| IVOD_ID |
16641 |
| IVOD_URL |
https://ivod.ly.gov.tw/Play/Full/1M/16641 |
| 日期 |
2025-05-01 |
| 會議資料.會議代碼 |
委員會-11-3-26-9 |
| 會議資料.會議代碼:str |
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 |
| 會議資料.屆 |
11 |
| 會議資料.會期 |
3 |
| 會議資料.會次 |
9 |
| 會議資料.種類 |
委員會 |
| 會議資料.委員會代碼[0] |
26 |
| 會議資料.委員會代碼:str[0] |
社會福利及衛生環境委員會 |
| 會議資料.標題 |
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 |
| 影片種類 |
Full |
| 開始時間 |
2025-05-01T08:31:00+08:00 |
| 結束時間 |
2025-05-01T13:27:00+08:00 |
| 影片長度 |
04:56:00 |
| 支援功能[0] |
ai-transcript |
| video_url |
https://h264media01.ly.gov.tw:443/vod_1/_definst_/mp4:1M/bfaf9b39ac01a68562c05bd4558c4086ce1f9dc46489d24114bfadd538e1bbbf29487090ad40d8725ea18f28b6918d91.mp4/playlist.m3u8 |
| 會議時間 |
2025-05-01T09:00:00+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第9次全體委員會議（事由：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16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「病人自主權利法第八條、第九條及第十五條條文修正草案」案。
【僅詢答】
【4月30日及5月1日二天一次會】） |
| 委員名稱 |
完整會議 |
| 委員發言時間 |
08:31:00 - 13:27:00 |
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SPEAKER_14 |
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SPEAKER_14 |
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1778.26 |
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現在繼續開會本會議議程為審查委員王玉敏等18人委員劉建國等16人分別離聚病人自主權利法部門條文修正草案 |
| transcript.whisperx[1].start |
1789.468 |
| transcript.whisperx[1].end |
1814.017 |
| transcript.whisperx[1].text |
以及邱志偉等19人委員邱志偉等19人離聚並能自主權力法第8條第9條及第15條條文修正查案等三案那我們現在來介紹在場委員及列席官員我們第一位是陳昭志陳委員第二位是蘇清泉蘇昭偉第三位是林月琴林委員第四位是王正旭王委員 |
| transcript.whisperx[2].start |
1828.718 |
| transcript.whisperx[2].end |
1840.842 |
| transcript.whisperx[2].text |
衛福部部長邱太元議事司司長李月平中央健保署署長石崇良法規會參事陳信誠 |
| transcript.whisperx[3].start |
1844.788 |
| transcript.whisperx[3].end |
1864.682 |
| transcript.whisperx[3].text |
護署醫療及社會福利機構管理會執行長 林慶豐長期照顧師 副市長 吳希文護理及健康照護師 副市長 陳清梅還有心理健康師 檢認濟證 李炳章國健署組長 林立儒還有社家署組長 李育瑩 |
| transcript.whisperx[4].start |
1871.753 |
| transcript.whisperx[4].end |
1898.012 |
| transcript.whisperx[4].text |
華為部參事汪蘭君現在請提案委員說明提案要職每位委員兩分鐘我們第一位委員還沒到第二位委員在主持第三位委員也還沒有到等下來的時候我們再讓他補充說明沒關係啦接下來請臥部邱部長說明 |
| transcript.whisperx[5].start |
1905.888 |
| transcript.whisperx[5].end |
1925.6 |
| transcript.whisperx[5].text |
主席 各位委員 女士先生今天大院第十一屆第三會期社會福利及衛生環境委員會召開全體委員會議本部呈要列席報告深感榮幸自救大院委員王一鳴等十八人 劉建國等十六人擬聚變成自主權利法部分 |
| transcript.whisperx[6].start |
1927.094 |
| transcript.whisperx[6].end |
1950.19 |
| transcript.whisperx[6].text |
條文修正草案 邱志瑋等19人擬拒病人自主權利法第8條、第9條及第15條文修正草案提出專案報告 敬請各位委員不吝會議指教1.有關王玉敏等18人擬拒病人自主權利法部分條例修正草案本部意見如下 |
| transcript.whisperx[7].start |
1951.502 |
| transcript.whisperx[7].end |
1973.836 |
| transcript.whisperx[7].text |
有關立委所提第16條之一第一項第二項修正草案內容有關預立醫療照護諮商所需醫療服務費用應由中央主管機關編列預算之應以及有關病人符合特定臨床條件之確認程序以病人接受緩和醫療及其他 |
| transcript.whisperx[8].start |
1975.618 |
| transcript.whisperx[8].end |
2001.493 |
