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00:00:58,675\n他的意願代理人來預你安寧緩和醫療書或預定那個醫療決定書要求醫生在往後的治療裡不要用人工營養跟流體餵養急救或者是維生醫療來做只是做一個維持心跳的無效的醫療但是安寧緩和和醫療\n\n4\n00:01:01,405 --> 00:01:20,070\n就非常挑戰我們的社會文化所以在法律要保護醫生避免受到家屬的攻擊而受到傷害而且要積極來促進以縮短病人的痛苦減少我們的醫療資源的浪費所以想問部長程序上病人自主並不是只要我喜歡有什麼不可以\n\n5\n00:01:20,570 --> 00:01:44,393\n必須是考量到病人本身跟醫護人員跟照顧者跟家庭成員跟重要他人的想法是多方協調後的結果可是還是會發生病人的決定家屬事實上是他不認同而跟醫生發生爭執的事件尤其是在安寧療護發生率更高所以衛福部如何支持醫生貫徹病人的決定做醫療\n\n6\n00:01:45,609 --> 00:02:01,715\n好,謝謝委員關心這麼重要的議題,也關心到生死大事以及善終是國人五福利門裡面最難達到的所以我們全國就像自治前法案,當時也是很辛苦\n\n7\n00:02:03,126 --> 00:02:17,066\n蘇委員在這裡,我想這兩位召委都有貢獻那當時都是希望達到這樣的一個目標那這中間的確是有這個人面對生命的默契\n\n8\n00:02:18,147 --> 00:02:36,220\n死亡就好像一個很強烈的陽光你無法去正視他家屬也沒辦法正視他但是我們醫療人員我們政府必須要幫他去正視他讓他能夠好好的過完末期以及能夠善終所以我覺得政府跟相關的立法院願意來討論這個題目個人站出來自我敬佩啦\n\n9\n00:02:42,885 --> 00:03:05,046\n法院依據合法的程序來確保醫生不受醫療過失的判決可是還是無法避免憤怒的家屬對醫師提告所以醫生一旦被告就是要花錢去請律師花錢去開庭對此衛福部能夠給醫生什麼樣的具體的支持這個跟委員報告一下這也是二三十年來\n\n10\n00:03:07,408 --> 00:03:35,384\n的一個大事情那在這的所有的委員尤其是蘇委員擔任那個立法擔任那個醫師公會理事長的時候有時候這有時候兩派意見牽扯但是我們終是把醫療法修法變成那個醫療的一個合理行者合理化那這個就是說以前可能會面對防疫性的醫療但是因為這個只要你好好的救病人\n\n11\n00:03:37,231 --> 00:04:00,780\n幾乎除了你有重大過失或錯誤不然是不會用行者加身所以那個時候就內外婦保科的住院醫師又通過了又上升了這樣子所以我們用各種法律然後再教育同時也讓民眾知道醫生是在幫你救你的命可能有兩成的救命機會\n\n12\n00:04:02,040 --> 00:04:27,977\n你說你要不要救病人家屬一定說一定要救啊可是八成是可能會他的疾病就是救不起來那就有八成的機會來告醫師啊那我說衛福部到底有沒有什麼具體的醫療行者合理化就是來保護這個啊就是這個已經做了很多的一個第一個這是第一個很重要的法案另外一個法案在前幾年通過的就是事故的一個\n\n13\n00:04:32,687 --> 00:04:56,792\n預防還有更調節就是要先調節讓醫師不要承受那麼大的壓力讓醫病能夠更和諧它是一個很光明的法案這兩個法案基本上是讓我們醫病在面對救命的時候能夠更和諧還是可以保障到醫生的權利嗎我問你第二個就是簽署人的資格民法第一\n\n14\n00:04:58,033 --> 00:05:22,152\n14條的第一項規定自然人如果精神障礙或心智缺陷的話不能跟他人溝通或不了解表達意思的話法院得為監護宣告可113年受監護宣告的人總數事實上是6047人其中18歲以上的有5999人其中以社會福利機構為監護人的有10件所以監護人有執行受監護的生活醫療照護跟財產管理的職務請問一下當\n\n15\n00:05:26,295 --> 00:05:35,813\n成年的病患本身意識不清楚的時候經法院為監護宣告的監護人依法可以為病患簽署安寧\n\n16\n00:05:41,574 --> 00:05:57,040\n我要講的是說安寧這邊的話其實他要啟動的這邊其實必須要經由就是說至少前面要有兩個專科醫師確認他默契他這一個所謂的安寧意願書由那個監護人簽署才會有效\n\n17\n00:05:57,620 --> 00:06:15,802\n然後可是在那個病人自主這邊的話他還是會回到了一個病人自主的一個前提在病人沒有表達意願就是他在意識狀況沒有沒有這麼重大改變之前沒有表示過任何意願的時候這個監護人其實他沒有辦法決定以上\n\n18\n00:06:16,647 --> 00:06:18,448\n那根據我們的健保署的分析在死亡前一個月內接受安寧療護的話\n\n19\n00:06:32,137 --> 00:06:50,207\n每個人可以減少到三萬兩千元的醫療支出如果去死亡前六個月接受安寧照護的話每個人可以減少到十萬七千元的醫療支出那育立醫療決定書也可以達到這樣的效果那育立醫療照護諮商一個案子\n\n20\n00:06:51,536 --> 00:07:14,764\n民眾要自費三千元就是要自己花三千元對多數人來講事實上是貴的所以去年七月我覺得衛福部也推出了一個育立醫療照護諮商推廣的獎勵計畫針對低收跟中低收的特定對象來提供免費的諮商服務可是看起來數據推了一年大概從兩萬四增加到兩萬五\n\n21\n00:07:16,567 --> 00:07:40,559\n沒有很顯著的提升啦所以想問一下花三千元可以省下大筆的醫療費用衛健保的財務永續衛福部一定會往這個方向推動可是去年推動的不利的原因是什麼因為增加不多好當然我們做調查包委員當然我們做調查的時候的確為什麼不簽民眾寫出來的原因當然就是說因為職場費用是蠻高的\n\n22\n00:07:45,701 --> 00:08:07,348\n我記得剛開始推出來的時候我們立法院好幾個委員都跑去台大醫院真的去做諮商那個我很敬佩他們就花幾千塊去做但是其實對一般的民眾來講的確是很負擔所以我們去年七月還有五月一號會擴大來讓更多的希望\n\n23\n00:08:08,248 --> 00:08:30,745\n有更多的機會來讓病人來簽那當然怎麼樣我們要去了解原因那衛生署也一直在請協界這邊了解原因是那部長你如果講說今天新聞報導也說5月7號要擴大啦所以你今年的預例醫療註記的人身要提升你目標是多少\n\n24\n00:08:33,772 --> 00:08:41,868\n今年你的預歷醫療助計的人數也要提升嘛齁你目標是多少希望\n\n25\n00:08:43,685 --> 00:09:00,840\n我補充一下這個吼我們會希望是說現在大概一年兩萬左右能夠透過今年因為才只有半年的執行期所以能夠就是加倍到四萬左右是我們的目標然後那剛剛那個委員槌尋的是說推廣這一塊的話其實我們發現是說民眾的認知跟我們傳統習\n\n26\n00:09:06,805 --> 00:09:32,399\n習俗文化的這個禁錮其實還是一個主因另外一塊就是財務所以才會是從財務面的地方我們跟健保署合作推廣面的部分的話我們會跟長照室合作因為目前看到願意簽署的都是人生經驗裡面有一些相關的所以目前大概是50歲以上是我們的一個target以上謝謝市長安寧療護的概念早在\n\n27\n00:09:33,154 --> 00:09:55,183\n立法前台灣大概就已經開始在推動大概現在已經20年了而且使用率逐年增加那從2022年使用的大概達到6萬7病人死亡前的一年的安寧利用率的話大概30.4%那可是還是上市量能不足那所以整個\n\n28\n00:09:56,283 --> 00:10:13,622\n他事實上是透過多種專業來對病人跟家屬做整體的輔導那他同時也是生理心理的一個醫療可是這個項目真的蠻燒錢的所以對醫院來說如果不是為了評鑑加分的話誘因不大所以\n\n29\n00:10:14,042 --> 00:10:38,687\n因此安寧病床的床位不多而採用安寧共照來替代所以112年全國有86家醫院共計915床到114年的時候變成是85家醫院大概910床整個需求多床位少可是四病每一天大家都有人在排隊所以想問一下目前實際上的安寧病床到底病床數有多少\n\n30\n00:10:40,087 --> 00:11:02,047\n是的薛委員剛剛您報的就是現在的就是910嗎整個不多所以就會有跨科的做安寧供照所以目前安寧供照對病人特別是家屬的照護能夠達到安寧病房的水準嗎衛福部怎麼去確保這個水準因為不一樣啊\n\n31\n00:11:02,788 --> 00:11:17,835\n我想安寧共照是一個有一點點不得不的站在我們的文化跟民眾的需求所衍生出來的因為你如果叫他不要去住安寧病房這個就是一個很大的關卡但是他在\n\n32\n00:11:18,815 --> 00:11:44,119\n其實安寧反流醫療最好是越早啟動越好所以也許他已經在做反核性的化療那個時代那個時候就應該有加入安寧反流醫療團隊來跟你的病房跟你介紹什麼叫安寧有時候你跟這個A病床的人說結果是B病床的人聽一聽說那我要去安寧病房所以那個越早啟動的時候讓真的\n\n33\n00:11:45,216 --> 00:11:57,551\n病人可以規劃未來可以做的事情所以安寧的構造是非常重要的那安寧構造的團隊其實也花了非常大的心力他的效果當然是沒辦法像安寧病房這樣子整個團隊來給他\n\n34\n00:12:05,020 --> 00:12:25,747\n各方面全方位的一個照顧所以當然怎麼樣讓需要安寧病房的人能夠住進來當然這邊也要跟委員實際上報告雖然這麼多床但是很多醫院的安寧病床因為文化的問題他們可能還是希望病人還是希望跟家屬還是希望共照他們\n\n35\n00:12:26,747 --> 00:12:48,813\n不太願意到安寧病房來的所以我們的你去分析各個醫院的占床率就知道其實更重要的更重要的是要去推展民眾的觀念這樣子是可是基於病人自主醫療的權利保障跟善終的期望那又你整個安寧病房的量又不足\n\n36\n00:12:49,253 --> 00:13:11,770\n使用率低的狀況這種現實問題我相信衛福部有義務也有能力要把整個政策建構更完整所以病人運營安寧緩和醫療書跟預訂醫療決定書這一整套的制度連結分級醫療體系的醫院跟社區兩端所以社區單這邊也可以看到有在宅\n\n37\n00:13:12,891 --> 00:13:23,654\n在宅安寧跟我們的機構安寧這兩種在宅的醫療形式讓病人除了住院以外另外在社區中老那你的政策經費是111年的居家醫療的照護整合計畫的2.0113年是全民健康保險在宅急症照護的事辦計畫這兩個\n\n38\n00:13:36,218 --> 00:13:59,982\n計畫在支撐所以想問的是在不論長照老人還是護理之家在住宿型機構籌組照護團隊的服務機構內的病人對於機構品質的提升一定有比較正面的影響對機構病人分級醫療各方面都有一些注意本來就是應該要大力推動的政策可是政府一直在考一直沒有把一個人考慮進來就是沒有考慮住宿機構來籌組照護團隊的經營的壓力這像\n\n39\n00:14:05,463 --> 00:14:34,262\n服務對醫院來講就是賠錢在座了那對住宿型機構來講更是那醫生探視費呢健保支付如果給醫院1500為什麼給住宿型機構只有1200這有20%的落差是打擊士氣所以本期認為醫院跟住宿型機構各項的醫事人員的訪視費要一致啊請你推動這項訴求那你同意嗎就是大家應該都是一致的\n\n40\n00:14:40,043 --> 00:14:57,120\n這個我們已經通過下半年會來做這個安寧照護品質的平和平和之後按照它的程度分別加成10%20%跟30%那這個包含了住院的安寧安寧共照跟居家安寧都適用\n\n41\n00:14:57,560 --> 00:15:25,167\n那另一方面我們下半年也會來檢討居家安寧的給付方式到底是要包月我們現在是論次那有沒有用包月的方式讓他更具彈性都會來檢討那至於在給付方面也一定朝向不同工不同酬的方式來思考所以下半年會開始去做規劃因為病人在住宿型機構發生醫療糾紛的時候勢必會大幅增加所以機構背後一定要有強大的支持系統也就是綠色通道所以\n\n42\n00:15:26,387 --> 00:15:46,657\n綠色通道除了提供緊急救援助援支援以外那人力技術也都是重要的一環所以衛福部是不是能夠確保機構具備有這項強大的後勤支援我想這是很重要要去努力的方向我們會一定來努力\n\n43\n00:15:47,409 --> 00:16:05,331\n所以最後麻煩我覺得我有三點訴求就是整個醫事的那個人員的支持方案面對病人的質疑跟訴訟我覺得還是要提供一些支持擴大育育醫療照護的諮商的全額補助對象今天應該也\n\n44\n00:16:06,232 --> 00:16:31,515\n得到你們的65歲以上都是提高我們住宿型機構的人士園的紡織費所以是不是下半年如果在討論的時候可能要考慮一下我剛剛講的是不是答案是同樣的綠色通道的糾紛避免依舊的部分要為住宿型機構提供後勤的支持那麻煩這些是不是在後面提供兩週內提供給我書面報告好謝謝\n\n","tsv":"start\tend\ttext\n9213\t20018\t主席麻煩邱部長請部長部長早部長你事實上是台灣安寧醫\n21945\t35083\t療護的專家那安寧緩和條例跟我們的自主權利法這兩部法律對末期跟或不可逆的喪失神志的病人透過病人跟家屬\n36664\t58675\t他的意願代理人來預你安寧緩和醫療書或預定那個醫療決定書要求醫生在往後的治療裡不要用人工營養跟流體餵養急救或者是維生醫療來做只是做一個維持心跳的無效的醫療但是安寧緩和和醫療\n61405\t80070\t就非常挑戰我們的社會文化所以在法律要保護醫生避免受到家屬的攻擊而受到傷害而且要積極來促進以縮短病人的痛苦減少我們的醫療資源的浪費所以想問部長程序上病人自主並不是只要我喜歡有什麼不可以\n80570\t104393\t必須是考量到病人本身跟醫護人員跟照顧者跟家庭成員跟重要他人的想法是多方協調後的結果可是還是會發生病人的決定家屬事實上是他不認同而跟醫生發生爭執的事件尤其是在安寧療護發生率更高所以衛福部如何支持醫生貫徹病人的決定做醫療\n105609\t121715\t好,謝謝委員關心這麼重要的議題,也關心到生死大事以及善終是國人五福利門裡面最難達到的所以我們全國就像自治前法案,當時也是很辛苦\n123126\t137066\t蘇委員在這裡,我想這兩位召委都有貢獻那當時都是希望達到這樣的一個目標那這中間的確是有這個人面對生命的默契\n138147\t156220\t死亡就好像一個很強烈的陽光 你無法去正視他家屬也沒辦法正視他但是我們醫療人員 我們政府必須要幫他去正視他讓他能夠好好的過完末期 以及能夠善終所以我覺得政府跟相關的立法院 願意來討論這個題目個人站出來自我敬佩啦\n162885\t185046\t法院依據合法的程序來確保醫生不受醫療過失的判決可是還是無法避免憤怒的家屬對醫師提告所以醫生一旦被告就是要花錢去請律師花錢去開庭對此衛福部能夠給醫生什麼樣的具體的支持這個跟委員報告一下這也是二三十年來\n187408\t215384\t的一個大事情那在這的所有的委員尤其是蘇委員擔任那個立法 擔任那個醫師公會理事長的時候有時候這有時候兩派意見牽扯但是我們終是把醫療法修法變成那個醫療的一個合理行者合理化那這個就是說以前可能會面對防疫性的醫療但是因為這個 只要你好好的救病人\n217231\t240780\t幾乎除了你有重大過失或錯誤不然是不會用行者加身所以那個時候就內外婦保科的住院醫師又通過了又上升了這樣子所以我們用各種法律然後再教育同時也讓民眾知道醫生是在幫你救你的命可能有兩成的救命機會\n242040\t267977\t你說你要不要救病人家屬一定說一定要救啊可是八成是可能會他的疾病就是救不起來那就有八成的機會來告醫師啊那我說衛福部到底有沒有什麼具體的醫療行者合理化就是來保護這個啊就是這個已經做了很多的一個第一個這是第一個很重要的法案另外一個法案在前幾年通過的就是事故的一個\n272687\t296792\t預防還有更調節就是要先調節讓醫師不要承受那麼大的壓力讓醫病能夠更和諧它是一個很光明的法案這兩個法案基本上是讓我們醫病在面對救命的時候能夠更和諧還是可以保障到醫生的權利嗎我問你第二個就是簽署人的資格民法第一\n298033\t322152\t14條的第一項規定自然人如果精神障礙或心智缺陷的話不能跟他人溝通或不了解表達意思的話法院得為監護宣告可113年受監護宣告的人總數事實上是6047人其中18歲以上的有5999人其中以社會福利機構為監護人的有10件所以監護人有執行受監護的生活醫療照護跟財產管理的職務請問一下當\n326295\t335813\t成年的病患本身意識不清楚的時候經法院為監護宣告的監護人依法可以為病患簽署安寧\n341574\t357040\t我要講的是說安寧這邊的話其實他要啟動的這邊其實必須要經由就是說至少前面要有兩個專科醫師確認他默契他這一個所謂的安寧意願書由那個監護人簽署才會有效\n357620\t375802\t然後可是在那個病人自主這邊的話他還是會回到了一個病人自主的一個前提在病人沒有表達意願就是他在意識狀況沒有沒有這麼重大改變之前沒有表示過任何意願的時候這個監護人其實他沒有辦法決定以上\n376647\t378448\t那根據我們的健保署的分析在死亡前一個月內接受安寧療護的話\n392137\t410207\t每個人可以減少到三萬兩千元的醫療支出如果去死亡前六個月接受安寧照護的話每個人可以減少到十萬七千元的醫療支出那育立醫療決定書也可以達到這樣的效果那育立醫療照護諮商一個案子\n411536\t434764\t民眾要自費三千元就是要自己花三千元對多數人來講事實上是貴的所以去年七月我覺得衛福部也推出了一個育立醫療照護諮商推廣的獎勵計畫針對低收跟中低收的特定對象來提供免費的諮商服務可是看起來數據推了一年大概從兩萬四增加到兩萬五\n436567\t460559\t沒有很顯著的提升啦所以想問一下花三千元可以省下大筆的醫療費用衛健保的財務永續衛福部一定會往這個方向推動可是去年推動的不利的原因是什麼因為增加不多好當然我們做調查包委員當然我們做調查的時候的確為什麼不簽民眾寫出來的原因當然就是說因為職場費用是蠻高的\n465701\t487348\t我記得剛開始推出來的時候我們立法院好幾個委員都跑去台大醫院真的去做諮商那個我很敬佩他們就花幾千塊去做但是其實對一般的民眾來講的確是很負擔所以我們去年七月還有五月一號會擴大來讓更多的希望\n488248\t510745\t有更多的機會來讓病人來簽那當然怎麼樣我們要去了解原因那衛生署也一直在請協界這邊了解原因是 