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\"score\": 0.812}, {\"word\": \"好\", \"start\": 847.624, \"end\": 847.644, \"score\": 0.0}, {\"word\": \"謝\"}, {\"word\": \"謝\"}], \"language\": \"zh\"}","srt":"1\n00:00:03,328 --> 00:00:04,731\n謝謝,謝謝劉召偉的禮讓,我先講還有秦部長,還有那個石署長\n\n2\n00:00:16,980 --> 00:00:42,916\n委員好這個ACP這個自主權力法這個在我給你review一下2015年通過的時候那個時候我在做教育那個時候劉建國也在這個王毅民也在那個時候為什麼這個法到最後你每一腳就退上去就是楊逸勳楊逸勳委員\n\n3\n00:00:46,476 --> 00:00:53,522\n現在剛才你說他做了幾個人的社會究竟那個時候他跟我講說他說蔣議員蘇委員我楊岳昕隨時會死啦2016年啦他說因為他是肌肉的問題嘛我現在看他每天真的很痛苦\n\n4\n00:01:09,008 --> 00:01:19,052\n他常常早上起來就好像無數的針在插他的肉這樣他這樣跟我描述我聽了一聽他說他應該讓他有選擇他要怎麼處理自己聽起來很有理的所以為了\n\n5\n00:01:27,310 --> 00:01:54,506\n這案子又遭到大宴會要報告,都遭到報告所以這個法通過之後,好像那個年代是很先進的全世界沒有幾個國家通過這個法案那這個法案2015年通過之後,到2019年你在做立委啊,你在做教委啊,部長你要教教委啊2019年到實施,實施到現在就是慢慢走慢慢走那現在就要大修法\n\n6\n00:01:55,607 --> 00:02:20,288\n我是比較保守啦比較保留那簽的人才ACP簽的人才10萬請問是要怎麼做我看不太一樣所以你個人你個人的看法是怎麼樣我是相對保守啦對ACP對我覺得ACP因為所以\n\n7\n00:02:24,520 --> 00:02:42,823\n這對蘇貞昌醫師本色,他覺得每天臨床上把病人照顧好,不管他是哪一種疾病尤其施昭維是照顧重症的病人、專家所以我們每天都在做倫理的決策其實給病人都是最適當的一個治療最適當的治療最好的照顧所以我們覺得\n\n8\n00:02:51,523 --> 00:03:00,593\n在其他法律方面的層面他到底他的意義何在這個部分我們會有思考我是很敬佩蘇伊斯這個見解\n\n9\n00:03:03,342 --> 00:03:19,796\n但是問題在不管是安寧緩和醫療安寧緩和醫療條例最早的時候其實是有一點點因為剛開始安寧在推嘛所以很多醫病的溝通又沒要做CPR這如果有一個補貨是比較好那以前安寧緩和醫療條例詭異喔其實對社會的一個\n\n10\n00:03:23,579 --> 00:03:36,894\n社會運動也是幫助很大喔大家有時候我會說三八月大家來簽安寧法律條例DNR簽了旁邊就旁邊像我旁邊剛才找王毅民我都拜了毅民姐你幫我簽見證人\n\n11\n00:03:39,690 --> 00:04:06,450\n他就變成見證人了你知道嗎就完成了安寧環的藥所以我覺得社會運動讓台灣的人民更知道關心到這一塊絕對是好事情那後來又有自治病前法案更是把它的範圍擴大所以這是對大家對生命教育其實是有幫助那我們也做一個研究我抱歉講不清楚因為我們做兩次研究當開始的時候\n\n12\n00:04:08,672 --> 00:04:34,726\n你要簽ACP,ACP裡面的AD簽好以後到實際上他面臨這個問題的時候,有七成的吻合力也就是說他不願意押胸、不願意插管,大概100%都符合但是在抗生素的使用、在人工輸液的使用哪一個是臨床上比較變化多要看當時的情況,我想你很清楚所以其實有幫忙啦\n\n13\n00:04:35,886 --> 00:04:59,273\n所以這個法規怎麼把它修好,我覺得這是一個好的方向因為當時是非常嚴謹,說要有醫師、有社工、婦女人員還有家屬,甚至要有公眾人數,大家都這樣集齊在那裡你現在要把它開放說比較簡單的,當便宜不用,可以住安養院、住婦女之家\n\n14\n00:05:00,413 --> 00:05:22,439\n不然那廟也可以那廟的老人家也可以這樣就合意啦因為不夠嚴謹就會覺得改是要很慎重啦執行倡議那我另外一個感覺會覺得說是不是更不夠逃避責任啦你看我們的平均壽命來\n\n15\n00:05:26,594 --> 00:05:34,116\n這是我們2023、2024平均壽命,台灣平均人平均壽命到80.3歲而已,80.3,老婆老婆比起來,老婆的83.7,老婆的76、77而已,我看起來是英年早逝\n\n16\n00:05:48,649 --> 00:05:50,912\n我現在出席參加個別席,增加了190個,越來越多,在沙坡人都多了70幾個,太少了吧平均起來在80.3,你知道嗎,日本現在是85.5,南米平均\n\n17\n00:06:07,005 --> 00:06:17,032\n然後日本的女人香港的女人居然活得比日本還久日本人其實我很欽佩我去日本很多次日本人沒有那麼快死啦因為怎樣咧三善啊又倒丟又撩骨又吃酒那怎麼會死啦\n\n18\n00:06:25,737 --> 00:06:32,623\n又愛排隊,又愛看背,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,\n\n19\n00:06:42,954 --> 00:06:57,189\n香港的我就覺得很奇怪香港的女人怎麼活一活那麼久我最近在問香港的醫生香港來台灣當醫生的我都請教也研究了一下他們的結論是走路\n\n20\n00:06:58,670 --> 00:07:17,670\n走路囉因為香港的地小人潮阿婆摩托車什麼都沒有所以都有走路坐街坐公車所以說走路是強迫走路嘛我們台灣不是啊都騎摩托車大家都騎摩托車買一個菜市場也騎摩托車香港都有走日本也很多都有走日本是有摩托車啦\n\n21\n00:07:19,171 --> 00:07:40,338\n所以香港澳門你看都這麼長那新加坡也很長怕死人那台灣是最後一名比韓國還短命所以這個你有那麼急一直要推這個DNR啦ACP啦在2015年楊宇新在這裡靠腰他現在2025年也不會死人\n\n22\n00:07:43,212 --> 00:07:54,598\n所以科技的進步會讓我們的壽命是可以解決的癌症的不要怕楊益心我前面有說你不要緊她不會害怕我會跟大家報告的是\n\n23\n00:08:01,311 --> 00:08:18,024\n以前沒有辦法醫治的,現在標靶藥什麼什麼生物自治一直出來就可以延長壽命啦所以不要說動不動就要叫人塞DNA動不動,我看那些以前沒人的現在都有人了,像以前來的,溫室的以前來的現在也有做治療很多年了,對不對,普遍那我感覺說,研究院就要升職,所以都一直塞,有這種事情嗎,署長\n\n24\n00:08:30,563 --> 00:08:56,891\n沒有我當然你的專業還有間諜你很敬佩但是從我的角度我會覺得所有從事推動安寧政策跟關心安寧政策跟實際上照顧人他們的心都是說當你真的沒辦法已經到末期的時候我怎麼樣讓你有生命品質怎麼樣讓你善終教育報告善終是五輔林門裡面最難達到的\n\n25\n00:08:58,311 --> 