| transcript.whisperx[8].text |
適當處置所需醫療服務費用應由中央主管機關納入全民健康保險醫療服務給予項目及支付標準應涉及屹立醫療照護相關費用給予事項尚需經深入政策研議與詳細預算規劃以確保其在實施過程中具可行性與臨床實務的成效二有關立委之所提 |
| transcript.whisperx[9].start |
2002.598 |
| transcript.whisperx[9].end |
2027.379 |
| transcript.whisperx[9].text |
第十六條之一 修正草案如未有全面性政策規劃及相關配套措施針對其項目支持的項目之補助恐造成預算執行上的負擔及政策執行上的疑慮三 其以條文僅為部分文字及配合實務運作修正無影響執行上的成效 |
| transcript.whisperx[10].start |
2029.092 |
| transcript.whisperx[10].end |
2042.973 |
| transcript.whisperx[10].text |
2.有關劉建國等16人女巨病人自主遣議法部分條文修正草案本部意見說明如下1.有關立委所提出第9條第一項第一款修正草案列議 |
| transcript.whisperx[11].start |
2044.555 |
| transcript.whisperx[11].end |
2068.86 |
| transcript.whisperx[11].text |
經主管機關核准之護理機構、長照機構、心理治療所、心理諮商所、社會工作室事務所及法人得提供預立醫療照護諮商經一位醫師診斷符合默契或中央主管機關公告第十四條第一項第五款疾病之病人的病人得豁免 |
| transcript.whisperx[12].start |
2070.42 |
| transcript.whisperx[12].end |
2088.256 |
| transcript.whisperx[12].text |
預立醫療照護智商監察上開機構其設置標準及人臉配置上無醫師等醫事服務提供者要查病人自治權益法第八條第一項規定列以據完全行為能力之人得訂定預立醫療決定 |
| transcript.whisperx[13].start |
2090.714 |
| transcript.whisperx[13].end |
2097.768 |
| transcript.whisperx[13].text |
已經醫師診斷符合特定臨床條件之病人的豁免諮商流程是有抵觸之餘二 |
| transcript.whisperx[14].start |
2101.141 |
| transcript.whisperx[14].end |
2128.617 |
| transcript.whisperx[14].text |
有關立委所提第十二條第二項修正草案內容醫院人之預歷醫療決定得由醫院人上傳網路版預歷醫療決定書於中央主管機關之資料庫網路版預歷醫療決定書應經預歷醫療照顧諮商提供機構數位簽章以符合第九條第一項第一款之合張證明規定 |
| transcript.whisperx[15].start |
2131.095 |
| transcript.whisperx[15].end |
2134.938 |
| transcript.whisperx[15].text |
為確保醫院人權利以減少爭議諮商過程應由專業諮商團隊執行以醫療機構做成記錄並經醫院人 |
| transcript.whisperx[16].start |
2142.065 |
| transcript.whisperx[16].end |
2168.461 |
| transcript.whisperx[16].text |
至醫院人及參與者簽名後,並同病例保存3.有關立委所提第16條之一及第二項修正草案內容有關益利醫療照顧至少所需醫療服務費用因爲中央主管機關編列預算支應以及有關病人符合特定臨床條件之確認程序與病人接受緩和醫療及其他 |
| transcript.whisperx[17].start |
2169.721 |
| transcript.whisperx[17].end |
2170.381 |
| transcript.whisperx[17].text |
有關邱智瑋 |
| transcript.whisperx[18].start |
2196.75 |
| transcript.whisperx[18].end |
2212.298 |
| transcript.whisperx[18].text |
等十九人擬計,並然自主權利法第八條、第九條及第十五條條文修正草案本部意見說明如下1.有關立委所提第八條第一項修正草案內容,具意識能力之成人 |
| transcript.whisperx[19].start |
2213.118 |
| transcript.whisperx[19].end |
2231.574 |
| transcript.whisperx[19].text |
得為毅力醫療決定並得隨時以書面撤回或變更之考量具意識能力之成員人用詞可能導致解釋不明確原建議為此具完全行為能力之人用詞二有關立委所提議 |
| transcript.whisperx[20].start |
2232.537 |
| transcript.whisperx[20].end |
2250.454 |
| transcript.whisperx[20].text |
第八條第二項修正草案內容預立醫療決定應包括醫院人於第十四條特定臨床條件時終止措施或不施行維持生命治療或人工營養及流體餵養之前部或一部 |
| transcript.whisperx[21].start |
2251.275 |
| transcript.whisperx[21].end |
2279.182 |
| transcript.whisperx[21].text |
查醫院人為預例醫療決定,得選擇當其處於特定臨床條件時接受或拒絕維持生命治療與人工營養及流體餵養,原建議維持原名詞3.有關立委所提第九條第一項修正草案內容醫院人為預例醫療決定應符合經醫療機構提供預例醫療教護諮商或經公證人公證 |
| transcript.whisperx[22].start |
2280.442 |
| transcript.whisperx[22].end |
2303.153 |
| transcript.whisperx[22].text |
或有具完全行為能力者二人以上在場見證之規定預立醫療決定簽署期經預立醫療照護諮商過程且由醫療機構合張證明公證人公證或具完全行為能力者二人以上在場見證以及註記於全民健康保險憑證堂衛經上接程序 |