那部長你如果講說今天新聞報導也說5月7號要擴大啦所以你今年的預例醫療註記的人身要提升你目標是多少\n513772\t521868\t今年你的預歷醫療助計的人數也要提升嘛齁你目標是多少希望\n523685\t540840\t我補充一下這個吼我們會希望是說現在大概一年兩萬左右能夠透過今年因為才只有半年的執行期所以能夠就是加倍到四萬左右是我們的目標然後那剛剛那個委員槌尋的是說推廣這一塊的話其實我們發現是說民眾的認知跟我們傳統習\n546805\t572399\t習俗文化的這個禁錮其實還是一個主因另外一塊就是財務所以才會是從財務面的地方我們跟健保署合作推廣面的部分的話我們會跟長照室合作因為目前看到願意簽署的都是人生經驗裡面有一些相關的所以目前大概是50歲以上是我們的一個target以上謝謝市長安寧療護的概念早在\n573154\t595183\t立法前台灣大概就已經開始在推動大概現在已經20年了而且使用率逐年增加那從2022年使用的大概達到6萬7病人死亡前的一年的安寧利用率的話大概30.4%那可是還是上市量能不足那所以整個\n596283\t613622\t他事實上是透過多種專業來對病人跟家屬做整體的輔導那他同時也是生理心理的一個醫療可是這個項目真的蠻燒錢的所以對醫院來說如果不是為了評鑑加分的話誘因不大所以\n614042\t638687\t因此安寧病床的床位不多而採用安寧共照來替代所以112年全國有86家醫院共計915床到114年的時候變成是85家醫院大概910床整個需求多床位少可是四病每一天大家都有人在排隊所以想問一下目前實際上的安寧病床到底病床數有多少\n640087\t662047\t是的 薛委員 剛剛您報的就是現在的就是910嗎 整個不多 所以就會有跨科的做安寧供照所以目前安寧供照對病人 特別是家屬的照護能夠達到安寧病房的水準嗎 衛福部怎麼去確保這個水準因為不一樣啊\n662788\t677835\t我想安寧共照是一個有一點點不得不的站在我們的文化跟民眾的需求所衍生出來的因為你如果叫他不要去住安寧病房這個就是一個很大的關卡但是他在\n678815\t704119\t其實安寧反流醫療最好是越早啟動越好所以也許他已經在做反核性的化療那個時代那個時候就應該有加入安寧反流醫療團隊來跟你的病房跟你介紹什麼叫安寧有時候你跟這個A病床的人說結果是B病床的人聽一聽說那我要去安寧病房所以那個越早啟動的時候讓真的\n705216\t717551\t病人可以規劃未來可以做的事情所以安寧的構造是非常重要的那安寧構造的團隊其實也花了非常大的心力他的效果當然是沒辦法像安寧病房這樣子整個團隊來給他\n725020\t745747\t各方面全方位的一個照顧所以當然怎麼樣讓需要安寧病房的人能夠住進來當然這邊也要跟委員實際上報告雖然這麼多床但是很多醫院的安寧病床因為文化的問題他們可能還是希望病人還是希望跟家屬還是希望共照他們\n746747\t768813\t不太願意到安寧病房來的所以我們的你去分析各個醫院的占床率就知道其實更重要的更重要的是要去推展民眾的觀念這樣子是可是基於病人自主醫療的權利保障跟善終的期望那又你整個安寧病房的量又不足\n769253\t791770\t使用率低的狀況這種現實問題我相信衛福部有義務也有能力要把整個政策建構更完整所以病人運營安寧緩和醫療書跟預訂醫療決定書這一整套的制度連結分級醫療體系的醫院跟社區兩端所以社區單這邊也可以看到有在宅\n792891\t803654\t在宅安寧跟我們的機構安寧這兩種在宅的醫療形式讓病人除了住院以外另外在社區中老那你的政策經費是111年的居家醫療的照護整合計畫的2.0113年是全民健康保險在宅急症照護的事辦計畫這兩個\n816218\t839982\t計畫在支撐所以想問的是在不論長照老人還是護理之家在住宿型機構籌組照護團隊的服務機構內的病人對於機構品質的提升一定有比較正面的影響對機構病人分級醫療各方面都有一些注意本來就是應該要大力推動的政策可是政府一直在考一直沒有把一個人考慮進來就是沒有考慮住宿機構來籌組照護團隊的經營的壓力這像\n845463\t874262\t服務對醫院來講就是賠錢在座了那對住宿型機構來講更是那醫生探視費呢健保支付如果給醫院1500為什麼給住宿型機構只有1200這有20%的落差是打擊士氣所以本期認為醫院跟住宿型機構各項的醫事人員的訪視費要一致啊請你推動這項訴求那你同意嗎就是大家應該都是一致的\n880043\t897120\t這個我們已經通過下半年會來做這個安寧照護品質的平和 平和之後按照它的程度分別加成10% 20%跟30%那這個包含了住院的安寧 安寧共照跟居家安寧都適用\n897560\t925167\t那另一方面我們下半年也會來檢討居家安寧的給付方式到底是要包月我們現在是論次那有沒有用包月的方式讓他更具彈性都會來檢討那至於在給付方面也一定朝向不同工不同酬的方式來思考所以下半年會開始去做規劃因為病人在住宿型機構發生醫療糾紛的時候勢必會大幅增加所以機構背後一定要有強大的支持系統也就是綠色通道所以\n926387\t946657\t綠色通道除了提供緊急救援助援支援以外那人力技術也都是重要的一環所以衛福部是不是能夠確保機構具備有這項強大的後勤支援我想這是很重要要去努力的方向我們會一定來努力\n947409\t965331\t所以最後麻煩我覺得我有三點訴求就是整個醫事的那個人員的支持方案面對病人的質疑跟訴訟我覺得還是要提供一些支持擴大育育醫療照護的諮商的全額補助對象今天應該也\n966232\t991515\t得到你們的65歲以上都是提高我們住宿型機構的人士園的紡織費所以是不是下半年如果在討論的時候可能要考慮一下我剛剛講的是不是答案是同樣的綠色通道的糾紛 避免依舊的部分要為住宿型機構提供後勤的支持那麻煩這些是不是在後面提供 兩週內提供給我書面報告好 謝謝\n","txt":"主席麻煩邱部長請部長部長早部長你事實上是台灣安寧醫\n療護的專家那安寧緩和條例跟我們的自主權利法這兩部法律對末期跟或不可逆的喪失神志的病人透過病人跟家屬\n他的意願代理人來預你安寧緩和醫療書或預定那個醫療決定書要求醫生在往後的治療裡不要用人工營養跟流體餵養急救或者是維生醫療來做只是做一個維持心跳的無效的醫療但是安寧緩和和醫療\n就非常挑戰我們的社會文化所以在法律要保護醫生避免受到家屬的攻擊而受到傷害而且要積極來促進以縮短病人的痛苦減少我們的醫療資源的浪費所以想問部長程序上病人自主並不是只要我喜歡有什麼不可以\n必須是考量到病人本身跟醫護人員跟照顧者跟家庭成員跟重要他人的想法是多方協調後的結果可是還是會發生病人的決定家屬事實上是他不認同而跟醫生發生爭執的事件尤其是在安寧療護發生率更高所以衛福部如何支持醫生貫徹病人的決定做醫療\n好,謝謝委員關心這麼重要的議題,也關心到生死大事以及善終是國人五福利門裡面最難達到的所以我們全國就像自治前法案,當時也是很辛苦\n蘇委員在這裡,我想這兩位召委都有貢獻那當時都是希望達到這樣的一個目標那這中間的確是有這個人面對生命的默契\n死亡就好像一個很強烈的陽光 你無法去正視他家屬也沒辦法正視他但是我們醫療人員 我們政府必須要幫他去正視他讓他能夠好好的過完末期 以及能夠善終所以我覺得政府跟相關的立法院 願意來討論這個題目個人站出來自我敬佩啦\n法院依據合法的程序來確保醫生不受醫療過失的判決可是還是無法避免憤怒的家屬對醫師提告所以醫生一旦被告就是要花錢去請律師花錢去開庭對此衛福部能夠給醫生什麼樣的具體的支持這個跟委員報告一下這也是二三十年來\n的一個大事情那在這的所有的委員尤其是蘇委員擔任那個立法 擔任那個醫師公會理事長的時候有時候這有時候兩派意見牽扯但是我們終是把醫療法修法變成那個醫療的一個合理行者合理化那這個就是說以前可能會面對防疫性的醫療但是因為這個 