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\"end\": 877.722, \"score\": 0.789}, {\"word\": \"力\", \"start\": 877.722, \"end\": 878.223, \"score\": 0.879}, {\"word\": \"但\", \"start\": 878.223, \"end\": 878.343, \"score\": 0.88}, {\"word\": \"是\", \"start\": 878.343, \"end\": 878.683, \"score\": 0.911}, {\"word\": \"我\", \"start\": 878.683, \"end\": 878.903, \"score\": 0.854}, {\"word\": \"們\"}, {\"word\": \"後\", \"start\": 878.903, \"end\": 879.063, \"score\": 0.871}, {\"word\": \"面\", \"start\": 879.063, \"end\": 879.243, \"score\": 0.955}, {\"word\": \"的\", \"start\": 879.243, \"end\": 879.404, \"score\": 0.99}, {\"word\": \"照\", \"start\": 879.404, \"end\": 879.584, \"score\": 0.944}, {\"word\": \"顧\"}, {\"word\": \"團\"}, {\"word\": \"隊\"}, {\"word\": \"是\", \"start\": 879.584, \"end\": 879.724, \"score\": 0.811}, {\"word\": \"很\", \"start\": 879.724, \"end\": 879.864, \"score\": 0.855}, {\"word\": \"堅\"}, {\"word\": \"強\"}, {\"word\": \"的\", \"start\": 879.864, \"end\": 879.884, \"score\": 0.019}, {\"word\": \"可\", \"start\": 879.884, \"end\": 880.024, \"score\": 0.854}, {\"word\": \"以\", \"start\": 880.024, \"end\": 880.144, \"score\": 0.833}, {\"word\": \"解\", \"start\": 880.144, \"end\": 880.264, \"score\": 0.822}, {\"word\": \"決\"}, {\"word\": \"很\", \"start\": 880.264, \"end\": 880.444, \"score\": 0.863}, {\"word\": \"多\", \"start\": 880.444, \"end\": 880.564, \"score\": 0.833}, {\"word\": \"的\", \"start\": 880.564, \"end\": 880.584, \"score\": 0.03}, {\"word\": \"問\"}, {\"word\": \"題\"}, {\"word\": \"好\", \"start\": 880.584, \"end\": 880.604, \"score\": 0.0}, {\"word\": \"謝\"}, {\"word\": \"謝\"}], \"language\": \"zh\"}","srt":"1\n00:00:05,210 --> 00:00:09,217\n謝謝主席,我們請部長你先喝一下不然市長先上來\n\n2\n00:00:19,898 --> 00:00:39,272\n委員好部長好今天大家關心的就是說我們從2019年這個病人自主權利法通過之後那這個這個預例醫療照護諮商的這一個好像這個幾年下來成效好像也不是那麼好\n\n3\n00:00:40,052 --> 00:00:55,908\n我們看到就是說那個實施到現在有簽署的人差不多10萬多人那這個簽署率差不多0.45%那又看到就是說到最後有真的照這樣子這個病人預歷醫療照護諮商\n\n4\n00:00:58,890 --> 00:01:13,097\n這樣的醫療到最後是不是有照這樣做的好像這個比例好像也很低那我想請教就是說到底有簽署然後到最後有照這樣去執行的這個比例到底有多少\n\n5\n00:01:14,377 --> 00:01:36,790\n報告委員,根據這個應該是衛福部委託的研究我們大概就是有簽署AD到後來的吻合率是七成那這七成裡面有分類,譬如說心外按摩室、插管這個大概百分之百吻合,那在比較困難的是在於\n\n6\n00:01:37,771 --> 00:01:54,847\n抗生素那個時候要不要使用要不要用人工營養比如說插鼻胃管胃躁揉或者是用點滴去打那個營養分這個部分到那個時候爭議爭議會比較大所以第一在前面的AD即使簽了以後你到臨床的現場\n\n7\n00:01:57,109 --> 00:02:22,689\n還是要不斷的溝通說明做最好政策這樣子部長我想請教就是說你們這樣子目前簽署十萬三千多人這個都是原本是用自費自己自費的嘛對不對那如果說自己自費然後簽署是只有十萬多人的話那未來你們也有特別提到就是說這個諮商65歲重大疾病的部分未來是要由健保這邊來給付嗎對不對\n\n8\n00:02:26,806 --> 00:02:52,255\n對嗎5月1號就今天開始今天開始那原本自己自費的自費表示他就是有未來有這個意願有這個意願那你看這樣你們簽署的這個執行率就已經那麼低那如果未來是健保的話那你們要怎麼去擴及是直接在醫療院所或者是你們到其他的可能老人比較多的場所去直接\n\n9\n00:02:54,076 --> 00:03:13,015\n這個說明然後鼓吹我不知道說你們未來要怎麼做我們當然可以都要思考怎麼樣把廣度深度都能夠加強我想這個部分也是大家的期望但是就是說我剛剛有講如果\n\n10\n00:03:14,492 --> 00:03:25,157\n剛剛第一階段是70%可是後來發現幾年以後再做一次吻合率比較低為什麼我們專家的研究就是因為諮商的品質降低\n\n11\n00:03:26,475 --> 00:03:43,744\n資商品質為什麼會降低就是可能他應該也是找醫師所以就是說是不是說時間上或者是怎麼樣這個就是在檢討啦這是一個檢討的可能那你現在5月1號開始上路就65歲重大傷病的我們還是會要求品質嘛要求品質你現在給他支付當然是要求品質啊如果沒做好品質這個大概就不用做了\n\n12\n00:03:52,349 --> 00:04:07,288\n那你們已經今天開始了嘛今天開始那你應該要怎麼去要求這個要怎麼要求你們應該自己有一套的要有一定的時間內容跟表單嘛應該都有一個監測的指標嘛\n\n13\n00:04:08,755 --> 00:04:28,850\n我先講一下因為其實病毒法實行到這邊五年多其實我們相關的醫護人員完成訓練的人數是夠的然後所以在過去像比如說剛剛那個趙葦這邊有在講等候的人數是因為過去醫院在開設門診的這一段他其實是有多少病人那時候是預約門診的部分\n\n14\n00:04:30,131 --> 00:04:54,983\n然後所以在開設加開兩年的部分的話因為人數夠多所以在這個可以解決就是目前現況的部分的話所以我們才會特別講是說健保署這邊如果開始開這個的話我們大概會監測希望是說至少在今年能夠我們最近兩年是一年大概兩萬人次的一個增加的一個幅度那我們希望今年開始能夠突破到四萬\n\n15\n00:04:55,623 --> 00:05:17,600\n那這短期間內就是說開出門診是一件事怎麼樣就是說透過這樣子的一個因為我們本來在基層診所這邊有去居家做的這一塊然後我們覺得是說這一塊也是可以來做協作希望能夠擴大量的而不是只靠門診的部分然後也因為這樣子其實我們下半年會有一些專家輔導團隊先做試辦看看怎麼去輔導已經\n\n16\n00:05:21,963 --> 00:05:45,355\n上完課有能力做的更敢做的這件事情這是我們下半年希望能夠突破這樣的量才會增加然後期待是說才能夠真的讓更多人了解病毒那我想請教就是說他有簽了那如果簽了到最後到最後他可能沒有意識那如果家人反對呢\n\n17\n00:05:46,656 --> 00:06:09,190\n如果醫師跟家人討論就是說他可能這個情況不是那麼樂觀那也許這個病人他原本就已經有簽那個醫主那簽完之後然後家屬反對那家屬反對到底這個醫生要按照他原本的這個醫主或者是他要聽家人的\n\n18\n00:06:10,912 --> 00:06:35,348\n這一段其實最重要這個法律的精神會希望是說一併和諧然後在執行的過程當中其實怎麼樣呈現出這個病人的爭議然後我們其實大概在兩年前其實就開始我們在簽這個所謂的AD這個的時候我們就希望同步一起能夠來就是說為什麼家屬一定要進來\n\n19\n00:06:36,689 --> 00:06:55,260\n因為這樣子的話才會有見證人其實是同步的證實說這個真的是病人的正義然後那這樣子的前提下面的時候進行的所謂的溝通對話醫護人員也比較敢是說跟另外的家屬說這個是病人真正的意願然後執行\n\n20\n00:06:55,740 --> 00:07:22,596\n因為在這個整個過程當中從一路走來的跟善終相關的從棄捐到安寧到病毒我們其實都發現我們華人社會其實還是一個家庭一個核心所以家人的共識家人的同意其實這件事情是重要的早點開啟對話後面也就是我們剛剛部長講的為什麼越早開啟對話的時候那大家的共識度也願意\n\n21\n00:07:24,257 --> 00:07:48,357\n讓這個病人最後的醫院能夠執行的這件事情是我覺得是今天也謝謝委員透過這樣的執行我們也希望民眾能夠知道是病人的爭議才是最重要的可是市長應該在醫療的第一線醫師跟家屬可能會做一個討論那醫師也會以他的專業覺得說我這個是不是還有機會那如果說這個\n\n22\n00:07:50,860 --> 00:08:04,756\n家屬跟這個醫師可能也許或者是病人本身也許如果會有一些矛盾的話也許病人本身他覺得說我可能就不插管或者是我可能\n\n23\n00:08:05,396 --> 00:08:28,542\n不做積極的那個治療那醫師覺得說還有機會那這樣子的話怎麼辦我們對於末期病人要兩位專科醫師共同確認所以在這個地方上面的醫療程序上面的一個完備其實會是讓我們的在跟病人家屬解釋這一段的時候我覺得會是一個比較清楚而不是一個醫師就說這個有救\n\n24\n00:08:29,142 --> 00:08:53,650\n因為要有科學的證據一起來做佐證的時候我覺得啦在決定的時候因為怎麼準備都不夠可是越多的客觀的一些資料幫忙輔助的時候其實在解釋這一段困難難以做決定的一個過程裡面我覺得是相對容易比較容易產生一個就是共識還是會回到了尊重病人自主的一個狀況以上\n\n25\n00:08:54,990 --> 00:09:15,865\n那我可以請教就是說這個從2019到現在就是有十萬三千多人有簽署那這十萬三千多人剛剛部長有特別提到就是差不多70%就是有按照原本的這個遺囑下去執行那有沒有碰到什麼樣的困難你們有沒有做一個統計\n\n26\n00:09:17,829 --> 00:09:39,950\n這部分的話我們那時候委託的研究只有就是說比較籠統的講到就是說需要再跟家屬再做進一步的溝通這個地方上面的一個困境因為我們當初在簽的時候跟執行AD的時候如果這個情境跟安寧很像就是末期的時候\n\n27\n00:09:40,430 --> 00:10:06,877\n那個家屬的理解度相對的高然後可是就是說在這一段過程裡面其實第一段執行在剛開始法律通過的時候其實是醫護人員醫療人員要怎麼執行這一段會有困擾所以我們大概透過輔導團隊然後跟線上的課程定期的一個線上臨床工作會議的一個聯繫會議去解決一開始的困境是有法律不知道怎麼做\n\n28\n00:10:07,717 --> 00:10:36,923\nACP很清楚執行AD不知道怎麼做透過大概兩年到三年的一個像這樣子的一個專業團隊的一起協助推動的時候現在的困擾其實會是說怎麼樣擴大相對的效應因為發現很多人還是不清楚那我想請教就是說你們原本執行了這個百分之七十幾的人或者是剩下百分之三十左右沒有按照原本的這一個簽署下去執行\n\n29\n00:10:37,664 --> 00:10:39,348\n那有沒有醫療糾紛的這種狀況出現\n\n30\n00:10:44,768 --> 00:11:09,388\n這個我不確定只是我們研究報告請研究團隊在跟我們做討論的時候並沒有人提到這一段我只能夠這樣講新的抑鬱法在上路之後一年多我們一年多裡面的案件並沒有看到末期病人的這一段所以就是說最主要是還要再跟家屬溝通應該就是原本他簽的時候雖然有一個家屬陪同\n\n31\n00:11:10,569 --> 00:11:25,708\n就是一個家屬至少要一個家屬陪同那可能在到最後的時候也許其他的家屬認為就是說那我還是要繼續救所以可能就會有這樣子一個矛盾產生那像這樣子的話要聽誰的\n\n32\n00:11:27,390 --> 00:11:55,929\n基本上面老實講在那段過程當中其實幾乎都是會在用溝通會的家庭會議這邊來做一個凝聚共識然後那結論的部分因為我自己沒有在做那個食物的臨床的經驗只是是說在跟研究團隊討論的過程當中其實很多因為後來幾乎都是走末期的這一段然後透過多次的一個會議之後其實逐漸產生的共識\n\n33\n00:11:57,730 --> 00:12:23,989\n比较多能够尊重病人只是这是要花时间来做跟家属这边的沟通其实我一直认为就是说病人的状况如果他真的是没办法没办法再回复或者是说已经就已经没办法了我觉得医师如果很明确的讲通常家属都可以可以接受就是说可能就是让他三中如果他还有自己签署的话那如果\n\n34\n00:12:24,909 --> 00:12:49,099\n我覺得這個可能跟醫師也有很大的一個關係那另外就是說要把這個丟給第一線的醫護人員我覺得好像也就譬如說醫師要跟家屬溝通我覺得這個也是要花蠻花時間的所以我覺得這個法也許我覺得還需要再更多的一個社會的溝通\n\n35\n00:12:51,425 --> 00:13:07,645\n包委員,前面這個法做得更好當然是絕對有幫助於後面照顧的品質但是一旦他要兩個醫師決定默契以後其實有很多溝通那剛剛講的在新惠富叔叔跟那個\n\n36\n00:13:09,906 --> 00:13:35,811\n呃插管這個部分幾乎他原來講不要大概那個時候也不會做啦齁但是在臨床上真的有很多決策齁那到底他這個狀況打抗生素是有沒有用打人工營養水分是養到細胞比較多還是養到正常的細胞你一直跟他講你一直跟他打打到都是細胞一直大起來他的肉一碟肉就沒有成果這種很嚴重的問題啊這就是communicationisthekey\n\n37\n00:13:37,791 --> 00:13:56,867\n就是一直在溝通每天我們都在做倫理決策那這個請放心我們的安寧團隊在這個部分台灣的安寧團安寧照顧品質是世界第三亞洲第一所以要善用我們這樣幾十年來建立的這樣一個有品質的團隊給病人可以好好的照顧所以我們反而要先導\n\n38\n00:13:58,496 --> 00:14:19,651\n早一點來照會病人如果到達比較重病的時候應該早一點不管是思考ACP或思考要接受安寧環而醫療照顧這個教育是非常重要的因為不但可以早一點追求善終的路生死良相安應該也讓資源得到最好的一個合理的分配\n\n39\n00:14:20,191 --> 00:14:40,604\n好我是覺得說應該這條路真的確實你們看從那個2019到現在有簽署的才10萬多人這個數字真的是非常少對當然土法不足以助行所以我們有很多要大家繼續努力但是我們後面的照顧團隊是很堅強的可以解決很多的問題好謝謝\n\n","tsv":"start\tend\ttext\n5210\t9217\t謝謝主席,我們請部長你先喝一下不然市長先上來\n19898\t39272\t委員好 部長好 今天大家關心的就是說我們從2019年這個病人自主權利法通過之後那這個這個預例醫療照護諮商的這一個好像這個幾年下來成效好像也不是那麼好\n40052\t55908\t我們看到就是說那個實施到現在有簽署的人差不多10萬多人那這個簽署率差不多0.45%那又看到就是說到最後有真的照這樣子這個病人預歷醫療照護諮商\n58890\t73097\t這樣的醫療到最後是不是有照這樣做的好像這個比例好像也很低那我想請教就是說到底有簽署然後到最後有照這樣去執行的這個比例到底有多少\n74377\t96790\t報告委員,根據這個應該是衛福部委託的研究我們大概就是有簽署AD到後來的吻合率是七成那這七成裡面有分類,譬如說心外按摩室、插管這個大概百分之百吻合,那在比較困難的是在於\n97771\t114847\t抗生素那個時候要不要使用要不要用人工營養比如說插鼻胃管 