| transcript.whisperx[23].start |
2305.754 |
| transcript.whisperx[23].end |
2314.088 |
| transcript.whisperx[23].text |
恐無法確保醫院人系出於自願簽署,且充分理解醫療結果及法律效力。 |
| transcript.whisperx[24].start |
2316.058 |
| transcript.whisperx[24].end |
2337.823 |
| transcript.whisperx[24].text |
有關立委所提第9條第2項修正草案列明醫院人為立立醫療決定,得註記於全民健康保險憑證該註記之效率與書面相同,但醫院人依前條以書面撤回或變更時以書面為準查病人自主權利法第12條第3項 |
| transcript.whisperx[25].start |
2339.984 |
| transcript.whisperx[25].end |
2355.959 |
| transcript.whisperx[25].text |
經注記於全民健康保險憑證之預歷醫療決定以醫院人臨床醫療過程中書面明示之意思表示不一致時應完成變更預歷醫療決定談醫院人未及時更新預歷醫療決定之注記醫療結構機構可能 |
| transcript.whisperx[26].start |
2361.499 |
| transcript.whisperx[26].end |
2390.295 |
| transcript.whisperx[26].text |
依據變更前意願執行醫療行為,恐違反醫院人之意願。4.結餘未落實以病人為中心的照護理念,本部持續推動病人自主潛力法,包括推動醫療機構設置育立醫療照護諮商門診,以建立諮商機制,培訓醫療專業人員,以及提升民眾簽署育立醫療決定意願等措施,以及逐步提升社會對於自立 |
| transcript.whisperx[27].start |
2391.363 |
| transcript.whisperx[27].end |
2416.471 |
| transcript.whisperx[27].text |
對於阻止醫療決策之適能與支持有關所提修正條文草案應涉及病人預立醫療意願之適用對象程序與費用支應等多方面向應是各界達成共識及實務運作更需完備再行通盤檢討修正原本部建議現階段為止現行條文 |
| transcript.whisperx[28].start |
2418.991 |
| transcript.whisperx[28].end |
2444.322 |
| transcript.whisperx[28].text |
本部曾大院各委員之指教及監督,在此敬致謝誠,並其各位委員繼續予以支持。以上報告,謝謝。好,謝謝部長。第一次聽部長在報告,有點嘎吱嘎吱。等一下在這邊宣告,提案委員有來的時候,還是會讓他來做提案說明,跟各位委員做這樣的一個說明。 |
| transcript.whisperx[29].start |
2445.031 |
| transcript.whisperx[29].end |
2473.72 |
| transcript.whisperx[29].text |
那第二個我還是提醒衛福部你們這個兩位委員三位委員總共提了十幾個條要修正你們只有針對部分來去做回應然後最後最後也沒有看到你們到底是是全部都反對還是怎麼樣也講不清楚包含你回我的部分我只是提醒你的第一項一面就已經很奇怪了把兩件不相干的事情放在一塊那凸顯你們真的是非常的不專業小心一點好 |
| transcript.whisperx[30].start |
2475.485 |
| transcript.whisperx[30].end |
2499.464 |
| transcript.whisperx[30].text |
現在有關於本次會議各項書面資料均列入記錄刊登公報現在開始宣導做一下宣告本會委員宣導時間6加2分鐘列席委員4加1分鐘10年半截止發言登記委員如果有書面質詢請於3月前提出預期不受理暫定10年半休息10分鐘那依往例審查法案不處理臨時提案現在請第一位登記第一位委員陳昭之委員來做發言 |
| transcript.whisperx[31].start |
2504.843 |
| transcript.whisperx[31].end |
2505.649 |
| transcript.whisperx[31].text |
謝謝主席麻煩邱部長 |
| transcript.whisperx[32].start |
2511.184 |
| transcript.whisperx[32].end |
2540.219 |
| transcript.whisperx[32].text |
吳院長今天是五一勞動節所以我還是想跟部長您討論一下醫護這個勞動權益的問題龍頭醫院台大醫院你我都服務過的醫院吳院長他還蠻喜歡公開評論時事所以我想以他帶領龍頭醫院加上他這個特質我認為他應該要對自己要求這個自我要求是要更高的你同意吧龍頭醫院然後他也會關心其他的事情 |
| transcript.whisperx[33].start |
2540.979 |
| transcript.whisperx[33].end |
2556.313 |
| transcript.whisperx[33].text |
但是台大公寓的七月公會剛會這個禮拜四月二十八號揭露台大院的荒唐行徑他在這個五月一號的這個假班別的一個議院調查表他只給護理人員兩個選項喔柏中這都很清楚你看到沒有 |
| transcript.whisperx[34].start |
2561.077 |
| transcript.whisperx[34].end |
2576.246 |
| transcript.whisperx[34].text |
你現在看兩個選項而已,同意到院工作後調一,國定假日,第二個同意到院工作後領加班費這是依法要休假一整天,當天不上班的選項沒了,不見了,它只有兩個選項 |
| transcript.whisperx[35].start |
2580.228 |
| transcript.whisperx[35].end |
2595.391 |
| transcript.whisperx[35].text |
一個非常清楚的事實台大醫院看似在徵詢醫院那事實上是已經徵詢就是同仁的意願但事實上已經設計好了不管你勾哪一項你那天就是得來一定要出勤部長你覺得這樣做可以嗎 |
| transcript.whisperx[36].start |
2596.172 |
| transcript.whisperx[36].end |
