma between ethics and law when patient's surrogate may not represent patient's best interest. Descriptive Statistics, Chi-square test and Logistic Regression will be used to analyze in this study. Result：In three scenarios, when patient's surrogate may not represent patient's best interest, physicians and lawyers both disapprove of obeying the substitute decision-making,“length of practice”and“religion”are the main factors to affect physicians' attitudes. Physicians disapprove patient's surrogate realizes the patient's wish, and lawyers disapprove the rights of patient's surrogate are lawful,“religion”and“hospital ownership”are the main factors to affect physicians' attitudes. Physicians and lawyers both approve of obeying the substitute decision-making is illegal,“the experience of medical malpractice dispute”is the main factor to affect physicians' attitudes. In three scenarios, most physicians and lawyers reach a consensus. But few physicians and lawyers have different opinions. This expression few physicians may offend the law because they don't understand the legal knowledge. And the difference of lawyers' opinions also express that the medical laws and regulations of patient's surrogate are not explicitly defined. Conclusion：The results of study will provide physicians a reference when they have clinical decision-making and provide a foundation in medical education, medical ethics, health policy and surrogate of law. Also, it will enhance patient's right and autonomy by improving surrogate decision more efficacious.
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