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\"end\": 1761.767, \"score\": 0.997}, {\"word\": \"想\", \"start\": 1761.767, \"end\": 1761.988, \"score\": 0.917}, {\"word\": \"性\", \"start\": 1761.988, \"end\": 1762.548, \"score\": 0.994}, {\"word\": \"不\", \"start\": 1762.548, \"end\": 1762.728, \"score\": 1.0}, {\"word\": \"存\", \"start\": 1762.728, \"end\": 1763.048, \"score\": 0.998}, {\"word\": \"在\", \"start\": 1763.048, \"end\": 1763.329, \"score\": 0.984}, {\"word\": \"啦\", \"start\": 1763.329, \"end\": 1763.349, \"score\": 0.086}], \"language\": \"zh\"}","srt":"1\n00:00:00,389 --> 00:00:01,050\n好謝謝主席是不是要請邱部長請部長委員好\n\n2\n00:00:18,872 --> 00:00:38,777\n部長今年正式邁入這個超高齡社會五個就有一個是65歲以上所以這個活得久已經大概不是很大的問題但是要活得好那活得好的話其實也難免生老病死所以其實不要講到說65歲以上的人包括我自己我跟我朋友之間在談的我們都講說害怕生不如死我自己見證過我自己兩個\n\n3\n00:00:48,901 --> 00:01:03,932\n父母他們都是中風的然後躺在醫院的很久的那在這種狀況裡面我也面臨過很多的情境所以都求善終並不是只有年紀大的人在想對我來講我就是\n\n4\n00:01:05,353 --> 00:01:09,316\n我甚至講跟朋友之間開玩笑就是說我75歲我大概自己如果沒有安樂死的這個法律的話我要自己去自殺那我告訴我的孩子說我是自主的而且是我很開心的我願意這麼做的那希望他們不要情緒不好所以我經常跟我兒子講說當我死亡的時候\n\n5\n00:01:28,347 --> 00:01:45,798\n你要給我還保障不要給我綁水牢我的意思是說我不要水障我在講的是生和死的溝通我經常告訴我的孩子我怎麼想免得到那一天的時候他不知道母親怎麼想那在這種狀況裡面今天的修法我必須要講說有的人希望說放寬ACP的經費啦ACP的執行場域去委託代理人的資格放寬等等\n\n6\n00:01:57,586 --> 00:02:26,769\n那大家講都講說這個簽署率只有0.45只有10.3萬人我還要你看到一個數字這個數字不是只有10.3萬人0.45的簽署率而是如果我問你已經簽署的到最後真的有去執行的比率有多高已經簽署的真正去落實這個簽署的人的意志那真正執行有多高呢\n\n7\n00:02:27,506 --> 00:02:37,732\n好這個我想意思是有研究不過我先跟委員做初步的報告那因為時間相當的短嘛2019到現在大概有70%有這麼高嗎到最後真正執行率吻合率吻合率那個是你們推估的\n\n8\n00:02:51,160 --> 00:02:55,222\n其實有人是認為說但是這是推估的其實大家都不認為說執行率很高所以顯然不是只有簽署的人數的問題而且就是說即便簽署了到最後的執行率為什麼沒有辦法執行\n\n9\n00:03:12,009 --> 00:03:34,615\n所以大家都想要尊嚴的善終要拒絕無效的醫療可是當走到那一步譬如說我的母親她在做DNR的時候我們都知道可是到那一刻要我們決定我理性上都知道該怎麼做我們全家人都知道該怎麼做可是到那一刻來的時候我們做不下去做不下去\n\n10\n00:03:37,495 --> 00:03:51,672\n然後就這樣又拖一拖到什麼時候才大家說放棄了吧因為覺得他這樣子下去拖下去太痛苦了所以我們才說那我們放棄吧所以我是要告訴你說從這個\n\n11\n00:03:55,736 --> 00:04:18,981\n衛生政策來檢驗這個病主法當然是還有在討論的這個空間但是並不是只有簽署率多高還包括執行上的障礙是什麼而這個東西是透過這一個法律就可以解決的嗎我想答案是否定的他不是只有一個病主法就足夠的所以\n\n12\n00:04:22,610 --> 00:04:45,442\n這種善終的概念喔老實說簽署率不高的原因還有一個啦大家對於病主法的想像跟他所想像的他以為這是一個善終的安樂死的概念的其實是不是的根本不是的當你真正去了解的時候發現不是的時候\n\n13\n00:04:46,793 --> 00:04:52,599\n那跟DNR差沒有很大的時候我認為DNR的簽署率很高啦到那一刻DNR的簽署率都很高\n\n14\n00:04:59,254 --> 00:05:20,083\n但DNR離這個病毒法的這個簽署那個內容並不是差異太大了老實說那我們講說這個無效醫療要善終但是監察院在2011年他其實有\n\n15\n00:05:21,864 --> 00:05:32,074\n這個讓無效醫療和臨終關懷扶上檯面那他指出臨床上界定治療無效或者是何時讓安寧緩和和醫療接手都沒有辦法明確定義那具體而言\n\n16\n00:05:38,059 --> 00:05:53,885\n國家透過法律保障和約束專業但醫療行為屬專業自主其內涵仰賴專業自律和主管機關的含釋所以在這種狀況裡面我們都看到專業的醫生的意見跟這個\n\n17\n00:05:56,306 --> 00:06:24,760\n社會大眾的期待的所謂的比較好的善終的這個手段其實落差還是很大所以這種情境善終的臨床的情境雖然不是專科所能擅自去做詮釋的但是如果謹守專業自主讓政策去導引而不是不當的介入原本在醫病之間互相理解和治療狀態下的照護喔這個一直都是修法的困境\n\n18\n00:06:26,072 --> 00:06:51,194\n那這個我要講這個是因為有一個月旦醫學法報告有一篇文章叫做圖法不足以自行圖法不足以自行這個病人自主權利法的反思善終政策不曉得師長或是部長有沒有看過這個郭文華教授的這一篇文章我們華麗專家有\n\n19\n00:06:54,787 --> 00:06:57,908\n病主法的困局其原因固然有民眾的誤解和醫界的被動但是不可諱言的有來自病主法的理想性\n\n20\n00:07:12,452 --> 00:07:35,100\n生命自主需要保障照護需要父權但是一般人並不容易理解這樣的一個抽象的概念更不要說在徹底了解後做的治療的選擇但我要講說其實他講的我部分上也認同但部分上不一定認同我覺得剛好相反很多人是相對的了解他對生命的價值和意義而想要選擇一種\n\n21\n00:07:36,300 --> 00:07:52,527\n善終的方式但是偏偏他所期待的是在病毒法這部法律裡面不能給的給不了的那從衛生的角度以外呢我們這個看到郭文華教授他要指出幾個盲點第一宣導跟現實的落差\n\n22\n00:07:57,469 --> 00:08:24,630\n如果在這個被認為創造病患可以無痛苦讓醫師減少臨床壓力然後大家說這樣去創造健保資源不浪費因為無效醫療就是浪費嘛大家會覺得這樣可是呢這樣的狀況沒有釐清政策效果的優先順序或者是為什麼要病人以自主之名去啟動要一般人立即理解善終主動尋求理解AD跟簽署\n\n23\n00:08:25,370 --> 00:08:47,532\n似乎誠意過高第二個諮商的門檻他們覺得ACP的法律程序諮商的行為受到法律的規範AD就是法律文件在沒有相關素養教育的配套下具有法律性質的醫療諮商扛起公民教育的責任可行性他們也覺得有疑慮\n\n24\n00:08:48,473 --> 00:08:55,238\n本來諮商是專業的本來諮商是沒有法律的責任的可是現在是必須透過諮商這個過程來建立法律的責任然後才能去簽AD那麼這個諮商的過程大家去都可能是速成法速成法可是大家對這個概念是要先有\n\n25\n00:09:08,187 --> 00:09:22,803\n這個公民教育的你對於這個生死的素養才能具備說你要去諮商然後你要去簽署這個文件可是如果沒有公民的素養沒有這個教育生死的教育然後直接就叫說我上一個諮商一下然後就簽了\n\n26\n00:09:24,564 --> 00:09:50,032\n這個可能在大家可行性上有疑慮然後呢在楊秀怡在期刊台灣公共衛生雜誌2020年6月的文章講到住院的病患家屬對病人自主權立法的認知態度及日歷醫療決定的行為意向他指出90%以上受訪者願意進行ACP的諮商卻\n\n27\n00:09:51,992 --> 00:10:06,380\n這個很重要我現在要告訴你們這個東西我要講楊秀宇的這篇文章很重要他做了研究他在醫院然後去做調查這個都是住院的病患的家屬了\n\n28\n00:10:08,877 --> 00:10:28,616\n90%以上去進行他們都願意這個預歷醫療照護諮商當他們都願意了以後進一階進階到要簽AD了就是要預歷醫療決定了他從90%以上的接受度瞬間減半掉為51.25%\n\n29\n00:10:33,662 --> 00:10:44,114\n並不是沒有接受諮商他去接受諮商了然後到要簽的時候剩下51.25%然後楊繡宇認為說這個是很有意義的發現為什麼為什麼這個是你們主導的政策為什麼你可以告訴我嗎保定你知道嗎市長你知道嗎\n\n30\n00:10:56,857 --> 00:11:18,230\n其實這一段的落差其實就變成是說我覺得是在簽署自己的名字那個必須是一個commitment這件事情其實產生了因為我們其實有做過其他相關的研究其實也都是在具名要簽下去這件事情的時候在整個過程當中產生了一個質疑所以在願意\n\n31\n00:11:19,130 --> 00:11:39,875\n智商完之後真的要簽下去其實還有周圍家屬一些因素影響其實實際上面的簽署率在一些相關的研究我忘記是不是楊老師的研究其實都有一些學者提出來所以我要講說簽署率不要成為你們的KPI不要把病毒法的KPI定為簽署率\n\n32\n00:11:41,324 --> 00:11:54,013\n楊秀瑜說他這個跟國際許多的研究觀察都是相符合的就是許多人並不排斥思考死亡和臨終善終的醫療照護的問題\n\n33\n00:11:56,454 --> 00:12:11,297\n但是真正要簽署的時候可能會考慮很多有時候是不願意和家人討論或行諸於文字或者是像是類似一種法律契約何以如此何以如此市長何以如此我們看到這個現象了但為什麼呢為什麼呢因為我們要討論修法要讓這個法律更進階來討論它的問題發生在哪裡但何以如此啊\n\n34\n00:12:26,082 --> 00:12:41,072\n所以陳慧覺得是說今天在討論所謂的病毒這件事情我們一直覺得是說需要做的事情在民眾死亡勢能這個部分其實我們需要去提市長你講了你都沒有看其實非常重要的一個原因就是\n\n35\n00:12:44,695 --> 00:13:04,189\n因為此時此地和當時當地不同啦選擇生命末期的醫療是非常艱難的選擇不管事前有再多的準備預備但是到了醫療現場在生死關頭還是有很多的猶豫反覆捨不得如果\n\n36\n00:13:05,049 --> 00:13:16,143\n大家都在那裡天人交戰包括我自己就曾經經歷過我都知道我也準備了我也認為什麼是最好的可是當時到此時不一樣\n\n37\n00:13:22,270 --> 00:13:37,687\n所以這篇調查是受訪者都是家人目前都是在家戶病房的家屬對醫療現場都有第一手的經驗更能了解做決定的艱難\n\n38\n00:13:39,309 --> 00:13:50,293\n而且他們對ACP都持開放的態度卻只有一半願意簽署AD這個你們一定要記住第三也就是最關鍵的政策成效的評估大家覺得說\n\n39\n00:13:55,295 --> 00:14:20,216\n這個評估是不是要有研擬運作的模式設立了示範的中心追蹤AD的簽署來作為政策的里程碑但這個做法看起來沒問題但實務上的障礙是民眾真的不容易理解病毒法和安寧條例為何並存宣導團隊也重疊然後相對ACP跟AD的簽署率的低我剛剛講過DNR大家\n\n40\n00:14:23,198 --> 00:14:30,491\n都是簽署率非常非常的高的你只要給他簽欸病危了然後拒絕心胃復甦或衛生醫療大家都簽啦十個有高的都有簽啦\n\n41\n00:14:34,938 --> 00:15:03,471\n所以在這種狀況裡面其實這些議題我們都希望說在你的政策有效性的評估並不要用那種方法那現在講說持續的問題是要推動生死素養的教育和政策要回到臨終狀況現場以更周全的方式去評估成果部長你認為有哪些方法還可以再改善\n\n42\n00:15:04,452 --> 00:15:15,053\n這種評估的效果不要一味的以AD的簽署數為評估的指標嘛其實那個委員主持的重點\n\n43\n00:15:16,531 --> 00:15:37,399\n其實你在簽AD到最後在面臨實際上那個時候的時候是非常困難的當然你前面早一點我再講還有什麼指標你就回答我就好了指標委員的意思是臨床現狀嗎就是說到底這種這種病人自主無效醫療然後這什麼樣的狀況認為是你們醫療政策推動的比較好的指標的觀察什麼東西好那個請問一下\n\n44\n00:15:45,900 --> 00:16:10,598\n這邊的話就臨床部分的話我們會希望是說其實是要一起看什麼意思就是說在推動所謂的剛剛委員特別有垂詢是說如果只單就一個AD的簽署率其實是應該把DNR跟安寧的這邊其實是一起看這是第一件事第二件事情就是一些量性指標的部分的話我們可以在六個月內如果有使用就是\n\n45\n00:16:11,618 --> 00:16:36,963\n因為當你的終點越清楚的時候其實一些醫療介入的措施我們是希望他能夠有這樣的概念不管我的進入的路徑是從病毒法或者是從安寧緩和條例六個月內沒有有使用像這樣子安寧照護的服務的比例能夠增加這是我們希望未來你們的安寧病床都是你們沒有滿床嗎照你們剛才的想法沒有滿床但是其實我曾經被拜託是排不到床的\n\n46\n00:16:38,039 --> 00:16:58,048\n他其實是有我曾經被拜託就說想要進去安寧病房都派不進去我要講的是說其實目前我們希望推動的在特別是在高齡少子社會裡面其實怎麼樣回到社區所以安寧共照然後居家安寧跟社區安寧我想的是這樣子啦市長你想的我直接跟你講我想什麼啦因為我覺得部長你剛才唱很多高調衛部部也唱很多高調什麼\n\n47\n00:17:06,952 --> 00:17:11,617\n給他照顧得很好有尊嚴不會痛苦就沒有人想要安樂死這個是唱很多高調啊你知道當在那一剎那的時候要多少經濟壓力當你們癌症治療的藥物設限這麼多標靶用藥設限那麼多然後要自費的話要花那麼多錢\n\n48\n00:17:26,994 --> 00:17:31,255\n你說要尊嚴要照護好你們連安寧病床可能都不夠然後呢醫護這個護理人員流失關床排不進去你們的照護品質不會好那家人古早人說孤單病不好走嘛那病人被人痛苦折磨然後要有好的藥門檻那麼高要自己自費買不起\n\n49\n00:17:51,396 --> 00:18:03,261\n所以難怪這個4月24台大公衛在講的是善終自主台灣民眾對醫師協助死亡的看法所以有這種狀況是有3992位然後進行這個死亡調查關於醫生協助死亡的調查研究這樣子\n\n50\n00:18:20,014 --> 00:18:47,040\n然後醫助死亡跟安樂死是不一樣的我們先講在這裡安樂死是醫生處理的可是醫助死亡是醫生協助而已讓受苦的病人加速離世如果我們的長照制度不好我們的照護品質不好如果病人的經濟能力不好如果我們健保的癌症藥物的給付不好你叫我們說沒有人會想要安樂死我告訴你現在台灣\n\n51\n00:18:48,340 --> 00:18:56,046\n很多生病的人包括我自己我都想要自己去自殺了如果有安樂死的話我會選擇安樂死為什麼因為我剛剛講你講說好的什麼那個高調的那個情境在台灣目前不會存在而且在執行上理想上也不太會存在不太可能因為資源有限因為人力耗盡在那裡因為大家都知道\n\n52\n00:19:16,431 --> 00:19:38,351\n無效的醫療再拖下去也是無效所以你說會有那種不想安樂死的我想大概對啦也有但是很多更多是想要安樂死的那在這種狀況裡面台大公衛的這份研究做了3992個將近4000個他依據死亡的支持度他設定了三種\n\n53\n00:19:39,392 --> 00:20:00,279\n三種就癌症末期而且預期壽命有限再活沒多久而且病人太痛苦了像癌症末期86.2%的支持度都要求可以有醫助死亡那第二種即便不是末期但根本就沒有藥可醫而且身上有無法忍受的痛苦如劍動人這種支持度79.6%\n\n54\n00:20:03,800 --> 00:20:27,046\n第三種病人嚴重喪失認知能力疾病無法治癒也沒有改善的方式如極重度的失智支持率有72%72.6%還有不分任何情境純粹就是你支不支持醫生可以協助民眾死亡的比例有67.6%所以這個台大公衛的學者呼籲了什麼他們呼籲什麼部長你知道嗎\n\n55\n00:20:35,939 --> 00:21:03,038\n我可以補充他其實呼籲的其實是對死亡這件事情應該有更多的社會的對話對保證妳要了解妳自己知道但是妳也要了解就是說妳要建議社會跟政府要跟所有的社會的對話都要開始溝通要開始對話甚至連這個醫治死亡都要開始討論啦\n\n56\n00:21:05,060 --> 00:21:07,781\n全台灣人過半以上都支持大家就要開始討論要你社會討論對不對社會討論重不重要保定非常重要那你們的次長為什麼為什麼你們的次長面對這樣的研究一出來你的處長怎麼說\n\n57\n00:21:27,998 --> 00:21:35,800\n安樂死斷食善終是不對的他連斷食善終都不對了這不是我們的病主法嗎市長怎麼這麼說他說這兩者都不會成為衛福部的政策選項你是誰啊你說了算喔社會對話這是社會對話喔\n\n58\n00:21:51,738 --> 00:22:00,291\n不管是斷食善中或安樂食他的intention我問你啦你的病足法裡面有沒有包含斷食善中\n\n59\n00:22:01,365 --> 00:22:25,879\n那個不叫斷食善中那個是不要去使用不必要的人工營養水分我想委員今天的一席話真的是非常專業我真的是覺得很敬佩但是我必須要講清楚斷食善中你不給他在營養供給了不給他鼻胃管了不給他這個營養供給了你知道插一個鼻胃管病人是多痛苦對啊\n\n60\n00:22:26,960 --> 00:22:32,887\n那你有很多的方式你會好好的照顧他他就會吃很多東西他雖然有時候有那種\n\n61\n00:22:36,678 --> 00:22:50,448\n需要鼻胃管的還有進食能力的如果那種連吞嚥功能都喪失的吞嚥功能譬如我舉個例子我現在不是跟你討論這個我是要告訴你你不要轉移焦點我是要告訴你說你的次長憑什麼他一個人說安樂時斷食善終都不會成為衛福部的政策選項你們說可以\n\n62\n00:23:06,044 --> 00:23:20,826\n可以透過支持性或緩解性的醫療照顧減輕病人痛苦但不贊同安樂死你講了支持性或緩解性的醫療照護真的是大家都可以得到這麼好的照顧嗎\n\n63\n00:23:22,691 --> 00:23:26,072\n百分之九十你的癌症用藥設限那麼多標靶用藥自費這麼貴然後家人家人也耗這麼多人家病人不願意了所以我沒有叫你藥喔我現在告訴你是醫師協助死亡這現在民意支持度這麼高的狀況\n\n64\n00:23:42,538 --> 00:24:02,118\n你應該要開啟社會對話而甚至你要去研究相關的法律的制度對醫療的衝擊對醫師的衝擊然後相應的問題可能會是什麼你也要去回應學者的這個現象到底問題產生在哪裡你應該去開啟社會溝通和對話\n\n65\n00:24:04,901 --> 00:24:08,162\n對不對那有可能你一個次長就來講不可能那我沒有愛我都沒有愛這樣就不用做了嗎我們幾十天來都一直在對話那我想次長我問你醫師協助死亡的議題你做過正式的政策評估或是跨部門討論嗎或者是你委託研究過嗎它的倫理法律和醫療實務的可行性\n\n66\n00:24:31,990 --> 00:24:42,644\n會遇到什麼困難可行不可行你們做過嗎有沒有做過醫師誰是智商其實也是安樂死的一種我現在就是在講\n\n67\n00:24:46,170 --> 00:24:56,941\n醫師協助死亡的安樂死方式對這個部分就是屬於在安樂死的一個範疇對我在問你說社會溝通對話那這個部分必須要更多的社會對話來溝通那當我們目前的政策台大現在這份研究\n\n68\n00:25:05,450 --> 00:25:17,275\n我們在講P.A.D合法就是醫治死亡的這個P.A.D的政策P.A.D的意思P.A.DDyingAssistantPhysicianPhysicianAssistedDying\n\n69\n00:25:33,817 --> 00:25:42,442\n就跟你講PAD啦我是要告訴這不重要啦我現在就是講喔當台大的公衛拿出這樣的數據的時候你們有沒有做過任何政策的研議倫理法律的社會心理的你們都沒有做一個處長一出來就跟人家說那都不可能我們不愛我們不接受那你現在是怎樣像林淑芬講的沒有我自己吃到75歲我自己去煮飯\n\n70\n00:26:03,325 --> 00:26:31,404\n你是要這樣子你知道我走出門你知道多少人給我懲罰立委啊你就趕快讓他安樂死合法化你就趕快立這個法律我告訴他什麼我不知道怎麼定這個法律啊整個社會溝通對話倫理的法律的社會心理的經濟的等等的生物上的我通通都沒有足夠的專業然後社會沒有對話\n\n71\n00:26:34,926 --> 00:26:50,257\n衛福部也從來不討論不委外研究沒有任何的政策研究我是要怎麼去產出一個法律啊你在這裡你到底你是跟你們處長一樣的立場是不是啦我就是在這裡問你你跟你們處長一樣就直接說我們反對安樂死絕對不要反安樂死你在這裡是要宣示這個政策嗎我們政策是一種開放的我現在講這個叫社會對話嗎社會對話是這樣的嗎\n\n72\n00:27:04,202 --> 00:27:31,283\n我們可以繼續來我今天不是在講病主法為什麼病主法的簽署率這麼低其中一個重要的原因就是民眾所想像的病主法所想像的安樂死的善終的概念跟這個法律落差太大了而民眾想要的很多民眾想要的當然也有很多民眾反對很多民眾想要的是真的是讓我好好的走吧善終安樂死\n\n73\n00:27:32,023 --> 00:27:56,241\n你最好是了解一下什麼叫一一社會對話溝通然後你最好去做一下研究好歹也做一下研究吧連這個都拒絕在這裡你都不做的話我只能說這個不但做國內的研究我們也做國際的研究做很多啊paper在哪裡你的委外研究經費編在哪裡你的委外研究的計畫成果在哪裡\n\n74\n00:27:59,215 --> 00:28:20,724\n那另外就是就是有國內有很多學者都有做學者做的跟你政府做的有一樣嗎在這裡信口開河青菜公共那你為什麼一直你一直用台大的公衛學者做為一個政府你用我們好朋友楊秀儀教授的文章來談論那不是政府喔那是拿政府的錢的嗎\n\n75\n00:28:21,992 --> 00:28:28,376\n不管怎麼樣這也是當然的我現在講我這裡我監督的是叫做政府我們人民要的是有政府能溝通我這裡怎麼去問責於一個學者你怎麼政府把責任就推給所有學者做了這是叫做政府嗎甘良秀儀咧主導這個政策\n\n76\n00:28:46,505 --> 00:28:56,568\n我們當然在主導政策啊但是我們要收集各方面的資訊不是喔你要開啟你是政府你要去做研究不是只說學者研究一分這樣就好了我現在不想聽骯髒我要聽你政府你政府你怎麼面對這個課題怎麼面對這個議題怎麼面對人民有這個需求\n\n77\n00:29:11,499 --> 00:29:23,349\n尤其是在你們醫療制度都在這麼緊張瀕臨崩潰的邊緣啦更不要講問題多啦在講說你好好的照顧這個理想性不存在啦\n\n","tsv":"start\tend\ttext\n389\t1050\t好 謝謝主席 是不是要請邱部長請部長委員好\n18872\t38777\t部長今年正式邁入這個超高齡社會五個就有一個是65歲以上所以這個活得久已經大概不是很大的問題但是要活得好那活得好的話其實也難免生老病死所以其實不要講到說65歲以上的人包括我自己我跟我朋友之間在談的我們都講說害怕生不如死我自己見證過我自己兩個\n48901\t63932\t父母他們都是中風的然後躺在醫院的很久的那在這種狀況裡面我也面臨過很多的情境所以都求善終並不是只有年紀大的人在想對我來講我就是\n65353\t69316\t我甚至講跟朋友之間開玩笑就是說我75歲我大概自己如果沒有安樂死的這個法律的話我要自己去自殺那我告訴我的孩子說我是自主的而且是我很開心的我願意這麼做的那希望他們不要情緒不好所以我經常跟我兒子講說當我死亡的時候\n88347\t105798\t你要給我還保障 不要給我綁水牢我的意思是說 我不要水障我在講的是生和死的溝通我經常告訴我的孩子我怎麼想免得到那一天的時候 他不知道母親怎麼想那在這種狀況裡面 今天的修法我必須要講說有的人希望說放寬ACP的經費啦ACP的執行場域去委託代理人的資格放寬等等\n117586\t146769\t那大家講都講說這個簽署率只有0.45只有10.3萬人我還要你看到一個數字這個數字不是只有10.3萬人0.45的簽署率而是如果我問你已經簽署的到最後真的有去執行的比率有多高已經簽署的真正去落實這個簽署的人的意志那真正執行有多高呢\n147506\t157732\t好 這個我想意思是有研究 不過我先跟委員做初步的報告那因為時間相當的短嘛 2019到現在大概有70% 有這麼高嗎到最後真正執行率 吻合率吻合率那個是你們推估的\n171160\t175222\t其實有人是認為說 但是這是推估的其實大家都不認為說執行率很高所以顯然不是只有簽署的人數的問題而且就是說即便簽署了到最後的執行率為什麼沒有辦法執行\n192009\t214615\t所以大家都想要尊嚴的善終 要拒絕無效的醫療可是當走到那一步 譬如說我的母親她在做DNR的時候我們都知道 可是到那一刻要我們決定我理性上都知道該怎麼做 我們全家人都知道該怎麼做可是到那一刻來的時候 我們做不下去 做不下去\n217495\t231672\t然後就這樣又拖一拖到什麼時候才大家說放棄了吧因為覺得他這樣子下去拖下去太痛苦了所以我們才說那我們放棄吧所以我是要告訴你說從這個\n235736\t258981\t衛生政策來檢驗這個病主法當然是還有在討論的這個空間但是並不是只有簽署率多高還包括執行上的障礙是什麼而這個東西是透過這一個法律就可以解決的嗎我想答案是否定的他不是只有一個病主法就足夠的所以\n262610\t285442\t這種善終的概念喔老實說簽署率不高的原因還有一個啦大家對於病主法的想像跟他所想像的他以為這是一個善終的安樂死的概念的其實是不是的根本不是的當你真正去了解的時候發現不是的時候\n286793\t292599\t那跟DNR差沒有很大的時候我認為DNR的簽署率很高啦到那一刻DNR的簽署率都很高\n299254\t320083\t但DNR離這個病毒法的這個簽署那個內容並不是差異太大了 老實說那我們講說這個無效醫療要善終但是監察院在2011年他其實有\n321864\t332074\t這個讓無效醫療和臨終關懷扶上檯面那他指出臨床上界定治療無效或者是何時讓安寧緩和和醫療接手都沒有辦法明確定義那具體而言\n338059\t353885\t國家透過法律保障和約束專業但醫療行為屬專業自主其內涵仰賴專業自律和主管機關的含釋所以在這種狀況裡面我們都看到專業的醫生的意見跟這個\n356306\t384760\t社會大眾的期待的所謂的比較好的善終的這個手段其實落差還是很大所以這種情境善終的臨床的情境雖然不是專科所能擅自去做詮釋的但是如果謹守專業自主讓政策去導引而不是不當的介入原本在醫病之間互相理解和治療狀態下的照護喔這個一直都是修法的困境\n386072\t411194\t那這個我要講這個是因為有一個月旦醫學法報告有一篇文章叫做圖法不足以自行圖法不足以自行這個病人自主權利法的反思善終政策不曉得師長或是部長有沒有看過這個郭文華教授的這一篇文章我們華麗專家有\n414787\t417908\t病主法的困局其原因固然有民眾的誤解和醫界的被動但是不可諱言的有來自病主法的理想性\n432452\t455100\t生命自主需要保障 照護需要父權但是一般人並不容易理解這樣的一個抽象的概念更不要說在徹底了解後做的治療的選擇但我要講說其實他講的我部分上也認同但部分上不一定認同我覺得剛好相反很多人是相對的了解他對生命的價值和意義而想要選擇一種\n456300\t472527\t善終的方式但是偏偏他所期待的是在病毒法這部法律裡面不能給的給不了的那從衛生的角度以外呢我們這個看到郭文華教授他要指出幾個盲點第一 宣導跟現實的落差\n477469\t504630\t如果在這個被認為創造病患可以無痛苦讓醫師減少臨床壓力然後大家說這樣去創造健保資源不浪費因為無效醫療就是浪費嘛大家會覺得這樣可是呢這樣的狀況沒有釐清政策效果的優先順序或者是為什麼要病人以自主之名去啟動要一般人立即理解善終主動尋求理解AD跟簽署\n505370\t527532\t似乎誠意過高第二個諮商的門檻他們覺得ACP的法律程序諮商的行為受到法律的規範AD就是法律文件在沒有相關素養教育的配套下具有法律性質的醫療諮商扛起公民教育的責任可行性他們也覺得有疑慮\n528473\t535238\t本來諮商是專業的本來諮商是沒有法律的責任的可是現在是必須透過諮商這個過程來建立法律的責任然後才能去簽AD那麼這個諮商的過程大家去都可能是速成法速成法可是大家對這個概念是要先有\n548187\t562803\t這個公民教育的你對於這個生死的素養才能具備說你要去諮商然後你要去簽署這個文件可是如果沒有公民的素養沒有這個教育生死的教育然後直接就叫說我上一個諮商一下然後就簽了\n564564\t590032\t這個可能在大家可行性上有疑慮然後呢在楊秀怡在期刊台灣公共衛生雜誌2020年6月的文章講到住院的病患家屬對病人自主權立法的認知態度及日歷醫療決定的行為意向他指出90%以上受訪者願意進行ACP的諮商卻\n591992\t606380\t這個很重要 我現在要告訴你們 這個東西我要講楊秀宇的這篇文章很重要他做了研究他在醫院 然後去做調查這個都是住院的病患的家屬了\n608877\t628616\t90%以上去進行他們都願意這個預歷醫療照護諮商當他們都願意了以後進一階 進階到要簽AD了就是要預歷醫療決定了他從90%以上的接受度瞬間減半掉為51.25%\n633662\t644114\t並不是沒有接受諮商 他去接受諮商了然後到要簽的時候 剩下51.25%然後楊繡宇認為說 這個是很有意義的發現 為什麼為什麼 這個是你們主導的政策 為什麼 你可以告訴我嗎保定你知道嗎 