2614.678 |
| transcript.whisperx[36].text |
高委員謝謝委員非常關心我們這種勞動的權益我想也不只臺大啦全國所有的醫療...沒有啦臺大是龍頭我們先聽著臺大都要做啦有關這點臺大有解說就是說這是針對來五一那天上班的人給他們簽你是要選擇 |
| transcript.whisperx[37].start |
2619.599 |
| transcript.whisperx[37].end |
2631.323 |
| transcript.whisperx[37].text |
我告訴你台大企業工會 工會 他們做的調查77點多就超過四分之三的人說他們根本沒有備心諮詢就直接排定了我給你做參考 |
| transcript.whisperx[38].start |
2633.344 |
| transcript.whisperx[38].end |
2655.132 |
| transcript.whisperx[38].text |
這個是臺大醫院說法 但事實上可能就不是如此博定還是請你要注意一下 雖然好像說臺大醫院是屬於教育部管不過我想衛福部也是您到督導的對象博定他這個預立醫組這個醫療決定推動到現在 您知道那個簽署率有多高嗎簽署率有多少嗎大概千分之1.31 |
| transcript.whisperx[39].start |
2657.192 |
| transcript.whisperx[39].end |
2668.699 |
| transcript.whisperx[39].text |
簽分之1.31 柏定拜託 高板櫃再不到百分之一 又簽分之幾統計學就是沒有嘛 等於沒有人簽嘛我大概可以這麼講 柏定你有簽嗎我有簽安寧環和醫療但病毒法沒有我覺得我們的意願都很清楚 已經可以表達了在安寧環和醫療法因為法推出以後就是鼓勵嘛 |
| transcript.whisperx[40].start |
2685.809 |
| transcript.whisperx[40].end |
2705.327 |
| transcript.whisperx[40].text |
鼓勵後我們還是會看一下數字啦這也不是對錯的問題嘛每個人都是這間排審的三個版本他當然主要在經費之應場域放寬還有代理人的一個這個限制調整也許大家不太一樣不過我覺得方向是整個是正確的那就是要尊重這個意願人他自主權但是我也要提醒這個衛福部 |
| transcript.whisperx[41].start |
2706.408 |
| transcript.whisperx[41].end |
2713.794 |
| transcript.whisperx[41].text |
就是說你們對於這個所有醫護跟相關學會的意見要要稍微去多多徵詢你知道以前的爭議點在哪裡嗎以前的爭議點對爭議點在什麼地方爭議點是在哪裡 |
| transcript.whisperx[42].start |
2727.082 |
| transcript.whisperx[42].end |
2733.505 |
| transcript.whisperx[42].text |
因為他的爭議點很多,病人自治權法案那個時候當時應該是蘇昭偉那個時代在推,但是我在學界應該也對這個法有相關的隱瞞因為爭議點是醫師說進戶總接任,轉嫁給醫師,就是醫師背負太多的責任 |
| transcript.whisperx[43].start |
2750.111 |
| transcript.whisperx[43].end |
2777.709 |
| transcript.whisperx[43].text |
爭議點那這個東西就是找醫護人員找他們來一起討論嘛怎麼樣讓他們就覺得是相對是讓他們願意做這樣的事情配合這個政策但是又不是說你責任最後都丟給我其實爭議點就是這個啦民眾黨我們期待的是有這個病毒法還要一個尊嚴善終法才能夠完善這個善終權那因為病毒法保障的是無效醫療嘛可以拒絕無效醫療那自然善終一個選擇 |
| transcript.whisperx[44].start |
2778.61 |
| transcript.whisperx[44].end |
2800.912 |
| transcript.whisperx[44].text |
但是尊嚴善終是進一步讓極度痛苦的人透過嚴謹的程序然後他可以這個做自主來選擇他比較有尊嚴有體面的方式來結束生命兩者是一個互補就是可以完善一個生命自主跟尊嚴死亡那這是一個現代的價值這個衛福部現在好像都不想面對這個問題 |
| transcript.whisperx[45].start |
2803.126 |
| transcript.whisperx[45].end |
2825.995 |
| transcript.whisperx[45].text |
報告委員我們不管是衛福部的各個單位跟學界跟相關的委員會始終在面對這個問題不是沒有面對這個問題博不丁我是要跟你提起遲早要面對因為所有的民調大概有七八成的民眾台灣民眾是支持這個法案的但這個法案怎麼寫我知道要很小心很謹慎但是我跟博不丁這樣說博不丁賴總統4月27日出席健康台灣全國論壇提了很多見解 |
| transcript.whisperx[46].start |
2831.597 |
| transcript.whisperx[46].end |
2852.288 |
| transcript.whisperx[46].text |
當天也在場,所以我想你應該都很清楚那我賴總統有表達,政府提出這個癌藥基金100億元那他先編列50億元但並不是100億元用完就結束,不夠了就補上去隔年再補這樣,讓這個水庫可以保持一定水平那我想提醒部長 |
| transcript.whisperx[47].start |
2853.849 |
| transcript.whisperx[47].end |
2870.78 |
| transcript.whisperx[47].text |
百億癌藥基金是個中繼站的概念你不知道中繼站過去的意思就是病人要團體期待然後去參觀其他國家的做法就是有一些加速審查的藥品他可能還沒有完全確定但是有些病人他有需求 |
| transcript.whisperx[48].start |
2871.4 |
| transcript.whisperx[48].end |
2899.732 |
| transcript.whisperx[48].text |
所以他讓這個中繼站能夠暫時性的支付這類的藥品目前健保署還沒有改口雖然我們有很多已經確定療效的安全性的都沒有付滿付足但是這一塊本來是要做這個部分它是一個中繼站的概念你看賴總統也是用水庫的概念水庫本來水就是進進出出的那就是要加速通過藥來用那既然是中繼站的話真正的問題是新藥經過開放性使用用這筆錢 |
