{"error":false,"id":["162478"],"data":{"IVOD_ID":162478,"IVOD_URL":"https://ivod.ly.gov.tw/Play/Clip/1M/162478","日期":"2025-06-12","會議資料":{"會議代碼":"公聽會-2025060694","會議代碼:str":"舉行「病人自主權利法修法」公聽會","屆":11,"會期":3,"臨時會會次":null,"種類":"公聽會","委員會代碼":[26],"委員會代碼:str":["社會福利及衛生環境委員會"],"標題":"立法院第11屆第3會期社會福利及衛生環境委員會公聽會（事由：舉行「病人自主權利法修法」公聽會）"},"影片種類":"Clip","開始時間":"2025-06-12T09:38:36+08:00","結束時間":"2025-06-12T09:45:33+08:00","影片長度":"00:06:57","支援功能":["ai-transcript"],"video_url":"https://ivod-lyvod.cdn.hinet.net/vod_1/_definst_/mp4:1MClips/cc296d1d2cabc1faa62a0fdd72ed0062d0f1804948a25d2608a222f77fdbc20a37a2079df6bf46255ea18f28b6918d91.mp4/playlist.m3u8","委員名稱":"林月琴","委員發言時間":"09:38:36 - 09:45:33","會議時間":"2025-06-12T09:00:00+08:00","會議名稱":"立法院第11屆第3會期社會福利及衛生環境委員會公聽會（事由：舉行「病人自主權利法修法」公聽會）","transcript":{"pyannote":[{"speaker":"SPEAKER_00","start":8.51909375,"end":8.87346875},{"speaker":"SPEAKER_00","start":9.19409375,"end":10.375343750000003},{"speaker":"SPEAKER_01","start":9.83534375,"end":10.004093750000003},{"speaker":"SPEAKER_00","start":10.746593750000002,"end":14.25659375},{"speaker":"SPEAKER_00","start":14.813468750000002,"end":22.930343750000002},{"speaker":"SPEAKER_00","start":23.23409375,"end":31.97534375},{"speaker":"SPEAKER_00","start":32.329718750000005,"end":34.47284375},{"speaker":"SPEAKER_00","start":34.79346875,"end":38.94471875},{"speaker":"SPEAKER_00","start":39.13034375,"end":41.34096875},{"speaker":"SPEAKER_00","start":41.492843750000006,"end":44.05784375},{"speaker":"SPEAKER_00","start":44.19284375,"end":45.35721875},{"speaker":"SPEAKER_00","start":45.54284375,"end":50.554718750000006},{"speaker":"SPEAKER_00","start":50.70659375,"end":52.91721875},{"speaker":"SPEAKER_00","start":56.798468750000005,"end":59.852843750000005},{"speaker":"SPEAKER_00","start":59.970968750000004,"end":69.08346875000001},{"speaker":"SPEAKER_00","start":69.31971875,"end":71.86784375},{"speaker":"SPEAKER_00","start":72.15471875,"end":98.15909375000001},{"speaker":"SPEAKER_00","start":98.27721875,"end":127.84221875000001},{"speaker":"SPEAKER_00","start":127.94346875000001,"end":157.17096875000001},{"speaker":"SPEAKER_00","start":157.45784375000002,"end":171.54846875},{"speaker":"SPEAKER_00","start":171.59909375,"end":171.64971875},{"speaker":"SPEAKER_00","start":171.88596875000002,"end":179.04096875000002},{"speaker":"SPEAKER_00","start":179.19284375,"end":207.71159375000002},{"speaker":"SPEAKER_00","start":209.55096875,"end":232.41659375},{"speaker":"SPEAKER_00","start":232.90596875000003,"end":249.12284375000002},{"speaker":"SPEAKER_00","start":249.20721875,"end":281.69159375000004},{"speaker":"SPEAKER_00","start":281.84346875,"end":285.99471875},{"speaker":"SPEAKER_00","start":288.39096875,"end":310.61534375},{"speaker":"SPEAKER_00","start":311.27346875,"end":317.28096875},{"speaker":"SPEAKER_00","start":317.56784375,"end":322.49534375},{"speaker":"SPEAKER_00","start":322.95096875,"end":336.95721875000004},{"speaker":"SPEAKER_00","start":339.96096875,"end":344.73659375},{"speaker":"SPEAKER_00","start":345.07409375000003,"end":350.08596875},{"speaker":"SPEAKER_00","start":350.49096875000004,"end