市長你知道嗎\n656857\t678230\t其實這一段的落差其實就變成是說我覺得是在簽署自己的名字那個必須是一個commitment這件事情其實產生了因為我們其實有做過其他相關的研究其實也都是在具名要簽下去這件事情的時候在整個過程當中產生了一個質疑所以在願意\n679130\t699875\t智商完之後真的要簽下去其實還有周圍家屬一些因素影響其實實際上面的簽署率在一些相關的研究我忘記是不是楊老師的研究其實都有一些學者提出來所以我要講說簽署率不要成為你們的KPI不要把病毒法的KPI定為簽署率\n701324\t714013\t楊秀瑜說他這個跟國際許多的研究觀察都是相符合的就是許多人並不排斥思考死亡和臨終善終的醫療照護的問題\n716454\t731297\t但是真正要簽署的時候可能會考慮很多有時候是不願意和家人討論或行諸於文字或者是像是類似一種法律契約何以如此 何以如此市長 何以如此我們看到這個現象了 但為什麼呢 為什麼呢因為我們要討論修法要讓這個法律更進階來討論它的問題發生在哪裡但何以如此啊\n746082\t761072\t所以陳慧覺得是說今天在討論所謂的病毒這件事情我們一直覺得是說需要做的事情在民眾死亡勢能這個部分其實我們需要去提市長你講了你都沒有看其實非常重要的一個原因就是\n764695\t784189\t因為此時此地和當時當地不同啦選擇生命末期的醫療是非常艱難的選擇不管事前有再多的準備預備但是到了醫療現場在生死關頭還是有很多的猶豫反覆捨不得如果\n785049\t796143\t大家都在那裡天人交戰包括我自己就曾經經歷過我都知道我也準備了我也認為什麼是最好的可是當時到此時不一樣\n802270\t817687\t所以這篇調查是受訪者都是家人目前都是在家戶病房的家屬對醫療現場都有第一手的經驗更能了解做決定的艱難\n819309\t830293\t而且他們對ACP都持開放的態度卻只有一半願意簽署AD這個你們一定要記住第三也就是最關鍵的政策成效的評估大家覺得說\n835295\t860216\t這個評估是不是要有研擬運作的模式設立了示範的中心追蹤AD的簽署來作為政策的里程碑但這個做法看起來沒問題但實務上的障礙是民眾真的不容易理解病毒法和安寧條例為何並存宣導團隊也重疊然後相對ACP跟AD的簽署率的低我剛剛講過DNR大家\n863198\t870491\t都是簽署率非常非常的高的你只要給他簽 欸 病危了然後拒絕心胃復甦或衛生醫療大家都簽啦 十個有高的都有簽啦\n874938\t903471\t所以在這種狀況裡面其實這些議題我們都希望說在你的政策有效性的評估並不要用那種方法那現在講說持續的問題是要推動生死素養的教育和政策要回到臨終狀況現場以更周全的方式去評估成果部長你認為有哪些方法還可以再改善\n904452\t915053\t這種評估的效果不要一味的以AD的簽署數為評估的指標嘛其實那個委員主持的重點\n916531\t937399\t其實你在簽AD到最後在面臨實際上那個時候的時候是非常困難的當然你前面早一點我再講還有什麼指標你就回答我就好了指標委員的意思是臨床現狀嗎就是說到底這種這種病人自主無效醫療然後這什麼樣的狀況認為是你們醫療政策推動的比較好的指標的觀察什麼東西好那個請問一下\n945900\t970598\t這邊的話就臨床部分的話我們會希望是說其實是要一起看什麼意思就是說在推動所謂的剛剛委員特別有垂詢是說如果只單就一個AD的簽署率其實是應該把DNR跟安寧的這邊其實是一起看這是第一件事第二件事情就是一些量性指標的部分的話我們可以在六個月內如果有使用就是\n971618\t996963\t因為當你的終點越清楚的時候其實一些醫療介入的措施我們是希望他能夠有這樣的概念不管我的進入的路徑是從病毒法或者是從安寧緩和條例六個月內沒有有使用像這樣子安寧照護的服務的比例能夠增加這是我們希望未來你們的安寧病床都是你們沒有滿床嗎照你們剛才的想法沒有滿床但是其實我曾經被拜託是排不到床的\n998039\t1018048\t他其實是有我曾經被拜託就說想要進去安寧病房都派不進去我要講的是說其實目前我們希望推動的在特別是在高齡少子社會裡面其實怎麼樣回到社區所以安寧共照然後居家安寧跟社區安寧我想的是這樣子啦市長你想的我直接跟你講我想什麼啦因為我覺得部長你剛才唱很多高調衛部部也唱很多高調什麼\n1026952\t1031617\t給他照顧得很好有尊嚴不會痛苦就沒有人想要安樂死這個是唱很多高調啊你知道當在那一剎那的時候要多少經濟壓力當你們癌症治療的藥物設限這麼多標靶用藥設限那麼多然後要自費的話要花那麼多錢\n1046994\t1051255\t你說要尊嚴 要照護好 你們連安寧病床可能都不夠然後呢 醫護 這個護理人員流失 關床 排不進去你們的照護品質不會好 那家人 古早人說孤單病不好走嘛那病人被人痛苦折磨 然後要有好的藥門檻那麼高 要自己自費買不起\n1071396\t1083261\t所以難怪這個4月24台大公衛在講的是善終自主台灣民眾對醫師協助死亡的看法所以有這種狀況是有3992位然後進行這個死亡調查關於醫生協助死亡的調查研究這樣子\n1100014\t1127040\t然後醫助死亡跟安樂死是不一樣的我們先講在這裡安樂死是醫生處理的可是醫助死亡是醫生協助而已讓受苦的病人加速離世如果我們的長照制度不好我們的照護品質不好如果病人的經濟能力不好如果我們健保的癌症藥物的給付不好你叫我們說沒有人會想要安樂死我告訴你現在台灣\n1128340\t1136046\t很多生病的人包括我自己我都想要自己去自殺了如果有安樂死的話我會選擇安樂死為什麼 因為我剛剛講你講說好的什麼那個高調的那個情境在台灣目前不會存在而且在執行上理想上也不太會存在不太可能 因為資源有限因為人力耗盡在那裡因為大家都知道\n1156431\t1178351\t無效的醫療再拖下去也是無效所以你說會有那種不想安樂死的我想大概對啦也有但是很多更多是想要安樂死的那在這種狀況裡面台大公衛的這份研究做了3992個將近4000個他依據死亡的支持度他設定了三種\n1179392\t1200279\t三種 就癌症末期而且預期壽命有限 再活沒多久而且病人太痛苦了 像癌症末期86.2%的支持度都要求可以有醫助死亡那第二種 即便不是末期 但根本就沒有藥可醫而且身上有無法忍受的痛苦 如劍動人這種支持度79.6%\n1203800\t1227046\t第三種病人嚴重喪失認知能力疾病無法治癒也沒有改善的方式如極重度的失智支持率有72%72.6%還有不分任何情境純粹就是你支不支持醫生可以協助民眾死亡的比例有67.6%所以這個台大公衛的學者呼籲了什麼他們呼籲什麼部長你知道嗎\n1235939\t1263038\t我可以補充 他其實呼籲的其實是對死亡這件事情應該有更多的社會的對話對 保證妳要了解 妳自己知道 但是妳也要了解就是說 妳要建議社會跟政府要跟所有的社會的對話都要開始溝通要開始對話 甚至連這個醫治死亡都要開始討論啦\n1265060\t1267781\t全台灣人 過半以上都支持大家就要開始討論 要你社會討論對不對 社會討論重不重要 保定非常重要那你們的次長為什麼為什麼你們的次長面對這樣的研究一出來你的處長怎麼說\n1287998\t1295800\t安樂死 斷食善終是不對的他連斷食善終都不對了這不是我們的病主法嗎市長怎麼這麼說他說這兩者都不會成為衛福部的政策選項你是誰啊 你說了算喔社會對話 這是社會對話喔\n1311738\t1320291\t不管是斷食善中或安樂食他的intention我問你啦你的病足法裡面有沒有包含斷食善中\n1321365\t1345879\t那個不叫斷食善中那個是不要去使用不必要的人工營養水分我想委員今天的一席話真的是非常專業我真的是覺得很敬佩但是我必須要講清楚斷食善中你不給他在營養供給了不給他鼻胃管了不給他這個營養供給了你知道插一個鼻胃管病人是多痛苦對啊\n1346960\t1352887\t那你有很多的方式你會好好的照顧他他就會吃很多東西他雖然有時候有那種\n1356678\t1370448\t需要鼻胃管的還有進食能力的如果那種連吞嚥功能都喪失的吞嚥功能 譬如我舉個例子我現在不是跟你討論這個我是要告訴你你不要轉移焦點我是要告訴你說你的次長憑什麼他一個人說安樂時 斷食善終都不會成為衛福部的政策選項你們說可以\n1386044\t1400826\t可以透過支持性或緩解性的醫療照顧減輕病人痛苦 但不贊同安樂死你講了支持性或緩解性的醫療照護真的是大家都可以得到這麼好的照顧嗎\n1402691\t1406072\t百分之九十你的癌症用藥設限那麼多標靶用藥自費這麼貴然後家人家人也耗這麼多人家病人不願意了所以我沒有叫你藥喔我現在告訴你是醫師協助死亡這現在民意支持度這麼高的狀況\n1422538\t1442118\t你應該要開啟社會對話 而甚至你要去研究相關的法律的制度對醫療的衝擊 對醫師的衝擊 然後相應的問題可能會是什麼你也要去回應學者的這個現象 到底問題產生在哪裡你應該去開啟社會溝通和對話\n1444901\t1448162\t對不對 那有可能你一個次長就來講 不可能 那我沒有愛我都沒有愛 這樣就不用做了嗎我們幾十天來都一直在對話 那我想次長我問你醫師協助死亡的議題 你做過正式的政策評估或是跨部門討論嗎 或者是你委託研究過嗎它的倫理法律和醫療實務的可行性\n1471990\t1482644\t會遇到什麼困難可行不可行你們做過嗎有沒有做過醫師誰是智商其實也是安樂死的一種我現在就是在講\n1486170\t1496941\t醫師協助死亡的安樂死方式對 這個部分就是屬於在安樂死的一個範疇對 我在問你說社會溝通對話那這個部分必須要更多的社會對話來溝通那當我們目前的政策台大現在這份研究\n1505450\t1517275\t我們在講P.A.D合法就是醫治死亡的這個P.A.D的政策P.A.D的意思P.A.DDying Assistant PhysicianPhysicianAssisted Dying\n1533817\t1542442\t就跟你講PAD啦 我是要告訴這不重要啦我現在就是講喔 當台大的公衛拿出這樣的數據的時候你們有沒有做過任何政策的研議倫理 法律的 社會心理的你們都沒有做 一個處長一出來就跟人家說那都不可能 我們不愛 我們不接受那你現在是怎樣 像林淑芬講的沒有我自己吃到75歲 我自己去煮飯\n1563325\t1591404\t你是要這樣子你知道我走出門 你知道多少人給我懲罰立委啊 你就趕快讓他安樂死 合法化你就趕快立這個法律 我告訴他什麼我不知道怎麼定這個法律啊整個社會溝通對話倫理的法律的社會心理的經濟的等等的生物上的我通通都沒有足夠的專業然後社會沒有對話\n1594926\t1610257\t衛福部也從來不討論不委外研究沒有任何的政策研究我是要怎麼去產出一個法律啊你在這裡你到底你是跟你們處長一樣的立場是不是啦我就是在這裡問你你跟你們處長一樣就直接說我們反對安樂死絕對不要反安樂死你在這裡是要宣示這個政策嗎我們政策是一種開放的我現在講這個叫社會對話嗎社會對話是這樣的嗎\n1624202\t1651283\t我們可以繼續來我今天不是在講病主法為什麼病主法的簽署率這麼低其中一個重要的原因就是民眾所想像的病主法所想像的安樂死的善終的概念跟這個法律落差太大了而民眾想要的很多民眾想要的當然也有很多民眾反對很多民眾想要的是真的是讓我好好的走吧善終安樂死\n1652023\t1676241\t你最好是了解一下什麼叫一一社會對話溝通然後你最好去做一下研究好歹也做一下研究吧連這個都拒絕在這裡你都不做的話我只能說這個不但做國內的研究我們也做國際的研究做很多啊 paper在哪裡你的委外研究經費編在哪裡你的委外研究的計畫成果在哪裡\n1679215\t1700724\t那另外就是就是有國內有很多學者都有做學者做的跟你政府做的有一樣嗎在這裡信口開河青菜公共那你為什麼一直你一直用台大的公衛學者做為一個政府你用我們好朋友楊秀儀教授的文章來談論那不是政府喔那是拿政府的錢的嗎\n1701992\t1708376\t不管怎麼樣這也是當然的我現在講我這裡我監督的是叫做政府我們人民要的是有政府能溝通我這裡怎麼去問責於一個學者你怎麼政府把責任就推給所有學者做了這是叫做政府嗎甘良秀儀咧主導這個政策\n1726505\t1736568\t我們當然在主導政策啊 但是我們要收集各方面的資訊不是喔 你要開啟 你是政府 你要去做研究不是只說學者研究一分 這樣就好了我現在不想聽骯髒 我要聽你政府你政府 你怎麼面對這個課題 怎麼面對這個議題怎麼面對人民有這個需求\n1751499\t1763349\t尤其是在你們醫療制度都在這麼緊張瀕臨崩潰的邊緣啦更不要講問題多啦在講說你好好的照顧這個理想性不存在啦\n","txt":"好 謝謝主席 是不是要請邱部長請部長委員好\n部長今年正式邁入這個超高齡社會五個就有一個是65歲以上所以這個活得久已經大概不是很大的問題但是要活得好那活得好的話其實也難免生老病死所以其實不要講到說65歲以上的人包括我自己我跟我朋友之間在談的我們都講說害怕生不如死我自己見證過我自己兩個\n父母他們都是中風的然後躺在醫院的很久的那在這種狀況裡面我也面臨過很多的情境所以都求善終並不是只有年紀大的人在想對我來講我就是\n我甚至講跟朋友之間開玩笑就是說我75歲我大概自己如果沒有安樂死的這個法律的話我要自己去自殺那我告訴我的孩子說我是自主的而且是我很開心的我願意這麼做的那希望他們不要情緒不好所以我經常跟我兒子講說當我死亡的時候\n你要給我還保障 不要給我綁水牢我的意思是說 我不要水障我在講的是生和死的溝通我經常告訴我的孩子我怎麼想免得到那一天的時候 他不知道母親怎麼想那在這種狀況裡面 今天的修法我必須要講說有的人希望說放寬ACP的經費啦ACP的執行場域去委託代理人的資格放寬等等\n那大家講都講說這個簽署率只有0.45只有10.3萬人我還要你看到一個數字這個數字不是只有10.3萬人0.45的簽署率而是如果我問你已經簽署的到最後真的有去執行的比率有多高已經簽署的真正去落實這個簽署的人的意志那真正執行有多高呢\n好 這個我想意思是有研究 不過我先跟委員做初步的報告那因為時間相當的短嘛 2019到現在大概有70% 有這麼高嗎到最後真正執行率 吻合率吻合率那個是你們推估的\n其實有人是認為說 但是這是推估的其實大家都不認為說執行率很高所以顯然不是只有簽署的人數的問題而且就是說即便簽署了到最後的執行率為什麼沒有辦法執行\n所以大家都想要尊嚴的善終 要拒絕無效的醫療可是當走到那一步 譬如說我的母親她在做DNR的時候我們都知道 可是到那一刻要我們決定我理性上都知道該怎麼做 我們全家人都知道該怎麼做可是到那一刻來的時候 我們做不下去 做不下去\n然後就這樣又拖一拖到什麼時候才大家說放棄了吧因為覺得他這樣子下去拖下去太痛苦了所以我們才說那我們放棄吧所以我是要告訴你說從這個\n衛生政策來檢驗這個病主法當然是還有在討論的這個空間但是並不是只有簽署率多高還包括執行上的障礙是什麼而這個東西是透過這一個法律就可以解決的嗎我想答案是否定的他不是只有一個病主法就足夠的所以\n這種善終的概念喔老實說簽署率不高的原因還有一個啦大家對於病主法的想像跟他所想像的他以為這是一個善終的安樂死的概念的其實是不是的根本不是的當你真正去了解的時候發現不是的時候\n那跟DNR差沒有很大的時候我認為DNR的簽署率很高啦到那一刻DNR的簽署率都很高\n但DNR離這個病毒法的這個簽署那個內容並不是差異太大了 