| transcript.whisperx[49].start |
2901.521 |
| transcript.whisperx[49].end |
2921.268 |
| transcript.whisperx[49].text |
那之後要評估嘛因為你暫時性使用那目前大概都兩年嘛署長沒有改變大概兩年後評估嘛那兩年後評估有三個結果柏中你要聽得很清楚你這個你日理千機吧賴總統日理萬機你日理千機百機你也是要清楚這件事那時署長要非常清楚因為他在執行這件事情 |
| transcript.whisperx[50].start |
2922.208 |
| transcript.whisperx[50].end |
2939.623 |
| transcript.whisperx[50].text |
你現在兩年後 結果會有三個評估以後 一個淘汰出局就這個 因為在加速生產那個經不起考驗淘汰第二個 我們覺得時間不夠 要繼續觀察第三個 他同意了 我們覺得他的療程安全都確定了所以我們要把它回歸到正常的使用 |
| transcript.whisperx[51].start |
2941.577 |
| transcript.whisperx[51].end |
2964.068 |
| transcript.whisperx[51].text |
這有三條路可以走不然我是要說的癌藥不斷的在研發需求也會增加百億如何分配我到現在看不到用完怎麼辦因為賴總統我覺得他不能理解很深入的是ok的因為日理萬機賴總統意思好像好像預期會有勝他先用多少不夠我再補他預期會有勝那部長你也會認為有勝嗎 |
| transcript.whisperx[52].start |
2968.57 |
| transcript.whisperx[52].end |
2994.116 |
| transcript.whisperx[52].text |
我有我的資深專業的那個經驗30年前告訴你 保留癌症病人絕對會面臨另外一個噩夢因為錢是不夠用的不夠用大概要讓這個滿足這一塊 幾百億都不夠那最後會怎麼樣呢 維持現況現況是什麼 就是不人道的方式你限制癌症病人使用的對象變得很小很窄然後限制他使用次數跟時間 |
| transcript.whisperx[53].start |
2995.876 |
| transcript.whisperx[53].end |
3020.472 |
| transcript.whisperx[53].text |
那這個這麼多先生這是第一個到最後回到現在的噩夢這個事情我可以確定是這樣第二個當剛剛我跟你說明過當挑選後經過評估因為要評估暫時中繼站那你要進進出出到哪個地方去根據美國的經驗繼續使用就是說確定療效大概有六成他沒有經驗所以我們先用美國的經驗有兩成大概淘汰還有兩成他大概說我們要更長時間的觀察那有這兩個事情在前提那我請問部長 |
| transcript.whisperx[54].start |
3025.196 |
| transcript.whisperx[54].end |
3031.094 |
| transcript.whisperx[54].text |
這個衛福部有規劃那個中長期的裁員嗎還是說你想說先擋個兩年拖個兩年再說呢 |
| transcript.whisperx[55].start |
3033.414 |
| transcript.whisperx[55].end |
3047.279 |
| transcript.whisperx[55].text |
包委員真的非常敬佩您指教這麼多專業的一個做法我相信對未來在處理心療癌症這個預算能夠有很大的幫助但是我必須要講賴總統絕對存著就是希望希望說真的病人需要癌藥的時候我們就是想盡辦法 |
| transcript.whisperx[56].start |
3058.323 |
| transcript.whisperx[56].end |
3070.832 |
| transcript.whisperx[56].text |
給他充分 足夠及時那這個部分後面他立定了一個很這麼關懷我們前骨癌症的病人的方向以後原則我沒有問題我們怎麼來把它做法就是我們必須要來把它落實但是他有總統也特別強調說要多少就補多少 |
| transcript.whisperx[57].start |
3088.203 |
| transcript.whisperx[57].end |
3114.025 |
| transcript.whisperx[57].text |
就是要把我們癌症的病人幫他照顧好降低宿舍我都會備那署長我剛剛講的這些問題你有了解嗎你也知道問題在哪裡嘛對不對加速的通過那你現在怎麼辦你準備好了沒有大概已經這個很快就是說你準備了這個要解決的問題齁就是這個癌藥癌症新藥基金這個等於是讓我們在財務預估上可以算準確 |
| transcript.whisperx[58].start |
3115.466 |
| transcript.whisperx[58].end |
3137.947 |
| transcript.whisperx[58].text |
我們現在有的時候呢還不知道到底使用會有多少所以未來還是會回到健保基金啦一樣的它回到健保所以在這健保裡面去編列這個新藥預算的時候讓它可以等你有一個庫讓你先了解那我跟你告訴你說美國大概六成人會回來你六成人回來錢都準備好了那你這樣病人怎麼辦我治療有效結果你不讓我繼續用惡夢出現 |
| transcript.whisperx[59].start |
3140.93 |
| transcript.whisperx[59].end |
3145.152 |
| transcript.whisperx[59].text |
無縫的接軌啦你今天也談不出這個100億怎麼分啦怎麼 allocation 怎麼分配啦這個還有很大的問題還是不夠因為賴總統他以為夠他還說不夠我就補回去不夠就補回去不夠的啦賴總統也知道需要再一直補充不夠的話問題就來那你就開始壓縮使用嘛壓縮就開始分配嘛 |
| transcript.whisperx[60].start |
3161.781 |
| transcript.whisperx[60].end |
3176.846 |
| transcript.whisperx[60].text |
分配就開始你誰先用這個就涉及每一個人的觀點主審的最大這個就是我跟你講很多人他不是真的要去圖利誰可是他有他自己的想法這個是很難處理的所以我也一直很關心這件事情然後現在我就回到說現在你的這個分區共管你知道這個有後遺症嗎不管署長或部長 |