胃躁揉或者是用點滴去打那個營養分這個部分到那個時候爭議爭議會比較大所以第一在前面的AD即使簽了以後你到臨床的現場\n117109\t142689\t還是要不斷的溝通說明做最好政策這樣子部長我想請教就是說你們這樣子目前簽署十萬三千多人這個都是原本是用自費自己自費的嘛對不對那如果說自己自費然後簽署是只有十萬多人的話那未來你們也有特別提到就是說這個諮商65歲重大疾病的部分未來是要由健保這邊來給付嗎對不對\n146806\t172255\t對嗎5月1號就今天開始今天開始那原本自己自費的自費表示他就是有未來有這個意願有這個意願那你看這樣你們簽署的這個執行率就已經那麼低那如果未來是健保的話那你們要怎麼去擴及是直接在醫療院所或者是你們到其他的可能老人比較多的場所去直接\n174076\t193015\t這個說明然後鼓吹我不知道說你們未來要怎麼做我們當然可以都要思考怎麼樣把廣度深度都能夠加強我想這個部分也是大家的期望但是就是說我剛剛有講如果\n194492\t205157\t剛剛第一階段是70%可是後來發現幾年以後再做一次 吻合率比較低為什麼 我們專家的研究就是因為諮商的品質降低\n206475\t223744\t資商品質為什麼會降低就是可能他應該也是找醫師所以就是說是不是說時間上或者是怎麼樣這個就是在檢討啦這是一個檢討的可能那你現在5月1號開始上路就65歲重大傷病的我們還是會要求品質嘛要求品質你現在給他支付當然是要求品質啊如果沒做好品質這個大概就不用做了\n232349\t247288\t那你們已經今天開始了嘛今天開始那你應該要怎麼去要求這個要怎麼要求你們應該自己有一套的要有一定的時間內容跟表單嘛應該都有一個監測的指標嘛\n248755\t268850\t我先講一下因為其實病毒法實行到這邊五年多其實我們相關的醫護人員完成訓練的人數是夠的然後所以在過去像比如說剛剛那個趙葦這邊有在講等候的人數是因為過去醫院在開設門診的這一段他其實是有多少病人那時候是預約門診的部分\n270131\t294983\t然後所以在開設加開兩年的部分的話因為人數夠多所以在這個可以解決就是目前現況的部分的話所以我們才會特別講是說健保署這邊如果開始開這個的話我們大概會監測希望是說至少在今年能夠我們最近兩年是一年大概兩萬人次的一個增加的一個幅度那我們希望今年開始能夠突破到四萬\n295623\t317600\t那這短期間內就是說開出門診是一件事怎麼樣就是說透過這樣子的一個因為我們本來在基層診所這邊有去居家做的這一塊然後我們覺得是說這一塊也是可以來做協作希望能夠擴大量的而不是只靠門診的部分然後也因為這樣子其實我們下半年會有一些專家輔導團隊先做試辦看看怎麼去輔導已經\n321963\t345355\t上完課有能力做的更敢做的這件事情這是我們下半年希望能夠突破這樣的量才會增加然後期待是說才能夠真的讓更多人了解病毒那我想請教就是說他有簽了那如果簽了到最後到最後他可能沒有意識那如果家人反對呢\n346656\t369190\t如果醫師跟家人討論就是說他可能這個情況不是那麼樂觀那也許這個病人他原本就已經有簽那個醫主那簽完之後然後家屬反對那家屬反對到底這個醫生要按照他原本的這個醫主或者是他要聽家人的\n370912\t395348\t這一段其實最重要這個法律的精神會希望是說一併和諧然後在執行的過程當中其實怎麼樣呈現出這個病人的爭議然後我們其實大概在兩年前其實就開始我們在簽這個所謂的AD這個的時候我們就希望同步一起能夠來就是說為什麼家屬一定要進來\n396689\t415260\t因為這樣子的話才會有見證人其實是同步的證實說這個真的是病人的正義然後那這樣子的前提下面的時候進行的所謂的溝通對話醫護人員也比較敢是說跟另外的家屬說這個是病人真正的意願然後執行\n415740\t442596\t因為在這個整個過程當中從一路走來的跟善終相關的從棄捐到安寧到病毒我們其實都發現我們華人社會其實還是一個家庭一個核心所以家人的共識家人的同意其實這件事情是重要的早點開啟對話後面也就是我們剛剛部長講的為什麼越早開啟對話的時候那大家的共識度也願意\n444257\t468357\t讓這個病人最後的醫院能夠執行的這件事情是我覺得是今天也謝謝委員透過這樣的執行我們也希望民眾能夠知道是病人的爭議才是最重要的可是市長應該在醫療的第一線醫師跟家屬可能會做一個討論那醫師也會以他的專業覺得說我這個是不是還有機會那如果說這個\n470860\t484756\t家屬跟這個醫師可能也許或者是病人本身也許如果會有一些矛盾的話也許病人本身他覺得說我可能就不插管或者是我可能\n485396\t508542\t不做積極的那個治療那醫師覺得說還有機會那這樣子的話怎麼辦我們對於末期病人要兩位專科醫師共同確認所以在這個地方上面的醫療程序上面的一個完備其實會是讓我們的在跟病人家屬解釋這一段的時候我覺得會是一個比較清楚而不是一個醫師就說這個有救\n509142\t533650\t因為要有科學的證據一起來做佐證的時候我覺得啦在決定的時候因為怎麼準備都不夠可是越多的客觀的一些資料幫忙輔助的時候其實在解釋這一段困難難以做決定的一個過程裡面我覺得是相對容易比較容易產生一個就是共識還是會回到了尊重病人自主的一個狀況以上\n534990\t555865\t那我可以請教就是說這個從2019到現在就是有十萬三千多人有簽署那這十萬三千多人剛剛部長有特別提到就是差不多70%就是有按照原本的這個遺囑下去執行那有沒有碰到什麼樣的困難你們有沒有做一個統計\n557829\t579950\t這部分的話我們那時候委託的研究只有就是說比較籠統的講到就是說需要再跟家屬再做進一步的溝通這個地方上面的一個困境因為我們當初在簽的時候跟執行AD的時候如果這個情境跟安寧很像就是末期的時候\n580430\t606877\t那個家屬的理解度相對的高然後可是就是說在這一段過程裡面其實第一段執行在剛開始法律通過的時候其實是醫護人員醫療人員要怎麼執行這一段會有困擾所以我們大概透過輔導團隊然後跟線上的課程定期的一個線上臨床工作會議的一個聯繫會議去解決一開始的困境是有法律不知道怎麼做\n607717\t636923\tACP很清楚執行AD不知道怎麼做透過大概兩年到三年的一個像這樣子的一個專業團隊的一起協助推動的時候現在的困擾其實會是說怎麼樣擴大相對的效應因為發現很多人還是不清楚那我想請教就是說你們原本執行了這個百分之七十幾的人或者是剩下百分之三十左右沒有按照原本的這一個簽署下去執行\n637664\t639348\t那有沒有醫療糾紛的這種狀況出現\n644768\t669388\t這個我不確定只是我們研究報告請研究團隊在跟我們做討論的時候並沒有人提到這一段我只能夠這樣講新的抑鬱法在上路之後一年多我們一年多裡面的案件並沒有看到末期病人的這一段所以就是說最主要是還要再跟家屬溝通應該就是原本他簽的時候雖然有一個家屬陪同\n670569\t685708\t就是一個家屬至少要一個家屬陪同那可能在到最後的時候也許其他的家屬認為就是說那我還是要繼續救所以可能就會有這樣子一個矛盾產生那像這樣子的話要聽誰的\n687390\t715929\t基本上面老實講在那段過程當中其實幾乎都是會在用溝通會的家庭會議這邊來做一個凝聚共識然後那結論的部分因為我自己沒有在做那個食物的臨床的經驗只是是說在跟研究團隊討論的過程當中其實很多因為後來幾乎都是走末期的這一段然後透過多次的一個會議之後其實逐漸產生的共識\n717730\t743989\t比较多能够尊重病人只是这是要花时间来做跟家属这边的沟通其实我一直认为就是说病人的状况如果他真的是没办法没办法再回复或者是说已经就已经没办法了我觉得医师如果很明确的讲通常家属都可以可以接受就是说可能就是让他三中如果他还有自己签署的话那如果\n744909\t769099\t我覺得這個可能跟醫師也有很大的一個關係那另外就是說要把這個丟給第一線的醫護人員我覺得好像也就譬如說醫師要跟家屬溝通我覺得這個也是要花蠻花時間的所以我覺得這個法也許我覺得還需要再更多的一個社會的溝通\n771425\t787645\t包委員,前面這個法做得更好當然是絕對有幫助於後面照顧的品質但是一旦他要兩個醫師決定默契以後其實有很多溝通那剛剛講的在新惠富叔叔跟那個\n789906\t815811\t呃 插管這個部分幾乎他原來講不要大概那個時候也不會做啦齁但是在臨床上真的有很多決策齁那到底他這個狀況打抗生素是有沒有用打人工營養水分是養到細胞比較多還是養到正常的細胞你一直跟他講你一直跟他打打到都是細胞一直大起來他的肉一碟肉就沒有成果這種很嚴重的問題啊這就是communicationis the