老實說那我們講說這個無效醫療要善終但是監察院在2011年他其實有\n這個讓無效醫療和臨終關懷扶上檯面那他指出臨床上界定治療無效或者是何時讓安寧緩和和醫療接手都沒有辦法明確定義那具體而言\n國家透過法律保障和約束專業但醫療行為屬專業自主其內涵仰賴專業自律和主管機關的含釋所以在這種狀況裡面我們都看到專業的醫生的意見跟這個\n社會大眾的期待的所謂的比較好的善終的這個手段其實落差還是很大所以這種情境善終的臨床的情境雖然不是專科所能擅自去做詮釋的但是如果謹守專業自主讓政策去導引而不是不當的介入原本在醫病之間互相理解和治療狀態下的照護喔這個一直都是修法的困境\n那這個我要講這個是因為有一個月旦醫學法報告有一篇文章叫做圖法不足以自行圖法不足以自行這個病人自主權利法的反思善終政策不曉得師長或是部長有沒有看過這個郭文華教授的這一篇文章我們華麗專家有\n病主法的困局其原因固然有民眾的誤解和醫界的被動但是不可諱言的有來自病主法的理想性\n生命自主需要保障 照護需要父權但是一般人並不容易理解這樣的一個抽象的概念更不要說在徹底了解後做的治療的選擇但我要講說其實他講的我部分上也認同但部分上不一定認同我覺得剛好相反很多人是相對的了解他對生命的價值和意義而想要選擇一種\n善終的方式但是偏偏他所期待的是在病毒法這部法律裡面不能給的給不了的那從衛生的角度以外呢我們這個看到郭文華教授他要指出幾個盲點第一 宣導跟現實的落差\n如果在這個被認為創造病患可以無痛苦讓醫師減少臨床壓力然後大家說這樣去創造健保資源不浪費因為無效醫療就是浪費嘛大家會覺得這樣可是呢這樣的狀況沒有釐清政策效果的優先順序或者是為什麼要病人以自主之名去啟動要一般人立即理解善終主動尋求理解AD跟簽署\n似乎誠意過高第二個諮商的門檻他們覺得ACP的法律程序諮商的行為受到法律的規範AD就是法律文件在沒有相關素養教育的配套下具有法律性質的醫療諮商扛起公民教育的責任可行性他們也覺得有疑慮\n本來諮商是專業的本來諮商是沒有法律的責任的可是現在是必須透過諮商這個過程來建立法律的責任然後才能去簽AD那麼這個諮商的過程大家去都可能是速成法速成法可是大家對這個概念是要先有\n這個公民教育的你對於這個生死的素養才能具備說你要去諮商然後你要去簽署這個文件可是如果沒有公民的素養沒有這個教育生死的教育然後直接就叫說我上一個諮商一下然後就簽了\n這個可能在大家可行性上有疑慮然後呢在楊秀怡在期刊台灣公共衛生雜誌2020年6月的文章講到住院的病患家屬對病人自主權立法的認知態度及日歷醫療決定的行為意向他指出90%以上受訪者願意進行ACP的諮商卻\n這個很重要 我現在要告訴你們 這個東西我要講楊秀宇的這篇文章很重要他做了研究他在醫院 然後去做調查這個都是住院的病患的家屬了\n90%以上去進行他們都願意這個預歷醫療照護諮商當他們都願意了以後進一階 進階到要簽AD了就是要預歷醫療決定了他從90%以上的接受度瞬間減半掉為51.25%\n並不是沒有接受諮商 他去接受諮商了然後到要簽的時候 剩下51.25%然後楊繡宇認為說 這個是很有意義的發現 為什麼為什麼 這個是你們主導的政策 為什麼 你可以告訴我嗎保定你知道嗎 市長你知道嗎\n其實這一段的落差其實就變成是說我覺得是在簽署自己的名字那個必須是一個commitment這件事情其實產生了因為我們其實有做過其他相關的研究其實也都是在具名要簽下去這件事情的時候在整個過程當中產生了一個質疑所以在願意\n智商完之後真的要簽下去其實還有周圍家屬一些因素影響其實實際上面的簽署率在一些相關的研究我忘記是不是楊老師的研究其實都有一些學者提出來所以我要講說簽署率不要成為你們的KPI不要把病毒法的KPI定為簽署率\n楊秀瑜說他這個跟國際許多的研究觀察都是相符合的就是許多人並不排斥思考死亡和臨終善終的醫療照護的問題\n但是真正要簽署的時候可能會考慮很多有時候是不願意和家人討論或行諸於文字或者是像是類似一種法律契約何以如此 何以如此市長 何以如此我們看到這個現象了 但為什麼呢 為什麼呢因為我們要討論修法要讓這個法律更進階來討論它的問題發生在哪裡但何以如此啊\n所以陳慧覺得是說今天在討論所謂的病毒這件事情我們一直覺得是說需要做的事情在民眾死亡勢能這個部分其實我們需要去提市長你講了你都沒有看其實非常重要的一個原因就是\n因為此時此地和當時當地不同啦選擇生命末期的醫療是非常艱難的選擇不管事前有再多的準備預備但是到了醫療現場在生死關頭還是有很多的猶豫反覆捨不得如果\n大家都在那裡天人交戰包括我自己就曾經經歷過我都知道我也準備了我也認為什麼是最好的可是當時到此時不一樣\n所以這篇調查是受訪者都是家人目前都是在家戶病房的家屬對醫療現場都有第一手的經驗更能了解做決定的艱難\n而且他們對ACP都持開放的態度卻只有一半願意簽署AD這個你們一定要記住第三也就是最關鍵的政策成效的評估大家覺得說\n這個評估是不是要有研擬運作的模式設立了示範的中心追蹤AD的簽署來作為政策的里程碑但這個做法看起來沒問題但實務上的障礙是民眾真的不容易理解病毒法和安寧條例為何並存宣導團隊也重疊然後相對ACP跟AD的簽署率的低我剛剛講過DNR大家\n都是簽署率非常非常的高的你只要給他簽 欸 病危了然後拒絕心胃復甦或衛生醫療大家都簽啦 十個有高的都有簽啦\n所以在這種狀況裡面其實這些議題我們都希望說在你的政策有效性的評估並不要用那種方法那現在講說持續的問題是要推動生死素養的教育和政策要回到臨終狀況現場以更周全的方式去評估成果部長你認為有哪些方法還可以再改善\n這種評估的效果不要一味的以AD的簽署數為評估的指標嘛其實那個委員主持的重點\n其實你在簽AD到最後在面臨實際上那個時候的時候是非常困難的當然你前面早一點我再講還有什麼指標你就回答我就好了指標委員的意思是臨床現狀嗎就是說到底這種這種病人自主無效醫療然後這什麼樣的狀況認為是你們醫療政策推動的比較好的指標的觀察什麼東西好那個請問一下\n這邊的話就臨床部分的話我們會希望是說其實是要一起看什麼意思就是說在推動所謂的剛剛委員特別有垂詢是說如果只單就一個AD的簽署率其實是應該把DNR跟安寧的這邊其實是一起看這是第一件事第二件事情就是一些量性指標的部分的話我們可以在六個月內如果有使用就是\n因為當你的終點越清楚的時候其實一些醫療介入的措施我們是希望他能夠有這樣的概念不管我的進入的路徑是從病毒法或者是從安寧緩和條例六個月內沒有有使用像這樣子安寧照護的服務的比例能夠增加這是我們希望未來你們的安寧病床都是你們沒有滿床嗎照你們剛才的想法沒有滿床但是其實我曾經被拜託是排不到床的\n他其實是有我曾經被拜託就說想要進去安寧病房都派不進去我要講的是說其實目前我們希望推動的在特別是在高齡少子社會裡面其實怎麼樣回到社區所以安寧共照然後居家安寧跟社區安寧我想的是這樣子啦市長你想的我直接跟你講我想什麼啦因為我覺得部長你剛才唱很多高調衛部部也唱很多高調什麼\n給他照顧得很好有尊嚴不會痛苦就沒有人想要安樂死這個是唱很多高調啊你知道當在那一剎那的時候要多少經濟壓力當你們癌症治療的藥物設限這麼多標靶用藥設限那麼多然後要自費的話要花那麼多錢\n你說要尊嚴 要照護好 你們連安寧病床可能都不夠然後呢 醫護 這個護理人員流失 關床 排不進去你們的照護品質不會好 那家人 古早人說孤單病不好走嘛那病人被人痛苦折磨 然後要有好的藥門檻那麼高 要自己自費買不起\n所以難怪這個4月24台大公衛在講的是善終自主台灣民眾對醫師協助死亡的看法所以有這種狀況是有3992位然後進行這個死亡調查關於醫生協助死亡的調查研究這樣子\n然後醫助死亡跟安樂死是不一樣的我們先講在這裡安樂死是醫生處理的可是醫助死亡是醫生協助而已讓受苦的病人加速離世如果我們的長照制度不好我們的照護品質不好如果病人的經濟能力不好如果我們健保的癌症藥物的給付不好你叫我們說沒有人會想要安樂死我告訴你現在台灣\n很多生病的人包括我自己我都想要自己去自殺了如果有安樂死的話我會選擇安樂死為什麼 因為我剛剛講你講說好的什麼那個高調的那個情境在台灣目前不會存在而且在執行上理想上也不太會存在不太可能 因為資源有限因為人力耗盡在那裡因為大家都知道\n無效的醫療再拖下去也是無效所以你說會有那種不想安樂死的我想大概對啦也有但是很多更多是想要安樂死的那在這種狀況裡面台大公衛的這份研究做了3992個將近4000個他依據死亡的支持度他設定了三種\n三種 就癌症末期而且預期壽命有限 再活沒多久而且病人太痛苦了 像癌症末期86.2%的支持度都要求可以有醫助死亡那第二種 即便不是末期 但根本就沒有藥可醫而且身上有無法忍受的痛苦 如劍動人這種支持度79.6%\n第三種病人嚴重喪失認知能力疾病無法治癒也沒有改善的方式如極重度的失智支持率有72%72.6%還有不分任何情境純粹就是你支不支持醫生可以協助民眾死亡的比例有67.6%所以這個台大公衛的學者呼籲了什麼他們呼籲什麼部長你知道嗎\n我可以補充 他其實呼籲的其實是對死亡這件事情應該有更多的社會的對話對 保證妳要了解 妳自己知道 但是妳也要了解就是說 妳要建議社會跟政府要跟所有的社會的對話都要開始溝通要開始對話 甚至連這個醫治死亡都要開始討論啦\n全台灣人 過半以上都支持大家就要開始討論 要你社會討論對不對 社會討論重不重要 保定非常重要那你們的次長為什麼為什麼你們的次長面對這樣的研究一出來你的處長怎麼說\n安樂死 斷食善終是不對的他連斷食善終都不對了這不是我們的病主法嗎市長怎麼這麼說他說這兩者都不會成為衛福部的政策選項你是誰啊 你說了算喔社會對話 這是社會對話喔\n不管是斷食善中或安樂食他的intention我問你啦你的病足法裡面有沒有包含斷食善中\n那個不叫斷食善中那個是不要去使用不必要的人工營養水分我想委員今天的一席話真的是非常專業我真的是覺得很敬佩但是我必須要講清楚斷食善中你不給他在營養供給了不給他鼻胃管了不給他這個營養供給了你知道插一個鼻胃管病人是多痛苦對啊\n那你有很多的方式你會好好的照顧他他就會吃很多東西他雖然有時候有那種\n需要鼻胃管的還有進食能力的如果那種連吞嚥功能都喪失的吞嚥功能 譬如我舉個例子我現在不是跟你討論這個我是要告訴你你不要轉移焦點我是要告訴你說你的次長憑什麼他一個人說安樂時 斷食善終都不會成為衛福部的政策選項你們說可以\n可以透過支持性或緩解性的醫療照顧減輕病人痛苦 但不贊同安樂死你講了支持性或緩解性的醫療照護真的是大家都可以得到這麼好的照顧嗎\n百分之九十你的癌症用藥設限那麼多標靶用藥自費這麼貴然後家人家人也耗這麼多人家病人不願意了所以我沒有叫你藥喔我現在告訴你是醫師協助死亡這現在民意支持度這麼高的狀況\n你應該要開啟社會對話 而甚至你要去研究相關的法律的制度對醫療的衝擊 對醫師的衝擊 然後相應的問題可能會是什麼你也要去回應學者的這個現象 到底問題產生在哪裡你應該去開啟社會溝通和對話\n對不對 那有可能你一個次長就來講 不可能 那我沒有愛我都沒有愛 這樣就不用做了嗎我們幾十天來都一直在對話 那我想次長我問你醫師協助死亡的議題 你做過正式的政策評估或是跨部門討論嗎 或者是你委託研究過嗎它的倫理法律和醫療實務的可行性\n會遇到什麼困難可行不可行你們做過嗎有沒有做過醫師誰是智商其實也是安樂死的一種我現在就是在講\n醫師協助死亡的安樂死方式對 這個部分就是屬於在安樂死的一個範疇對 我在問你說社會溝通對話那這個部分必須要更多的社會對話來溝通那當我們目前的政策台大現在這份研究\n我們在講P.A.D合法就是醫治死亡的這個P.A.D的政策P.A.D的意思P.A.DDying Assistant PhysicianPhysicianAssisted Dying\n就跟你講PAD啦 我是要告訴這不重要啦我現在就是講喔 當台大的公衛拿出這樣的數據的時候你們有沒有做過任何政策的研議倫理 法律的 社會心理的你們都沒有做 一個處長一出來就跟人家說那都不可能 我們不愛 我們不接受那你現在是怎樣 像林淑芬講的沒有我自己吃到75歲 我自己去煮飯\n你是要這樣子你知道我走出門 你知道多少人給我懲罰立委啊 你就趕快讓他安樂死 合法化你就趕快立這個法律 我告訴他什麼我不知道怎麼定這個法律啊整個社會溝通對話倫理的法律的社會心理的經濟的等等的生物上的我通通都沒有足夠的專業然後社會沒有對話\n衛福部也從來不討論不委外研究沒有任何的政策研究我是要怎麼去產出一個法律啊你在這裡你到底你是跟你們處長一樣的立場是不是啦我就是在這裡問你你跟你們處長一樣就直接說我們反對安樂死絕對不要反安樂死你在這裡是要宣示這個政策嗎我們政策是一種開放的我現在講這個叫社會對話嗎社會對話是這樣的嗎\n我們可以繼續來我今天不是在講病主法為什麼病主法的簽署率這麼低其中一個重要的原因就是民眾所想像的病主法所想像的安樂死的善終的概念跟這個法律落差太大了而民眾想要的很多民眾想要的當然也有很多民眾反對很多民眾想要的是真的是讓我好好的走吧善終安樂死\n你最好是了解一下什麼叫一一社會對話溝通然後你最好去做一下研究好歹也做一下研究吧連這個都拒絕在這裡你都不做的話我只能說這個不但做國內的研究我們也做國際的研究做很多啊 paper在哪裡你的委外研究經費編在哪裡你的委外研究的計畫成果在哪裡\n那另外就是就是有國內有很多學者都有做學者做的跟你政府做的有一樣嗎在這裡信口開河青菜公共那你為什麼一直你一直用台大的公衛學者做為一個政府你用我們好朋友楊秀儀教授的文章來談論那不是政府喔那是拿政府的錢的嗎\n不管怎麼樣這也是當然的我現在講我這裡我監督的是叫做政府我們人民要的是有政府能溝通我這裡怎麼去問責於一個學者你怎麼政府把責任就推給所有學者做了這是叫做政府嗎甘良秀儀咧主導這個政策\n我們當然在主導政策啊 但是我們要收集各方面的資訊不是喔 你要開啟 你是政府 你要去做研究不是只說學者研究一分 這樣就好了我現在不想聽骯髒 我要聽你政府你政府 你怎麼面對這個課題 怎麼面對這個議題怎麼面對人民有這個需求\n尤其是在你們醫療制度都在這麼緊張瀕臨崩潰的邊緣啦更不要講問題多啦在講說你好好的照顧這個理想性不存在啦\n","vtt":"WEBVTT\n\n00:00.389 --> 00:01.050\n好謝謝主席是不是要請邱部長請部長委員好\n\n00:18.872 --> 00:38.777\n部長今年正式邁入這個超高齡社會五個就有一個是65歲以上所以這個活得久已經大概不是很大的問題但是要活得好那活得好的話其實也難免生老病死所以其實不要講到說65歲以上的人包括我自己我跟我朋友之間在談的我們都講說害怕生不如死我自己見證過我自己兩個\n\n00:48.901 --> 01:03.932\n父母他們都是中風的然後躺在醫院的很久的那在這種狀況裡面我也面臨過很多的情境所以都求善終並不是只有年紀大的人在想對我來講我就是\n\n01:05.353 --> 01:09.316\n我甚至講跟朋友之間開玩笑就是說我75歲我大概自己如果沒有安樂死的這個法律的話我要自己去自殺那我告訴我的孩子說我是自主的而且是我很開心的我願意這麼做的那希望他們不要情緒不好所以我經常跟我兒子講說當我死亡的時候\n\n01:28.347 --> 01:45.798\n你要給我還保障不要給我綁水牢我的意思是說我不要水障我在講的是生和死的溝通我經常告訴我的孩子我怎麼想免得到那一天的時候他不知道母親怎麼想那在這種狀況裡面今天的修法我必須要講說有的人希望說放寬ACP的經費啦ACP的執行場域去委託代理人的資格放寬等等\n\n01:57.586 --> 02:26.769\n那大家講都講說這個簽署率只有0.45只有10.3萬人我還要你看到一個數字這個數字不是只有10.3萬人0.45的簽署率而是如果我問你已經簽署的到最後真的有去執行的比率有多高已經簽署的真正去落實這個簽署的人的意志那真正執行有多高呢\n\n02:27.506 --> 02:37.732\n好這個我想意思是有研究不過我先跟委員做初步的報告那因為時間相當的短嘛2019到現在大概有70%有這麼高嗎到最後真正執行率吻合率吻合率那個是你們推估的\n\n02:51.160 --> 02:55.222\n其實有人是認為說但是這是推估的其實大家都不認為說執行率很高所以顯然不是只有簽署的人數的問題而且就是說即便簽署了到最後的執行率為什麼沒有辦法執行\n\n03:12.009 --> 03:34.615\n所以大家都想要尊嚴的善終要拒絕無效的醫療可是當走到那一步譬如說我的母親她在做DNR的時候我們都知道可是到那一刻要我們決定我理性上都知道該怎麼做我們全家人都知道該怎麼做可是到那一刻來的時候我們做不下去做不下去\n\n03:37.495 --> 03:51.672\n然後就這樣又拖一拖到什麼時候才大家說放棄了吧因為覺得他這樣子下去拖下去太痛苦了所以我們才說那我們放棄吧所以我是要告訴你說從這個\n\n03:55.736 --> 04:18.981\n衛生政策來檢驗這個病主法當然是還有在討論的這個空間但是並不是只有簽署率多高還包括執行上的障礙是什麼而這個東西是透過這一個法律就可以解決的嗎我想答案是否定的他不是只有一個病主法就足夠的所以\n\n04:22.610 --> 04:45.442\n這種善終的概念喔老實說簽署率不高的原因還有一個啦大家對於病主法的想像跟他所想像的他以為這是一個善終的安樂死的概念的其實是不是的根本不是的當你真正去了解的時候發現不是的時候\n\n04:46.793 --> 04:52.599\n那跟DNR差沒有很大的時候我認為DNR的簽署率很高啦到那一刻DNR的簽署率都很高\n\n04:59.254 --> 05:20.083\n但DNR離這個病毒法的這個簽署那個內容並不是差異太大了老實說那我們講說這個無效醫療要善終但是監察院在2011年他其實有\n\n05:21.864 --> 05:32.074\n這個讓無效醫療和臨終關懷扶上檯面那他指出臨床上界定治療無效或者是何時讓安寧緩和和醫療接手都沒有辦法明確定義那具體而言\n\n05:38.059 --> 05:53.885\n國家透過法律保障和約束專業但醫療行為屬專業自主其內涵仰賴專業自律和主管機關的含釋所以在這種狀況裡面我們都看到專業的醫生的意見跟這個\n\n05:56.306 --> 06:24.760\n社會大眾的期待的所謂的比較好的善終的這個手段其實落差還是很大所以這種情境善終的臨床的情境雖然不是專科所能擅自去做詮釋的但是如果謹守專業自主讓政策去導引而不是不當的介入原本在醫病之間互相理解和治療狀態下的照護喔這個一直都是修法的困境\n\n06:26.072 --> 06:51.194\n那這個我要講這個是因為有一個月旦醫學法報告有一篇文章叫做圖法不足以自行圖法不足以自行這個病人自主權利法的反思善終政策不曉得師長或是部長有沒有看過這個郭文華教授的這一篇文章我們華麗專家有\n\n06:54.787 --> 06:57.908\n病主法的困局其原因固然有民眾的誤解和醫界的被動但是不可諱言的有來自病主法的理想性\n\n07:12.452 --> 07:35.100\n生命自主需要保障照護需要父權但是一般人並不容易理解這樣的一個抽象的概念更不要說在徹底了解後做的治療的選擇但我要講說其實他講的我部分上也認同但部分上不一定認同我覺得剛好相反很多人是相對的了解他對生命的價值和意義而想要選擇一種\n\n07:36.300 --> 07:52.527\n善終的方式但是偏偏他所期待的是在病毒法這部法律裡面不能給的給不了的那從衛生的角度以外呢我們這個看到郭文華教授他要指出幾個盲點第一宣導跟現實的落差\n\n07:57.469 --> 08:24.630\n如果在這個被認為創造病患可以無痛苦讓醫師減少臨床壓力然後大家說這樣去創造健保資源不浪費因為無效醫療就是浪費嘛大家會覺得這樣可是呢這樣的狀況沒有釐清政策效果的優先順序或者是為什麼要病人以自主之名去啟動要一般人立即理解善終主動尋求理解AD跟簽署\n\n08:25.370 --> 08:47.532\n似乎誠意過高第二個諮商的門檻他們覺得ACP的法律程序諮商的行為受到法律的規範AD就是法律文件在沒有相關素養教育的配套下具有法律性質的醫療諮商扛起公民教育的責任可行性他們也覺得有疑慮\n\n08:48.473 --> 08:55.238\n本來諮商是專業的本來諮商是沒有法律的責任的可是現在是必須透過諮商這個過程來建立法律的責任然後才能去簽AD那麼這個諮商的過程大家去都可能是速成法速成法可是大家對這個概念是要先有\n\n09:08.187 --> 09:22.803\n這個公民教育的你對於這個生死的素養才能具備說你要去諮商然後你要去簽署這個文件可是如果沒有公民的素養沒有這個教育生死的教育然後直接就叫說我上一個諮商一下然後就簽了\n\n09:24.564 --> 09:50.032\n這個可能在大家可行性上有疑慮然後呢在楊秀怡在期刊台灣公共衛生雜誌2020年6月的文章講到住院的病患家屬對病人自主權立法的認知態度及日歷醫療決定的行為意向他指出90%以上受訪者願意進行ACP的諮商卻\n\n09:51.992 --> 10:06.380\n這個很重要我現在要告訴你們這個東西我要講楊秀宇的這篇文章很重要他做了研究他在醫院然後去做調查這個都是住院的病患的家屬了\n\n10:08.877 --> 10:28.616\n90%以上去進行他們都願意這個預歷醫療照護諮商當他們都願意了以後進一階進階到要簽AD了就是要預歷醫療決定了他從90%以上的接受度瞬間減半掉為51.25%\n\n10:33.662 --> 10:44.114\n並不是沒有接受諮商他去接受諮商了然後到要簽的時候剩下51.25%然後楊繡宇認為說這個是很有意義的發現為什麼為什麼這個是你們主導的政策為什麼你可以告訴我嗎保定你知道嗎市長你知道嗎\n\n10:56.857 --> 11:18.230\n其實這一段的落差其實就變成是說我覺得是在簽署自己的名字那個必須是一個commitment這件事情其實產生了因為我們其實有做過其他相關的研究其實也都是在具名要簽下去這件事情的時候在整個過程當中產生了一個質疑所以在願意\n\n11:19.130 --> 11:39.875\n智商完之後真的要簽下去其實還有周圍家屬一些因素影響其實實際上面的簽署率在一些相關的研究我忘記是不是楊老師的研究其實都有一些學者提出來所以我要講說簽署率不要成為你們的KPI不要把病毒法的KPI定為簽署率\n\n11:41.324 --> 11:54.013\n楊秀瑜說他這個跟國際許多的研究觀察都是相符合的就是許多人並不排斥思考死亡和臨終善終的醫療照護的問題\n\n11:56.454 --> 12:11.297\n但是真正要簽署的時候可能會考慮很多有時候是不願意和家人討論或行諸於文字或者是像是類似一種法律契約何以如此何以如此市長何以如此我們看到這個現象了但為什麼呢為什麼呢因為我們要討論修法要讓這個法律更進階來討論它的問題發生在哪裡但何以如此啊\n\n12:26.082 --> 12:41.072\n所以陳慧覺得是說今天在討論所謂的病毒這件事情我們一直覺得是說需要做的事情在民眾死亡勢能這個部分其實我們需要去提市長你講了你都沒有看其實非常重要的一個原因就是\n\n12:44.695 --> 13:04.189\n因為此時此地和當時當地不同啦選擇生命末期的醫療是非常艱難的選擇不管事前有再多的準備預備但是到了醫療現場在生死關頭還是有很多的猶豫反覆捨不得如果\n\n13:05.049 --> 13:16.143\n大家都在那裡天人交戰包括我自己就曾經經歷過我都知道我也準備了我也認為什麼是最好的可是當時到此時不一樣\n\n13:22.270 --> 13:37.687\n所以這篇調查是受訪者都是家人目前都是在家戶病房的家屬對醫療現場都有第一手的經驗更能了解做決定的艱難\n\n13:39.309 --> 13:50.293\n而且他們對ACP都持開放的態度卻只有一半願意簽署AD這個你們一定要記住第三也就是最關鍵的政策成效的評估大家覺得說\n\n13:55.295 --> 14:20.216\n這個評估是不是要有研擬運作的模式設立了示範的中心追蹤AD的簽署來作為政策的里程碑但這個做法看起來沒問題但實務上的障礙是民眾真的不容易理解病毒法和安寧條例為何並存宣導團隊也重疊然後相對ACP跟AD的簽署率的低我剛剛講過DNR大家\n\n14:23.198 --> 14:30.491\n都是簽署率非常非常的高的你只要給他簽欸病危了然後拒絕心胃復甦或衛生醫療大家都簽啦十個有高的都有簽啦\n\n14:34.938 --> 15:03.471\n所以在這種狀況裡面其實這些議題我們都希望說在你的政策有效性的評估並不要用那種方法那現在講說持續的問題是要推動生死素養的教育和政策要回到臨終狀況現場以更周全的方式去評估成果部長你認為有哪些方法還可以再改善\n\n15:04.452 --> 15:15.053\n這種評估的效果不要一味的以AD的簽署數為評估的指標嘛其實那個委員主持的重點\n\n15:16.531 --> 15:37.399\n其實你在簽AD到最後在面臨實際上那個時候的時候是非常困難的當然你前面早一點我再講還有什麼指標你就回答我就好了指標委員的意思是臨床現狀嗎就是說到底這種這種病人自主無效醫療然後這什麼樣的狀況認為是你們醫療政策推動的比較好的指標的觀察什麼東西好那個請問一下\n\n15:45.900 --> 16:10.598\n這邊的話就臨床部分的話我們會希望是說其實是要一起看什麼意思就是說在推動所謂的剛剛委員特別有垂詢是說如果只單就一個AD的簽署率其實是應該把DNR跟安寧的這邊其實是一起看這是第一件事第二件事情就是一些量性指標的部分的話我們可以在六個月內如果有使用就是\n\n16:11.618 --> 16:36.963\n因為當你的終點越清楚的時候其實一些醫療介入的措施我們是希望他能夠有這樣的概念不管我的進入的路徑是從病毒法或者是從安寧緩和條例六個月內沒有有使用像這樣子安寧照護的服務的比例能夠增加這是我們希望未來你們的安寧病床都是你們沒有滿床嗎照你們剛才的想法沒有滿床但是其實我曾經被拜託是排不到床的\n\n16:38.039 --> 16:58.048\n他其實是有我曾經被拜託就說想要進去安寧病房都派不進去我要講的是說其實目前我們希望推動的在特別是在高齡少子社會裡面其實怎麼樣回到社區所以安寧共照然後居家安寧跟社區安寧我想的是這樣子啦市長你想的我直接跟你講我想什麼啦因為我覺得部長你剛才唱很多高調衛部部也唱很多高調什麼\n\n17:06.952 --> 17:11.617\n給他照顧得很好有尊嚴不會痛苦就沒有人想要安樂死這個是唱很多高調啊你知道當在那一剎那的時候要多少經濟壓力當你們癌症治療的藥物設限這麼多標靶用藥設限那麼多然後要自費的話要花那麼多錢\n\n17:26.994 --> 17:31.255\n你說要尊嚴要照護好你們連安寧病床可能都不夠然後呢醫護這個護理人員流失關床排不進去你們的照護品質不會好那家人古早人說孤單病不好走嘛那病人被人痛苦折磨然後要有好的藥門檻那麼高要自己自費買不起\n\n17:51.396 --> 18:03.261\n所以難怪這個4月24台大公衛在講的是善終自主台灣民眾對醫師協助死亡的看法所以有這種狀況是有3992位然後進行這個死亡調查關於醫生協助死亡的調查研究這樣子\n\n18:20.014 --> 18:47.040\n然後醫助死亡跟安樂死是不一樣的我們先講在這裡安樂死是醫生處理的可是醫助死亡是醫生協助而已讓受苦的病人加速離世如果我們的長照制度不好我們的照護品質不好如果病人的經濟能力不好如果我們健保的癌症藥物的給付不好你叫我們說沒有人會想要安樂死我告訴你現在台灣\n\n18:48.340 --> 18:56.046\n很多生病的人包括我自己我都想要自己去自殺了如果有安樂死的話我會選擇安樂死為什麼因為我剛剛講你講說好的什麼那個高調的那個情境在台灣目前不會存在而且在執行上理想上也不太會存在不太可能因為資源有限因為人力耗盡在那裡因為大家都知道\n\n19:16.431 --> 19:38.351\n無效的醫療再拖下去也是無效所以你說會有那種不想安樂死的我想大概對啦也有但是很多更多是想要安樂死的那在這種狀況裡面台大公衛的這份研究做了3992個將近4000個他依據死亡的支持度他設定了三種\n\n19:39.392 --> 20:00.279\n三種就癌症末期而且預期壽命有限再活沒多久而且病人太痛苦了像癌症末期86.2%的支持度都要求可以有醫助死亡那第二種即便不是末期但根本就沒有藥可醫而且身上有無法忍受的痛苦如劍動人這種支持度79.6%\n\n20:03.800 --> 20:27.046\n第三種病人嚴重喪失認知能力疾病無法治癒也沒有改善的方式如極重度的失智支持率有72%72.6%還有不分任何情境純粹就是你支不支持醫生可以協助民眾死亡的比例有67.6%所以這個台大公衛的學者呼籲了什麼他們呼籲什麼部長你知道嗎\n\n20:35.939 --> 21:03.038\n我可以補充他其實呼籲的其實是對死亡這件事情應該有更多的社會的對話對保證妳要了解妳自己知道但是妳也要了解就是說妳要建議社會跟政府要跟所有的社會的對話都要開始溝通要開始對話甚至連這個醫治死亡都要開始討論啦\n\n21:05.060 --> 21:07.781\n全台灣人過半以上都支持大家就要開始討論要你社會討論對不對社會討論重不重要保定非常重要那你們的次長為什麼為什麼你們的次長面對這樣的研究一出來你的處長怎麼說\n\n21:27.998 --> 21:35.800\n安樂死斷食善終是不對的他連斷食善終都不對了這不是我們的病主法嗎市長怎麼這麼說他說這兩者都不會成為衛福部的政策選項你是誰啊你說了算喔社會對話這是社會對話喔\n\n21:51.738 --> 22:00.291\n不管是斷食善中或安樂食他的intention我問你啦你的病足法裡面有沒有包含斷食善中\n\n22:01.365 --> 22:25.879\n那個不叫斷食善中那個是不要去使用不必要的人工營養水分我想委員今天的一席話真的是非常專業我真的是覺得很敬佩但是我必須要講清楚斷食善中你不給他在營養供給了不給他鼻胃管了不給他這個營養供給了你知道插一個鼻胃管病人是多痛苦對啊\n\n22:26.960 --> 22:32.887\n那你有很多的方式你會好好的照顧他他就會吃很多東西他雖然有時候有那種\n\n22:36.678 --> 22:50.448\n需要鼻胃管的還有進食能力的如果那種連吞嚥功能都喪失的吞嚥功能譬如我舉個例子我現在不是跟你討論這個我是要告訴你你不要轉移焦點我是要告訴你說你的次長憑什麼他一個人說安樂時斷食善終都不會成為衛福部的政策選項你們說可以\n\n23:06.044 --> 23:20.826\n可以透過支持性或緩解性的醫療照顧減輕病人痛苦但不贊同安樂死你講了支持性或緩解性的醫療照護真的是大家都可以得到這麼好的照顧嗎\n\n23:22.691 --> 23:26.072\n百分之九十你的癌症用藥設限那麼多標靶用藥自費這麼貴然後家人家人也耗這麼多人家病人不願意了所以我沒有叫你藥喔我現在告訴你是醫師協助死亡這現在民意支持度這麼高的狀況\n\n23:42.538 --> 24:02.118\n你應該要開啟社會對話而甚至你要去研究相關的法律的制度對醫療的衝擊對醫師的衝擊然後相應的問題可能會是什麼你也要去回應學者的這個現象到底問題產生在哪裡你應該去開啟社會溝通和對話\n\n24:04.901 --> 24:08.162\n對不對那有可能你一個次長就來講不可能那我沒有愛我都沒有愛這樣就不用做了嗎我們幾十天來都一直在對話那我想次長我問你醫師協助死亡的議題你做過正式的政策評估或是跨部門討論嗎或者是你委託研究過嗎它的倫理法律和醫療實務的可行性\n\n24:31.990 --> 24:42.644\n會遇到什麼困難可行不可行你們做過嗎有沒有做過醫師誰是智商其實也是安樂死的一種我現在就是在講\n\n24:46.170 --> 24:56.941\n醫師協助死亡的安樂死方式對這個部分就是屬於在安樂死的一個範疇對我在問你說社會溝通對話那這個部分必須要更多的社會對話來溝通那當我們目前的政策台大現在這份研究\n\n25:05.450 --> 25:17.275\n我們在講P.A.D合法就是醫治死亡的這個P.A.D的政策P.A.D的意思P.A.DDyingAssistantPhysicianPhysicianAssistedDying\n\n25:33.817 --> 25:42.442\n就跟你講PAD啦我是要告訴這不重要啦我現在就是講喔當台大的公衛拿出這樣的數據的時候你們有沒有做過任何政策的研議倫理法律的社會心理的你們都沒有做一個處長一出來就跟人家說那都不可能我們不愛我們不接受那你現在是怎樣像林淑芬講的沒有我自己吃到75歲我自己去煮飯\n\n26:03.325 --> 26:31.404\n你是要這樣子你知道我走出門你知道多少人給我懲罰立委啊你就趕快讓他安樂死合法化你就趕快立這個法律我告訴他什麼我不知道怎麼定這個法律啊整個社會溝通對話倫理的法律的社會心理的經濟的等等的生物上的我通通都沒有足夠的專業然後社會沒有對話\n\n26:34.926 --> 26:50.257\n衛福部也從來不討論不委外研究沒有任何的政策研究我是要怎麼去產出一個法律啊你在這裡你到底你是跟你們處長一樣的立場是不是啦我就是在這裡問你你跟你們處長一樣就直接說我們反對安樂死絕對不要反安樂死你在這裡是要宣示這個政策嗎我們政策是一種開放的我現在講這個叫社會對話嗎社會對話是這樣的嗎\n\n27:04.202 --> 27:31.283\n我們可以繼續來我今天不是在講病主法為什麼病主法的簽署率這麼低其中一個重要的原因就是民眾所想像的病主法所想像的安樂死的善終的概念跟這個法律落差太大了而民眾想要的很多民眾想要的當然也有很多民眾反對很多民眾想要的是真的是讓我好好的走吧善終安樂死\n\n27:32.023 --> 27:56.241\n你最好是了解一下什麼叫一一社會對話溝通然後你最好去做一下研究好歹也做一下研究吧連這個都拒絕在這裡你都不做的話我只能說這個不但做國內的研究我們也做國際的研究做很多啊paper在哪裡你的委外研究經費編在哪裡你的委外研究的計畫成果在哪裡\n\n27:59.215 --> 28:20.724\n那另外就是就是有國內有很多學者都有做學者做的跟你政府做的有一樣嗎在這裡信口開河青菜公共那你為什麼一直你一直用台大的公衛學者做為一個政府你用我們好朋友楊秀儀教授的文章來談論那不是政府喔那是拿政府的錢的嗎\n\n28:21.992 --> 28:28.376\n不管怎麼樣這也是當然的我現在講我這裡我監督的是叫做政府我們人民要的是有政府能溝通我這裡怎麼去問責於一個學者你怎麼政府把責任就推給所有學者做了這是叫做政府嗎甘良秀儀咧主導這個政策\n\n28:46.505 --> 28:56.568\n我們當然在主導政策啊但是我們要收集各方面的資訊不是喔你要開啟你是政府你要去做研究不是只說學者研究一分這樣就好了我現在不想聽骯髒我要聽你政府你政府你怎麼面對這個課題怎麼面對這個議題怎麼面對人民有這個需求\n\n29:11.499 --> 29:23.349\n尤其是在你們醫療制度都在這麼緊張瀕臨崩潰的邊緣啦更不要講問題多啦在講說你好好的照顧這個理想性不存在啦\n\n","segments":[{"start":0.389,"end":1.05,"text":"好 謝謝主席 是不是要請邱部長請部長委員好"},{"start":18.872,"end":38.777,"text":"部長今年正式邁入這個超高齡社會五個就有一個是65歲以上所以這個活得久已經大概不是很大的問題但是要活得好那活得好的話其實也難免生老病死所以其實不要講到說65歲以上的人包括我自己我跟我朋友之間在談的我們都講說害怕生不如死我自己見證過我自己兩個"},{"start":48.901,"end":63.932,"text":"父母他們都是中風的然後躺在醫院的很久的那在這種狀況裡面我也面臨過很多的情境所以都求善終並不是只有年紀大的人在想對我來講我就是"},{"start":65.353,"end":69.316,"text":"我甚至講跟朋友之間開玩笑就是說我75歲我大概自己如果沒有安樂死的這個法律的話我要自己去自殺那我告訴我的孩子說我是自主的而且是我很開心的我願意這麼做的那希望他們不要情緒不好所以我經常跟我兒子講說當我死亡的時候"},{"start":88.347,"end":105.798,"text":"你要給我還保障 不要給我綁水牢我的意思是說 我不要水障我在講的是生和死的溝通我經常告訴我的孩子我怎麼想免得到那一天的時候 他不知道母親怎麼想那在這種狀況裡面 今天的修法我必須要講說有的人希望說放寬ACP的經費啦ACP的執行場域去委託代理人的資格放寬等等"},{"start":117.586,"end":146.769,"text":"那大家講都講說這個簽署率只有0.45只有10.3萬人我還要你看到一個數字這個數字不是只有10.3萬人0.45的簽署率而是如果我問你已經簽署的到最後真的有去執行的比率有多高已經簽署的真正去落實這個簽署的人的意志那真正執行有多高呢"},{"start":147.506,"end":157.732,"text":"好 這個我想意思是有研究 不過我先跟委員做初步的報告那因為時間相當的短嘛 2019到現在大概有70% 有這麼高嗎到最後真正執行率 吻合率吻合率那個是你們推估的"},{"start":171.16,"end":175.222,"text":"其實有人是認為說 但是這是推估的其實大家都不認為說執行率很高所以顯然不是只有簽署的人數的問題而且就是說即便簽署了到最後的執行率為什麼沒有辦法執行"},{"start":192.009,"end":214.615,"text":"所以大家都想要尊嚴的善終 要拒絕無效的醫療可是當走到那一步 譬如說我的母親她在做DNR的時候我們都知道 可是到那一刻要我們決定我理性上都知道該怎麼做 我們全家人都知道該怎麼做可是到那一刻來的時候 我們做不下去 做不下去"},{"start":217.495,"end":231.672,"text":"然後就這樣又拖一拖到什麼時候才大家說放棄了吧因為覺得他這樣子下去拖下去太痛苦了所以我們才說那我們放棄吧所以我是要告訴你說從這個"},{"start":235.736,"end":258.981,"text":"衛生政策來檢驗這個病主法當然是還有在討論的這個空間但是並不是只有簽署率多高還包括執行上的障礙是什麼而這個東西是透過這一個法律就可以解決的嗎我想答案是否定的他不是只有一個病主法就足夠的所以"},{"start":262.61,"end":285.442,"text":"這種善終的概念喔老實說簽署率不高的原因還有一個啦大家對於病主法的想像跟他所想像的他以為這是一個善終的安樂死的概念的其實是不是的根本不是的當你真正去了解的時候發現不是的時候"},{"start":286.793,"end":292.599,"text":"那跟DNR差沒有很大的時候我認為DNR的簽署率很高啦到那一刻DNR的簽署率都很高"},{"start":299.254,"end":320.083,"text":"但DNR離這個病毒法的這個簽署那個內容並不是差異太大了 老實說那我們講說這個無效醫療要善終但是監察院在2011年他其實有"},{"start":321.864,"end":332.074,"text":"這個讓無效醫療和臨終關懷扶上檯面那他指出臨床上界定治療無效或者是何時讓安寧緩和和醫療接手都沒有辦法明確定義那具體而言"},{"start":338.059,"end":353.885,"text":"國家透過法律保障和約束專業但醫療行為屬專業自主其內涵仰賴專業自律和主管機關的含釋所以在這種狀況裡面我們都看到專業的醫生的意見跟這個"},{"start":356.306,"end":384.76,"text":"社會大眾的期待的所謂的比較好的善終的這個手段其實落差還是很大所以這種情境善終的臨床的情境雖然不是專科所能擅自去做詮釋的但是如果謹守專業自主讓政策去導引而不是不當的介入原本在醫病之間互相理解和治療狀態下的照護喔這個一直都是修法的困境"},{"start":386.072,"end":411.194,"text":"那這個我要講這個是因為有一個月旦醫學法報告有一篇文章叫做圖法不足以自行圖法不足以自行這個病人自主權利法的反思善終政策不曉得師長或是部長有沒有看過這個郭文華教授的這一篇文章我們華麗專家有"},{"start":414.787,"end":417.908,"text":"病主法的困局其原因固然有民眾的誤解和醫界的被動但是不可諱言的有來自病主法的理想性"},{"start":432.452,"end":455.1,"text":"生命自主需要保障 照護需要父權但是一般人並不容易理解這樣的一個抽象的概念更不要說在徹底了解後做的治療的選擇但我要講說其實他講的我部分上也認同但部分上不一定認同我覺得剛好相反很多人是相對的了解他對生命的價值和意義而想要選擇一種"},{"start":456.3,"end":472.527,"text":"善終的方式但是偏偏他所期待的是在病毒法這部法律裡面不能給的給不了的那從衛生的角度以外呢我們這個看到郭文華教授他要指出幾個盲點第一 宣導跟現實的落差"},{"start":477.469,"end":504.63,"text":"如果在這個被認為創造病患可以無痛苦讓醫師減少臨床壓力然後大家說這樣去創造健保資源不浪費因為無效醫療就是浪費嘛大家會覺得這樣可是呢這樣的狀況沒有釐清政策效果的優先順序或者是為什麼要病人以自主之名去啟動要一般人立即理解善終主動尋求理解AD跟簽署"},{"start":505.37,"end":527.532,"text":"似乎誠意過高第二個諮商的門檻他們覺得ACP的法律程序諮商的行為受到法律的規範AD就是法律文件在沒有相關素養教育的配套下具有法律性質的醫療諮商扛起公民教育的責任可行性他們也覺得有疑慮"},{"start":528.473,"end":535.238,"text":"本來諮商是專業的本來諮商是沒有法律的責任的可是現在是必須透過諮商這個過程來建立法律的責任然後才能去簽AD那麼這個諮商的過程大家去都可能是速成法速成法可是大家對這個概念是要先有"},{"start":548.187,"end":562.803,"text":"這個公民教育的你對於這個生死的素養才能具備說你要去諮商然後你要去簽署這個文件可是如果沒有公民的素養沒有這個教育生死的教育然後直接就叫說我上一個諮商一下然後就簽了"},{"start":564.564,"end":590.032,"text":"這個可能在大家可行性上有疑慮然後呢在楊秀怡在期刊台灣公共衛生雜誌2020年6月的文章講到住院的病患家屬對病人自主權立法的認知態度及日歷醫療決定的行為意向他指出90%以上受訪者願意進行ACP的諮商卻"},{"start":591.992,"end":606.38,"text":"這個很重要 我現在要告訴你們 這個東西我要講楊秀宇的這篇文章很重要他做了研究他在醫院 然後去做調查這個都是住院的病患的家屬了"},{"start":608.877,"end":628.616,"text":"90%以上去進行他們都願意這個預歷醫療照護諮商當他們都願意了以後進一階 進階到要簽AD了就是要預歷醫療決定了他從90%以上的接受度瞬間減半掉為51.25%"},{"start":633.662,"end":644.114,"text":"並不是沒有接受諮商 他去接受諮商了然後到要簽的時候 剩下51.25%然後楊繡宇認為說 這個是很有意義的發現 為什麼為什麼 這個是你們主導的政策 為什麼 你可以告訴我嗎保定你知道嗎 市長你知道嗎"},{"start":656.857,"end":678.23,"text":"其實這一段的落差其實就變成是說我覺得是在簽署自己的名字那個必須是一個commitment這件事情其實產生了因為我們其實有做過其他相關的研究其實也都是在具名要簽下去這件事情的時候在整個過程當中產生了一個質疑所以在願意"},{"start":679.13,"end":699.875,"text":"智商完之後真的要簽下去其實還有周圍家屬一些因素影響其實實際上面的簽署率在一些相關的研究我忘記是不是楊老師的研究其實都有一些學者提出來所以我要講說簽署率不要成為你們的KPI不要把病毒法的KPI定為簽署率"},{"start":701.324,"end":714.013,"text":"楊秀瑜說他這個跟國際許多的研究觀察都是相符合的就是許多人並不排斥思考死亡和臨終善終的醫療照護的問題"},{"start":716.454,"end":731.297,"text":"但是真正要簽署的時候可能會考慮很多有時候是不願意和家人討論或行諸於文字或者是像是類似一種法律契約何以如此 何以如此市長 何以如此我們看到這個現象了 但為什麼呢 為什麼呢因為我們要討論修法要讓這個法律更進階來討論它的問題發生在哪裡但何以如此啊"},{"start":746.082,"end":761.072,"text":"所以陳慧覺得是說今天在討論所謂的病毒這件事情我們一直覺得是說需要做的事情在民眾死亡勢能這個部分其實我們需要去提市長你講了你都沒有看其實非常重要的一個原因就是"},{"start":764.695,"end":784.189,"text":"因為此時此地和當時當地不同啦選擇生命末期的醫療是非常艱難的選擇不管事前有再多的準備預備但是到了醫療現場在生死關頭還是有很多的猶豫反覆捨不得如果"},{"start":785.049,"end":796.143,"text":"大家都在那裡天人交戰包括我自己就曾經經歷過我都知道我也準備了我也認為什麼是最好的可是當時到此時不一樣"},{"start":802.27,"end":817.687,"text":"所以這篇調查是受訪者都是家人目前都是在家戶病房的家屬對醫療現場都有第一手的經驗更能了解做決定的艱難"},{"start":819.309,"end":830.293,"text":"而且他們對ACP都持開放的態度卻只有一半願意簽署AD這個你們一定要記住第三也就是最關鍵的政策成效的評估大家覺得說"},{"start":835.295,"end":860.216,"text":"這個評估是不是要有研擬運作的模式設立了示範的中心追蹤AD的簽署來作為政策的里程碑但這個做法看起來沒問題但實務上的障礙是民眾真的不容易理解病毒法和安寧條例為何並存宣導團隊也重疊然後相對ACP跟AD的簽署率的低我剛剛講過DNR大家"},{"start":863.198,"end":870.491,"text":"都是簽署率非常非常的高的你只要給他簽 欸 病危了然後拒絕心胃復甦或衛生醫療大家都簽啦 