| transcript.whisperx[61].start |
3182.068 |
| transcript.whisperx[61].end |
3200.645 |
| transcript.whisperx[61].text |
不同區域之一人之人本來就不均勻啦你分區共管那會不會惡化那個城鄉的差距呢而且如果地方管理適當齁那健保這個費用運用適當民眾群會不會受損那衛福部跟健保署是否已經有事辦範圍啊標準配套監督機制你就等於說幫他去管啊 |
| transcript.whisperx[62].start |
3201.966 |
| transcript.whisperx[62].end |
3211.996 |
| transcript.whisperx[62].text |
那每個醫院就管你在這個情況下如果你在等於在自生自滅喔你不把總額這個大帽子拿掉你等於讓各地區各醫院自己去自生自滅喔 |
| transcript.whisperx[63].start |
3213.684 |
| transcript.whisperx[63].end |
3227.375 |
| transcript.whisperx[63].text |
現在已經發生了你看好我看下一張好了就是我告訴你這個現象你們大家知道你看現在醫院怎麼存活南部的醫學中心就在醫生的處方的螢光幕上跟你說跟你說我建議你開這個藥因為這個要打圈圈兩個圈圈為什麼呢因為利潤最高 |
| transcript.whisperx[64].start |
3232.139 |
| transcript.whisperx[64].end |
3235.622 |
| transcript.whisperx[64].text |
你難免逼著人家去做這件事嘛而且就是說還寫說敬請開立藥品時同時考慮醫療經濟學的成本效益其實藥品在價格不代表醫療成本效益經濟學的但是它就是一個簡化的方式那他們的醫師自己說這些提示雖然沒有強制但是在這個院務會議這個每一季的討論的時候你就科別你業績不好啊你這個要被檢討績效不好啊 |
| transcript.whisperx[65].start |
3261.563 |
| transcript.whisperx[65].end |
3270.788 |
| transcript.whisperx[65].text |
這個情況下醫師就被迫去勾那個藥啊已經出現了啦部長署長我想你們都知道吧醫院會建議你醫生怎麼藥病人聽聽看外醫生是醫院建議他用哪一個藥那我的感覺呢我的權益呢病醫生的專業權自主權怎麼辦後遺症都出現所以我才說你要分區各管共管但是你有沒有監測的配套的機制去看看這個品質嘛對不對 |
| transcript.whisperx[66].start |
3290.478 |
| transcript.whisperx[66].end |
3317.33 |
| transcript.whisperx[66].text |
就像署長昨天那個林靜儀的那件事情對不對他提出來的那個國際要價不是那個藥品的國際要價他把它grouping掉今天的專科醫師都跑出來講了說它裡面那個不同的那個所謂的那個封口劑裡面有不同還有人添加凝血因子還有人添加防沾黏的功能根本都不一樣你把它全部從這個分類分組一個叫grouping他們最害怕這個字你沒有廠牌之分把它放在同一組 |
| transcript.whisperx[67].start |
3318.57 |
| transcript.whisperx[67].end |
3346.239 |
| transcript.whisperx[67].text |
用那裡面最低的價錢林靜儀次長唸出來的這邊都有公開的資料他唸的不是那個藥品的國際藥價但是你們在分組的時候可能出問題現在醫師大反彈因為那個病只有一次救命的機會對不對大動脈剝離主動脈剝離只有一次救命機會他當時沒有辦法就沒有辦法如果你把它縫好了水還是漏出來血還是漏出來就要靠這個凝膠去把它黏住就像拎刀水管的施力控一樣對不對 |
| transcript.whisperx[68].start |
3347.919 |
| transcript.whisperx[68].end |
3352.441 |
| transcript.whisperx[68].text |
他可能是本質不一樣我是看專科醫師在談這件事情那你要把他放在同一組以後請林次長不懂不要亂講話現在醫師大反彈 |
| transcript.whisperx[69].start |
3360.547 |
| transcript.whisperx[69].end |
3376.317 |
| transcript.whisperx[69].text |
委員我簡單回應一下,第一個就是各區的公關,我想你來行的,你是不是所有相關的委員會你都當過,其實在南區做得不錯但是這個現象都出現啊 |
| transcript.whisperx[70].start |
3379.439 |
| transcript.whisperx[70].end |
3403.537 |
| transcript.whisperx[70].text |
所以美國的模式,我們總是要突破嘛所以是可以用在各區也是共管,其實這樣各區也是自己共管只是方式不太一樣現在出現後遺症我們告訴你嘛我們一定是預防後遺症那像剛剛提出這個部分我們請健保署去了解逼迫醫院去這樣做啊 |
| transcript.whisperx[71].start |
3404.698 |
| transcript.whisperx[71].end |
3417.427 |
| transcript.whisperx[71].text |
其實如果一個以,因為我也是醫師,我也非常反對影響到醫師的住宿專業錢跟一樣嘛,我們不管是醫藥都是專業的嘛,我們真的很不希望被影響但是怎麼樣慢慢的讓整個醫療的行為能夠 |
| transcript.whisperx[72].start |
3423.431 |
| transcript.whisperx[72].end |
3447.725 |
| transcript.whisperx[72].text |
能夠恢復健康經濟,然後對人民好我們價值理念都一樣,我現在在說很實務啦署長,另外署長你在醫材,那個當然我在藥品採取醫材的部分,你要grouping的時候你要把它分類成同一組,當作你們是同一夥的,同樣的東西我只花一樣的錢去買的時候,還是要小心啊因為醫生說不同成分,裡面我一聽有磷血因子,加磷血因子當然貴啊 |
| transcript.whisperx[73].start |
3450.233 |
| transcript.whisperx[73].end |
3470.21 |