":358.75971875000005},{"speaker":"SPEAKER_00","start":359.24909375000004,"end":362.43846875},{"speaker":"SPEAKER_00","start":362.53971875,"end":362.70846875},{"speaker":"SPEAKER_00","start":363.01221875000005,"end":367.80471875},{"speaker":"SPEAKER_00","start":368.49659375000005,"end":370.92659375000005},{"speaker":"SPEAKER_00","start":371.44971875000005,"end":376.02284375000005},{"speaker":"SPEAKER_00","start":376.12409375000004,"end":377.03534375000004},{"speaker":"SPEAKER_00","start":377.32221875000005,"end":381.79409375},{"speaker":"SPEAKER_00","start":382.45221875000004,"end":414.98721875}],"whisperx":[{"start":9.263,"end":9.283,"text":"哈呃"},{"start":10.834,"end":38.685,"text":"我們各位專家學者還有我們的政府部門那的確今天事實上是討論法案不過我覺得更想要去提的事實上是整個的相關的措施在民國八九年安寧緩和條例跟一百到一百零八年的個人自主病人自主權利法就是病主法相繼實施那兩法呢事實上是規定了病人可以在臨終前的自主決定照護方式"},{"start":39.226,"end":47.737,"text":"醫療機構當然需要尊重決定採取或不採取治療目的皆在避免過度的醫療並授權醫師醫病人的預例意願來採取採取緩和手段"},{"start":57.38,"end":77.37,"text":"案例緩和條例的確讓末期病人透過一個預歷醫療書來提出緩和的醫療要求大概只針對於末期病人那病毒法事實上相對適用的範圍比較廣那我認為立法大有四個一個主要的重大的意義"},{"start":77.93,"end":101.785,"text":"第一個是保護病人免受無效的醫療的折磨第二個是保障醫師合法執行不急救行為來避免觸發第三個是讓病人跟家屬提早面對死亡的準備第四個是節省醫療的支援那身為民醫代表那當然就會接受到各方的一個針對於他們提出來的一些疑慮所以今天就來提出來"},{"start":102.452,"end":122.481,"text":"不管是醫院或醫師或病人對這個制度的疑慮也希望這個公聽會能夠共同大家理性的去做討論推動一些可行的方案那在醫院這一端就安寧療護事實上推行了20年使用率雖提升可是2022年大概也有6.7萬人接受"},{"start":124.242,"end":143.937,"text":"死亡前一年使用率达到30.4%可是医疗的量能还是很有限原因之一事实上是成本非常的高安宁疗护需由跨专业的团队来提供生理跟心理的照护医院如果不是凭借加分的话优因不高那床位成长就很有限"},{"start":144.937,"end":163.133,"text":"所以多數都是改成安眠共照來替代那112年全台僅86家醫院915床114年降到85家910床那床位事實上非常稀缺導致病人需排隊或的就是做跨科共照"},{"start":164.094,"end":193.332,"text":"那醫生這一端的確剛剛如我們前面的兩位先生大概有會提到的一些糾紛所在就是說面對生命的時候醫生到底是穿上盔甲還是會感到迷茫呢為什麼因為病人自主實務上涉及到病人家屬跟醫護人員多方的意見常見家屬不同意病人做選擇的時候引發醫病的糾紛儘管安寧條例跟病毒法醫療法跟醫療事故預防跟"},{"start":193.932,"end":207.441,"text":"争议处理法保护医师免疫因不急救行为来处罚那搭配医疗事前告知跟争议的处理机制还是很难化解医生对生命责任跟输送风险的顾虑"},{"start":209.602,"end":232.08,"text":"病人這一邊事實上預例醫療一組大概整個的諮商費用大概是3000元對多數民眾來講還是屬於高價的雖然衛福部現在對弱勢有提供免費的服務可是成效不彰因為只從2.4萬人提升到2.5萬人那有些縣市甚至動員街友來簽署以來增加的量"},{"start":232.981,"end":246.961,"text":"那即使衛福部經營會擴大到65歲以上重大傷病的患者潛在180萬人目標是4萬人可是我還是要指出民眾不簽不一定只有費用的問題而已而是面對死亡上的迫切感或還沒有思考過"},{"start":249.545,"end":267.143,"text":"另外就是2024年我們的受監護宣告人數總數字上是6047人其中18歲以上的話有5999人那其中以社會福利機構為監護人的有10件那監護人有執行受監護的生活那醫療"},{"start":268.824,"end":285.73,"text":"养护照顾跟我们的财产管理的职务可是阅历医疗的决定还是要本人来做签署所以监护人没有办法代为签署权所以安宁照护仅能依据医师的判断与监护人无关这是目前制度尚未厘清的问题"},{"start":288.49,"end":315.297,"text":"所以安寧照護養護就安寧療護絕對是一個很好的政策他實現病人自主善終的期待可面對到床位不足跟使用率偏低的現況跟安寧共照應延伸到社區共照發展成居家安寧機構安寧等在宅那個醫療模式讓病人有住院以外的選擇健保署當然也啟動了居家醫療照護整合計畫的2.0跟在宅"},{"start":317.665,"end":336.666,"text":"及政的招呼事辦計畫5月我在質詢的時候就獲得確認下半年將針對各類安民招呼進行品質平和給予最高30%的給付加成並規劃包月制的給付實現不同工不同酬"},{"start":339.997,"end":367.522,"text":"最後就是病人在宅安眠發生我們病危則送醫送到醫院病人在住宿機構安眠的時候發生病危或是在機構過世勢必導致發生醫療糾紛的比例大幅增加所以因此醫療的背後一定要有強大的支持系統也就是分級醫療院所所應該垂直整合的綠色通道那而且這綠色通道除了提供傳統的緊急救護住院"},{"start":368.902,"end":391.179,"text":"資源以外那人力技術支持也是一個重要的一環所以衛福部必須要建立重大的一個這個強大的後勤資源跟確保系統來能夠承擔安民的業務我剛剛也很贊成孫教授剛剛撥放那個黃錢總院長我也覺得事實上是不是有更多人能夠進來我覺得這事實上是"},{"start":392.219,"end":414.461,"text":"針對這住法 我的看法可是我覺得不是只有這個所以我認為整個醫療決定到安寧照護的政策體系裡邊希望能夠提高住宿機構的醫事人員的訪視費跟積極提升在宅醫療的量能還有能夠綠色通道的避免依舊來為住宿機構提供後勤的支援系統 以上謝謝"}]}},"supported_relations":[],"relations":[]}