00:09:22,920\n所以我們一定要面對這個事情過去二十多年義大利的時候他們早上打招呼不是說早安是說你今天想到死亡了沒他們在推行死亡教育就是這樣在推行讓大家有一點準備當然我們希望一五十歲很重視這個但是多到八二歲你現在如果去炒地硬貢你如果說阿公阿嬤十八歲他們都不會打招呼\n\n26\n00:09:25,001 --> 00:09:50,762\n大家吃霸凌他們就破壞了所以可能大家期待但是如果你比較面對人生有時候很難講的你如果比較了解的話你也能幫忙你的親戚朋友你酒瓶的人互相都有這個面對死亡的一個怎麼樣做好善終的一個準備這是好事啦這是好事所以我蔣議員他們都要講很多所以你先時間給我一下齁\n\n27\n00:09:55,206 --> 00:10:17,961\n什麼要我給他檢部署建議啦你現在很大的一個希望就是說把什麼刀山包海全部都納進來這也我給你欽佩啦但是你們一納進來之後就把那個壓價格壓壓壓壓的很低心臟支架在我那個年代是全部都是智慧放一支支架要五六萬沒有塗藥的喔\n\n28\n00:10:20,903 --> 00:10:27,606\n後來健保局跟支付料一支支付一萬五千點點喔不是錢喔\n\n29\n00:10:31,345 --> 00:10:56,771\n啊,過來還有塗藥支叫出來,塗藥支叫他付差額那個開急追的那個Cage,那個空啊,也是你們付,還沒付之前智慧是四五萬塊你們付的時候也是一萬多點,一萬多點齁那現在像剛剛陳昭之講的那種靈交,那個開心臟外科是以前都是智慧嘛,啊你現在給他支付之後,付一個萬多點\n\n30\n00:10:58,803 --> 00:11:20,242\n亂說也好,是不夠,有這樣的退出所以有時候你要包山包海的時候這次川普政府來跟我們要求其中一點就是他要讓我們開放一個智慧的平台新藥、新科技、新耗材,想付的人也付得起的人他們有一個空間\n\n31\n00:11:22,792 --> 00:11:40,504\n這樣我覺得這樣是對的啦你每一樣都把它壓來健保幾戶標靶藥拿來幾戶很多藥廠受不了那都不賣台灣了嘛那也是我們的損失嘛對不對很多藥我可以唸出來喔沒有時間了齁我都是這樣退出台灣的市場所以\n\n32\n00:11:41,724 --> 00:12:07,236\n裡面是照顧普羅大眾這是要欽佩的但是有一些還是開放一點點讓他們有一個這次關稅談就會談到這個所以署長你的行情我很欽佩你的做法我也很認同但是如果什麼空間再來就是要和解的時候你每天都用乳品也是要考慮署長你講一下\n\n33\n00:12:11,251 --> 00:12:33,285\n謝謝委員的指教啦確實啦很多東西是有人想納入健保有人不想納入健保所以同一個產品也都有不同的意見癌藥也是如此醫茶也是如此所以健保呢秉持的就是第一個齁那麼急重難症要先照顧啦不要讓這個病人在危急的時候還要再考慮荷包的問題啦\n\n34\n00:12:34,085 --> 00:12:59,181\n所以第一個我們的態度就是這樣所以像這個凝膠我們也不是全面擠附我們也是主要挑這個主動脈玻璃這種非常緊急這個委員也清楚那個這是TypeA從這個主動脈根部撕裂的這一種那麼它的縫合後的這個凝膠使用所以適用對象大概就是1400多位所以其餘的我們也是還在留在自費市場\n\n35\n00:12:59,941 --> 00:13:20,794\n我們就是讓這個危及生命的時候能夠得到健保的給付所以我們考量上第一個一定先從集中南海優先那行有餘力我們的預算夠大家這個健保費繳的夠那我們再逐步的擴大所以這個我們都有這個倫理的考量也有這個疾病需求的考量這些都會一起\n\n36\n00:13:21,574 --> 00:13:37,443\n我們國家的先進指標,就GDP國民收入,再來就是平均壽命,再來是癌症死亡年齡死亡率,再來公共衛生等等,這都是指標,平均壽命這樣還不夠長,在阿姨家還剩下了\n\n37\n00:13:40,425 --> 00:14:07,644\n所以很需要努力的空間啦所以這個法是我們起頭的現在要修改我是相對保留啦跟部長講我的立場好不好好首先我要報告一下平均寿命或者健康的平均移民是我們現在目前國家的政策重要的所以會來努力這不會在困難裡的啦這大家共同努力啦好謝謝\n\n","tsv":"start\tend\ttext\n3328\t4731\t謝謝,謝謝劉召偉的禮讓,我先講還有秦部長,還有那個石署長\n16980\t42916\t委員好這個ACP這個自主權力法這個在我給你review一下2015年通過的時候那個時候我在做教育那個時候劉建國也在這個王毅民也在那個時候為什麼這個法到最後你每一腳就退上去就是楊逸勳楊逸勳委員\n46476\t53522\t現在剛才你說他做了幾個人的社會究竟那個時候他跟我講說他說 蔣議員 蘇委員 我楊岳昕隨時會死啦2016年啦 他說因為他是肌肉的問題嘛我現在看他每天真的很痛苦\n69008\t79052\t他常常早上起來就好像無數的針在插他的肉這樣他這樣跟我描述我聽了一聽他說他應該讓他有選擇他要怎麼處理自己聽起來很有理的所以為了\n87310\t114506\t這案子又遭到大宴會要報告,都遭到報告所以這個法通過之後,好像那個年代是很先進的全世界沒有幾個國家通過這個法案那這個法案2015年通過之後,到2019年你在做立委啊,你在做教委啊,部長你要教教委啊2019年到實施,實施到現在就是慢慢走慢慢走那現在就要大修法\n115607\t140288\t我是比較保守啦 比較保留那簽的人才ACP 簽的人才10萬請問是要怎麼做 我看不太一樣所以你個人 你個人的看法是怎麼樣我是相對保守啦對 ACP對 我覺得ACP因為 所以\n144520\t162823\t這對蘇貞昌醫師本色,他覺得每天臨床上把病人照顧好,不管他是哪一種疾病尤其施昭維是照顧重症的病人、專家所以我們每天都在做倫理的決策其實給病人都是最適當的一個治療最適當的治療最好的照顧所以我們覺得\n171523\t180593\t在其他法律方面的層面他到底他的意義何在這個部分我們會有思考我是很敬佩蘇伊斯這個見解\n183342\t199796\t但是問題在不管是安寧緩和醫療安寧緩和醫療條例最早的時候其實是有一點點因為剛開始安寧在推嘛所以很多醫病的溝通又沒要做CPR這如果有一個補貨是比較好那以前安寧緩和醫療條例詭異喔其實對社會的一個\n203579\t216894\t社會運動也是幫助很大喔大家有時候我會說三八月大家來簽安寧法律條例DNR簽了 旁邊就旁邊像我旁邊剛才找王毅民我都拜了 毅民姐你幫我簽見證人\n219690\t246450\t他就變成見證人了你知道嗎就完成了安寧環的藥所以我覺得社會運動讓台灣的人民更知道關心到這一塊絕對是好事情那後來又有自治病前法案更是把它的範圍擴大所以這是對大家對生命教育其實是有幫助那我們也做一個研究我抱歉講不清楚因為我們做兩次研究當開始的時候\n248672\t274726\t你要簽ACP,ACP裡面的AD簽好以後到實際上他面臨這個問題的時候,有七成的吻合力也就是說他不願意押胸、不願意插管,大概100%都符合但是在抗生素的使用、在人工輸液的使用哪一個是臨床上比較變化多要看當時的情況,我想你很清楚所以其實有幫忙啦\n275886\t299273\t所以這個法規怎麼把它修好,我覺得這是一個好的方向因為當時是非常嚴謹,說要有醫師、有社工、婦女人員還有家屬,甚至要有公眾人數,大家都這樣集齊在那裡你現在要把它開放說比較簡單的,當便宜不用,可以住安養院、住婦女之家\n300413\t322439\t不然那廟也可以 那廟的老人家也可以這樣就合意啦 因為不夠嚴謹就會覺得改是要很慎重啦 執行倡議那我另外一個感覺會覺得說是不是更不夠逃避責任啦你看我們的平均壽命 