只要你好好的救病人\n幾乎除了你有重大過失或錯誤不然是不會用行者加身所以那個時候就內外婦保科的住院醫師又通過了又上升了這樣子所以我們用各種法律然後再教育同時也讓民眾知道醫生是在幫你救你的命可能有兩成的救命機會\n你說你要不要救病人家屬一定說一定要救啊可是八成是可能會他的疾病就是救不起來那就有八成的機會來告醫師啊那我說衛福部到底有沒有什麼具體的醫療行者合理化就是來保護這個啊就是這個已經做了很多的一個第一個這是第一個很重要的法案另外一個法案在前幾年通過的就是事故的一個\n預防還有更調節就是要先調節讓醫師不要承受那麼大的壓力讓醫病能夠更和諧它是一個很光明的法案這兩個法案基本上是讓我們醫病在面對救命的時候能夠更和諧還是可以保障到醫生的權利嗎我問你第二個就是簽署人的資格民法第一\n14條的第一項規定自然人如果精神障礙或心智缺陷的話不能跟他人溝通或不了解表達意思的話法院得為監護宣告可113年受監護宣告的人總數事實上是6047人其中18歲以上的有5999人其中以社會福利機構為監護人的有10件所以監護人有執行受監護的生活醫療照護跟財產管理的職務請問一下當\n成年的病患本身意識不清楚的時候經法院為監護宣告的監護人依法可以為病患簽署安寧\n我要講的是說安寧這邊的話其實他要啟動的這邊其實必須要經由就是說至少前面要有兩個專科醫師確認他默契他這一個所謂的安寧意願書由那個監護人簽署才會有效\n然後可是在那個病人自主這邊的話他還是會回到了一個病人自主的一個前提在病人沒有表達意願就是他在意識狀況沒有沒有這麼重大改變之前沒有表示過任何意願的時候這個監護人其實他沒有辦法決定以上\n那根據我們的健保署的分析在死亡前一個月內接受安寧療護的話\n每個人可以減少到三萬兩千元的醫療支出如果去死亡前六個月接受安寧照護的話每個人可以減少到十萬七千元的醫療支出那育立醫療決定書也可以達到這樣的效果那育立醫療照護諮商一個案子\n民眾要自費三千元就是要自己花三千元對多數人來講事實上是貴的所以去年七月我覺得衛福部也推出了一個育立醫療照護諮商推廣的獎勵計畫針對低收跟中低收的特定對象來提供免費的諮商服務可是看起來數據推了一年大概從兩萬四增加到兩萬五\n沒有很顯著的提升啦所以想問一下花三千元可以省下大筆的醫療費用衛健保的財務永續衛福部一定會往這個方向推動可是去年推動的不利的原因是什麼因為增加不多好當然我們做調查包委員當然我們做調查的時候的確為什麼不簽民眾寫出來的原因當然就是說因為職場費用是蠻高的\n我記得剛開始推出來的時候我們立法院好幾個委員都跑去台大醫院真的去做諮商那個我很敬佩他們就花幾千塊去做但是其實對一般的民眾來講的確是很負擔所以我們去年七月還有五月一號會擴大來讓更多的希望\n有更多的機會來讓病人來簽那當然怎麼樣我們要去了解原因那衛生署也一直在請協界這邊了解原因是 那部長你如果講說今天新聞報導也說5月7號要擴大啦所以你今年的預例醫療註記的人身要提升你目標是多少\n今年你的預歷醫療助計的人數也要提升嘛齁你目標是多少希望\n我補充一下這個吼我們會希望是說現在大概一年兩萬左右能夠透過今年因為才只有半年的執行期所以能夠就是加倍到四萬左右是我們的目標然後那剛剛那個委員槌尋的是說推廣這一塊的話其實我們發現是說民眾的認知跟我們傳統習\n習俗文化的這個禁錮其實還是一個主因另外一塊就是財務所以才會是從財務面的地方我們跟健保署合作推廣面的部分的話我們會跟長照室合作因為目前看到願意簽署的都是人生經驗裡面有一些相關的所以目前大概是50歲以上是我們的一個target以上謝謝市長安寧療護的概念早在\n立法前台灣大概就已經開始在推動大概現在已經20年了而且使用率逐年增加那從2022年使用的大概達到6萬7病人死亡前的一年的安寧利用率的話大概30.4%那可是還是上市量能不足那所以整個\n他事實上是透過多種專業來對病人跟家屬做整體的輔導那他同時也是生理心理的一個醫療可是這個項目真的蠻燒錢的所以對醫院來說如果不是為了評鑑加分的話誘因不大所以\n因此安寧病床的床位不多而採用安寧共照來替代所以112年全國有86家醫院共計915床到114年的時候變成是85家醫院大概910床整個需求多床位少可是四病每一天大家都有人在排隊所以想問一下目前實際上的安寧病床到底病床數有多少\n是的 薛委員 剛剛您報的就是現在的就是910嗎 整個不多 所以就會有跨科的做安寧供照所以目前安寧供照對病人 特別是家屬的照護能夠達到安寧病房的水準嗎 衛福部怎麼去確保這個水準因為不一樣啊\n我想安寧共照是一個有一點點不得不的站在我們的文化跟民眾的需求所衍生出來的因為你如果叫他不要去住安寧病房這個就是一個很大的關卡但是他在\n其實安寧反流醫療最好是越早啟動越好所以也許他已經在做反核性的化療那個時代那個時候就應該有加入安寧反流醫療團隊來跟你的病房跟你介紹什麼叫安寧有時候你跟這個A病床的人說結果是B病床的人聽一聽說那我要去安寧病房所以那個越早啟動的時候讓真的\n病人可以規劃未來可以做的事情所以安寧的構造是非常重要的那安寧構造的團隊其實也花了非常大的心力他的效果當然是沒辦法像安寧病房這樣子整個團隊來給他\n各方面全方位的一個照顧所以當然怎麼樣讓需要安寧病房的人能夠住進來當然這邊也要跟委員實際上報告雖然這麼多床但是很多醫院的安寧病床因為文化的問題他們可能還是希望病人還是希望跟家屬還是希望共照他們\n不太願意到安寧病房來的所以我們的你去分析各個醫院的占床率就知道其實更重要的更重要的是要去推展民眾的觀念這樣子是可是基於病人自主醫療的權利保障跟善終的期望那又你整個安寧病房的量又不足\n使用率低的狀況這種現實問題我相信衛福部有義務也有能力要把整個政策建構更完整所以病人運營安寧緩和醫療書跟預訂醫療決定書這一整套的制度連結分級醫療體系的醫院跟社區兩端所以社區單這邊也可以看到有在宅\n在宅安寧跟我們的機構安寧這兩種在宅的醫療形式讓病人除了住院以外另外在社區中老那你的政策經費是111年的居家醫療的照護整合計畫的2.0113年是全民健康保險在宅急症照護的事辦計畫這兩個\n計畫在支撐所以想問的是在不論長照老人還是護理之家在住宿型機構籌組照護團隊的服務機構內的病人對於機構品質的提升一定有比較正面的影響對機構病人分級醫療各方面都有一些注意本來就是應該要大力推動的政策可是政府一直在考一直沒有把一個人考慮進來就是沒有考慮住宿機構來籌組照護團隊的經營的壓力這像\n服務對醫院來講就是賠錢在座了那對住宿型機構來講更是那醫生探視費呢健保支付如果給醫院1500為什麼給住宿型機構只有1200這有20%的落差是打擊士氣所以本期認為醫院跟住宿型機構各項的醫事人員的訪視費要一致啊請你推動這項訴求那你同意嗎就是大家應該都是一致的\n這個我們已經通過下半年會來做這個安寧照護品質的平和 平和之後按照它的程度分別加成10% 20%跟30%那這個包含了住院的安寧 安寧共照跟居家安寧都適用\n那另一方面我們下半年也會來檢討居家安寧的給付方式到底是要包月我們現在是論次那有沒有用包月的方式讓他更具彈性都會來檢討那至於在給付方面也一定朝向不同工不同酬的方式來思考所以下半年會開始去做規劃因為病人在住宿型機構發生醫療糾紛的時候勢必會大幅增加所以機構背後一定要有強大的支持系統也就是綠色通道所以\n綠色通道除了提供緊急救援助援支援以外那人力技術也都是重要的一環所以衛福部是不是能夠確保機構具備有這項強大的後勤支援我想這是很重要要去努力的方向我們會一定來努力\n所以最後麻煩我覺得我有三點訴求就是整個醫事的那個人員的支持方案面對病人的質疑跟訴訟我覺得還是要提供一些支持擴大育育醫療照護的諮商的全額補助對象今天應該也\n得到你們的65歲以上都是提高我們住宿型機構的人士園的紡織費所以是不是下半年如果在討論的時候可能要考慮一下我剛剛講的是不是答案是同樣的綠色通道的糾紛 避免依舊的部分要為住宿型機構提供後勤的支持那麻煩這些是不是在後面提供 兩週內提供給我書面報告好 謝謝\n","vtt":"WEBVTT\n\n00:09.213 --> 00:20.018\n主席麻煩邱部長請部長部長早部長你事實上是台灣安寧醫\n\n00:21.945 --> 00:35.083\n療護的專家那安寧緩和條例跟我們的自主權利法這兩部法律對末期跟或不可逆的喪失神志的病人透過病人跟家屬\n\n00:36.664 --> 00:58.675\n他的意願代理人來預你安寧緩和醫療書或預定那個醫療決定書要求醫生在往後的治療裡不要用人工營養跟流體餵養急救或者是維生醫療來做只是做一個維持心跳的無效的醫療但是安寧緩和和醫療\n\n01:01.405 --> 01:20.070\n就非常挑戰我們的社會文化所以在法律要保護醫生避免受到家屬的攻擊而受到傷害而且要積極來促進以縮短病人的痛苦減少我們的醫療資源的浪費所以想問部長程序上病人自主並不是只要我喜歡有什麼不可以\n\n01:20.570 --> 01:44.393\n必須是考量到病人本身跟醫護人員跟照顧者跟家庭成員跟重要他人的想法是多方協調後的結果可是還是會發生病人的決定家屬事實上是他不認同而跟醫生發生爭執的事件尤其是在安寧療護發生率更高所以衛福部如何支持醫生貫徹病人的決定做醫療\n\n01:45.609 --> 02:01.715\n好,謝謝委員關心這麼重要的議題,也關心到生死大事以及善終是國人五福利門裡面最難達到的所以我們全國就像自治前法案,當時也是很辛苦\n\n02:03.126 --> 02:17.066\n蘇委員在這裡,我想這兩位召委都有貢獻那當時都是希望達到這樣的一個目標那這中間的確是有這個人面對生命的默契\n\n02:18.147 --> 02:36.220\n死亡就好像一個很強烈的陽光你無法去正視他家屬也沒辦法正視他但是我們醫療人員我們政府必須要幫他去正視他讓他能夠好好的過完末期以及能夠善終所以我覺得政府跟相關的立法院願意來討論這個題目個人站出來自我敬佩啦\n\n02:42.885 --> 03:05.046\n法院依據合法的程序來確保醫生不受醫療過失的判決可是還是無法避免憤怒的家屬對醫師提告所以醫生一旦被告就是要花錢去請律師花錢去開庭對此衛福部能夠給醫生什麼樣的具體的支持這個跟委員報告一下這也是二三十年來\n\n03:07.408 --> 03:35.384\n的一個大事情那在這的所有的委員尤其是蘇委員擔任那個立法擔任那個醫師公會理事長的時候有時候這有時候兩派意見牽扯但是我們終是把醫療法修法變成那個醫療的一個合理行者合理化那這個就是說以前可能會面對防疫性的醫療但是因為這個只要你好好的救病人\n\n03:37.231 --> 04:00.780\n幾乎除了你有重大過失或錯誤不然是不會用行者加身所以那個時候就內外婦保科的住院醫師又通過了又上升了這樣子所以我們用各種法律然後再教育同時也讓民眾知道醫生是在幫你救你的命可能有兩成的救命機會\n\n04:02.040 --> 04:27.977\n你說你要不要救病人家屬一定說一定要救啊可是八成是可能會他的疾病就是救不起來那就有八成的機會來告醫師啊那我說衛福部到底有沒有什麼具體的醫療行者合理化就是來保護這個啊就是這個已經做了很多的一個第一個這是第一個很重要的法案另外一個法案在前幾年通過的就是事故的一個\n\n04:32.687 --> 04:56.792\n預防還有更調節就是要先調節讓醫師不要承受那麼大的壓力讓醫病能夠更和諧它是一個很光明的法案這兩個法案基本上是讓我們醫病在面對救命的時候能夠更和諧還是可以保障到醫生的權利嗎我問你第二個就是簽署人的資格民法第一\n\n04:58.033 --> 05:22.152\n14條的第一項規定自然人如果精神障礙或心智缺陷的話不能跟他人溝通或不了解表達意思的話法院得為監護宣告可113年受監護宣告的人總數事實上是6047人其中18歲以上的有5999人其中以社會福利機構為監護人的有10件所以監護人有執行受監護的生活醫療照護跟財產管理的職務請問一下當\n\n05:26.295 --> 05:35.813\n成年的病患本身意識不清楚的時候經法院為監護宣告的監護人依法可以為病患簽署安寧\n\n05:41.574 --> 05:57.040\n我要講的是說安寧這邊的話其實他要啟動的這邊其實必須要經由就是說至少前面要有兩個專科醫師確認他默契他這一個所謂的安寧意願書由那個監護人簽署才會有效\n\n05:57.620 --> 06:15.802\n然後可是在那個病人自主這邊的話他還是會回到了一個病人自主的一個前提在病人沒有表達意願就是他在意識狀況沒有沒有這麼重大改變之前沒有表示過任何意願的時候這個監護人其實他沒有辦法決定以上\n\n06:16.647 --> 06:18.448\n那根據我們的健保署的分析在死亡前一個月內接受安寧療護的話\n\n06:32.137 --> 06:50.207\n每個人可以減少到三萬兩千元的醫療支出如果去死亡前六個月接受安寧照護的話每個人可以減少到十萬七千元的醫療支出那育立醫療決定書也可以達到這樣的效果那育立醫療照護諮商一個案子\n\n06:51.536 --> 07:14.764\n民眾要自費三千元就是要自己花三千元對多數人來講事實上是貴的所以去年七月我覺得衛福部也推出了一個育立醫療照護諮商推廣的獎勵計畫針對低收跟中低收的特定對象來提供免費的諮商服務可是看起來數據推了一年大概從兩萬四增加到兩萬五\n\n07:16.567 --> 07:40.559\n沒有很顯著的提升啦所以想問一下花三千元可以省下大筆的醫療費用衛健保的財務永續衛福部一定會往這個方向推動可是去年推動的不利的原因是什麼因為增加不多好當然我們做調查包委員當然我們做調查的時候的確為什麼不簽民眾寫出來的原因當然就是說因為職場費用是蠻高的\n\n07:45.701 --> 08:07.348\n我記得剛開始推出來的時候我們立法院好幾個委員都跑去台大醫院真的去做諮商那個我很敬佩他們就花幾千塊去做但是其實對一般的民眾來講的確是很負擔所以我們去年七月還有五月一號會擴大來讓更多的希望\n\n08:08.248 --> 08:30.745\n有更多的機會來讓病人來簽那當然怎麼樣我們要去了解原因那衛生署也一直在請協界這邊了解原因是那部長你如果講說今天新聞報導也說5月7號要擴大啦所以你今年的預例醫療註記的人身要提升你目標是多少\n\n08:33.772 --> 08:41.868\n今年你的預歷醫療助計的人數也要提升嘛齁你目標是多少希望\n\n08:43.685 --> 09:00.840\n我補充一下這個吼我們會希望是說現在大概一年兩萬左右能夠透過今年因為才只有半年的執行期所以能夠就是加倍到四萬左右是我們的目標然後那剛剛那個委員槌尋的是說推廣這一塊的話其實我們發現是說民眾的認知跟我們傳統習\n\n09:06.805 --> 09:32.399\n習俗文化的這個禁錮其實還是一個主因另外一塊就是財務所以才會是從財務面的地方我們跟健保署合作推廣面的部分的話我們會跟長照室合作因為目前看到願意簽署的都是人生經驗裡面有一些相關的所以目前大概是50歲以上是我們的一個target以上謝謝市長安寧療護的概念早在\n\n09:33.154 --> 09:55.183\n立法前台灣大概就已經開始在推動大概現在已經20年了而且使用率逐年增加那從2022年使用的大概達到6萬7病人死亡前的一年的安寧利用率的話大概30.4%那可是還是上市量能不足那所以整個\n\n09:56.283 --> 10:13.622\n他事實上是透過多種專業來對病人跟家屬做整體的輔導那他同時也是生理心理的一個醫療可是這個項目真的蠻燒錢的所以對醫院來說如果不是為了評鑑加分的話誘因不大所以\n\n10:14.042 --> 10:38.687\n因此安寧病床的床位不多而採用安寧共照來替代所以112年全國有86家醫院共計915床到114年的時候變成是85家醫院大概910床整個需求多床位少可是四病每一天大家都有人在排隊所以想問一下目前實際上的安寧病床到底病床數有多少\n\n10:40.087 --> 11:02.047\n是的薛委員剛剛您報的就是現在的就是910嗎整個不多所以就會有跨科的做安寧供照所以目前安寧供照對病人特別是家屬的照護能夠達到安寧病房的水準嗎衛福部怎麼去確保這個水準因為不一樣啊\n\n11:02.788 --> 11:17.835\n我想安寧共照是一個有一點點不得不的站在我們的文化跟民眾的需求所衍生出來的因為你如果叫他不要去住安寧病房這個就是一個很大的關卡但是他在\n\n11:18.815 --> 11:44.119\n其實安寧反流醫療最好是越早啟動越好所以也許他已經在做反核性的化療那個時代那個時候就應該有加入安寧反流醫療團隊來跟你的病房跟你介紹什麼叫安寧有時候你跟這個A病床的人說結果是B病床的人聽一聽說那我要去安寧病房所以那個越早啟動的時候讓真的\n\n11:45.216 --> 11:57.551\n病人可以規劃未來可以做的事情所以安寧的構造是非常重要的那安寧構造的團隊其實也花了非常大的心力他的效果當然是沒辦法像安寧病房這樣子整個團隊來給他\n\n12:05.020 --> 12:25.747\n各方面全方位的一個照顧所以當然怎麼樣讓需要安寧病房的人能夠住進來當然這邊也要跟委員實際上報告雖然這麼多床但是很多醫院的安寧病床因為文化的問題他們可能還是希望病人還是希望跟家屬還是希望共照他們\n\n12:26.747 --> 12:48.813\n不太願意到安寧病房來的所以我們的你去分析各個醫院的占床率就知道其實更重要的更重要的是要去推展民眾的觀念這樣子是可是基於病人自主醫療的權利保障跟善終的期望那又你整個安寧病房的量又不足\n\n12:49.253 --> 13:11.770\n使用率低的狀況這種現實問題我相信衛福部有義務也有能力要把整個政策建構更完整所以病人運營安寧緩和醫療書跟預訂醫療決定書這一整套的制度連結分級醫療體系的醫院跟社區兩端所以社區單這邊也可以看到有在宅\n\n13:12.891 --> 13:23.654\n在宅安寧跟我們的機構安寧這兩種在宅的醫療形式讓病人除了住院以外另外在社區中老那你的政策經費是111年的居家醫療的照護整合計畫的2.0113年是全民健康保險在宅急症照護的事辦計畫這兩個\n\n13:36.218 --> 13:59.982\n計畫在支撐所以想問的是在不論長照老人還是護理之家在住宿型機構籌組照護團隊的服務機構內的病人對於機構品質的提升一定有比較正面的影響對機構病人分級醫療各方面都有一些注意本來就是應該要大力推動的政策可是政府一直在考一直沒有把一個人考慮進來就是沒有考慮住宿機構來籌組照護團隊的經營的壓力這像\n\n14:05.463 --> 14:34.262\n服務對醫院來講就是賠錢在座了那對住宿型機構來講更是那醫生探視費呢健保支付如果給醫院1500為什麼給住宿型機構只有1200這有20%的落差是打擊士氣所以本期認為醫院跟住宿型機構各項的醫事人員的訪視費要一致啊請你推動這項訴求那你同意嗎就是大家應該都是一致的\n\n14:40.043 --> 14:57.120\n這個我們已經通過下半年會來做這個安寧照護品質的平和平和之後按照它的程度分別加成10%20%跟30%那這個包含了住院的安寧安寧共照跟居家安寧都適用\n\n14:57.560 --> 