key\n817791\t836867\t就是一直在溝通每天我們都在做倫理決策那這個請放心我們的安寧團隊在這個部分台灣的安寧團安寧照顧品質是世界第三亞洲第一所以要善用我們這樣幾十年來建立的這樣一個有品質的團隊給病人可以好好的照顧所以我們反而要先導\n838496\t859651\t早一點來照會 病人如果到達比較重病的時候應該早一點不管是思考ACP或思考要接受安寧環而醫療照顧這個教育是非常重要的因為不但可以早一點追求善終的路生死良相安應該也讓資源得到最好的一個合理的分配\n860191\t880604\t好 我是覺得說應該這條路真的確實你們看從那個2019到現在有簽署的才10萬多人這個數字真的是非常少對 當然土法不足以助行所以我們有很多要大家繼續努力但是我們後面的照顧團隊是很堅強的可以解決很多的問題好 謝謝\n","txt":"謝謝主席,我們請部長你先喝一下不然市長先上來\n委員好 部長好 今天大家關心的就是說我們從2019年這個病人自主權利法通過之後那這個這個預例醫療照護諮商的這一個好像這個幾年下來成效好像也不是那麼好\n我們看到就是說那個實施到現在有簽署的人差不多10萬多人那這個簽署率差不多0.45%那又看到就是說到最後有真的照這樣子這個病人預歷醫療照護諮商\n這樣的醫療到最後是不是有照這樣做的好像這個比例好像也很低那我想請教就是說到底有簽署然後到最後有照這樣去執行的這個比例到底有多少\n報告委員,根據這個應該是衛福部委託的研究我們大概就是有簽署AD到後來的吻合率是七成那這七成裡面有分類,譬如說心外按摩室、插管這個大概百分之百吻合,那在比較困難的是在於\n抗生素那個時候要不要使用要不要用人工營養比如說插鼻胃管 胃躁揉或者是用點滴去打那個營養分這個部分到那個時候爭議爭議會比較大所以第一在前面的AD即使簽了以後你到臨床的現場\n還是要不斷的溝通說明做最好政策這樣子部長我想請教就是說你們這樣子目前簽署十萬三千多人這個都是原本是用自費自己自費的嘛對不對那如果說自己自費然後簽署是只有十萬多人的話那未來你們也有特別提到就是說這個諮商65歲重大疾病的部分未來是要由健保這邊來給付嗎對不對\n對嗎5月1號就今天開始今天開始那原本自己自費的自費表示他就是有未來有這個意願有這個意願那你看這樣你們簽署的這個執行率就已經那麼低那如果未來是健保的話那你們要怎麼去擴及是直接在醫療院所或者是你們到其他的可能老人比較多的場所去直接\n這個說明然後鼓吹我不知道說你們未來要怎麼做我們當然可以都要思考怎麼樣把廣度深度都能夠加強我想這個部分也是大家的期望但是就是說我剛剛有講如果\n剛剛第一階段是70%可是後來發現幾年以後再做一次 吻合率比較低為什麼 我們專家的研究就是因為諮商的品質降低\n資商品質為什麼會降低就是可能他應該也是找醫師所以就是說是不是說時間上或者是怎麼樣這個就是在檢討啦這是一個檢討的可能那你現在5月1號開始上路就65歲重大傷病的我們還是會要求品質嘛要求品質你現在給他支付當然是要求品質啊如果沒做好品質這個大概就不用做了\n那你們已經今天開始了嘛今天開始那你應該要怎麼去要求這個要怎麼要求你們應該自己有一套的要有一定的時間內容跟表單嘛應該都有一個監測的指標嘛\n我先講一下因為其實病毒法實行到這邊五年多其實我們相關的醫護人員完成訓練的人數是夠的然後所以在過去像比如說剛剛那個趙葦這邊有在講等候的人數是因為過去醫院在開設門診的這一段他其實是有多少病人那時候是預約門診的部分\n然後所以在開設加開兩年的部分的話因為人數夠多所以在這個可以解決就是目前現況的部分的話所以我們才會特別講是說健保署這邊如果開始開這個的話我們大概會監測希望是說至少在今年能夠我們最近兩年是一年大概兩萬人次的一個增加的一個幅度那我們希望今年開始能夠突破到四萬\n那這短期間內就是說開出門診是一件事怎麼樣就是說透過這樣子的一個因為我們本來在基層診所這邊有去居家做的這一塊然後我們覺得是說這一塊也是可以來做協作希望能夠擴大量的而不是只靠門診的部分然後也因為這樣子其實我們下半年會有一些專家輔導團隊先做試辦看看怎麼去輔導已經\n上完課有能力做的更敢做的這件事情這是我們下半年希望能夠突破這樣的量才會增加然後期待是說才能夠真的讓更多人了解病毒那我想請教就是說他有簽了那如果簽了到最後到最後他可能沒有意識那如果家人反對呢\n如果醫師跟家人討論就是說他可能這個情況不是那麼樂觀那也許這個病人他原本就已經有簽那個醫主那簽完之後然後家屬反對那家屬反對到底這個醫生要按照他原本的這個醫主或者是他要聽家人的\n這一段其實最重要這個法律的精神會希望是說一併和諧然後在執行的過程當中其實怎麼樣呈現出這個病人的爭議然後我們其實大概在兩年前其實就開始我們在簽這個所謂的AD這個的時候我們就希望同步一起能夠來就是說為什麼家屬一定要進來\n因為這樣子的話才會有見證人其實是同步的證實說這個真的是病人的正義然後那這樣子的前提下面的時候進行的所謂的溝通對話醫護人員也比較敢是說跟另外的家屬說這個是病人真正的意願然後執行\n因為在這個整個過程當中從一路走來的跟善終相關的從棄捐到安寧到病毒我們其實都發現我們華人社會其實還是一個家庭一個核心所以家人的共識家人的同意其實這件事情是重要的早點開啟對話後面也就是我們剛剛部長講的為什麼越早開啟對話的時候那大家的共識度也願意\n讓這個病人最後的醫院能夠執行的這件事情是我覺得是今天也謝謝委員透過這樣的執行我們也希望民眾能夠知道是病人的爭議才是最重要的可是市長應該在醫療的第一線醫師跟家屬可能會做一個討論那醫師也會以他的專業覺得說我這個是不是還有機會那如果說這個\n家屬跟這個醫師可能也許或者是病人本身也許如果會有一些矛盾的話也許病人本身他覺得說我可能就不插管或者是我可能\n不做積極的那個治療那醫師覺得說還有機會那這樣子的話怎麼辦我們對於末期病人要兩位專科醫師共同確認所以在這個地方上面的醫療程序上面的一個完備其實會是讓我們的在跟病人家屬解釋這一段的時候我覺得會是一個比較清楚而不是一個醫師就說這個有救\n因為要有科學的證據一起來做佐證的時候我覺得啦在決定的時候因為怎麼準備都不夠可是越多的客觀的一些資料幫忙輔助的時候其實在解釋這一段困難難以做決定的一個過程裡面我覺得是相對容易比較容易產生一個就是共識還是會回到了尊重病人自主的一個狀況以上\n那我可以請教就是說這個從2019到現在就是有十萬三千多人有簽署那這十萬三千多人剛剛部長有特別提到就是差不多70%就是有按照原本的這個遺囑下去執行那有沒有碰到什麼樣的困難你們有沒有做一個統計\n這部分的話我們那時候委託的研究只有就是說比較籠統的講到就是說需要再跟家屬再做進一步的溝通這個地方上面的一個困境因為我們當初在簽的時候跟執行AD的時候如果這個情境跟安寧很像就是末期的時候\n那個家屬的理解度相對的高然後可是就是說在這一段過程裡面其實第一段執行在剛開始法律通過的時候其實是醫護人員醫療人員要怎麼執行這一段會有困擾所以我們大概透過輔導團隊然後跟線上的課程定期的一個線上臨床工作會議的一個聯繫會議去解決一開始的困境是有法律不知道怎麼做\nACP很清楚執行AD不知道怎麼做透過大概兩年到三年的一個像這樣子的一個專業團隊的一起協助推動的時候現在的困擾其實會是說怎麼樣擴大相對的效應因為發現很多人還是不清楚那我想請教就是說你們原本執行了這個百分之七十幾的人或者是剩下百分之三十左右沒有按照原本的這一個簽署下去執行\n那有沒有醫療糾紛的這種狀況出現\n這個我不確定只是我們研究報告請研究團隊在跟我們做討論的時候並沒有人提到這一段我只能夠這樣講新的抑鬱法在上路之後一年多我們一年多裡面的案件並沒有看到末期病人的這一段所以就是說最主要是還要再跟家屬溝通應該就是原本他簽的時候雖然有一個家屬陪同\n就是一個家屬至少要一個家屬陪同那可能在到最後的時候也許其他的家屬認為就是說那我還是要繼續救所以可能就會有這樣子一個矛盾產生那像這樣子的話要聽誰的\n基本上面老實講在那段過程當中其實幾乎都是會在用溝通會的家庭會議這邊來做一個凝聚共識然後那結論的部分因為我自己沒有在做那個食物的臨床的經驗只是是說在跟研究團隊討論的過程當中其實很多因為後來幾乎都是走末期的這一段然後透過多次的一個會議之後其實逐漸產生的共識\n比较多能够尊重病人只是这是要花时间来做跟家属这边的沟通其实我一直认为就是说病人的状况如果他真的是没办法没办法再回复或者是说已经就已经没办法了我觉得医师如果很明确的讲通常家属都可以可以接受就是说可能就是让他三中如果他还有自己签署的话那如果\n我覺得這個可能跟醫師也有很大的一個關係那另外就是說要把這個丟給第一線的醫護人員我覺得好像也就譬如說醫師要跟家屬溝通我覺得這個也是要花蠻花時間的所以我覺得這個法也許我覺得還需要再更多的一個社會的溝通\n包委員,前面這個法做得更好當然是絕對有幫助於後面照顧的品質但是一旦他要兩個醫師決定默契以後其實有很多溝通那剛剛講的在新惠富叔叔跟那個\n呃 