來\n326594\t334116\t這是我們2023、2024平均壽命,台灣平均人平均壽命到80.3歲而已,80.3,老婆老婆比起來,老婆的83.7,老婆的76、77而已,我看起來是英年早逝\n348649\t350912\t我現在出席參加個別席,增加了190個,越來越多,在沙坡人都多了70幾個,太少了吧平均起來在80.3,你知道嗎,日本現在是85.5,南米平均\n367005\t377032\t然後日本的女人 香港的女人居然活得比日本還久日本人其實我很欽佩 我去日本很多次日本人沒有那麼快死啦因為怎樣咧 三善啊 又倒丟 又撩骨 又吃酒 那怎麼會死啦\n385737\t392623\t又愛排隊,又愛看背,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,\n402954\t417189\t香港的我就覺得很奇怪香港的女人怎麼活一活那麼久我最近在問香港的醫生香港來台灣當醫生的我都請教也研究了一下他們的結論是走路\n418670\t437670\t走路囉 因為香港的地小人潮 阿婆 摩托車 什麼都沒有所以都有走路 坐街 坐公車所以說走路是強迫走路嘛我們台灣不是啊 都騎摩托車 大家都騎摩托車買一個菜市場也騎摩托車 香港都有走日本也很多都有走 日本是有摩托車啦\n439171\t460338\t所以香港 澳門 你看都這麼長那新加坡也很長 怕死人那台灣是最後一名 比韓國還短命所以這個你有那麼急 一直要推這個DNR啦 ACP啦在2015年 楊宇新在這裡靠腰他現在2025年也不會死人\n463212\t474598\t所以科技的進步會讓我們的壽命是可以解決的癌症的不要怕 楊益心我前面有說你不要緊 她不會害怕我會跟大家報告的是\n481311\t498024\t以前沒有辦法醫治的,現在標靶藥什麼什麼生物自治一直出來就可以延長壽命啦所以不要說動不動就要叫人塞DNA動不動,我看那些以前沒人的現在都有人了,像以前來的,溫室的以前來的現在也有做治療很多年了,對不對,普遍那我感覺說,研究院就要升職,所以都一直塞,有這種事情嗎,署長\n510563\t536891\t沒有 我當然你的專業還有間諜你很敬佩但是從我的角度我會覺得所有從事推動安寧政策跟關心安寧政策跟實際上照顧人他們的心都是說當你真的沒辦法已經到末期的時候我怎麼樣讓你有生命品質怎麼樣讓你善終教育報告善終是五輔林門裡面最難達到的\n538311\t562920\t所以我們一定要面對這個事情過去二十多年義大利的時候他們早上打招呼不是說早安是說你今天想到死亡了沒他們在推行死亡教育就是這樣在推行讓大家有一點準備當然我們希望一五十歲很重視這個但是多到八二歲你現在如果去炒地硬貢你如果說阿公阿嬤十八歲他們都不會打招呼\n565001\t590762\t大家吃霸凌他們就破壞了所以可能大家期待但是如果你比較面對人生有時候很難講的你如果比較了解的話你也能幫忙你的親戚朋友你酒瓶的人互相都有這個面對死亡的一個怎麼樣做好善終的一個準備這是好事啦這是好事所以我蔣議員他們都要講很多所以你先時間給我一下齁\n595206\t617961\t什麼要我給他檢部署建議啦你現在很大的一個希望就是說把什麼刀山包海全部都納進來這也我給你欽佩啦但是你們一納進來之後就把那個壓價格壓壓壓壓的很低心臟支架在我那個年代是全部都是智慧放一支支架要五六萬沒有塗藥的喔\n620903\t627606\t後來健保局跟支付料一支支付一萬五千點點喔不是錢喔\n631345\t656771\t啊,過來還有塗藥支叫出來,塗藥支叫他付差額那個開急追的那個Cage,那個空啊,也是你們付,還沒付之前智慧是四五萬塊你們付的時候也是一萬多點,一萬多點齁那現在像剛剛陳昭之講的那種靈交,那個開心臟外科是以前都是智慧嘛,啊你現在給他支付之後,付一個萬多點\n658803\t680242\t亂說也好,是不夠,有這樣的退出所以有時候你要包山包海的時候這次川普政府來跟我們要求其中一點就是他要讓我們開放一個智慧的平台新藥、新科技、新耗材,想付的人也付得起的人他們有一個空間\n682792\t700504\t這樣我覺得這樣是對的啦你每一樣都把它壓來健保幾戶標靶藥拿來幾戶很多藥廠受不了那都不賣台灣了嘛那也是我們的損失嘛對不對很多藥我可以唸出來喔沒有時間了齁我都是這樣退出台灣的市場所以\n701724\t727236\t裡面是照顧普羅大眾這是要欽佩的但是有一些還是開放一點點讓他們有一個這次關稅談就會談到這個所以署長你的行情我很欽佩你的做法我也很認同但是如果什麼空間再來就是要和解的時候你每天都用乳品也是要考慮署長你講一下\n731251\t753285\t謝謝委員的指教啦 確實啦 很多東西是有人想納入健保 有人不想納入健保所以同一個產品也都有不同的意見 癌藥也是如此 醫茶也是如此所以健保呢秉持的就是第一個齁 那麼急重難症要先照顧啦不要讓這個病人在危急的時候還要再考慮荷包的問題啦\n754085\t779181\t所以第一個我們的態度就是這樣所以像這個凝膠我們也不是全面擠附我們也是主要挑這個主動脈玻璃這種非常緊急這個委員也清楚那個這是Type A從這個主動脈根部撕裂的這一種那麼它的縫合後的這個凝膠使用所以適用對象大概就是1400多位所以其餘的我們也是還在留在自費市場\n779941\t800794\t我們就是讓這個危及生命的時候能夠得到健保的給付所以我們考量上第一個一定先從集中南海優先那行有餘力我們的預算夠大家這個健保費繳的夠那我們再逐步的擴大所以這個我們都有這個倫理的考量也有這個疾病需求的考量這些都會一起\n801574\t817443\t我們國家的先進指標,就GDP國民收入,再來就是平均壽命,再來是癌症死亡年齡死亡率,再來公共衛生等等,這都是指標,平均壽命這樣還不夠長,在阿姨家還剩下了\n820425\t847644\t所以很需要努力的空間啦所以這個法是我們起頭的現在要修改我是相對保留啦跟部長講我的立場好不好好 首先我要報告一下平均寿命或者健康的平均移民是我們現在目前國家的政策重要的所以會來努力這不會在困難裡的啦這大家共同努力啦好 謝謝\n","txt":"謝謝,謝謝劉召偉的禮讓,我先講還有秦部長,還有那個石署長\n委員好這個ACP這個自主權力法這個在我給你review一下2015年通過的時候那個時候我在做教育那個時候劉建國也在這個王毅民也在那個時候為什麼這個法到最後你每一腳就退上去就是楊逸勳楊逸勳委員\n現在剛才你說他做了幾個人的社會究竟那個時候他跟我講說他說 蔣議員 蘇委員 我楊岳昕隨時會死啦2016年啦 他說因為他是肌肉的問題嘛我現在看他每天真的很痛苦\n他常常早上起來就好像無數的針在插他的肉這樣他這樣跟我描述我聽了一聽他說他應該讓他有選擇他要怎麼處理自己聽起來很有理的所以為了\n這案子又遭到大宴會要報告,都遭到報告所以這個法通過之後,好像那個年代是很先進的全世界沒有幾個國家通過這個法案那這個法案2015年通過之後,到2019年你在做立委啊,你在做教委啊,部長你要教教委啊2019年到實施,實施到現在就是慢慢走慢慢走那現在就要大修法\n我是比較保守啦 比較保留那簽的人才ACP 簽的人才10萬請問是要怎麼做 我看不太一樣所以你個人 你個人的看法是怎麼樣我是相對保守啦對 ACP對 我覺得ACP因為 所以\n這對蘇貞昌醫師本色,他覺得每天臨床上把病人照顧好,不管他是哪一種疾病尤其施昭維是照顧重症的病人、專家所以我們每天都在做倫理的決策其實給病人都是最適當的一個治療最適當的治療最好的照顧所以我們覺得\n在其他法律方面的層面他到底他的意義何在這個部分我們會有思考我是很敬佩蘇伊斯這個見解\n但是問題在不管是安寧緩和醫療安寧緩和醫療條例最早的時候其實是有一點點因為剛開始安寧在推嘛所以很多醫病的溝通又沒要做CPR這如果有一個補貨是比較好那以前安寧緩和醫療條例詭異喔其實對社會的一個\n社會運動也是幫助很大喔大家有時候我會說三八月大家來簽安寧法律條例DNR簽了 