15:25.167\n那另一方面我們下半年也會來檢討居家安寧的給付方式到底是要包月我們現在是論次那有沒有用包月的方式讓他更具彈性都會來檢討那至於在給付方面也一定朝向不同工不同酬的方式來思考所以下半年會開始去做規劃因為病人在住宿型機構發生醫療糾紛的時候勢必會大幅增加所以機構背後一定要有強大的支持系統也就是綠色通道所以\n\n15:26.387 --> 15:46.657\n綠色通道除了提供緊急救援助援支援以外那人力技術也都是重要的一環所以衛福部是不是能夠確保機構具備有這項強大的後勤支援我想這是很重要要去努力的方向我們會一定來努力\n\n15:47.409 --> 16:05.331\n所以最後麻煩我覺得我有三點訴求就是整個醫事的那個人員的支持方案面對病人的質疑跟訴訟我覺得還是要提供一些支持擴大育育醫療照護的諮商的全額補助對象今天應該也\n\n16:06.232 --> 16:31.515\n得到你們的65歲以上都是提高我們住宿型機構的人士園的紡織費所以是不是下半年如果在討論的時候可能要考慮一下我剛剛講的是不是答案是同樣的綠色通道的糾紛避免依舊的部分要為住宿型機構提供後勤的支持那麻煩這些是不是在後面提供兩週內提供給我書面報告好謝謝\n\n","segments":[{"start":9.213,"end":20.018,"text":"主席麻煩邱部長請部長部長早部長你事實上是台灣安寧醫"},{"start":21.945,"end":35.083,"text":"療護的專家那安寧緩和條例跟我們的自主權利法這兩部法律對末期跟或不可逆的喪失神志的病人透過病人跟家屬"},{"start":36.664,"end":58.675,"text":"他的意願代理人來預你安寧緩和醫療書或預定那個醫療決定書要求醫生在往後的治療裡不要用人工營養跟流體餵養急救或者是維生醫療來做只是做一個維持心跳的無效的醫療但是安寧緩和和醫療"},{"start":61.405,"end":80.07,"text":"就非常挑戰我們的社會文化所以在法律要保護醫生避免受到家屬的攻擊而受到傷害而且要積極來促進以縮短病人的痛苦減少我們的醫療資源的浪費所以想問部長程序上病人自主並不是只要我喜歡有什麼不可以"},{"start":80.57,"end":104.393,"text":"必須是考量到病人本身跟醫護人員跟照顧者跟家庭成員跟重要他人的想法是多方協調後的結果可是還是會發生病人的決定家屬事實上是他不認同而跟醫生發生爭執的事件尤其是在安寧療護發生率更高所以衛福部如何支持醫生貫徹病人的決定做醫療"},{"start":105.609,"end":121.715,"text":"好,謝謝委員關心這麼重要的議題,也關心到生死大事以及善終是國人五福利門裡面最難達到的所以我們全國就像自治前法案,當時也是很辛苦"},{"start":123.126,"end":137.066,"text":"蘇委員在這裡,我想這兩位召委都有貢獻那當時都是希望達到這樣的一個目標那這中間的確是有這個人面對生命的默契"},{"start":138.147,"end":156.22,"text":"死亡就好像一個很強烈的陽光 你無法去正視他家屬也沒辦法正視他但是我們醫療人員 我們政府必須要幫他去正視他讓他能夠好好的過完末期 以及能夠善終所以我覺得政府跟相關的立法院 願意來討論這個題目個人站出來自我敬佩啦"},{"start":162.885,"end":185.046,"text":"法院依據合法的程序來確保醫生不受醫療過失的判決可是還是無法避免憤怒的家屬對醫師提告所以醫生一旦被告就是要花錢去請律師花錢去開庭對此衛福部能夠給醫生什麼樣的具體的支持這個跟委員報告一下這也是二三十年來"},{"start":187.408,"end":215.384,"text":"的一個大事情那在這的所有的委員尤其是蘇委員擔任那個立法 擔任那個醫師公會理事長的時候有時候這有時候兩派意見牽扯但是我們終是把醫療法修法變成那個醫療的一個合理行者合理化那這個就是說以前可能會面對防疫性的醫療但是因為這個 只要你好好的救病人"},{"start":217.231,"end":240.78,"text":"幾乎除了你有重大過失或錯誤不然是不會用行者加身所以那個時候就內外婦保科的住院醫師又通過了又上升了這樣子所以我們用各種法律然後再教育同時也讓民眾知道醫生是在幫你救你的命可能有兩成的救命機會"},{"start":242.04,"end":267.977,"text":"你說你要不要救病人家屬一定說一定要救啊可是八成是可能會他的疾病就是救不起來那就有八成的機會來告醫師啊那我說衛福部到底有沒有什麼具體的醫療行者合理化就是來保護這個啊就是這個已經做了很多的一個第一個這是第一個很重要的法案另外一個法案在前幾年通過的就是事故的一個"},{"start":272.687,"end":296.792,"text":"預防還有更調節就是要先調節讓醫師不要承受那麼大的壓力讓醫病能夠更和諧它是一個很光明的法案這兩個法案基本上是讓我們醫病在面對救命的時候能夠更和諧還是可以保障到醫生的權利嗎我問你第二個就是簽署人的資格民法第一"},{"start":298.033,"end":322.152,"text":"14條的第一項規定自然人如果精神障礙或心智缺陷的話不能跟他人溝通或不了解表達意思的話法院得為監護宣告可113年受監護宣告的人總數事實上是6047人其中18歲以上的有5999人其中以社會福利機構為監護人的有10件所以監護人有執行受監護的生活醫療照護跟財產管理的職務請問一下當"},{"start":326.295,"end":335.813,"text":"成年的病患本身意識不清楚的時候經法院為監護宣告的監護人依法可以為病患簽署安寧"},{"start":341.574,"end":357.04,"text":"我要講的是說安寧這邊的話其實他要啟動的這邊其實必須要經由就是說至少前面要有兩個專科醫師確認他默契他這一個所謂的安寧意願書由那個監護人簽署才會有效"},{"start":357.62,"end":375.802,"text":"然後可是在那個病人自主這邊的話他還是會回到了一個病人自主的一個前提在病人沒有表達意願就是他在意識狀況沒有沒有這麼重大改變之前沒有表示過任何意願的時候這個監護人其實他沒有辦法決定以上"},{"start":376.647,"end":378.448,"text":"那根據我們的健保署的分析在死亡前一個月內接受安寧療護的話"},{"start":392.137,"end":410.207,"text":"每個人可以減少到三萬兩千元的醫療支出如果去死亡前六個月接受安寧照護的話每個人可以減少到十萬七千元的醫療支出那育立醫療決定書也可以達到這樣的效果那育立醫療照護諮商一個案子"},{"start":411.536,"end":434.764,"text":"民眾要自費三千元就是要自己花三千元對多數人來講事實上是貴的所以去年七月我覺得衛福部也推出了一個育立醫療照護諮商推廣的獎勵計畫針對低收跟中低收的特定對象來提供免費的諮商服務可是看起來數據推了一年大概從兩萬四增加到兩萬五"},{"start":436.567,"end":460.559,"text":"沒有很顯著的提升啦所以想問一下花三千元可以省下大筆的醫療費用衛健保的財務永續衛福部一定會往這個方向推動可是去年推動的不利的原因是什麼因為增加不多好當然我們做調查包委員當然我們做調查的時候的確為什麼不簽民眾寫出來的原因當然就是說因為職場費用是蠻高的"},{"start":465.701,"end":487.348,"text":"我記得剛開始推出來的時候我們立法院好幾個委員都跑去台大醫院真的去做諮商那個我很敬佩他們就花幾千塊去做但是其實對一般的民眾來講的確是很負擔所以我們去年七月還有五月一號會擴大來讓更多的希望"},{"start":488.248,"end":510.745,"text":"有更多的機會來讓病人來簽那當然怎麼樣我們要去了解原因那衛生署也一直在請協界這邊了解原因是 