| transcript.whisperx[73].text |
當然我不知道,那林次長他給的那個國際要價不是他的國際要價然後大家就會以為說,就這麼貴你怎麼還要炒,炒的是醫生啊謝謝委員,我跟委員一樣都不是對所有的藥物都那麼清楚所以還是需要專家的意見為主啦所以我們會再回去,我們都有機制 |
| transcript.whisperx[74].start |
3472.612 |
| transcript.whisperx[74].end |
3501.183 |
| transcript.whisperx[74].text |
我們這個過去全部都是自費啦過去都是自費現在才納入健保給付那至於一開始五月要納入健保給付他還有時間來申付他要提高價格把成本給我們看我們還是要為健保的財務把關啦所以我們要跟國際要價相比需要看他的成本和給一個合理的價格但是沒有他就隱藏他的自己的國際要價嘛你們這個共理會的表就隱藏他是空白啦只有他空白其他都有啊 |
| transcript.whisperx[75].start |
3502.163 |
| transcript.whisperx[75].end |
3517.353 |
| transcript.whisperx[75].text |
所以就是這個藥出問題啦這個藥也不是最主流的藥,所以其他主流的藥沒有問題,所以公藥上沒有問題好謝謝,我以表達謝謝主席,好謝謝好謝謝委員這樣有充分表達啦接下來請林業勳委員來做詢問 |
| transcript.whisperx[76].start |
3533.669 |
| transcript.whisperx[76].end |
3560.335 |
| transcript.whisperx[76].text |
主席 麻煩邱部長 請部長部長早 部長你事實上是台灣安寧醫療護的專家安寧緩和條例跟自主權立法這兩部法律對末期跟或不可逆的喪失神志的病人 透過病人跟家屬或 |
| transcript.whisperx[77].start |
3561.155 |
| transcript.whisperx[77].end |
3583.174 |
| transcript.whisperx[77].text |
他的意願代理人來預你安寧緩和醫療書或預定一個醫療決定書要求醫生在往後的治療裡不要用人工營養跟流體餵養急救或者是維生醫療來做只是做一個維持心跳的無效的醫療但是安寧緩和和醫療 |
| transcript.whisperx[78].start |
3585.876 |
| transcript.whisperx[78].end |
3604.558 |
| transcript.whisperx[78].text |
就非常挑戰我們的社會文化所以在法律要保護醫生避免受到家屬的攻擊而受到傷害而且要積極來促進以縮短病人的痛苦減少我們的醫療資源的浪費所以想問部長程序上病人自主並不是只要我喜歡有什麼不可以 |
| transcript.whisperx[79].start |
3605.049 |
| transcript.whisperx[79].end |
3628.867 |
| transcript.whisperx[79].text |
必須是考量到病人本身跟醫護人員跟照顧者跟家庭成員跟重要他人的想法是多方協調後的結果可是還是會發生病人的決定家屬事實上是他不認同而跟醫生發生爭執的事件尤其是在安寧療護發生率更高所以衛福部如何支持醫生貫徹病人的決定做醫療 |
| transcript.whisperx[80].start |
3630.1 |
| transcript.whisperx[80].end |
3646.189 |
| transcript.whisperx[80].text |
好,謝謝委員關心這麼重要的議題,也關心到生死大事以及善終是國人五福音門裡面最難達到的所以我們全國就像自治前法案,當時也是很辛苦 |
| transcript.whisperx[81].start |
3647.674 |
| transcript.whisperx[81].end |
3661.534 |
| transcript.whisperx[81].text |
蘇委員在這裡,我想這兩位召委都有貢獻那當時都是希望達到這樣的一個目標那這中間的確是有這個人面對生命的默契 |
| transcript.whisperx[82].start |
3662.615 |
| transcript.whisperx[82].end |
3685.875 |
| transcript.whisperx[82].text |
死亡就好像一個很強烈的陽光 你無法去正視它家屬也沒辦法正視它但是我們醫療人員 我們政府必須要幫他去正視它讓他能夠好好的過完末期 以及能夠善終所以我覺得政府跟相關的立法院 NE 來討論這個題目個人站在 自我敬佩啦 |
| transcript.whisperx[83].start |
3687.376 |
| transcript.whisperx[83].end |
3710.697 |
| transcript.whisperx[83].text |
法院依據合法的程序來確保醫生不受醫療過失的判決可是還是無法避免憤怒的家屬對醫師提告所以醫生一旦被告就是要花錢去請律師花錢去開庭對此衛福部能夠給醫生什麼樣的具體的支持這個跟委員報告一下這也是二三十年來醫界 |
| transcript.whisperx[84].start |
3711.878 |
| transcript.whisperx[84].end |
3739.875 |
| transcript.whisperx[84].text |
的一個大事情那在這的所有的委員尤其是蘇委員擔任那個立法 擔任那個醫師公會理事長的時候有的這有的有兩派意見牽扯到那但是我們終是把醫療法修法變成那個醫療的一個合理行者合理化那這個就是說以前可能會面對防疫性的醫療但是因為這個只要你好好的救病人 |
| transcript.whisperx[85].start |
3741.719 |
| transcript.whisperx[85].end |
3765.25 |
| transcript.whisperx[85].text |
幾乎除了你有重大過失或錯誤不然是不會用行者加身所以那個時候就內外婦保科的住院醫師又通過了又上升了這樣子所以我們用各種法律然後再教育同時也讓民眾知道醫生是在幫你救你的命可能有兩成的救命機會 |
| transcript.whisperx[86].start |
3766.511 |
| transcript.whisperx[86].end |
3792.44 |