旁邊就旁邊像我旁邊剛才找王毅民我都拜了 毅民姐你幫我簽見證人\n他就變成見證人了你知道嗎就完成了安寧環的藥所以我覺得社會運動讓台灣的人民更知道關心到這一塊絕對是好事情那後來又有自治病前法案更是把它的範圍擴大所以這是對大家對生命教育其實是有幫助那我們也做一個研究我抱歉講不清楚因為我們做兩次研究當開始的時候\n你要簽ACP,ACP裡面的AD簽好以後到實際上他面臨這個問題的時候,有七成的吻合力也就是說他不願意押胸、不願意插管,大概100%都符合但是在抗生素的使用、在人工輸液的使用哪一個是臨床上比較變化多要看當時的情況,我想你很清楚所以其實有幫忙啦\n所以這個法規怎麼把它修好,我覺得這是一個好的方向因為當時是非常嚴謹,說要有醫師、有社工、婦女人員還有家屬,甚至要有公眾人數,大家都這樣集齊在那裡你現在要把它開放說比較簡單的,當便宜不用,可以住安養院、住婦女之家\n不然那廟也可以 那廟的老人家也可以這樣就合意啦 因為不夠嚴謹就會覺得改是要很慎重啦 執行倡議那我另外一個感覺會覺得說是不是更不夠逃避責任啦你看我們的平均壽命 來\n這是我們2023、2024平均壽命,台灣平均人平均壽命到80.3歲而已,80.3,老婆老婆比起來,老婆的83.7,老婆的76、77而已,我看起來是英年早逝\n我現在出席參加個別席,增加了190個,越來越多,在沙坡人都多了70幾個,太少了吧平均起來在80.3,你知道嗎,日本現在是85.5,南米平均\n然後日本的女人 香港的女人居然活得比日本還久日本人其實我很欽佩 我去日本很多次日本人沒有那麼快死啦因為怎樣咧 三善啊 又倒丟 又撩骨 又吃酒 那怎麼會死啦\n又愛排隊,又愛看背,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,\n香港的我就覺得很奇怪香港的女人怎麼活一活那麼久我最近在問香港的醫生香港來台灣當醫生的我都請教也研究了一下他們的結論是走路\n走路囉 因為香港的地小人潮 阿婆 摩托車 什麼都沒有所以都有走路 坐街 坐公車所以說走路是強迫走路嘛我們台灣不是啊 都騎摩托車 大家都騎摩托車買一個菜市場也騎摩托車 香港都有走日本也很多都有走 日本是有摩托車啦\n所以香港 澳門 你看都這麼長那新加坡也很長 怕死人那台灣是最後一名 比韓國還短命所以這個你有那麼急 一直要推這個DNR啦 ACP啦在2015年 楊宇新在這裡靠腰他現在2025年也不會死人\n所以科技的進步會讓我們的壽命是可以解決的癌症的不要怕 楊益心我前面有說你不要緊 她不會害怕我會跟大家報告的是\n以前沒有辦法醫治的,現在標靶藥什麼什麼生物自治一直出來就可以延長壽命啦所以不要說動不動就要叫人塞DNA動不動,我看那些以前沒人的現在都有人了,像以前來的,溫室的以前來的現在也有做治療很多年了,對不對,普遍那我感覺說,研究院就要升職,所以都一直塞,有這種事情嗎,署長\n沒有 我當然你的專業還有間諜你很敬佩但是從我的角度我會覺得所有從事推動安寧政策跟關心安寧政策跟實際上照顧人他們的心都是說當你真的沒辦法已經到末期的時候我怎麼樣讓你有生命品質怎麼樣讓你善終教育報告善終是五輔林門裡面最難達到的\n所以我們一定要面對這個事情過去二十多年義大利的時候他們早上打招呼不是說早安是說你今天想到死亡了沒他們在推行死亡教育就是這樣在推行讓大家有一點準備當然我們希望一五十歲很重視這個但是多到八二歲你現在如果去炒地硬貢你如果說阿公阿嬤十八歲他們都不會打招呼\n大家吃霸凌他們就破壞了所以可能大家期待但是如果你比較面對人生有時候很難講的你如果比較了解的話你也能幫忙你的親戚朋友你酒瓶的人互相都有這個面對死亡的一個怎麼樣做好善終的一個準備這是好事啦這是好事所以我蔣議員他們都要講很多所以你先時間給我一下齁\n什麼要我給他檢部署建議啦你現在很大的一個希望就是說把什麼刀山包海全部都納進來這也我給你欽佩啦但是你們一納進來之後就把那個壓價格壓壓壓壓的很低心臟支架在我那個年代是全部都是智慧放一支支架要五六萬沒有塗藥的喔\n後來健保局跟支付料一支支付一萬五千點點喔不是錢喔\n啊,過來還有塗藥支叫出來,塗藥支叫他付差額那個開急追的那個Cage,那個空啊,也是你們付,還沒付之前智慧是四五萬塊你們付的時候也是一萬多點,一萬多點齁那現在像剛剛陳昭之講的那種靈交,那個開心臟外科是以前都是智慧嘛,啊你現在給他支付之後,付一個萬多點\n亂說也好,是不夠,有這樣的退出所以有時候你要包山包海的時候這次川普政府來跟我們要求其中一點就是他要讓我們開放一個智慧的平台新藥、新科技、新耗材,想付的人也付得起的人他們有一個空間\n這樣我覺得這樣是對的啦你每一樣都把它壓來健保幾戶標靶藥拿來幾戶很多藥廠受不了那都不賣台灣了嘛那也是我們的損失嘛對不對很多藥我可以唸出來喔沒有時間了齁我都是這樣退出台灣的市場所以\n裡面是照顧普羅大眾這是要欽佩的但是有一些還是開放一點點讓他們有一個這次關稅談就會談到這個所以署長你的行情我很欽佩你的做法我也很認同但是如果什麼空間再來就是要和解的時候你每天都用乳品也是要考慮署長你講一下\n謝謝委員的指教啦 確實啦 很多東西是有人想納入健保 有人不想納入健保所以同一個產品也都有不同的意見 癌藥也是如此 醫茶也是如此所以健保呢秉持的就是第一個齁 那麼急重難症要先照顧啦不要讓這個病人在危急的時候還要再考慮荷包的問題啦\n所以第一個我們的態度就是這樣所以像這個凝膠我們也不是全面擠附我們也是主要挑這個主動脈玻璃這種非常緊急這個委員也清楚那個這是Type A從這個主動脈根部撕裂的這一種那麼它的縫合後的這個凝膠使用所以適用對象大概就是1400多位所以其餘的我們也是還在留在自費市場\n我們就是讓這個危及生命的時候能夠得到健保的給付所以我們考量上第一個一定先從集中南海優先那行有餘力我們的預算夠大家這個健保費繳的夠那我們再逐步的擴大所以這個我們都有這個倫理的考量也有這個疾病需求的考量這些都會一起\n我們國家的先進指標,就GDP國民收入,再來就是平均壽命,再來是癌症死亡年齡死亡率,再來公共衛生等等,這都是指標,平均壽命這樣還不夠長,在阿姨家還剩下了\n所以很需要努力的空間啦所以這個法是我們起頭的現在要修改我是相對保留啦跟部長講我的立場好不好好 首先我要報告一下平均寿命或者健康的平均移民是我們現在目前國家的政策重要的所以會來努力這不會在困難裡的啦這大家共同努力啦好 謝謝\n","vtt":"WEBVTT\n\n00:03.328 --> 00:04.731\n謝謝,謝謝劉召偉的禮讓,我先講還有秦部長,還有那個石署長\n\n00:16.980 --> 00:42.916\n委員好這個ACP這個自主權力法這個在我給你review一下2015年通過的時候那個時候我在做教育那個時候劉建國也在這個王毅民也在那個時候為什麼這個法到最後你每一腳就退上去就是楊逸勳楊逸勳委員\n\n00:46.476 --> 00:53.522\n現在剛才你說他做了幾個人的社會究竟那個時候他跟我講說他說蔣議員蘇委員我楊岳昕隨時會死啦2016年啦他說因為他是肌肉的問題嘛我現在看他每天真的很痛苦\n\n01:09.008 --> 01:19.052\n他常常早上起來就好像無數的針在插他的肉這樣他這樣跟我描述我聽了一聽他說他應該讓他有選擇他要怎麼處理自己聽起來很有理的所以為了\n\n01:27.310 --> 