那部長你如果講說今天新聞報導也說5月7號要擴大啦所以你今年的預例醫療註記的人身要提升你目標是多少"},{"start":513.772,"end":521.868,"text":"今年你的預歷醫療助計的人數也要提升嘛齁你目標是多少希望"},{"start":523.685,"end":540.84,"text":"我補充一下這個吼我們會希望是說現在大概一年兩萬左右能夠透過今年因為才只有半年的執行期所以能夠就是加倍到四萬左右是我們的目標然後那剛剛那個委員槌尋的是說推廣這一塊的話其實我們發現是說民眾的認知跟我們傳統習"},{"start":546.805,"end":572.399,"text":"習俗文化的這個禁錮其實還是一個主因另外一塊就是財務所以才會是從財務面的地方我們跟健保署合作推廣面的部分的話我們會跟長照室合作因為目前看到願意簽署的都是人生經驗裡面有一些相關的所以目前大概是50歲以上是我們的一個target以上謝謝市長安寧療護的概念早在"},{"start":573.154,"end":595.183,"text":"立法前台灣大概就已經開始在推動大概現在已經20年了而且使用率逐年增加那從2022年使用的大概達到6萬7病人死亡前的一年的安寧利用率的話大概30.4%那可是還是上市量能不足那所以整個"},{"start":596.283,"end":613.622,"text":"他事實上是透過多種專業來對病人跟家屬做整體的輔導那他同時也是生理心理的一個醫療可是這個項目真的蠻燒錢的所以對醫院來說如果不是為了評鑑加分的話誘因不大所以"},{"start":614.042,"end":638.687,"text":"因此安寧病床的床位不多而採用安寧共照來替代所以112年全國有86家醫院共計915床到114年的時候變成是85家醫院大概910床整個需求多床位少可是四病每一天大家都有人在排隊所以想問一下目前實際上的安寧病床到底病床數有多少"},{"start":640.087,"end":662.047,"text":"是的 薛委員 剛剛您報的就是現在的就是910嗎 整個不多 所以就會有跨科的做安寧供照所以目前安寧供照對病人 特別是家屬的照護能夠達到安寧病房的水準嗎 衛福部怎麼去確保這個水準因為不一樣啊"},{"start":662.788,"end":677.835,"text":"我想安寧共照是一個有一點點不得不的站在我們的文化跟民眾的需求所衍生出來的因為你如果叫他不要去住安寧病房這個就是一個很大的關卡但是他在"},{"start":678.815,"end":704.119,"text":"其實安寧反流醫療最好是越早啟動越好所以也許他已經在做反核性的化療那個時代那個時候就應該有加入安寧反流醫療團隊來跟你的病房跟你介紹什麼叫安寧有時候你跟這個A病床的人說結果是B病床的人聽一聽說那我要去安寧病房所以那個越早啟動的時候讓真的"},{"start":705.216,"end":717.551,"text":"病人可以規劃未來可以做的事情所以安寧的構造是非常重要的那安寧構造的團隊其實也花了非常大的心力他的效果當然是沒辦法像安寧病房這樣子整個團隊來給他"},{"start":725.02,"end":745.747,"text":"各方面全方位的一個照顧所以當然怎麼樣讓需要安寧病房的人能夠住進來當然這邊也要跟委員實際上報告雖然這麼多床但是很多醫院的安寧病床因為文化的問題他們可能還是希望病人還是希望跟家屬還是希望共照他們"},{"start":746.747,"end":768.813,"text":"不太願意到安寧病房來的所以我們的你去分析各個醫院的占床率就知道其實更重要的更重要的是要去推展民眾的觀念這樣子是可是基於病人自主醫療的權利保障跟善終的期望那又你整個安寧病房的量又不足"},{"start":769.253,"end":791.77,"text":"使用率低的狀況這種現實問題我相信衛福部有義務也有能力要把整個政策建構更完整所以病人運營安寧緩和醫療書跟預訂醫療決定書這一整套的制度連結分級醫療體系的醫院跟社區兩端所以社區單這邊也可以看到有在宅"},{"start":792.891,"end":803.654,"text":"在宅安寧跟我們的機構安寧這兩種在宅的醫療形式讓病人除了住院以外另外在社區中老那你的政策經費是111年的居家醫療的照護整合計畫的2.0113年是全民健康保險在宅急症照護的事辦計畫這兩個"},{"start":816.218,"end":839.982,"text":"計畫在支撐所以想問的是在不論長照老人還是護理之家在住宿型機構籌組照護團隊的服務機構內的病人對於機構品質的提升一定有比較正面的影響對機構病人分級醫療各方面都有一些注意本來就是應該要大力推動的政策可是政府一直在考一直沒有把一個人考慮進來就是沒有考慮住宿機構來籌組照護團隊的經營的壓力這像"},{"start":845.463,"end":874.262,"text":"服務對醫院來講就是賠錢在座了那對住宿型機構來講更是那醫生探視費呢健保支付如果給醫院1500為什麼給住宿型機構只有1200這有20%的落差是打擊士氣所以本期認為醫院跟住宿型機構各項的醫事人員的訪視費要一致啊請你推動這項訴求那你同意嗎就是大家應該都是一致的"},{"start":880.043,"end":897.12,"text":"這個我們已經通過下半年會來做這個安寧照護品質的平和 平和之後按照它的程度分別加成10% 20%跟30%那這個包含了住院的安寧 安寧共照跟居家安寧都適用"},{"start":897.56,"end":925.167,"text":"那另一方面我們下半年也會來檢討居家安寧的給付方式到底是要包月我們現在是論次那有沒有用包月的方式讓他更具彈性都會來檢討那至於在給付方面也一定朝向不同工不同酬的方式來思考所以下半年會開始去做規劃因為病人在住宿型機構發生醫療糾紛的時候勢必會大幅增加所以機構背後一定要有強大的支持系統也就是綠色通道所以"},{"start":926.387,"end":946.657,"text":"綠色通道除了提供緊急救援助援支援以外那人力技術也都是重要的一環所以衛福部是不是能夠確保機構具備有這項強大的後勤支援我想這是很重要要去努力的方向我們會一定來努力"},{"start":947.409,"end":965.331,"text":"所以最後麻煩我覺得我有三點訴求就是整個醫事的那個人員的支持方案面對病人的質疑跟訴訟我覺得還是要提供一些支持擴大育育醫療照護的諮商的全額補助對象今天應該也"},{"start":966.232,"end":991.515,"text":"得到你們的65歲以上都是提高我們住宿型機構的人士園的紡織費所以是不是下半年如果在討論的時候可能要考慮一下我剛剛講的是不是答案是同樣的綠色通道的糾紛 避免依舊的部分要為住宿型機構提供後勤的支持那麻煩這些是不是在後面提供 兩週內提供給我書面報告好 謝謝"}]}}},"gazette":{"lineno":166,"blocks":[["林委員月琴：（9時29分）主席，麻煩邱部長。"],["主席：請部長。"],["邱部長泰源：委員早。"],["林委員月琴：部長早。部長，你事實上是臺灣安寧療護的專家，安寧緩和醫療條例跟病人自主權利法這兩部法律，對於末期或不可逆、喪失神智的病人，透過病人跟家屬或他的意願代理人，預立安寧緩和醫療書或預立醫療決定書，要求醫生在往後的治療裡，不要用人工營養跟流體餵養、急救或者是維生醫療等，只是做維持心跳的無效醫療。但是安寧緩和醫療就非常挑戰我們的社會文化，所以在法律上要保護醫生，避免受到家屬的攻擊而受到傷害，而且要積極促進，以縮短病人的痛苦，減少我們醫療資源的浪費。","我想問部長，在程序上，病人自主並不是「只要我喜歡，有什麼不可以」，必須考量到病人本身、醫護人員、照顧者、家庭成員、重要他人的想法，是多方協調後的結果，可是還是會發生病人的決定，家屬事實上不認同，而跟醫生發生爭執的事件，尤其是在安寧療護的發生率更高，所以衛福部如何支持醫生、貫徹病人的決定做醫療？"],["邱部長泰源：謝謝委員關心這麼重要的議題，也關心到生死大事。善終是國人五福臨門裡面最難達到的，所以我們全國……就像自主權法案，當時也是很辛苦，蘇委員跟劉召委在這裡，我想兩位召委都有貢獻，當時都是希望達到這樣的一個目標，這中間的確是有很……人面對生命的末期，死亡就好像一個很強烈的陽光，你無法去正視它，家屬也沒辦法正視它，但是我們醫療人員、我們政府必須要幫他去正視它，讓他能夠好好地過完末期以及能夠善終。所以我覺得政府跟相關的如立法院願意來討論這個題目，我個人站在……"],["林委員月琴：對，可是部長……"],["邱部長泰源：敬佩……"],["林委員月琴：有時候法院依據合法的程序來確保醫生不受醫療過失的判決，可是還是無法避免憤怒的家屬對醫師提告。醫生一旦被告，就是要花錢去請律師、花錢去開庭，對此，衛福部能夠給醫生什麼樣的具體支持？"],["邱部長泰源：跟委員報告，這也是二、三十年來醫界的一個大事情，在座的所有委員，尤其是蘇委員，擔任醫師公會理事長的時候，為了這個也被兩派意見折騰，但是我們最終把醫療法修法變成醫療的刑責合理化。也就是說，以前可能會面對防禦性的醫療，但是因為這個，只要他好好地救病人，除非他有重大過失或錯誤，不然不會用刑責加身，所以那個時候，內外婦兒科的住院醫師在通過以後又上升了。因此我們用各種法律，然後再教育，同時也讓民眾知道醫生是在救他的命，可能有兩成的救命機會，你說要不要救？病人家屬一定說一定要救啊！可是有八成可能他的疾病就是救不起來，就有八成的機會來告醫師，這是過去有的事情。"],["林委員月琴：對，衛福部到底有沒有什麼具體的……"],["邱部長泰源：醫療刑責合理化就是來保護這個啊！這個已經做了很多的……這是第一個很重要的法案，另外一個法案在前幾年通過的，就是事故的預防，也就是醫預法，包含預防跟調解，就是要先調解，讓醫師不要承受那麼大的壓力。"],["林委員月琴：好，部長……"],["邱部長泰源：讓醫病能夠更和諧，它是一個很光明的法案，這兩個法案基本上是讓醫病面對救命的時候能夠更和諧。"],["林委員月琴：還是可以保障到醫生的權利嘛！