插管這個部分幾乎他原來講不要大概那個時候也不會做啦齁但是在臨床上真的有很多決策齁那到底他這個狀況打抗生素是有沒有用打人工營養水分是養到細胞比較多還是養到正常的細胞你一直跟他講你一直跟他打打到都是細胞一直大起來他的肉一碟肉就沒有成果這種很嚴重的問題啊這就是communicationis the key\n就是一直在溝通每天我們都在做倫理決策那這個請放心我們的安寧團隊在這個部分台灣的安寧團安寧照顧品質是世界第三亞洲第一所以要善用我們這樣幾十年來建立的這樣一個有品質的團隊給病人可以好好的照顧所以我們反而要先導\n早一點來照會 病人如果到達比較重病的時候應該早一點不管是思考ACP或思考要接受安寧環而醫療照顧這個教育是非常重要的因為不但可以早一點追求善終的路生死良相安應該也讓資源得到最好的一個合理的分配\n好 我是覺得說應該這條路真的確實你們看從那個2019到現在有簽署的才10萬多人這個數字真的是非常少對 當然土法不足以助行所以我們有很多要大家繼續努力但是我們後面的照顧團隊是很堅強的可以解決很多的問題好 謝謝\n","vtt":"WEBVTT\n\n00:05.210 --> 00:09.217\n謝謝主席,我們請部長你先喝一下不然市長先上來\n\n00:19.898 --> 00:39.272\n委員好部長好今天大家關心的就是說我們從2019年這個病人自主權利法通過之後那這個這個預例醫療照護諮商的這一個好像這個幾年下來成效好像也不是那麼好\n\n00:40.052 --> 00:55.908\n我們看到就是說那個實施到現在有簽署的人差不多10萬多人那這個簽署率差不多0.45%那又看到就是說到最後有真的照這樣子這個病人預歷醫療照護諮商\n\n00:58.890 --> 01:13.097\n這樣的醫療到最後是不是有照這樣做的好像這個比例好像也很低那我想請教就是說到底有簽署然後到最後有照這樣去執行的這個比例到底有多少\n\n01:14.377 --> 01:36.790\n報告委員,根據這個應該是衛福部委託的研究我們大概就是有簽署AD到後來的吻合率是七成那這七成裡面有分類,譬如說心外按摩室、插管這個大概百分之百吻合,那在比較困難的是在於\n\n01:37.771 --> 01:54.847\n抗生素那個時候要不要使用要不要用人工營養比如說插鼻胃管胃躁揉或者是用點滴去打那個營養分這個部分到那個時候爭議爭議會比較大所以第一在前面的AD即使簽了以後你到臨床的現場\n\n01:57.109 --> 02:22.689\n還是要不斷的溝通說明做最好政策這樣子部長我想請教就是說你們這樣子目前簽署十萬三千多人這個都是原本是用自費自己自費的嘛對不對那如果說自己自費然後簽署是只有十萬多人的話那未來你們也有特別提到就是說這個諮商65歲重大疾病的部分未來是要由健保這邊來給付嗎對不對\n\n02:26.806 --> 02:52.255\n對嗎5月1號就今天開始今天開始那原本自己自費的自費表示他就是有未來有這個意願有這個意願那你看這樣你們簽署的這個執行率就已經那麼低那如果未來是健保的話那你們要怎麼去擴及是直接在醫療院所或者是你們到其他的可能老人比較多的場所去直接\n\n02:54.076 --> 03:13.015\n這個說明然後鼓吹我不知道說你們未來要怎麼做我們當然可以都要思考怎麼樣把廣度深度都能夠加強我想這個部分也是大家的期望但是就是說我剛剛有講如果\n\n03:14.492 --> 03:25.157\n剛剛第一階段是70%可是後來發現幾年以後再做一次吻合率比較低為什麼我們專家的研究就是因為諮商的品質降低\n\n03:26.475 --> 03:43.744\n資商品質為什麼會降低就是可能他應該也是找醫師所以就是說是不是說時間上或者是怎麼樣這個就是在檢討啦這是一個檢討的可能那你現在5月1號開始上路就65歲重大傷病的我們還是會要求品質嘛要求品質你現在給他支付當然是要求品質啊如果沒做好品質這個大概就不用做了\n\n03:52.349 --> 04:07.288\n那你們已經今天開始了嘛今天開始那你應該要怎麼去要求這個要怎麼要求你們應該自己有一套的要有一定的時間內容跟表單嘛應該都有一個監測的指標嘛\n\n04:08.755 --> 04:28.850\n我先講一下因為其實病毒法實行到這邊五年多其實我們相關的醫護人員完成訓練的人數是夠的然後所以在過去像比如說剛剛那個趙葦這邊有在講等候的人數是因為過去醫院在開設門診的這一段他其實是有多少病人那時候是預約門診的部分\n\n04:30.131 --> 04:54.983\n然後所以在開設加開兩年的部分的話因為人數夠多所以在這個可以解決就是目前現況的部分的話所以我們才會特別講是說健保署這邊如果開始開這個的話我們大概會監測希望是說至少在今年能夠我們最近兩年是一年大概兩萬人次的一個增加的一個幅度那我們希望今年開始能夠突破到四萬\n\n04:55.623 --> 05:17.600\n那這短期間內就是說開出門診是一件事怎麼樣就是說透過這樣子的一個因為我們本來在基層診所這邊有去居家做的這一塊然後我們覺得是說這一塊也是可以來做協作希望能夠擴大量的而不是只靠門診的部分然後也因為這樣子其實我們下半年會有一些專家輔導團隊先做試辦看看怎麼去輔導已經\n\n05:21.963 --> 05:45.355\n上完課有能力做的更敢做的這件事情這是我們下半年希望能夠突破這樣的量才會增加然後期待是說才能夠真的讓更多人了解病毒那我想請教就是說他有簽了那如果簽了到最後到最後他可能沒有意識那如果家人反對呢\n\n05:46.656 --> 06:09.190\n如果醫師跟家人討論就是說他可能這個情況不是那麼樂觀那也許這個病人他原本就已經有簽那個醫主那簽完之後然後家屬反對那家屬反對到底這個醫生要按照他原本的這個醫主或者是他要聽家人的\n\n06:10.912 --> 06:35.348\n這一段其實最重要這個法律的精神會希望是說一併和諧然後在執行的過程當中其實怎麼樣呈現出這個病人的爭議然後我們其實大概在兩年前其實就開始我們在簽這個所謂的AD這個的時候我們就希望同步一起能夠來就是說為什麼家屬一定要進來\n\n06:36.689 --> 06:55.260\n因為這樣子的話才會有見證人其實是同步的證實說這個真的是病人的正義然後那這樣子的前提下面的時候進行的所謂的溝通對話醫護人員也比較敢是說跟另外的家屬說這個是病人真正的意願然後執行\n\n06:55.740 --> 07:22.596\n因為在這個整個過程當中從一路走來的跟善終相關的從棄捐到安寧到病毒我們其實都發現我們華人社會其實還是一個家庭一個核心所以家人的共識家人的同意其實這件事情是重要的早點開啟對話後面也就是我們剛剛部長講的為什麼越早開啟對話的時候那大家的共識度也願意\n\n07:24.257 --> 07:48.357\n讓這個病人最後的醫院能夠執行的這件事情是我覺得是今天也謝謝委員透過這樣的執行我們也希望民眾能夠知道是病人的爭議才是最重要的可是市長應該在醫療的第一線醫師跟家屬可能會做一個討論那醫師也會以他的專業覺得說我這個是不是還有機會那如果說這個\n\n07:50.860 --> 08:04.756\n家屬跟這個醫師可能也許或者是病人本身也許如果會有一些矛盾的話也許病人本身他覺得說我可能就不插管或者是我可能\n\n08:05.396 --> 08:28.542\n不做積極的那個治療那醫師覺得說還有機會那這樣子的話怎麼辦我們對於末期病人要兩位專科醫師共同確認所以在這個地方上面的醫療程序上面的一個完備其實會是讓我們的在跟病人家屬解釋這一段的時候我覺得會是一個比較清楚而不是一個醫師就說這個有救\n\n08:29.142 --> 08:53.650\n因為要有科學的證據一起來做佐證的時候我覺得啦在決定的時候因為怎麼準備都不夠可是越多的客觀的一些資料幫忙輔助的時候其實在解釋這一段困難難以做決定的一個過程裡面我覺得是相對容易比較容易產生一個就是共識還是會回到了尊重病人自主的一個狀況以上\n\n08:54.990 --> 09:15.865\n那我可以請教就是說這個從2019到現在就是有十萬三千多人有簽署那這十萬三千多人剛剛部長有特別提到就是差不多70%就是有按照原本的這個遺囑下去執行那有沒有碰到什麼樣的困難你們有沒有做一個統計\n\n09:17.829 --> 09:39.950\n這部分的話我們那時候委託的研究只有就是說比較籠統的講到就是說需要再跟家屬再做進一步的溝通這個地方上面的一個困境因為我們當初在簽的時候跟執行AD的時候如果這個情境跟安寧很像就是末期的時候\n\n09:40.430 --> 