01:54.506\n這案子又遭到大宴會要報告,都遭到報告所以這個法通過之後,好像那個年代是很先進的全世界沒有幾個國家通過這個法案那這個法案2015年通過之後,到2019年你在做立委啊,你在做教委啊,部長你要教教委啊2019年到實施,實施到現在就是慢慢走慢慢走那現在就要大修法\n\n01:55.607 --> 02:20.288\n我是比較保守啦比較保留那簽的人才ACP簽的人才10萬請問是要怎麼做我看不太一樣所以你個人你個人的看法是怎麼樣我是相對保守啦對ACP對我覺得ACP因為所以\n\n02:24.520 --> 02:42.823\n這對蘇貞昌醫師本色,他覺得每天臨床上把病人照顧好,不管他是哪一種疾病尤其施昭維是照顧重症的病人、專家所以我們每天都在做倫理的決策其實給病人都是最適當的一個治療最適當的治療最好的照顧所以我們覺得\n\n02:51.523 --> 03:00.593\n在其他法律方面的層面他到底他的意義何在這個部分我們會有思考我是很敬佩蘇伊斯這個見解\n\n03:03.342 --> 03:19.796\n但是問題在不管是安寧緩和醫療安寧緩和醫療條例最早的時候其實是有一點點因為剛開始安寧在推嘛所以很多醫病的溝通又沒要做CPR這如果有一個補貨是比較好那以前安寧緩和醫療條例詭異喔其實對社會的一個\n\n03:23.579 --> 03:36.894\n社會運動也是幫助很大喔大家有時候我會說三八月大家來簽安寧法律條例DNR簽了旁邊就旁邊像我旁邊剛才找王毅民我都拜了毅民姐你幫我簽見證人\n\n03:39.690 --> 04:06.450\n他就變成見證人了你知道嗎就完成了安寧環的藥所以我覺得社會運動讓台灣的人民更知道關心到這一塊絕對是好事情那後來又有自治病前法案更是把它的範圍擴大所以這是對大家對生命教育其實是有幫助那我們也做一個研究我抱歉講不清楚因為我們做兩次研究當開始的時候\n\n04:08.672 --> 04:34.726\n你要簽ACP,ACP裡面的AD簽好以後到實際上他面臨這個問題的時候,有七成的吻合力也就是說他不願意押胸、不願意插管,大概100%都符合但是在抗生素的使用、在人工輸液的使用哪一個是臨床上比較變化多要看當時的情況,我想你很清楚所以其實有幫忙啦\n\n04:35.886 --> 04:59.273\n所以這個法規怎麼把它修好,我覺得這是一個好的方向因為當時是非常嚴謹,說要有醫師、有社工、婦女人員還有家屬,甚至要有公眾人數,大家都這樣集齊在那裡你現在要把它開放說比較簡單的,當便宜不用,可以住安養院、住婦女之家\n\n05:00.413 --> 05:22.439\n不然那廟也可以那廟的老人家也可以這樣就合意啦因為不夠嚴謹就會覺得改是要很慎重啦執行倡議那我另外一個感覺會覺得說是不是更不夠逃避責任啦你看我們的平均壽命來\n\n05:26.594 --> 05:34.116\n這是我們2023、2024平均壽命,台灣平均人平均壽命到80.3歲而已,80.3,老婆老婆比起來,老婆的83.7,老婆的76、77而已,我看起來是英年早逝\n\n05:48.649 --> 05:50.912\n我現在出席參加個別席,增加了190個,越來越多,在沙坡人都多了70幾個,太少了吧平均起來在80.3,你知道嗎,日本現在是85.5,南米平均\n\n06:07.005 --> 06:17.032\n然後日本的女人香港的女人居然活得比日本還久日本人其實我很欽佩我去日本很多次日本人沒有那麼快死啦因為怎樣咧三善啊又倒丟又撩骨又吃酒那怎麼會死啦\n\n06:25.737 --> 06:32.623\n又愛排隊,又愛看背,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,\n\n06:42.954 --> 06:57.189\n香港的我就覺得很奇怪香港的女人怎麼活一活那麼久我最近在問香港的醫生香港來台灣當醫生的我都請教也研究了一下他們的結論是走路\n\n06:58.670 --> 07:17.670\n走路囉因為香港的地小人潮阿婆摩托車什麼都沒有所以都有走路坐街坐公車所以說走路是強迫走路嘛我們台灣不是啊都騎摩托車大家都騎摩托車買一個菜市場也騎摩托車香港都有走日本也很多都有走日本是有摩托車啦\n\n07:19.171 --> 07:40.338\n所以香港澳門你看都這麼長那新加坡也很長怕死人那台灣是最後一名比韓國還短命所以這個你有那麼急一直要推這個DNR啦ACP啦在2015年楊宇新在這裡靠腰他現在2025年也不會死人\n\n07:43.212 --> 07:54.598\n所以科技的進步會讓我們的壽命是可以解決的癌症的不要怕楊益心我前面有說你不要緊她不會害怕我會跟大家報告的是\n\n08:01.311 --> 08:18.024\n以前沒有辦法醫治的,現在標靶藥什麼什麼生物自治一直出來就可以延長壽命啦所以不要說動不動就要叫人塞DNA動不動,我看那些以前沒人的現在都有人了,像以前來的,溫室的以前來的現在也有做治療很多年了,對不對,普遍那我感覺說,研究院就要升職,所以都一直塞,有這種事情嗎,署長\n\n08:30.563 --> 08:56.891\n沒有我當然你的專業還有間諜你很敬佩但是從我的角度我會覺得所有從事推動安寧政策跟關心安寧政策跟實際上照顧人他們的心都是說當你真的沒辦法已經到末期的時候我怎麼樣讓你有生命品質怎麼樣讓你善終教育報告善終是五輔林門裡面最難達到的\n\n08:58.311 --> 09:22.920\n所以我們一定要面對這個事情過去二十多年義大利的時候他們早上打招呼不是說早安是說你今天想到死亡了沒他們在推行死亡教育就是這樣在推行讓大家有一點準備當然我們希望一五十歲很重視這個但是多到八二歲你現在如果去炒地硬貢你如果說阿公阿嬤十八歲他們都不會打招呼\n\n09:25.001 --> 09:50.762\n大家吃霸凌他們就破壞了所以可能大家期待但是如果你比較面對人生有時候很難講的你如果比較了解的話你也能幫忙你的親戚朋友你酒瓶的人互相都有這個面對死亡的一個怎麼樣做好善終的一個準備這是好事啦這是好事所以我蔣議員他們都要講很多所以你先時間給我一下齁\n\n09:55.206 --> 10:17.961\n什麼要我給他檢部署建議啦你現在很大的一個希望就是說把什麼刀山包海全部都納進來這也我給你欽佩啦但是你們一納進來之後就把那個壓價格壓壓壓壓的很低心臟支架在我那個年代是全部都是智慧放一支支架要五六萬沒有塗藥的喔\n\n10:20.903 --> 10:27.606\n後來健保局跟支付料一支支付一萬五千點點喔不是錢喔\n\n10:31.345 --> 10:56.771\n啊,過來還有塗藥支叫出來,塗藥支叫他付差額那個開急追的那個Cage,那個空啊,也是你們付,還沒付之前智慧是四五萬塊你們付的時候也是一萬多點,一萬多點齁那現在像剛剛陳昭之講的那種靈交,那個開心臟外科是以前都是智慧嘛,啊你現在給他支付之後,付一個萬多點\n\n10:58.803 --> 11:20.242\n亂說也好,是不夠,有這樣的退出所以有時候你要包山包海的時候這次川普政府來跟我們要求其中一點就是他要讓我們開放一個智慧的平台新藥、新科技、新耗材,想付的人也付得起的人他們有一個空間\n\n11:22.792 --> 11:40.504\n這樣我覺得這樣是對的啦你每一樣都把它壓來健保幾戶標靶藥拿來幾戶很多藥廠受不了那都不賣台灣了嘛那也是我們的損失嘛對不對很多藥我可以唸出來喔沒有時間了齁我都是這樣退出台灣的市場所以\n\n11:41.724 --> 