我問第二個，就是簽署人的資格，依民法第十四條第一項規定，自然人如果精神障礙或心智缺陷，致不能跟他人溝通或不了解其表達的意思，法院得為監護宣告。113年受監護宣告總數是6,047人，其中18歲以上有5,999人，其中以社會福利機構為監護人的有10件，監護人有執行受監護人生活、醫療照護及財產管理的職務。請問一下，當成年病患本身意識不清楚的時候，經法院為監護宣告的監護人，依法可以為病患簽署安寧意願書嗎？"],["邱部長泰源：我請醫事司司長說明。"],["劉司長越萍：我要講的是，安寧部分的話，要啟動其實必須要經由……就是至少前面要有兩個專科醫師確認他末期，這個安寧意願書由監護人簽署才會有效；可是在病人自主部分的話，還是會回到病人自主的前提，在病人沒有表達意願，就是他在意識狀況沒有這麼重大改變之前，沒有表示過任何意願的時候，這個監護人其實沒有辦法決定，以上。"],["林委員月琴：好，我覺得衛福部也應該要去評估一下監護人到底是不是具有這樣的權利，到逐條討論的時候，你們可以再說明。","根據健保署的分析，在死亡前一個月內接受安寧療護的話，每個人可以減少約3萬2,000元的醫療支出；如果死亡前六個月接受安寧照護的話，每個人可以減少約10萬7,000元的醫療支出。預立醫療決定書也可以達到這樣的效果，預立醫療照護諮商一個案子民眾要自費3,000元，就是要自己花3,000元，對多數人來講，事實上是貴的。去年7月衛福部也推出了一個預立醫療照護諮商推廣獎勵計畫，針對低收、中低收等特定對象提供免費的諮商服務，可是從數據看起來，推了一年，大概從二萬四增加到二萬五千人，沒有很顯著的提升，所以想問一下，花3,000元可以省下大筆的醫療費用，為了健保財務永續，衛福部一定會往這個方向推動，可是去年推動不利的原因是什麼？因為增加不多。"],["邱部長泰源：報告委員，當我們做調查的時候，為什麼不簽？民眾寫出來的原因，當然就是因為諮商費用……"],["林委員月琴：是滿高的。"],["邱部長泰源：有點負擔啦！我記得剛開始推出來的時候，立法院好幾個委員都跑去臺大醫院，真的去諮商，我很敬佩，他們花幾千塊去做了。但是其實對一般的民眾來講，的確是很有負擔，所以我們去年7月還有5月1號會擴大，希望有更多的機會讓病人來簽，當然，我們要去了解原因，衛生署也一直在請學界了解原因，來推動……"],["林委員月琴：是，部長，今天新聞報導也說5月1號要擴大，今年的預立醫療註記人數要提升，你的目標是多少？"],["劉司長越萍：我補充一下，現在大概一年2萬左右，因為只有半年的執行期，所以加倍到4萬左右是我們的目標。剛剛委員垂詢的推廣費這一塊，其實我們發現民眾的認知跟我們傳統習俗、文化的禁錮還是一個主因。另外一塊就是財務，財務面我們跟健保署合作，推廣面的部分我們會跟長照司合作，因為目前看到願意簽署的，都是人生經驗裡面有一些相關的，所以目前大概50歲以上是我們的一個target，以上。"],["林委員月琴：好，謝謝司長。安寧療護的概念早在立法前就已經開始在臺灣推動，現在大概已經20年了，而且使用率逐年增加，2022年使用的人數達到6萬7,000人，病人死亡前一年的安寧利用率大概30.4%，可是量能還是不足，它事實上是透過多種專業對病人跟家屬做整體的輔導，同時是生理、心理的醫療，可是這個項目真的滿燒錢的，所以對醫院來說，如果不是為了評鑑加分的話，誘因不大，因此安寧病床的床位不多，而採用安寧共照來替代。112年全國有86家醫院，共計915床，到114年的時候變成85家醫院，大概910床，需求多，床位少，勢必每一天都有人在排隊，所以想問一下，目前實際上的安寧病床數到底有多少？"],["邱部長泰源：是的，謝謝委員，剛剛您報的就是現在的數字。"],["林委員月琴：就是910嗎？"],["邱部長泰源：是的，大概九百多。"],["林委員月琴：整體來說不多，所以就會有病人跨科做安寧共照，目前安寧共照對病人，特別是家屬的照護，能夠達到安寧病房的水準嗎？衛福部怎麼去確保這個水準？因為不一樣啊！"],["邱部長泰源：我想安寧共照是站在我們的文化跟民眾的需求所衍生出來的，因為你如果叫他去住安寧病房，這個就是一個很大的關卡，但是其實安寧緩和醫療最好是越早啟動越好。也許他已經在做緩和性的化療，那個時候就應該加入安寧緩和醫療團隊，來你的病房跟你解釋什麼叫做安寧，有時候你跟A病床的人說明，結果是B病床的人聽一聽說：我要去安寧病房。那個越早啟動可以讓病人規劃未來可以做的事情，所以安寧的共照是非常重要的，安寧共照的團隊其實也花了非常大的心力。"],["林委員月琴：對，可是它的品質、水準真的就是沒有辦法跟安寧……"],["邱部長泰源：它的效果當然沒辦法像安寧病房這樣子，整個團隊來給他各方面、全方位的照顧，所以怎麼樣讓需要安寧病房的人能夠住進來，當然這邊也要跟委員報告，雖然有這麼多床，但是很多醫院的安寧病床因為文化的問題，病人跟家屬還是希望共照，他們不太願意到安寧病房，所以我們分析各個醫院的占床率，就知道其實更重要的是要去推展民眾的觀念。"],["林委員月琴：可是基於病人自主醫療的權利保障跟善終的期望，在整個安寧病房的量不足，使用率又低的狀況下，這種現實問題，我相信衛福部有義務也有能力把整個政策建構得更完整。"],["邱部長泰源：是。"],["林委員月琴：病人預立安寧緩和醫療書跟預立醫療決定書，這一整套的制度連結分級醫療體系的醫院跟社區兩端，社區端也可以看到有在宅安寧跟機構安寧這兩種在宅的醫療形式，讓病人除了住院以外，另外在社區終老。你的政策經費是111年「居家醫療照護整合計畫2.0」、113年「全民健康保險在宅急症照護試辦計畫」這兩個計畫在支撐，所以想問，不論長照、老人，還是護理之家，在住宿型機構籌組照護團隊服務機構內的病人，對於機構品質的提升一定有比較正面的影響，對機構、病人、分級醫療等各方面都有一些助益，本來就是應該要大力推動的政策，可是政府一直沒有把一個部分考慮進來，就是沒有考慮住宿機構籌組照護團隊的經營壓力，這項服務對醫院來講就是賠錢在做，對住宿型機構來講更是，像醫生訪視費，健保支付如果給醫院1,500，為什麼只有給住宿型機構1,200？這20%的落差是會打擊士氣的，所以本席認為，醫院跟住宿型機構各項醫事人員的訪視費要一致，請你推動這項訴求，你同意嗎？就是大家應該都是一致的，差了20%……"],["邱部長泰源：請健保署署長說明給付方面。"],["石署長崇良：跟委員報告，這個我們已經通過，下半年會來做安寧照護品質的評核，評核之後按照他的程度，分別加成10%、20%跟30%，這個包含了住院的安寧、安寧共照跟居家安寧都適用。另一方面，我們下半年也會來檢討居家安寧的給付方式，我們現在是論次，有沒有要用包月的方式讓它更具彈性，都會一一來檢討。至於給付方面，也一定會朝向不同工不同酬的方式來思考。"],["林委員月琴：好，所以下半年會開始去做規劃。"],["石署長崇良：對。"],["林委員月琴：因為病人在住宿型機構發生醫療糾紛，勢必會大幅增加，所以機構背後一定要有強大的支持系統，也就是綠色通道。綠色通道除了提供緊急救援、住院支援以外，人力、技術也都是重要的一環，所以衛福部是不是能夠確保機構具備這項強大的後勤資源？"],["邱部長泰源：好，我想這是很重要，要去努力的方向，我們一定會來努力。"],["林委員月琴：最後，我有三點訴求，就是對於整個醫事人員的支持方案，面對病人家屬的質疑跟訴訟，我覺得還是要提供一些支持。"],["邱部長泰源：是的。"],["林委員月琴：還有擴大預立醫療照護諮商的全額補助對象，今天應該也得到你們的……65歲以上都是。還有提高住宿型機構醫事人員的訪視費，所以下半年如果在討論的時候，可能要考慮一下我剛剛講的，是不是大家都是同樣的。再來，綠色通道避免醫糾的部分，要為住宿型機構提供後勤的支持系統，這些是不是在兩週內提供書面報告給我？謝謝。"],["邱部長泰源：好，我們再把計畫書提供給委員，謝謝。"],["主席：好，謝謝。","接下來請蘇清泉召委詢答。"]],"agenda":{"page_end":422,"meet_id":"委員會-11-3-26-9","speakers":["劉建國","陳昭姿","林月琴","蘇清泉","邱鎮軍","王育敏","楊瓊瓔","莊瑞雄","廖偉翔","林淑芬","黃秀芳","王正旭","陳培瑜","楊曜","陳瑩","涂權吉","陳菁徽"],"page_start":359,"meetingDate":["2025-05-01"],"gazette_id":"1144501","agenda_lcidc_ids":["1144501_00008"],"meet_name":"立法院第11屆第3會期社會福利及衛生環境委員會第9次全體委員會議紀錄","content":"審查：一、委員王育敏等18人擬具「病人自主權利法部分條文修正草案」案；二、委員劉建國等\n16人擬具「病人自主權利法部分條文修正草案」案；三、委員邱志偉等19人擬具「病人自主權利\n法第八條、第九條及第十五條條文修正草案」案【僅詢答】","agenda_id":"1144501_00007"}}}