10:06.877\n那個家屬的理解度相對的高然後可是就是說在這一段過程裡面其實第一段執行在剛開始法律通過的時候其實是醫護人員醫療人員要怎麼執行這一段會有困擾所以我們大概透過輔導團隊然後跟線上的課程定期的一個線上臨床工作會議的一個聯繫會議去解決一開始的困境是有法律不知道怎麼做\n\n10:07.717 --> 10:36.923\nACP很清楚執行AD不知道怎麼做透過大概兩年到三年的一個像這樣子的一個專業團隊的一起協助推動的時候現在的困擾其實會是說怎麼樣擴大相對的效應因為發現很多人還是不清楚那我想請教就是說你們原本執行了這個百分之七十幾的人或者是剩下百分之三十左右沒有按照原本的這一個簽署下去執行\n\n10:37.664 --> 10:39.348\n那有沒有醫療糾紛的這種狀況出現\n\n10:44.768 --> 11:09.388\n這個我不確定只是我們研究報告請研究團隊在跟我們做討論的時候並沒有人提到這一段我只能夠這樣講新的抑鬱法在上路之後一年多我們一年多裡面的案件並沒有看到末期病人的這一段所以就是說最主要是還要再跟家屬溝通應該就是原本他簽的時候雖然有一個家屬陪同\n\n11:10.569 --> 11:25.708\n就是一個家屬至少要一個家屬陪同那可能在到最後的時候也許其他的家屬認為就是說那我還是要繼續救所以可能就會有這樣子一個矛盾產生那像這樣子的話要聽誰的\n\n11:27.390 --> 11:55.929\n基本上面老實講在那段過程當中其實幾乎都是會在用溝通會的家庭會議這邊來做一個凝聚共識然後那結論的部分因為我自己沒有在做那個食物的臨床的經驗只是是說在跟研究團隊討論的過程當中其實很多因為後來幾乎都是走末期的這一段然後透過多次的一個會議之後其實逐漸產生的共識\n\n11:57.730 --> 12:23.989\n比较多能够尊重病人只是这是要花时间来做跟家属这边的沟通其实我一直认为就是说病人的状况如果他真的是没办法没办法再回复或者是说已经就已经没办法了我觉得医师如果很明确的讲通常家属都可以可以接受就是说可能就是让他三中如果他还有自己签署的话那如果\n\n12:24.909 --> 12:49.099\n我覺得這個可能跟醫師也有很大的一個關係那另外就是說要把這個丟給第一線的醫護人員我覺得好像也就譬如說醫師要跟家屬溝通我覺得這個也是要花蠻花時間的所以我覺得這個法也許我覺得還需要再更多的一個社會的溝通\n\n12:51.425 --> 13:07.645\n包委員,前面這個法做得更好當然是絕對有幫助於後面照顧的品質但是一旦他要兩個醫師決定默契以後其實有很多溝通那剛剛講的在新惠富叔叔跟那個\n\n13:09.906 --> 13:35.811\n呃插管這個部分幾乎他原來講不要大概那個時候也不會做啦齁但是在臨床上真的有很多決策齁那到底他這個狀況打抗生素是有沒有用打人工營養水分是養到細胞比較多還是養到正常的細胞你一直跟他講你一直跟他打打到都是細胞一直大起來他的肉一碟肉就沒有成果這種很嚴重的問題啊這就是communicationisthekey\n\n13:37.791 --> 13:56.867\n就是一直在溝通每天我們都在做倫理決策那這個請放心我們的安寧團隊在這個部分台灣的安寧團安寧照顧品質是世界第三亞洲第一所以要善用我們這樣幾十年來建立的這樣一個有品質的團隊給病人可以好好的照顧所以我們反而要先導\n\n13:58.496 --> 14:19.651\n早一點來照會病人如果到達比較重病的時候應該早一點不管是思考ACP或思考要接受安寧環而醫療照顧這個教育是非常重要的因為不但可以早一點追求善終的路生死良相安應該也讓資源得到最好的一個合理的分配\n\n14:20.191 --> 14:40.604\n好我是覺得說應該這條路真的確實你們看從那個2019到現在有簽署的才10萬多人這個數字真的是非常少對當然土法不足以助行所以我們有很多要大家繼續努力但是我們後面的照顧團隊是很堅強的可以解決很多的問題好謝謝\n\n","segments":[{"start":5.21,"end":9.217,"text":"謝謝主席,我們請部長你先喝一下不然市長先上來"},{"start":19.898,"end":39.272,"text":"委員好 部長好 今天大家關心的就是說我們從2019年這個病人自主權利法通過之後那這個這個預例醫療照護諮商的這一個好像這個幾年下來成效好像也不是那麼好"},{"start":40.052,"end":55.908,"text":"我們看到就是說那個實施到現在有簽署的人差不多10萬多人那這個簽署率差不多0.45%那又看到就是說到最後有真的照這樣子這個病人預歷醫療照護諮商"},{"start":58.89,"end":73.097,"text":"這樣的醫療到最後是不是有照這樣做的好像這個比例好像也很低那我想請教就是說到底有簽署然後到最後有照這樣去執行的這個比例到底有多少"},{"start":74.377,"end":96.79,"text":"報告委員,根據這個應該是衛福部委託的研究我們大概就是有簽署AD到後來的吻合率是七成那這七成裡面有分類,譬如說心外按摩室、插管這個大概百分之百吻合,那在比較困難的是在於"},{"start":97.771,"end":114.847,"text":"抗生素那個時候要不要使用要不要用人工營養比如說插鼻胃管 胃躁揉或者是用點滴去打那個營養分這個部分到那個時候爭議爭議會比較大所以第一在前面的AD即使簽了以後你到臨床的現場"},{"start":117.109,"end":142.689,"text":"還是要不斷的溝通說明做最好政策這樣子部長我想請教就是說你們這樣子目前簽署十萬三千多人這個都是原本是用自費自己自費的嘛對不對那如果說自己自費然後簽署是只有十萬多人的話那未來你們也有特別提到就是說這個諮商65歲重大疾病的部分未來是要由健保這邊來給付嗎對不對"},{"start":146.806,"end":172.255,"text":"對嗎5月1號就今天開始今天開始那原本自己自費的自費表示他就是有未來有這個意願有這個意願那你看這樣你們簽署的這個執行率就已經那麼低那如果未來是健保的話那你們要怎麼去擴及是直接在醫療院所或者是你們到其他的可能老人比較多的場所去直接"},{"start":174.076,"end":193.015,"text":"這個說明然後鼓吹我不知道說你們未來要怎麼做我們當然可以都要思考怎麼樣把廣度深度都能夠加強我想這個部分也是大家的期望但是就是說我剛剛有講如果"},{"start":194.492,"end":205.157,"text":"剛剛第一階段是70%可是後來發現幾年以後再做一次 吻合率比較低為什麼 我們專家的研究就是因為諮商的品質降低"},{"start":206.475,"end":223.744,"text":"資商品質為什麼會降低就是可能他應該也是找醫師所以就是說是不是說時間上或者是怎麼樣這個就是在檢討啦這是一個檢討的可能那你現在5月1號開始上路就65歲重大傷病的我們還是會要求品質嘛要求品質你現在給他支付當然是要求品質啊如果沒做好品質這個大概就不用做了"},{"start":232.349,"end":247.288,"text":"那你們已經今天開始了嘛今天開始那你應該要怎麼去要求這個要怎麼要求你們應該自己有一套的要有一定的時間內容跟表單嘛應該都有一個監測的指標嘛"},{"start":248.755,"end":268.85,"text":"我先講一下因為其實病毒法實行到這邊五年多其實我們相關的醫護人員完成訓練的人數是夠的然後所以在過去像比如說剛剛那個趙葦這邊有在講等候的人數是因為過去醫院在開設門診的這一段他其實是有多少病人那時候是預約門診的部分"},{"start":270.131,"end":294.983,"text":"然後所以在開設加開兩年的部分的話因為人數夠多所以在這個可以解決就是目前現況的部分的話所以我們才會特別講是說健保署這邊如果開始開這個的話我們大概會監測希望是說至少在今年能夠我們最近兩年是一年大概兩萬人次的一個增加的一個幅度那我們希望今年開始能夠突破到四萬"},{"start":295.623,"end":317.6,"text":"那這短期間內就是說開出門診是一件事怎麼樣就是說透過這樣子的一個因為我們本來在基層診所這邊有去居家做的這一塊然後我們覺得是說這一塊也是可以來做協作希望能夠擴大量的而不是只靠門診的部分然後也因為這樣子其實我們下半年會有一些專家輔導團隊先做試辦看看怎麼去輔導已經"},{"start":321.963,"end":345.355,"text":"上完課有能力做的更敢做的這件事情這是我們下半年希望能夠突破這樣的量才會增加然後期待是說才能夠真的讓更多人了