十個有高的都有簽啦"},{"start":874.938,"end":903.471,"text":"所以在這種狀況裡面其實這些議題我們都希望說在你的政策有效性的評估並不要用那種方法那現在講說持續的問題是要推動生死素養的教育和政策要回到臨終狀況現場以更周全的方式去評估成果部長你認為有哪些方法還可以再改善"},{"start":904.452,"end":915.053,"text":"這種評估的效果不要一味的以AD的簽署數為評估的指標嘛其實那個委員主持的重點"},{"start":916.531,"end":937.399,"text":"其實你在簽AD到最後在面臨實際上那個時候的時候是非常困難的當然你前面早一點我再講還有什麼指標你就回答我就好了指標委員的意思是臨床現狀嗎就是說到底這種這種病人自主無效醫療然後這什麼樣的狀況認為是你們醫療政策推動的比較好的指標的觀察什麼東西好那個請問一下"},{"start":945.9,"end":970.598,"text":"這邊的話就臨床部分的話我們會希望是說其實是要一起看什麼意思就是說在推動所謂的剛剛委員特別有垂詢是說如果只單就一個AD的簽署率其實是應該把DNR跟安寧的這邊其實是一起看這是第一件事第二件事情就是一些量性指標的部分的話我們可以在六個月內如果有使用就是"},{"start":971.618,"end":996.963,"text":"因為當你的終點越清楚的時候其實一些醫療介入的措施我們是希望他能夠有這樣的概念不管我的進入的路徑是從病毒法或者是從安寧緩和條例六個月內沒有有使用像這樣子安寧照護的服務的比例能夠增加這是我們希望未來你們的安寧病床都是你們沒有滿床嗎照你們剛才的想法沒有滿床但是其實我曾經被拜託是排不到床的"},{"start":998.039,"end":1018.048,"text":"他其實是有我曾經被拜託就說想要進去安寧病房都派不進去我要講的是說其實目前我們希望推動的在特別是在高齡少子社會裡面其實怎麼樣回到社區所以安寧共照然後居家安寧跟社區安寧我想的是這樣子啦市長你想的我直接跟你講我想什麼啦因為我覺得部長你剛才唱很多高調衛部部也唱很多高調什麼"},{"start":1026.952,"end":1031.617,"text":"給他照顧得很好有尊嚴不會痛苦就沒有人想要安樂死這個是唱很多高調啊你知道當在那一剎那的時候要多少經濟壓力當你們癌症治療的藥物設限這麼多標靶用藥設限那麼多然後要自費的話要花那麼多錢"},{"start":1046.994,"end":1051.255,"text":"你說要尊嚴 要照護好 你們連安寧病床可能都不夠然後呢 醫護 這個護理人員流失 關床 排不進去你們的照護品質不會好 那家人 古早人說孤單病不好走嘛那病人被人痛苦折磨 然後要有好的藥門檻那麼高 要自己自費買不起"},{"start":1071.396,"end":1083.261,"text":"所以難怪這個4月24台大公衛在講的是善終自主台灣民眾對醫師協助死亡的看法所以有這種狀況是有3992位然後進行這個死亡調查關於醫生協助死亡的調查研究這樣子"},{"start":1100.014,"end":1127.04,"text":"然後醫助死亡跟安樂死是不一樣的我們先講在這裡安樂死是醫生處理的可是醫助死亡是醫生協助而已讓受苦的病人加速離世如果我們的長照制度不好我們的照護品質不好如果病人的經濟能力不好如果我們健保的癌症藥物的給付不好你叫我們說沒有人會想要安樂死我告訴你現在台灣"},{"start":1128.34,"end":1136.046,"text":"很多生病的人包括我自己我都想要自己去自殺了如果有安樂死的話我會選擇安樂死為什麼 因為我剛剛講你講說好的什麼那個高調的那個情境在台灣目前不會存在而且在執行上理想上也不太會存在不太可能 因為資源有限因為人力耗盡在那裡因為大家都知道"},{"start":1156.431,"end":1178.351,"text":"無效的醫療再拖下去也是無效所以你說會有那種不想安樂死的我想大概對啦也有但是很多更多是想要安樂死的那在這種狀況裡面台大公衛的這份研究做了3992個將近4000個他依據死亡的支持度他設定了三種"},{"start":1179.392,"end":1200.279,"text":"三種 就癌症末期而且預期壽命有限 再活沒多久而且病人太痛苦了 像癌症末期86.2%的支持度都要求可以有醫助死亡那第二種 即便不是末期 但根本就沒有藥可醫而且身上有無法忍受的痛苦 如劍動人這種支持度79.6%"},{"start":1203.8,"end":1227.046,"text":"第三種病人嚴重喪失認知能力疾病無法治癒也沒有改善的方式如極重度的失智支持率有72%72.6%還有不分任何情境純粹就是你支不支持醫生可以協助民眾死亡的比例有67.6%所以這個台大公衛的學者呼籲了什麼他們呼籲什麼部長你知道嗎"},{"start":1235.939,"end":1263.038,"text":"我可以補充 他其實呼籲的其實是對死亡這件事情應該有更多的社會的對話對 保證妳要了解 妳自己知道 但是妳也要了解就是說 妳要建議社會跟政府要跟所有的社會的對話都要開始溝通要開始對話 甚至連這個醫治死亡都要開始討論啦"},{"start":1265.06,"end":1267.781,"text":"全台灣人 過半以上都支持大家就要開始討論 要你社會討論對不對 社會討論重不重要 保定非常重要那你們的次長為什麼為什麼你們的次長面對這樣的研究一出來你的處長怎麼說"},{"start":1287.998,"end":1295.8,"text":"安樂死 斷食善終是不對的他連斷食善終都不對了這不是我們的病主法嗎市長怎麼這麼說他說這兩者都不會成為衛福部的政策選項你是誰啊 你說了算喔社會對話 這是社會對話喔"},{"start":1311.738,"end":1320.291,"text":"不管是斷食善中或安樂食他的intention我問你啦你的病足法裡面有沒有包含斷食善中"},{"start":1321.365,"end":1345.879,"text":"那個不叫斷食善中那個是不要去使用不必要的人工營養水分我想委員今天的一席話真的是非常專業我真的是覺得很敬佩但是我必須要講清楚斷食善中你不給他在營養供給了不給他鼻胃管了不給他這個營養供給了你知道插一個鼻胃管病人是多痛苦對啊"},{"start":1346.96,"end":1352.887,"text":"那你有很多的方式你會好好的照顧他他就會吃很多東西他雖然有時候有那種"},{"start":1356.678,"end":1370.448,"text":"需要鼻胃管的還有進食能力的如果那種連吞嚥功能都喪失的吞嚥功能 譬如我舉個例子我現在不是跟你討論這個我是要告訴你你不要轉移焦點我是要告訴你說你的次長憑什麼他一個人說安樂時 斷食善終都不會成為衛福部的政策選項你們說可以"},{"start":1386.044,"end":1400.826,"text":"可以透過支持性或緩解性的醫療照顧減輕病人痛苦 但不贊同安樂死你講了支持性或緩解性的醫療照護真的是大家都可以得到這麼好的照顧嗎"},{"start":1402.691,"end":1406.072,"text":"百分之九十你的癌症用藥設限那麼多標靶用藥自費這麼貴然後家人家人也耗這麼多人家病人不願意了所以我沒有叫你藥喔我現在告訴你是醫師協助死亡這現在民意支持度這麼高的狀況"},{"start":1422.538,"end":1442.118,"text":"你應該要開啟社會對話 而甚至你要去研究相關的法律的制度對醫療的衝擊 對醫師的衝擊 然後相應的問題可能會是什麼你也要去回應學者的這個現象 到底問題產生在哪裡你應該去開啟社會溝通和對話"},{"start":1444.901,"end":1448.162,"text":"對不對 那有可能你一個次長就來講 不可能 那我沒有愛我都沒有愛 這樣就不用做了嗎我們幾十天來都一直在對話 那我想次長我問你醫師協助死亡的議題 你做過正式的政策評估或是跨部門討論嗎 或者是你委託研究過嗎它的倫理法律和醫療實務的可行性"},{"start":1471.99,"end":1482.644,"text":"會遇到什麼困難可行不可行你們做過嗎有沒有做過醫師誰是智商其實也是安樂死的一種我現在就是在講"},{"start":1486.17,"end":1496.941,"text":"醫師協助死亡的安樂死方式對 這個部分就是屬於在安樂死的一個範疇對 我在問你說社會溝通對話那這個部分必須要更多的社會對話來溝通那當我們目前的政策台大現在這份研究"},{"start":1505.45,"end":1517.275,"text":"我們在講P.A.D合法就是醫治死亡的這個P.A.D的政策P.A.D的意思P.A.DDying Assistant PhysicianPhysicianAssisted Dying"},{"start":1533.817,"end":1542.442,"text":"就跟你講PAD啦 我是要告訴這不重要啦我現在就是講喔 當台大的公衛拿出這樣的數據的時候你們有沒有做過任何政策的研議倫理 法律的 社會心理的你們都沒有做 一個處長一出來就跟人家說那都不可能 我們不愛 我們不接受那你現在是怎樣 像林淑芬講的沒有我自己吃到75歲 我自己去煮飯"},{"start":1563.325,"end":1591.404,"text":"你是要這樣子你知道我走出門 你知道多少人給我懲罰立委啊 你就趕快讓他安樂死 合法化你就趕快立這個法律 我告訴他什麼我不知道怎麼定這個法律啊整個社會溝通對話倫理的法律的社會心理的經濟的等等的生物上的我通通都沒有足夠的專業然後社會沒有對話"},{"start":1594.926,"end":1610.257,"text":"衛福部也從來不討論不委外研究沒有任何的政策研究我是要怎麼去產出一個法律啊你在這裡你到底你是跟你們處長一樣的立場是不是啦我就是在這裡問你你跟你們處長一樣就直接說我們反對安樂死絕對不要反安樂死你在這裡是要宣示這個政策嗎我們政策是一種開放的我現在講這個叫社會對話嗎社會對話是這樣的嗎"},{"start":1624.202,"end":1651.283,"text":"我們可以繼續來我今天不是在講病主法為什麼病主法的簽署率這麼低其中一個重要的原因就是民眾所想像的病主法所想像的安樂死的善終的概念跟這個法律落差太大了而民眾想要的很多民眾想要的當然也有很多民眾反對很多民眾想要的是真的是讓我好好的走吧善終安樂死"},{"start":1652.023,"end":1676.241,"text":"你最好是了解一下什麼叫一一社會對話溝通然後你最好去做一下研究好歹也做一下研究吧連這個都拒絕在這裡你都不做的話我只能說這個不但做國內的研究我們也做國際的研究做很多啊 paper在哪裡你的委外研究經費編在哪裡你的委外研究的計畫成果在哪裡"},{"start":1679.215,"end":1700.724,"text":"那另外就是就是有國內有很多學者都有做學者做的跟你政府做的有一樣嗎在這裡信口開河青菜公共那你為什麼一直你一直用台大的公衛學者做為一個政府你用我們好朋友楊秀儀教授的文章來談論那不是政府喔那是拿政府的錢的嗎"},{"start":1701.992,"end":1708.376,"text":"不管怎麼樣這也是當然的我現在講我這裡我監督的是叫做政府我們人民要的是有政府能溝通我這裡怎麼去問責於一個學者你怎麼政府把責任就推給所有學者做了這是叫做政府嗎甘良秀儀咧主導這個政策"},{"start":1726.505,"end":1736.568,"text":"我們當然在主導政策啊 但是我們要收集各方面的資訊不是喔 你要開啟 你是政府 你要去做研究不是只說學者研究一分 這樣就好了我現在不想聽骯髒 我要聽你政府你政府 你怎麼面對這個課題 怎麼面對這個議題怎麼面對人民有這個需求"},{"start":1751.499,"end":1763.349,"text":"尤其是在你們醫療制度都在這麼緊張瀕臨崩潰的邊緣啦更不要講問題多啦在講說你好好的照顧這個理想性不存在啦"}]}}},"gazette":{"lineno":479,"blocks":[["林委員淑芬：（11時19分）謝謝主席，還是請邱部長。"],["主席：請部長。"],["邱部長泰源：委員好。"],["林委員淑芬：部長，今年正式邁入超高齡社會，每5人中就有1人是65歲以上，所以活得久大概已經不是很大的問題，但是要活得好。人難免生老病死嘛，其實不要說65歲以上的人，包括我自己，我跟朋友之間都說害怕生不如死，我自己見證過，我的父母他們都是中風的，躺在醫院很久，在這種狀況下，我也面臨過很多的情境，所以求善終並不是只有年紀大的人在想，對我來講，我也是如此。甚至我跟朋友之間開玩笑時也曾說，到了75歲的時候，如果沒有安樂死的法律的話，我要自己去自殺，我會告訴我的孩子說我是自主的，而且是很開心的，我願意這麼做的，希望他們不要情緒不好。我經常跟我兒子說，當我死亡的時候，你要給我環保葬，不要給我「放水流」，我的意思是說我不要水葬，我在講的是生和死的溝通，我經常告訴我的孩子我是怎麼想的，免得到那一天的時候他不知道母親怎麼想。","對於今天的修法，我必須要講的是，有的人希望放寬ACP的經費、ACP的執行場域及委任代理人的資格放寬等等。大家都講簽署率只有0.45%，只有10.3萬人完成簽署，但我還要你看到一個數字，這個數字不是只有10.3萬人、0.45%的簽署率，而是如果我問你，已經簽署且到最後真的有去執行的比率有多高？也就是說，已經簽署且真正落實簽署者意志的執行率有多高？"],["邱部長泰源：這個部分我想醫事司是有研究，不過我先跟委員做初步的報告，因為時間相當的短……"],["林委員淑芬：2019年到現在。"],["邱部長泰源：簽署到現在大概有70%……"],["林委員淑芬：有這麼高嗎？到最後真正執行率……"],["邱部長泰源：這是吻合率。"],["林委員淑芬：吻合率？那個是你們推估的，其實有人認為……"],["邱部長泰源：這是專家……"],["林委員淑芬：但這是推估的，其實大家都不認為執行率很高，所以顯然不是只有簽署人數的問題，即便簽署了，到最後執行的時候為什麼沒有辦法執行？大家都想要有尊嚴的善終，要拒絕無效的醫療，可是當走到那一步，比如我的母親在做DNR的時候我們都知道，可是真到那一刻要我們做決定的時候，我理性上都知道該怎麼做，我們全家人都知道該怎麼做，可是真到那一刻來的時候我們做不下去，做不下去啊！然後就這樣拖一拖，到什麼時候大家才說放棄了吧？是因為覺得他這樣拖下去太痛苦了，所以我們才說我們放棄吧！我是要告訴部長，從衛生政策來檢驗病主法當然還有再討論的空間，但是並不是只有簽署率多高，還包括執行上的障礙是什麼，而這個東西是透過這個法律可以解決的嗎？我想答案是否定的，這不是只有一個病主法就足夠的。","所以這種善終的概念，老實說，簽署率不高的原因還有一個，大家對病主法的想像是以為這是一個善終的、安樂死的概念，但其實不是的，根本不是的，當你真正去了解之後發現不是的，那個跟DNR差沒有很大，我認為DNR的簽署率很高，DNR的簽署率都很高，但DNR跟病主法的簽署內容並不是差異太大，老實說啦！","我們說要避免無效醫療、要善終，但是監察院在2011年其實有讓無效醫療和臨終關懷浮上檯面，他指出臨床上界定治療無效或者是何時讓安寧緩和醫療接手都沒有辦法明確定義。具體而言，國家透過法律保障和約束專業，但醫療行為屬專業自主，其內涵仰賴專業自律和主管機關的函釋。所以在這種狀況裡面，我們看到專業醫生的意見跟社會大眾期待所謂比較好的善終的這個手段，其實落差還是很大。善終的臨床情境雖然不是專科能擅自詮釋的，但是如果謹守專業自主，讓政策去導引，而不是不當的介入原本在醫病之間互相理解和治療狀態下的照護，這個一直都是修法的困境。","部長，在月旦醫事法報告裡面有一篇文章叫做徒法尚不足自行：從「病人自主權利法」反思善終政策，不曉得司長或是部長有沒有看過郭文華教授的這一篇文章？"],["劉司長越萍：沒有，我只看到那個summary，沒有仔細看裡面的內文。"],["林委員淑芬：好。