12:07.236\n裡面是照顧普羅大眾這是要欽佩的但是有一些還是開放一點點讓他們有一個這次關稅談就會談到這個所以署長你的行情我很欽佩你的做法我也很認同但是如果什麼空間再來就是要和解的時候你每天都用乳品也是要考慮署長你講一下\n\n12:11.251 --> 12:33.285\n謝謝委員的指教啦確實啦很多東西是有人想納入健保有人不想納入健保所以同一個產品也都有不同的意見癌藥也是如此醫茶也是如此所以健保呢秉持的就是第一個齁那麼急重難症要先照顧啦不要讓這個病人在危急的時候還要再考慮荷包的問題啦\n\n12:34.085 --> 12:59.181\n所以第一個我們的態度就是這樣所以像這個凝膠我們也不是全面擠附我們也是主要挑這個主動脈玻璃這種非常緊急這個委員也清楚那個這是TypeA從這個主動脈根部撕裂的這一種那麼它的縫合後的這個凝膠使用所以適用對象大概就是1400多位所以其餘的我們也是還在留在自費市場\n\n12:59.941 --> 13:20.794\n我們就是讓這個危及生命的時候能夠得到健保的給付所以我們考量上第一個一定先從集中南海優先那行有餘力我們的預算夠大家這個健保費繳的夠那我們再逐步的擴大所以這個我們都有這個倫理的考量也有這個疾病需求的考量這些都會一起\n\n13:21.574 --> 13:37.443\n我們國家的先進指標,就GDP國民收入,再來就是平均壽命,再來是癌症死亡年齡死亡率,再來公共衛生等等,這都是指標,平均壽命這樣還不夠長,在阿姨家還剩下了\n\n13:40.425 --> 14:07.644\n所以很需要努力的空間啦所以這個法是我們起頭的現在要修改我是相對保留啦跟部長講我的立場好不好好首先我要報告一下平均寿命或者健康的平均移民是我們現在目前國家的政策重要的所以會來努力這不會在困難裡的啦這大家共同努力啦好謝謝\n\n","segments":[{"start":3.328,"end":4.731,"text":"謝謝,謝謝劉召偉的禮讓,我先講還有秦部長,還有那個石署長"},{"start":16.98,"end":42.916,"text":"委員好這個ACP這個自主權力法這個在我給你review一下2015年通過的時候那個時候我在做教育那個時候劉建國也在這個王毅民也在那個時候為什麼這個法到最後你每一腳就退上去就是楊逸勳楊逸勳委員"},{"start":46.476,"end":53.522,"text":"現在剛才你說他做了幾個人的社會究竟那個時候他跟我講說他說 蔣議員 蘇委員 我楊岳昕隨時會死啦2016年啦 他說因為他是肌肉的問題嘛我現在看他每天真的很痛苦"},{"start":69.008,"end":79.052,"text":"他常常早上起來就好像無數的針在插他的肉這樣他這樣跟我描述我聽了一聽他說他應該讓他有選擇他要怎麼處理自己聽起來很有理的所以為了"},{"start":87.31,"end":114.506,"text":"這案子又遭到大宴會要報告,都遭到報告所以這個法通過之後,好像那個年代是很先進的全世界沒有幾個國家通過這個法案那這個法案2015年通過之後,到2019年你在做立委啊,你在做教委啊,部長你要教教委啊2019年到實施,實施到現在就是慢慢走慢慢走那現在就要大修法"},{"start":115.607,"end":140.288,"text":"我是比較保守啦 比較保留那簽的人才ACP 簽的人才10萬請問是要怎麼做 我看不太一樣所以你個人 你個人的看法是怎麼樣我是相對保守啦對 ACP對 我覺得ACP因為 所以"},{"start":144.52,"end":162.823,"text":"這對蘇貞昌醫師本色,他覺得每天臨床上把病人照顧好,不管他是哪一種疾病尤其施昭維是照顧重症的病人、專家所以我們每天都在做倫理的決策其實給病人都是最適當的一個治療最適當的治療最好的照顧所以我們覺得"},{"start":171.523,"end":180.593,"text":"在其他法律方面的層面他到底他的意義何在這個部分我們會有思考我是很敬佩蘇伊斯這個見解"},{"start":183.342,"end":199.796,"text":"但是問題在不管是安寧緩和醫療安寧緩和醫療條例最早的時候其實是有一點點因為剛開始安寧在推嘛所以很多醫病的溝通又沒要做CPR這如果有一個補貨是比較好那以前安寧緩和醫療條例詭異喔其實對社會的一個"},{"start":203.579,"end":216.894,"text":"社會運動也是幫助很大喔大家有時候我會說三八月大家來簽安寧法律條例DNR簽了 旁邊就旁邊像我旁邊剛才找王毅民我都拜了 毅民姐你幫我簽見證人"},{"start":219.69,"end":246.45,"text":"他就變成見證人了你知道嗎就完成了安寧環的藥所以我覺得社會運動讓台灣的人民更知道關心到這一塊絕對是好事情那後來又有自治病前法案更是把它的範圍擴大所以這是對大家對生命教育其實是有幫助那我們也做一個研究我抱歉講不清楚因為我們做兩次研究當開始的時候"},{"start":248.672,"end":274.726,"text":"你要簽ACP,ACP裡面的AD簽好以後到實際上他面臨這個問題的時候,有七成的吻合力也就是說他不願意押胸、不願意插管,大概100%都符合但是在抗生素的使用、在人工輸液的使用哪一個是臨床上比較變化多要看當時的情況,我想你很清楚所以其實有幫忙啦"},{"start":275.886,"end":299.273,"text":"所以這個法規怎麼把它修好,我覺得這是一個好的方向因為當時是非常嚴謹,說要有醫師、有社工、婦女人員還有家屬,甚至要有公眾人數,大家都這樣集齊在那裡你現在要把它開放說比較簡單的,當便宜不用,可以住安養院、住婦女之家"},{"start":300.413,"end":322.439,"text":"不然那廟也可以 那廟的老人家也可以這樣就合意啦 因為不夠嚴謹就會覺得改是要很慎重啦 執行倡議那我另外一個感覺會覺得說是不是更不夠逃避責任啦你看我們的平均壽命 來"},{"start":326.594,"end":334.116,"text":"這是我們2023、2024平均壽命,台灣平均人平均壽命到80.3歲而已,80.3,老婆老婆比起來,老婆的83.7,老婆的76、77而已,我看起來是英年早逝"},{"start":348.649,"end":350.912,"text":"我現在出席參加個別席,增加了190個,越來越多,在沙坡人都多了70幾個,太少了吧平均起來在80.3,你知道嗎,日本現在是85.5,南米平均"},{"start":367.005,"end":377.032,"text":"然後日本的女人 香港的女人居然活得比日本還久日本人其實我很欽佩 我去日本很多次日本人沒有那麼快死啦因為怎樣咧 三善啊 又倒丟 又撩骨 又吃酒 那怎麼會死啦"},{"start":385.737,"end":392.623,"text":"又愛排隊,又愛看背,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,又愛吃健康食品,"},{"start":402.954,"end":417.189,"text":"香港的我就覺得很奇怪香港的女人怎麼活一活那麼久我最近在問香港的醫生香港來台灣當醫生的我都請教也研究了一下他們的結論是走路"},{"start":418.67,"end":437.67,"text":"走路囉 因為香港的地小人潮 阿婆 摩托車 什麼都沒有所以都有走路 坐街 