解病毒那我想請教就是說他有簽了那如果簽了到最後到最後他可能沒有意識那如果家人反對呢"},{"start":346.656,"end":369.19,"text":"如果醫師跟家人討論就是說他可能這個情況不是那麼樂觀那也許這個病人他原本就已經有簽那個醫主那簽完之後然後家屬反對那家屬反對到底這個醫生要按照他原本的這個醫主或者是他要聽家人的"},{"start":370.912,"end":395.348,"text":"這一段其實最重要這個法律的精神會希望是說一併和諧然後在執行的過程當中其實怎麼樣呈現出這個病人的爭議然後我們其實大概在兩年前其實就開始我們在簽這個所謂的AD這個的時候我們就希望同步一起能夠來就是說為什麼家屬一定要進來"},{"start":396.689,"end":415.26,"text":"因為這樣子的話才會有見證人其實是同步的證實說這個真的是病人的正義然後那這樣子的前提下面的時候進行的所謂的溝通對話醫護人員也比較敢是說跟另外的家屬說這個是病人真正的意願然後執行"},{"start":415.74,"end":442.596,"text":"因為在這個整個過程當中從一路走來的跟善終相關的從棄捐到安寧到病毒我們其實都發現我們華人社會其實還是一個家庭一個核心所以家人的共識家人的同意其實這件事情是重要的早點開啟對話後面也就是我們剛剛部長講的為什麼越早開啟對話的時候那大家的共識度也願意"},{"start":444.257,"end":468.357,"text":"讓這個病人最後的醫院能夠執行的這件事情是我覺得是今天也謝謝委員透過這樣的執行我們也希望民眾能夠知道是病人的爭議才是最重要的可是市長應該在醫療的第一線醫師跟家屬可能會做一個討論那醫師也會以他的專業覺得說我這個是不是還有機會那如果說這個"},{"start":470.86,"end":484.756,"text":"家屬跟這個醫師可能也許或者是病人本身也許如果會有一些矛盾的話也許病人本身他覺得說我可能就不插管或者是我可能"},{"start":485.396,"end":508.542,"text":"不做積極的那個治療那醫師覺得說還有機會那這樣子的話怎麼辦我們對於末期病人要兩位專科醫師共同確認所以在這個地方上面的醫療程序上面的一個完備其實會是讓我們的在跟病人家屬解釋這一段的時候我覺得會是一個比較清楚而不是一個醫師就說這個有救"},{"start":509.142,"end":533.65,"text":"因為要有科學的證據一起來做佐證的時候我覺得啦在決定的時候因為怎麼準備都不夠可是越多的客觀的一些資料幫忙輔助的時候其實在解釋這一段困難難以做決定的一個過程裡面我覺得是相對容易比較容易產生一個就是共識還是會回到了尊重病人自主的一個狀況以上"},{"start":534.99,"end":555.865,"text":"那我可以請教就是說這個從2019到現在就是有十萬三千多人有簽署那這十萬三千多人剛剛部長有特別提到就是差不多70%就是有按照原本的這個遺囑下去執行那有沒有碰到什麼樣的困難你們有沒有做一個統計"},{"start":557.829,"end":579.95,"text":"這部分的話我們那時候委託的研究只有就是說比較籠統的講到就是說需要再跟家屬再做進一步的溝通這個地方上面的一個困境因為我們當初在簽的時候跟執行AD的時候如果這個情境跟安寧很像就是末期的時候"},{"start":580.43,"end":606.877,"text":"那個家屬的理解度相對的高然後可是就是說在這一段過程裡面其實第一段執行在剛開始法律通過的時候其實是醫護人員醫療人員要怎麼執行這一段會有困擾所以我們大概透過輔導團隊然後跟線上的課程定期的一個線上臨床工作會議的一個聯繫會議去解決一開始的困境是有法律不知道怎麼做"},{"start":607.717,"end":636.923,"text":"ACP很清楚執行AD不知道怎麼做透過大概兩年到三年的一個像這樣子的一個專業團隊的一起協助推動的時候現在的困擾其實會是說怎麼樣擴大相對的效應因為發現很多人還是不清楚那我想請教就是說你們原本執行了這個百分之七十幾的人或者是剩下百分之三十左右沒有按照原本的這一個簽署下去執行"},{"start":637.664,"end":639.348,"text":"那有沒有醫療糾紛的這種狀況出現"},{"start":644.768,"end":669.388,"text":"這個我不確定只是我們研究報告請研究團隊在跟我們做討論的時候並沒有人提到這一段我只能夠這樣講新的抑鬱法在上路之後一年多我們一年多裡面的案件並沒有看到末期病人的這一段所以就是說最主要是還要再跟家屬溝通應該就是原本他簽的時候雖然有一個家屬陪同"},{"start":670.569,"end":685.708,"text":"就是一個家屬至少要一個家屬陪同那可能在到最後的時候也許其他的家屬認為就是說那我還是要繼續救所以可能就會有這樣子一個矛盾產生那像這樣子的話要聽誰的"},{"start":687.39,"end":715.929,"text":"基本上面老實講在那段過程當中其實幾乎都是會在用溝通會的家庭會議這邊來做一個凝聚共識然後那結論的部分因為我自己沒有在做那個食物的臨床的經驗只是是說在跟研究團隊討論的過程當中其實很多因為後來幾乎都是走末期的這一段然後透過多次的一個會議之後其實逐漸產生的共識"},{"start":717.73,"end":743.989,"text":"比较多能够尊重病人只是这是要花时间来做跟家属这边的沟通其实我一直认为就是说病人的状况如果他真的是没办法没办法再回复或者是说已经就已经没办法了我觉得医师如果很明确的讲通常家属都可以可以接受就是说可能就是让他三中如果他还有自己签署的话那如果"},{"start":744.909,"end":769.099,"text":"我覺得這個可能跟醫師也有很大的一個關係那另外就是說要把這個丟給第一線的醫護人員我覺得好像也就譬如說醫師要跟家屬溝通我覺得這個也是要花蠻花時間的所以我覺得這個法也許我覺得還需要再更多的一個社會的溝通"},{"start":771.425,"end":787.645,"text":"包委員,前面這個法做得更好當然是絕對有幫助於後面照顧的品質但是一旦他要兩個醫師決定默契以後其實有很多溝通那剛剛講的在新惠富叔叔跟那個"},{"start":789.906,"end":815.811,"text":"呃 插管這個部分幾乎他原來講不要大概那個時候也不會做啦齁但是在臨床上真的有很多決策齁那到底他這個狀況打抗生素是有沒有用打人工營養水分是養到細胞比較多還是養到正常的細胞你一直跟他講你一直跟他打打到都是細胞一直大起來他的肉一碟肉就沒有成果這種很嚴重的問題啊這就是communicationis the key"},{"start":817.791,"end":836.867,"text":"就是一直在溝通每天我們都在做倫理決策那這個請放心我們的安寧團隊在這個部分台灣的安寧團安寧照顧品質是世界第三亞洲第一所以要善用我們這樣幾十年來建立的這樣一個有品質的團隊給病人可以好好的照顧所以我們反而要先導"},{"start":838.496,"end":859.651,"text":"早一點來照會 病人如果到達比較重病的時候應該早一點不管是思考ACP或思考要接受安寧環而醫療照顧這個教育是非常重要的因為不但可以早一點追求善終的路生死良相安應該也讓資源得到最好的一個合理的分配"},{"start":860.191,"end":880.604,"text":"好 我是覺得說應該這條路真的確實你們看從那個2019到現在有簽署的才10萬多人這個數字真的是非常少對 當然土法不足以助行所以我們有很多要大家繼續努力但是我們後面的照顧團隊是很堅強的可以解決很多的問題好 謝謝"}]}}},"gazette":{"lineno":578,"blocks":[["黃委員秀芳：（11時49分）謝謝主席，我們請部長。"],["主席：來，部長。"],["邱部長泰源：委員好。"],["黃委員秀芳：部長好。部長，今天大家關心的是，我們從2019年病人自主權利法通過之後，預立醫療照護諮商這幾年下來，成效好像也不是那麼好，我們看到實施到現在，有簽署的人差不多十萬多人，這個簽署率差不多0.45%，又看到最後是不是真的有照病人預立醫療照護諮商這樣做的，好像這個比例也很低。我想請教有簽署且到最後也有照這樣去執行的，這個比例到底有多少？"],["邱部長泰源：報告委員，根據衛福部委託的研究，有簽署AD到後來的吻合率是七成，這七成裡面有分類，譬如心外按摩術、插管，這個大概百分之百吻合，比較困難的是在於抗生素要不要使用，要不要用人工營養，譬如插鼻胃管、胃造廔，或者是用點滴去打營養的，這個部分到那個時候爭議會比較大。