他指出病主法的困局其原因固然有民眾的誤解和醫界的被動，但不可諱言有部分來自病主法的理想性。生命自主需要保障，照護需要賦權，但是一般人並不容易理解這樣抽象的概念，更不要說在澈底了解後所做的治療選擇。但我要講的是，其實他的看法我有部分認同，但有部分不一定認同，我覺得剛好相反，很多人是相對的了解生命的價值和意義，而想要選擇一種善終的方式，但是偏偏他所期待的是病主法這部法律裡面不能給的、給不了的。","從衛生政策的角度以外，我們看到郭文華教授有指出幾個盲點：第一個是宣導與現實的落差，善終被認為可以創造病患無痛苦、讓醫師減少臨床壓力，然後大家就說這樣可以使健保資源不浪費，因為無效醫療就是浪費嘛，大家可能覺得是這樣，可是沒有釐清政策效果的優先順序，或者是為什麼要由病人以自主之名啟動，要一般人立即理解善終，主動尋求理解AD與簽署，似乎陳義過高啦！第二個是諮商的政策門檻，他覺得ACP是法律程序，諮商行為受到法律規範，AD是法律文件，在沒有相關素養教育的配套下，以具有法律性質的醫療諮商扛起公民教育的責任，可行性上或有疑慮。本來諮商是專業的，本來諮商是沒有法律責任的，可是現在必須透過諮商這個過程來建立法律的責任，然後才能去簽AD，那麼這個諮商的過程，大家去都可能是「速成法」，可是大家對這個概念應該是先有公民教育對於生死的素養，才能具備先要去諮商，再去簽署這個文件；如果沒有公民的素養、沒有生死的教育，就直接去諮商，然後就簽署了，可能大家在可行性上會有疑慮。","楊秀儀教授在2020年6月發表在「台灣公共衛生雜誌」期刊的文章提到，住院的病患家屬對病人自主權利法的認知、態度及預立醫療決定的行為意向，指出90%以上受訪者願意進行ACP的諮商。我要告訴你們，楊秀儀教授這篇文章所做的研究很重要，她在醫院所調查的受訪對象，這些都是住院病患的家屬，他們有90%以上都願意預立醫療照護諮商，當他們都願意了以後，進階到要簽署AD，也就是要預立醫療決定，卻從90%以上的接受度瞬間減半掉到51.25%，所以並不是沒有接受諮商，是他去接受諮商了，但到要簽署的時候僅剩下51.25%，楊秀儀教授認為這個是很有意義的發現，為什麼？這個是你們主導的政策，你可以告訴我為什麼嗎？部長知道嗎？司長知道嗎？"],["劉司長越萍：我覺得這一段的落差是在簽署自己的名字，必須是commitment這件事情所產生的落差。我們其實有做過其他相關的研究，也都是在具名要簽下去這件事情的時候，在整個過程當中產生了質疑，所以在願意諮商完之後，要真的簽下去時，還是有受周圍家屬一些因素影響，實際上的簽署率，在一些相關的研究，我忘記是不是楊老師的研究，其實都有一些學者提出一些……"],["林委員淑芬：所以我要提的是簽署率不要成為你們的KPI，不要把簽署率訂為病主法的KPI。楊秀儀說這個跟國際許多的研究觀察都是相符合的，也就是許多人並不排斥思考死亡和臨終善終醫療照護的問題，但是真正要簽署的時候，可能會考慮很多，有時候是不願意和家人討論或形諸於文字，或者像是類似一種法律契約。何以如此？司長何以如此？我們看到這個現象了，但為什麼呢？為什麼呢？"],["劉司長越萍：我覺得……"],["林委員淑芬：如果我們要討論修法，要讓這個法律更進階來討論它的問題發生在哪裡，但何以如此啊？"],["劉司長越萍：所以今天在討論所謂病主的這件事情，我們才會一直覺得需要做的事情，在民眾死亡失能這個部分，其實是我們需要提昇的。"],["林委員淑芬：司長剛講的，你都沒有在看，其實非常重要的原因是，很簡單啦！一般人也都聽得懂，因為此時此地和當時當地不同啦！選擇生命末期的醫療是非常艱難的選擇，不管事前有再多的準備及預備，但是到了醫療現場，在生死關頭還是有很多的猶豫、反覆、捨不得。如果大家都在那裡天人交戰……包括我自己就曾經經歷過，我都知道、我也準備了、我也認為什麼是最好的，可是當時到此時不一樣、不一樣。這篇調查的受訪者都是家人，目前都是在加護病房的家屬，對醫療現場都有第一手的經驗，更能了解做決定的艱難，而且他們對ACP都持開放的態度，卻只有一半願意簽署AD，這個你們一定要記住。","第三個，最關鍵是政策成效的評估，大家覺得這個評估是不是要有研擬運作的模式，設立示範的中心及追蹤AD的簽署，以作為政策的里程碑？雖然這個作法看起來沒問題，但實務上的障礙是民眾真的不容易理解病主法和安寧條例為何並存，宣導團隊也重疊，然後相對於ACP跟AD的低簽署率，我剛剛講過的DNR，這簽署率是非常非常的高，只要給他簽署病危了，然後拒絕心肺復甦或維生醫療，這大家都會簽，十個中有九個都會簽。","所以在這種狀況裡，這些議題我們都希望在你的政策有效性的評估，不要用那種方法，現在講的持續問題是要推動生死素養的教育和政策，要回到臨終照護現場，以更周全的方式評估成果。部長認為有哪些方法還可以再改善這種評估的效果？不要一昧地以AD的簽署數作為評估的指標。"],["邱部長泰源：委員指出了重點，你簽AD到最後實際上面臨的那個時候是非常困難的，當然你前面早一點……"],["林委員淑芬：我在問還有什麼指標，你就回答我就好了。"],["邱部長泰源：指標？委員指的意思是臨床現況嗎？"],["林委員淑芬：就是這種病人自主無效醫療，在這樣的狀況，你們會認為是醫療政策推動的比較好的觀察指標？"],["邱部長泰源：好，請司長回答。"],["劉司長越萍：就臨床部分的話，我們會希望是要一起看，什麼意思呢？就是在推動所謂的剛剛委員特別有提到，如果只單就一個AD的簽署率，其實應該是把DNR跟安寧的部分一起看，這第一個；第二個是一些量性指標的部分，我們可以在6個月內如果有使用……因為當你的終點越清楚的時候，其實一些醫療介入的措施，我們是希望它能夠有這樣概念，不管進入的路徑是從病主法或者從安寧緩和醫療條例，6個月內有使用像這樣子安寧照護服務的比例能夠增加，這會是我們希望未來擴充的……"],["林委員淑芬：你們的安寧病床沒有滿床嗎？照你們剛才講法。"],["劉司長越萍：沒有滿床，而且有……"],["林委員淑芬：但是我曾經被拜託過，是排不到床耶！"],["劉司長越萍：其實也是有……"],["林委員淑芬：我曾經被拜託耶！就是想要進去安寧病房都排不進去。"],["劉司長越萍：目前我們希望推動的特別是在高齡少子社會裡要怎麼樣回到社區，所以安寧共照、居家安寧及社區安寧是我們推動的目標。"],["林委員淑芬：我想的是這樣子啦！司長，我直接跟你講我的想法，因為我覺得部長剛才唱很多高調，衛福部也唱很多高調，什麼給他照顧得很好、有尊嚴、不會痛苦，就沒有人想要安樂死，這個是唱很多高調啦！你知道當在那一剎那的時候，要承受多少經濟壓力，你們癌症治療的藥物設限這麼多、標靶用藥設限那麼多，然後自費要花那麼多錢，你說要尊嚴、要照護好，你們連安寧病床可能都不夠，然後這些護理人員的流失、關床及排不進去，你們的照護品質是不會好的。古人說：「久長病，無孝子」，病人本人痛苦折磨，要有好的藥，門檻那麼高，要自己自費卻買不起！難怪今年4月24日臺大公衛發表的研究在講「善終自主：臺灣民眾對醫師協助死亡的看法」，有3,992位成人進行關於醫生協助死亡的調查研究，醫助死亡跟安樂死是不一樣的，安樂死是醫生處理的，可是醫助死亡是醫生協助而已，讓受苦的病人加速離世。如果我們的長照制度不好、我們的照護品質不好、病人的經濟能力不好、我們健保癌症藥物的給付不好，你跟我們說沒有人會想要安樂死！我告訴你，現在臺灣很多生病的人，包括我自己，我都想要自己去自殺了，如果有安樂死的話，我會選擇安樂死。為什麼？因為我剛剛講，你說好的什麼……那個高調的情境，在臺灣目前不會存在，而且在執行上及理想上也不太會存在，不太可能，因為資源有限，因為人力耗盡在那裡，因為大家都知道無效的醫療再拖下去也是無效。所以你說會有那種不想安樂死的，我想大概……對啦，也有，但是更多是想要安樂死的。在這種狀況裡面，臺大公衛的這份研究做了3,992個，將近四千個，他們針對醫助死亡的支持度設定了三種，就是癌症末期而且預期壽命有限，再活沒多久，而且病人太痛苦了，像癌症末期，86.2%的支持度，都要求可以有醫助死亡；第二種，即便不是末期，但根本就沒有藥可醫，而且身上有無法忍受的痛苦，如漸凍人這種，支持度79.6%；第三種，病人嚴重喪失認知能力，疾病無法治癒，也沒有改善的方式，如極重度的失智，支持率有72.6%；還有不分任何情境，純粹就是你支不支持醫生可以協助民眾死亡的比例有67.6%，所以臺大公衛的學者呼籲什麼，部長，你知道嗎？"],["劉司長越萍：我可不可以補充？其實他們呼籲的是針對死亡這件事情，應該有更多的社會的對話。"],["林委員淑芬：對，部長你要了解，司長知道，但是你也要了解。就是說你要建議社會跟政府，所有的社會對話都要開始溝通，要開始對話，甚至連醫助死亡都要開始討論，全臺灣人過半以上都支持，大家就要開始討論，要社會討論，對不對？社會討論重不重要？部長。"],["邱部長泰源：非常重要，已經在……"],["林委員淑芬：那為什麼你們的次長面對這樣的研究一出來……你們的次長怎麼說？呂建德怎麼說？他說安樂死、斷食善終是不對的，他連斷食善終都說不對了，這不是我們的病主法嗎？你的次長怎麼這麼說？他說這兩者都不會成為衛福部的政策選項，你是誰啊？你說了算喔？社會對話，這社會對話喔？"],["邱部長泰源：不管是斷食善終或安樂死，它都intention想要縮短病人生病……"],["林委員淑芬：我問你啦，你的病主法裡面有沒有包含斷食善終？"],["邱部長泰源：那個不叫斷食善終，那個是不要使用不必要的人工營養、水份，我想委員今天的一席話真的是非常專業，我真的很敬佩，但是我必須要講清楚，斷食善終跟不給他人工……"],["林委員淑芬：你不再給他營養供給了……"],["邱部長泰源：那是不給他額外的。"],["林委員淑芬：不給他鼻胃管了，不給他營養供給了……"],["邱部長泰源：報告委員，你知道插一個鼻胃管，病人是多痛苦？"],["林委員淑芬：對啊！"],["邱部長泰源：你有很多的方式，可以好好的照顧他，他可以吃很多東西，他雖然有時候……"],["林委員淑芬：蛤？有那種需要鼻胃管還有進食能力的？如果那種連吞嚥功能都喪失的咧？"],["邱部長泰源：吞嚥功能，我舉個例子，我有……"],["林委員淑芬：我現在不是跟你討論這個，我是要告訴你……"],["邱部長泰源：我必須要很嚴肅講這個問題……"],["林委員淑芬：你不要轉移焦點！我是要告訴你，憑什麼你的次長他一個人說安樂死、斷食善終都不會成為衛福部的政策選項？你們說可以透過支持性或緩解性的醫療照顧，減輕病人痛苦，但不贊同安樂死，你講的支持性或緩解性的醫療照護，真的是大家都可以得到這麼好的照顧嗎？"],["邱部長泰源：95%的癌痛可以得到緩解。"],["林委員淑芬：你的癌症用藥設限那麼多，標靶用藥自費這麼貴，然後家人也耗這麼多，人家病人不願意了，所以我沒有叫你要，我現在是告訴你，醫師協助死亡在現在民意支持度這麼高的狀況下，你應該要開啟社會對話，甚至要去研究相關的法律制度、對醫療的衝擊、對醫師的衝擊，然後相應的問題可能會是什麼，你也要去回應學者，這個現象到底問題在哪裡，你應該去開啟社會溝通和對話，對不對？怎麼可能你們一個次長就來說不可能，我們都不要，這樣都不用做了嗎？"],["邱部長泰源：我們幾十年來都一直在對話，我想次長的意思……"],["林委員淑芬：那我問你醫師協助死亡的議題，你做過正式的政策評估或跨部門討論嗎？或者是你委託研究過嗎？它的倫理、法律和醫療實務的可行性會遇到什麼困難？可行不可行？你們做過嗎？有沒有做過？"],["邱部長泰源：醫師協助自殺其實也是安樂死的一種。"],["林委員淑芬：我現在就是在講醫師協助死亡的安樂死方式。"],["邱部長泰源：對，這個部分就是屬於安樂死的範疇。"],["林委員淑芬：對，我在問你說社會溝通對話……"],["邱部長泰源：這部分必須要更多的社會對話來溝通，但我們目前的政策是推行安寧緩和醫療……"],["林委員淑芬：臺大現在這份研究，我們在講PAD合法，就是醫助死亡這個PAD的政策。"],["邱部長泰源：PAS嗎？physician-assisted suicide的意思嗎？"],["林委員淑芬：PAD的意思physician-assisted dying，就跟你講PAD。這不重要啦！我現在就是講，當臺大的公衛拿出這樣的數據的時候，你們有沒有做過任何政策的研議？倫理、法律、社會心理的，你們都沒有做，一個次長一出來就跟人家說，那都不可能，我們不要，我們不接受，你們現在是怎樣？不然，像林淑芬講的，我活到75歲，我自己去自殺？你知道我走出門，有多少人跟我陳情？「立委啊！你們就去讓安樂死合法化，趕快去立一個這樣的法律。」我跟他說什麼，你知道嗎？我要怎麼跟他說，你知道嗎？我說我不知道怎麼訂這個法律。整個社會溝通對話，倫理的、法律的、社會心理的、經濟的、生物上的，我通通沒有足夠的專業，然後社會沒有對話，衛福部也從來不討論，不委外研究，沒有任何的政策研究，我是要怎麼去產出一個法律？你們在這裡是跟你們次長一樣的立場，是不是？"],["邱部長泰源：研究的paper很多啦！"],["林委員淑芬：我就是在這裡問你，你跟你們次長一樣，就直接說我們反對安樂死，絕對不要安樂死，你在這裡是要宣示這個政策嗎？"],["邱部長泰源：我們的政策是開放的，但是我必須跟委員報告……"],["林委員淑芬：現在這個叫社會對話嗎？社會對話是這樣的嗎？"],["邱部長泰源：我們可以繼續來對話。"],["林委員淑芬：我今天不是在講病主法，為什麼病主法的簽署率這麼低？其中一個重要的原因就是民眾所想像的安樂死、善終的概念，跟這個法律落差太大了，而民眾想要的，很多民眾想要的，當然也有很多民眾反對，很多民眾想要的是真的讓我好好的走吧！善終、安樂死。你最好了解一下什麼叫社會對話溝通，然後你最好去做一下研究，好歹也做一下研究吧！連這個都拒絕，在這裡你說不做的話，我只能說……"],["邱部長泰源：這個不但做國內的研究，我們也做國際的研究，做很多。"],["林委員淑芬：好，paper在哪裡？你的委外研究經費編在哪裡？你的委外研究計畫成果在哪裡？"],["邱部長泰源：國內有很多學者都有做。"],["林委員淑芬：學者做的跟政府做的一樣嗎？在這裡信口開河！隨便說說！"],["邱部長泰源：那你為什麼一直……"],["林委員淑芬：我現在說的是作為一個政府……"],["邱部長泰源：一直引用臺大公衛學者、我的好朋友楊秀儀教授的文章來討論呢？"],["林委員淑芬：那不是政府哦！那是拿政府的錢的嗎？"],["邱部長泰源：不管怎麼樣，這也是當然……很多都是國科會的錢。"],["林委員淑芬：我現在講，我在這裡我監督的叫做政府，我們人民要的是「有政府、能溝通」，我怎麼去問責於一個學者？"],["邱部長泰源：我們是在以專業解決問題。"],["林委員淑芬：政府怎麼把責任就推給說有學者做了，這叫做政府嗎？"],["邱部長泰源：我們尊重專業學者的研究結果。"],["林委員淑芬：難道是楊秀儀在主導這個政策嗎？是嗎？"],["邱部長泰源：我們當然在主導政策啊！但是我們要蒐集各方面的資料。"],["林委員淑芬：我現在要叫你……不是喔！你要花錢，你是政府，你要去做研究，不是只有學者研究一份，這樣就好了。"],["邱部長泰源：不是一份啦，很多份啦！"],["林委員淑芬：我現在不要聽學者，我要聽你政府，政府怎麼面對這個課題？怎麼面對這個議題？怎麼面對人民有這個需求？尤其是你們醫療制度都在這麼緊張、瀕臨崩潰的邊緣，更不要講問題很多，再講你好好的照顧，這個理想性不存在啦！"],["主席：好，謝謝，謝謝林委員、謝謝部長。"],["邱部長泰源：謝謝林委員指教，我們一起努力。"],["主席：謝謝。","接下來請黃秀芳委員詢答。"]],"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"}}}