坐公車所以說走路是強迫走路嘛我們台灣不是啊 都騎摩托車 大家都騎摩托車買一個菜市場也騎摩托車 香港都有走日本也很多都有走 日本是有摩托車啦"},{"start":439.171,"end":460.338,"text":"所以香港 澳門 你看都這麼長那新加坡也很長 怕死人那台灣是最後一名 比韓國還短命所以這個你有那麼急 一直要推這個DNR啦 ACP啦在2015年 楊宇新在這裡靠腰他現在2025年也不會死人"},{"start":463.212,"end":474.598,"text":"所以科技的進步會讓我們的壽命是可以解決的癌症的不要怕 楊益心我前面有說你不要緊 她不會害怕我會跟大家報告的是"},{"start":481.311,"end":498.024,"text":"以前沒有辦法醫治的,現在標靶藥什麼什麼生物自治一直出來就可以延長壽命啦所以不要說動不動就要叫人塞DNA動不動,我看那些以前沒人的現在都有人了,像以前來的,溫室的以前來的現在也有做治療很多年了,對不對,普遍那我感覺說,研究院就要升職,所以都一直塞,有這種事情嗎,署長"},{"start":510.563,"end":536.891,"text":"沒有 我當然你的專業還有間諜你很敬佩但是從我的角度我會覺得所有從事推動安寧政策跟關心安寧政策跟實際上照顧人他們的心都是說當你真的沒辦法已經到末期的時候我怎麼樣讓你有生命品質怎麼樣讓你善終教育報告善終是五輔林門裡面最難達到的"},{"start":538.311,"end":562.92,"text":"所以我們一定要面對這個事情過去二十多年義大利的時候他們早上打招呼不是說早安是說你今天想到死亡了沒他們在推行死亡教育就是這樣在推行讓大家有一點準備當然我們希望一五十歲很重視這個但是多到八二歲你現在如果去炒地硬貢你如果說阿公阿嬤十八歲他們都不會打招呼"},{"start":565.001,"end":590.762,"text":"大家吃霸凌他們就破壞了所以可能大家期待但是如果你比較面對人生有時候很難講的你如果比較了解的話你也能幫忙你的親戚朋友你酒瓶的人互相都有這個面對死亡的一個怎麼樣做好善終的一個準備這是好事啦這是好事所以我蔣議員他們都要講很多所以你先時間給我一下齁"},{"start":595.206,"end":617.961,"text":"什麼要我給他檢部署建議啦你現在很大的一個希望就是說把什麼刀山包海全部都納進來這也我給你欽佩啦但是你們一納進來之後就把那個壓價格壓壓壓壓的很低心臟支架在我那個年代是全部都是智慧放一支支架要五六萬沒有塗藥的喔"},{"start":620.903,"end":627.606,"text":"後來健保局跟支付料一支支付一萬五千點點喔不是錢喔"},{"start":631.345,"end":656.771,"text":"啊,過來還有塗藥支叫出來,塗藥支叫他付差額那個開急追的那個Cage,那個空啊,也是你們付,還沒付之前智慧是四五萬塊你們付的時候也是一萬多點,一萬多點齁那現在像剛剛陳昭之講的那種靈交,那個開心臟外科是以前都是智慧嘛,啊你現在給他支付之後,付一個萬多點"},{"start":658.803,"end":680.242,"text":"亂說也好,是不夠,有這樣的退出所以有時候你要包山包海的時候這次川普政府來跟我們要求其中一點就是他要讓我們開放一個智慧的平台新藥、新科技、新耗材,想付的人也付得起的人他們有一個空間"},{"start":682.792,"end":700.504,"text":"這樣我覺得這樣是對的啦你每一樣都把它壓來健保幾戶標靶藥拿來幾戶很多藥廠受不了那都不賣台灣了嘛那也是我們的損失嘛對不對很多藥我可以唸出來喔沒有時間了齁我都是這樣退出台灣的市場所以"},{"start":701.724,"end":727.236,"text":"裡面是照顧普羅大眾這是要欽佩的但是有一些還是開放一點點讓他們有一個這次關稅談就會談到這個所以署長你的行情我很欽佩你的做法我也很認同但是如果什麼空間再來就是要和解的時候你每天都用乳品也是要考慮署長你講一下"},{"start":731.251,"end":753.285,"text":"謝謝委員的指教啦 確實啦 很多東西是有人想納入健保 有人不想納入健保所以同一個產品也都有不同的意見 癌藥也是如此 醫茶也是如此所以健保呢秉持的就是第一個齁 那麼急重難症要先照顧啦不要讓這個病人在危急的時候還要再考慮荷包的問題啦"},{"start":754.085,"end":779.181,"text":"所以第一個我們的態度就是這樣所以像這個凝膠我們也不是全面擠附我們也是主要挑這個主動脈玻璃這種非常緊急這個委員也清楚那個這是Type A從這個主動脈根部撕裂的這一種那麼它的縫合後的這個凝膠使用所以適用對象大概就是1400多位所以其餘的我們也是還在留在自費市場"},{"start":779.941,"end":800.794,"text":"我們就是讓這個危及生命的時候能夠得到健保的給付所以我們考量上第一個一定先從集中南海優先那行有餘力我們的預算夠大家這個健保費繳的夠那我們再逐步的擴大所以這個我們都有這個倫理的考量也有這個疾病需求的考量這些都會一起"},{"start":801.574,"end":817.443,"text":"我們國家的先進指標,就GDP國民收入,再來就是平均壽命,再來是癌症死亡年齡死亡率,再來公共衛生等等,這都是指標,平均壽命這樣還不夠長,在阿姨家還剩下了"},{"start":820.425,"end":847.644,"text":"所以很需要努力的空間啦所以這個法是我們起頭的現在要修改我是相對保留啦跟部長講我的立場好不好好 首先我要報告一下平均寿命或者健康的平均移民是我們現在目前國家的政策重要的所以會來努力這不會在困難裡的啦這大家共同努力啦好 謝謝"}]}}},"gazette":{"lineno":212,"blocks":[["蘇委員清泉：（9時46分）謝謝劉召委的禮讓，讓我先發言。請部長還有石署長。"],["主席：請部長、署長。"],["邱部長泰源：委員好。"],["蘇委員清泉：部長，ACP自主權利法我跟你review一下啦，2015年通過的時候我在當召委，那個時候劉建國也在，王育敏也在，那個時候為什麼這部法到最後會臨門一腳就推上去？就是楊玉欣委員，剛才你說他現在是基隆市社會處處長嘛。"],["邱部長泰源：對，社會處。"],["蘇委員清泉：那個時候他跟我說：蘇召委，我楊玉欣隨時會死。2015年他說是因為肌肉萎縮的問題。我看他每天真的很痛苦，他說他早上起來就好像有無數的針在刺他的肉，他這樣跟我描述，我聽到覺得……他說應該要讓他有選擇要怎麼處理他自己，聽起來很有道理，所以後來這個案子又跑到院會報告。病人自主權利法通過之後，在那個年代好像是很先進的，全世界沒有幾個國家通過這個法案。那這個法案2015年通過之後到2019年，部長，你在當召委了，自2019年實施到現在就是這樣慢慢推行。現在說要大修法，我是比較保守，持保留態度，有簽ACP的才10萬人，簽那麼多是要做什麼？我看法不太一樣，所以你個人的看法是怎麼樣？我是相對保守。"],["邱部長泰源：你說對ACP？"],["蘇委員清泉：對。"],["邱部長泰源：我覺得ACP，這就是蘇召委的醫師本色，他覺得每天在臨床上把病人照顧好，不管他是哪一種疾病，尤其蘇召委是照顧重症病人的專家，所以我們每天都已經在做倫理的決策，其實給病人的都是最適當的治療、最好的照顧，所以我們會覺得在其他法律的層面，到底它的意義何在？所以這個部分我們會去思考。