所以第一，在前面的AD即使簽了以後，你到臨床的現場還是要不斷溝通、說明，做好決策這樣子。"],["黃委員秀芳：部長，我想請教，目前簽署十萬三千多人，這個原本都是自己自費的嘛？"],["邱部長泰源：是。"],["黃委員秀芳：如果自己自費，簽署只有十萬多人的話，你們也有特別提到65歲重大疾病的部分，未來諮商是要由健保給付，對不對？對嗎？"],["邱部長泰源：5月1日會擴大。"],["黃委員秀芳：5月1日就是今天開始嘛！原本自己自費的，自費表示他就是未來有這個意願，你看簽署的執行率就已經那麼低，如果未來是健保給付，你們要怎麼去擴及？是直接在醫療院所，或者是你們到其他可能老人比較多的場所直接說明，然後鼓吹？我不知道你們未來要怎麼做。"],["邱部長泰源：我們當然都要思考怎麼樣把廣度、深度都能夠加強，我想這個部分也是大家的期望，但是我剛剛有講，第一階段是70%，可是後來發現幾年以後再做一次，吻合率比較低，為什麼？我們專家的研究就是因為諮商的品質降低。"],["黃委員秀芳：諮商品質為什麼會降低？"],["邱部長泰源：就是可能……"],["黃委員秀芳：他應該也是找醫師。"],["邱部長泰源：對，所以這是不是時間上或者是怎麼樣，這個在檢討，這是一個檢討的可能……"],["黃委員秀芳：是，你現在5月1日開始上路，就是65歲重大傷病者……"],["邱部長泰源：我們還是會去要求品質。"],["黃委員秀芳：對，你們要怎麼去……"],["邱部長泰源：你現在幫他給付，當然是要要求品質，如果沒沒做好品質，這個大概就不用做了，幹嘛做這個？"],["黃委員秀芳：你們今天開始了，你應該要怎麼去要求？這個要怎麼要求，你們應該自己有一套的……"],["邱部長泰源：監測的指標要有一定的時間、內容跟填表單，應該都有一個監測的指標……"],["劉司長越萍：我先講一下，病主法施行到這邊五年多，其實我們相關的醫護人員完成訓練的人數是夠的，過去譬如剛剛召委講的等候人數，因為過去醫院在開設門診的這一段有多少病人，那時候是預約門診……在開設加開量能的部分，因為人數夠多，所以可以解決現況的部分，所以我們才會特別講健保署如果開始開了這個，我們大概會監測，希望至少在今年能夠突破，最近兩年，一年大概兩萬人次的增加幅度，我們希望今年開始能夠突破到4萬。短期間內，開出門診是一件事，怎麼樣透過這樣子的方式，因為我們本來在基層診所有去居家做的這一塊，我們覺得這一塊也是可以協作，希望能夠擴大量能，而不是只靠門診的部分。也因為這樣子，其實我們下半年會有一些專家輔導團隊先試辦，看看怎麼去輔導，已經上完課有能力做的、更敢做的這件事情，這是我們下半年希望能夠突破的，這樣量才會增加，期待能夠真的讓更多人了解病主，以上。"],["黃委員秀芳：我想請教，他有簽了，但是到最後他可能沒有意識，如果家人反對呢？如果醫師跟家人討論，告知這個情況可能不是那麼樂觀，也許這個病人原本就已經有簽醫囑，但是簽完之後，家屬反對，在家屬反對的情況下，到底這個醫生要按照他原本的醫囑，或者是他要聽家人的？"],["劉司長越萍：這個法律最重要的精神會希望醫病和諧，在執行的過程當中，怎麼樣呈現出這個病人的真意，大概在兩年前開始在簽所謂AD的時候，我們就希望能夠同步一起，為什麼家屬一定要進來？因為這樣子才會有見證人，其實是同步的證實這個真的是病人的真意，在這樣子的前提下進行的溝通對話，醫護人員也比較敢跟另外的家屬說這個是病人真正的意願，然後執行，因為在整個過程當中，一路走來跟善終相關的，從器捐到安寧、到病主，我們都發現華人社會其實還是以一個家庭為核心，所以家人的共識、家人的同意，其實這件事情是重要的。早點開啟對話，後面也就是剛剛我們部長講的，越早開啟對話，大家的共識度也願意讓病人最後的意願能夠執行這件事情，今天也謝謝委員透過這樣的質詢，我們也希望民眾能夠知道病人的真意才是最重要的。"],["黃委員秀芳：是，可是司長，在醫療的第一線醫師跟家屬可能會做討論，醫師也會以他的專業判斷這是不是還有機會。如果家屬跟醫師或者是病人本身有一些矛盾的話，也許病人本身會覺得我可能就不插管，或者是我可能不做積極的治療，但是醫師覺得還有機會，這樣子的話該怎麼辦？"],["劉司長越萍：我們對於末期病人要兩位專科醫師共同確認，所以在這個地方上面，醫療程序的完備其實會讓我們在跟病人家屬解釋這一段的時候，我覺得會比較清楚，而不是一個醫師說這個有救，因為要有科學的證據一起做佐證。我覺得在決定的時候，怎麼準備都不夠，可是越多客觀的一些資料幫忙輔助，其實在解釋這一段困難、難以做決定的過程裡面，我覺得是相對容易，比較容易產生一個共識，還是會回到尊重病人自主的狀況，以上。"],["黃委員秀芳：我可不可以請教，從2019到現在，有十萬三千多人簽署，這十萬三千多人剛剛部長有特別提到，差不多70%有按照原本的醫囑下去執行，有沒有碰到什麼樣的困難，你們有沒有統計？"],["劉司長越萍：關於這部分，我們那時候委託的研究，只有比較籠統的講到，需要跟家屬再做進一步溝通這個地方上面的困境。因為當初在簽的時候、執行AD的時候，如果情境跟安寧很像，就是末期的時候，家屬的理解度相對高，可是就是在這第一段執行的過程中，在法律剛通過的時候，其實醫護人員、醫療人員要怎麼執行的這一段是會有困擾的。所以我們大概是透過輔導團隊和定期線上課程的臨床工作聯繫會議去解決，一開始的困境是有法律但不知道怎麼做，ACP很清楚，但執行AD不知道要怎麼做，大概透過兩年到三年這樣的專業團隊一起協助推動，現在的困擾則是怎麼擴大相對的效應，因為我們發現很多人還是不清楚。"],["黃委員秀芳：原本執行了百分之七十幾的人，或者是剩下百分之三十左右的人沒有按照原本的簽署執行，有沒有出現醫療糾紛的狀況？"],["劉司長越萍：這個我不確定，只是我們在和研究團隊討論的時候，並沒有人提到這一段，我只能這樣講。新的預立法在上路後的一年多，我們的案件裡並沒有看到末期病人的這一段。"],["黃委員秀芳：就是說最主要還是要再跟家屬溝通？"],["劉司長越萍：對。"],["黃委員秀芳：應該是原本他簽的時候，雖然至少要有一個家屬陪同……"],["劉司長越萍：二等親。"],["黃委員秀芳：可是到最後的時候，也許其他家屬認為還要繼續救，所以會有這樣的矛盾產生，像這樣的話，要聽誰的？"],["劉司長越萍：老實講，基本上在那段過程當中，幾乎都會再用家庭會議來做一個共識的凝聚，至於結論部分，因為我自己沒有實務上的臨床經驗，只是在跟研究團隊討論的過程當中，因為很多後來幾乎都是走末期這一段，然後透過多次的會議之後，逐漸產生共識，也比較能夠尊重病人，只是要花時間來進行跟家屬的溝通。"],["黃委員秀芳：其實我一直認為病人的狀況如果真的沒辦法回復，或者已經沒辦法了，如果醫師可以很明確的講，通常家屬都可以接受讓他善終，如果他自己還有簽署的話，這可能跟醫師也有很大關係。另外就是要把這個問題丟給第一線醫護人員，變成是醫師要跟家屬溝通，也是蠻花時間的，所以我覺得這個法也許還需要社會更多的溝通。"],["邱部長泰源：報告委員，也許前面這個法做得更好，當然絕對有助於後面照護的品質，但如果要兩個醫師界定末期，其實需要很多溝通。譬如剛剛講的心肺復甦術和插管部分，他原來講不要，大概那時候也不會做，但是在臨床上真的有很多決策，到底這個狀況打抗生素有沒有用？打人工營養、水分是養到壞細胞比較多，還是養到正常的細胞？你一直幫他打，打到細胞一直大起來，但他的肉一點都沒有增加，這都是很專業的問題，這就是communication is the key，就是要一直溝通，每天我們都在做倫理決策，這個請放心，臺灣的安寧照護品質是世界第三、亞洲第一，所以要善用幾十年來建立的這樣一個有品質的團隊，我們一定會好好照顧病人。所以我覺得反而要宣導早一點來照會，就是病人如果到比較重病的時候，應該早一點，不管是思考ACP或思考接受安寧緩和醫療照顧，這個教育非常重要，因為不但可以早一點追求善終的路，生死兩相安，也讓資源得到最好的合理分配。"],["黃委員秀芳：好，我覺得這條路真的……確實你看從2019到現在，簽署的人才十萬多人，數字真的非常少，真的是非常少。"],["邱部長泰源：對，當然徒法不足以自行，所以還有很多需要大家繼續努力。"],["黃委員秀芳：還要繼續努力啦！"],["邱部長泰源：但是我們後面的照顧團隊是很堅強的，可以解決很多問題。"],["黃委員秀芳：好，謝謝。"],["邱部長泰源：謝謝。"],["主席：好，謝謝黃委員、謝謝部長。","請王正旭委員。"]],"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"}}}