我很敬佩蘇醫師有這個見解，但是問題在安寧緩和醫療條例最早推行的時候，因為剛開始在推安寧，所以醫病需要很多溝通，又沒有要做CPR的情況，如果有一個保護是比較好，而且安寧緩和醫療條例過了以後，其實對社會運動也是幫助很大。有時候在演講現場有300個，大家來簽安寧緩和醫療條例，DNR簽下去，像我旁邊剛好坐王育敏委員，育敏姐，你幫我簽見證人，他就變成見證人了，就完成了安寧緩和醫療的簽署，所以我覺得這個社會運動，讓臺灣人民更關心到這一塊，絕對是好事情。後來又有病人自主權利法案更是把它的範圍擴大，這對生命教育其實有幫助。不好意思說明一下，我們做過兩次的研究，剛開始的時候，如果ACP裡面的AD簽好以後，跟他們實際上面臨問題的時候有七成的吻合力，也就是說他不願意壓胸、不願意插管，大概100%都符合，但是在抗生素的使用、在人工輸液的使用，在臨床上變化就比較多，要看當時的情況，我想你很清楚，其實是有幫忙的，所以病人自主權利法要怎麼修得更好，我覺得這是一個好的方向。"],["蘇委員清泉：因為當時非常嚴謹，所以要有醫師、社工、護理人員，還有家屬，甚至要有公正人士，大家都要集合在那裡。現在要開放比較簡單點，可以不用在醫院，可以在安養院、在護理之家，不然在廟裡也可以、在老人會也可以？因為不夠嚴謹就會覺得……要改執行場域要很慎重；我另外一個感覺會覺得是不是健保局在逃避責任？你看我國的平均壽命，臺灣2023年、2024年的平均壽命到80.3歲而已，如果男女比，女的83.7歲；男的76、77歲而已，這76、77歲我看來叫英年早逝。我現在參加告別式，鄉下八、九十歲的越來越多，男人活到七十幾歲這壽命太少了吧！平均壽命才80.3歲，你知道日本現在是85.5歲，男女平均喔！香港的女人居然活得比日本還久。我很欽佩日本人，我去日本很多次，日本人沒這麼早死，因為瘦瘦的、又矮矮的、又駝背、又吃少，這樣哪會死啦！還要排隊看病、還要吃藥、還要吃健康食品，每天都吃味噌湯、吃發酵的納豆、臭酸豆子什麼都吃，所以那種國家能活到100歲也沒什麼稀罕啦！","香港我就覺得很奇怪，香港的女人怎麼可以活這麼久？像我最近在問香港的醫生，從香港來臺灣當醫生的，我都請教並研究一下，他們的結論是走路，他說香港地小人稠，沒有摩托車、什麼都沒有，所以他們走路去搭捷運、搭公車，所以他說香港是強迫走路，但是臺灣不是，大家都騎摩托車，去菜市場也騎摩托車，香港都用走的，日本也有很多人用走的、也有騎摩托車的，所以香港、澳門，你看壽命都這麼長，新加坡也很長，嚇死人。臺灣是最後一名，比韓國還短命，所以你那麼急著一直要推DNR、ACP，2015年楊玉欣在這裡「哭枵」，現在2025年他也還沒死，他還活著啊！所以代表什麼？科技的進步讓我們的壽命是可以延長的，一些癌症的、標靶的……楊玉欣，我跟他很好，我這樣說他沒關系，他不會罵我啦！我要跟大家報告，以前沒有辦法醫治的，現在標靶藥、什麼生物製劑一直出來，就可以延長壽命啦！所以不要動不動就叫人家sign DNR，我覺得以前沒有機會的，現在都有機會了。就像胰臟癌以前必死無疑，現在做治療也可以活很多年，對不對？部長，我就覺得健保局是為了要省錢，所以都一直推廣，有這個事情嗎？署長。"],["邱部長泰源：沒有，當然你的專業還有見解，令人敬佩。但是從我的角度，我會覺得所有從事推動安寧政策、關心安寧政策，跟實際照顧者，他們的心情就是當病人真的沒辦法，已經到末期的時候，要怎麼樣讓他的生命有品質、怎麼樣讓他善終。跟召委報告，善終是五福臨門裡面最難達到的，所以我們一定要面對這個事情。過去20年前在義大利，他們早上打招呼不是說早安，是說你今天想到死亡了沒，他們在推行死亡教育就是這樣在推行，讓大家有一點準備。當然我們也希望50歲很重視善終，但是可以活到120歲，你現在如果去鄉下演講，你如果說阿公阿嬤活到百歲，他們都不會拍手，但如果說活到120歲，他們就拍手了。"],["蘇委員清泉：對！"],["邱部長泰源：大家可能期待長壽，如果早點面對，人生有時候也很難說，如果了解的話，也可以幫忙親戚朋友、周邊的人，互相都有面對死亡、做好善終的準備，這是好事情啦！"],["蘇委員清泉：最後我要建議健保署，你現在最大的希望，就是包山包海全部都納進來，我也欽佩你啦！但是你們納進來之後就把價格壓得很低。心臟支架在我那個年代全部都是自費，放一支支架要5、6萬，沒有塗藥的喔！後來健保局給付之後，一支支架付1萬5,000點，是點數不是錢喔！後來才有塗藥的支架出來，塗藥支架才付差額；開脊椎的cage也是你們付，還沒付之前自費是4、5萬塊，你們付了之後也是一萬多點；現在像剛剛陳昭姿講的凝膠，開心臟外科手術凝膠以前都是自費，現在給付一萬多點，一萬多塊也好，是不夠的，藥廠就會退出。所以你要包山包海的時候，這次川普政府跟我們要求，其中一點就是他要讓我們開放一個智慧的平台，新藥、新科技、新耗材，要讓想付的也付得起的人有一個空間，我覺得這樣是對的啦！你每一樣都把它押來健保給付，標靶藥拿來給付，很多藥廠受不了都不賣臺灣也是我們的損失，很多藥我可以念出來但是沒有時間，都是這樣退出臺灣的市場。你們是照顧普羅大眾，這是讓人欽佩的，但是有一些還是要開放一點點，這次關稅就會談到這個。署長的胸襟我很欽佩，你的做法我也很認同，但是要留一點空間。再來就是藥在核價的時候，你每一樣都用grouping也是要考慮。署長，你說一下。"],["石署長崇良：謝謝委員的指教，確實很多東西有人想納入健保，有人不想納入健保，同一個產品也都有不同的意見，藥是如此，醫材也是如此，所以健保秉持的第一個就是急重難症要先照顧，不要讓病人在危急的時候還要考慮荷包的問題，第一個我們的態度就是這樣。像凝膠也不是全面給付，也是主要挑主動脈剝離這種非常緊急的，委員也清楚這是Type A從主動脈根部撕裂縫合後的凝膠使用，所以適用對象大概就是一千四百多位，其餘的還是留在自費市場，我們就是讓危及生命的時候能夠得到健保的給付，所以我們考量上第一個一定先從急重難罕優先，行有餘力，我們的預算夠、大家健保費繳得夠，再逐步擴大，都有倫理的考量也有疾病需求的考量，這些都會一起思考。"],["蘇委員清泉：我們國家的先進指標是GDP國民收入，再來是平均壽命，再來是癌症的年齡、死亡率，再來公共衛生等等這些都是指標，我們的平均壽命這樣還不夠長，在亞洲還算倒數，所以還有很多要努力的空間，這個法是我們起頭的，現在要修改我是相對保留，跟部長說我的立場，好不好？"],["邱部長泰源：好，蘇召委，我要報告一下，平均壽命或者健康的平均餘命是目前國家政策重點，我也會來努力。"],["蘇委員清泉：這不分藍綠，大家共同努力。"],["邱部長泰源：一起來努力。"],["蘇委員清泉：好，謝謝。"],["邱部長泰源：謝謝。"],["主席：我是要提醒蘇召委，醫界多數都支持ACP這個服務的量能要擴大，也希望從經濟面考量健保署、衛福部要來支持，這個是你們醫界大家應該有的共識，都有發聲明稿。第二，你講現在醫療很進步沒有錯，但是我們在公告第五款寫得非常清楚，楊委員是主提案，我也是提案人還有王委員，你也是，當時規定其他經中央主管機關公告之病人疾病狀況或痛苦難以忍受、疾病無法治癒且依當時醫療水準無其他合適解決方法之情形，所以要比餘命是要比健康餘命，如果在比不健康餘命就不用比了啊！人到最後要善終是要好走，不要難走，不要躺在那邊用無效醫療一直顧，顧到反而讓健保負擔一直提高，今天訂這個法的目是在這個地方，你很清楚啊！但是我剛才聽你說……好了，這樣就好，不要再說了，不好意思。","請邱鎮軍委員詢答，謝謝。"]],"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"}}}