| transcript.whisperx[86].text |
你說你要不要救病人家屬一定說一定要救啊可是八成是可能會他的疾病就是救不起來那就有八成的機會來告醫師啊那我說衛福部到底有沒有什麼具體的醫療行者合理化就是來保護這個啊就是這個已經做了很多的一個第一個這是第一個很重要的法案另外一個法案在前幾年通過的就是事故的一個 |
| transcript.whisperx[87].start |
3794.157 |
| transcript.whisperx[87].end |
3821.263 |
| transcript.whisperx[87].text |
預防先預法預防還有更調節就是要先調節讓醫師不要承受那麼大的壓力讓醫病能夠更和諧它是一個很光明的法案這兩個法案基本上是讓我們醫病在面對救命的時候還是可以保障到醫生的權利嗎那來我問第二個就簽署人的資格民法第一 |
| transcript.whisperx[88].start |
3822.5 |
| transcript.whisperx[88].end |
3846.605 |
| transcript.whisperx[88].text |
14條的第一項規定自然人如果精神障礙或心智缺陷的話不能跟他人溝通或不了解表達意思的話法院得為監護宣告可113年受監護宣告的人總數事實上是6047人其中18歲以上的有5999人其中以社會福利機構為監護人的有10件所以監護人有執行受監護的生活醫療照護跟財產管理的職務請問一下當 |
| transcript.whisperx[89].start |
3850.766 |
| transcript.whisperx[89].end |
3874.615 |
| transcript.whisperx[89].text |
成年的病患本身意識不清楚的時候經法院為監護宣告的監護人依法可以為病患簽署安寧意願書嗎同意書嗎我要講的是說安寧這邊的話其實他要啟動的這邊其實必須要經由就是說至少前面要有兩個專科醫師確認他默契 |
| transcript.whisperx[90].start |
3876.596 |
| transcript.whisperx[90].end |
3900.274 |
| transcript.whisperx[90].text |
他這一個所謂的安寧意願書由那個監護人簽署才會有效然後可是在那個病人自主這邊的話他還是會回到了一個病人自主的一個前提在病人沒有表達意願就是他在意識狀況沒有沒有這麼重大改變之前沒有表示過任何意願的時候這個監護人其實他沒有辦法決定以上 |
| transcript.whisperx[91].start |
3901.135 |
| transcript.whisperx[91].end |
3902.937 |
| transcript.whisperx[91].text |
那根據我們的健保署的分析在死亡前一個月內接受安寧療護的話 |
| transcript.whisperx[92].start |
3916.608 |
| transcript.whisperx[92].end |
3934.707 |
| transcript.whisperx[92].text |
每個人可以減少到三萬兩千元的醫療支出如果去死亡前六個月接受安寧照護的話每個人可以減少到十萬七千元的醫療支出預歷醫療決定書也可以達到這樣的效果那預歷醫療照護諮商一個案子 |
| transcript.whisperx[93].start |
3936.024 |
| transcript.whisperx[93].end |
3959.234 |
| transcript.whisperx[93].text |
民眾要自費三千元就是要自己花三千元對多數人來講事實上是貴的所以去年七月我覺得衛福部也推出了一個育立醫療照護諮商推廣的獎勵計畫針對低收跟中低收的特定對象來提供免費的諮商服務可是看起來數據推了一年大概從兩萬四增加到兩萬五 |
| transcript.whisperx[94].start |
3961.038 |
| transcript.whisperx[94].end |
3987.707 |
| transcript.whisperx[94].text |
沒有很顯著的提升啦所以想問一下花三千元可以省下大筆的醫療費用為健保的財務永續衛福部一定會往這個方向推動可是去年推動的不利的原因是什麼因為增加不多好當然我們做調查 包委員當然我們做調查的時候的確為什麼不簽民眾寫出來的原因當然就是說因為諮商費用對啊是蠻高的那 |
| transcript.whisperx[95].start |
3989.918 |
| transcript.whisperx[95].end |
4011.838 |
| transcript.whisperx[95].text |
我記得剛開始推出來的時候我們立法院好幾個委員都跑去台大醫院真的去做諮商那個我很敬佩他們就花幾千塊去做但是其實對一般的民眾來講的確是很負擔所以我們去年7月還有5月1號會擴大來讓那個更多的希望 |
| transcript.whisperx[96].start |
4012.719 |
| transcript.whisperx[96].end |
4035.229 |
| transcript.whisperx[96].text |
有更多的機會來讓病人來簽那當然怎麼樣我們要去了解原因那衛生署也一直在請協界這邊了解原因今天新聞報導也說5月7號要擴大所以你今年的預例醫療註記的人身要提升你目標是多少 |
| transcript.whisperx[97].start |
4038.26 |
| transcript.whisperx[97].end |
4046.359 |
| transcript.whisperx[97].text |
今年你的預例醫療租金的人數也要提升嘛齁你目標是多少希望 |
| transcript.whisperx[98].start |
4048.176 |
| transcript.whisperx[98].end |
4066.652 |
| transcript.whisperx[98].text |
我補充一下這個吼我們會希望是說現在大概一年兩萬左右能夠透過今年因為才只有半年的執行期所以能夠就是加倍到四萬左右是我們的目標然後那剛剛那個委員吹詢的是說推廣這一塊的話其實我們發現是說民眾的認知跟我們傳統習 |
| transcript.whisperx[99].start |
4071.276 |
| transcript.whisperx[99].end |
4096.873 |
| transcript.whisperx[99].text |
習俗文化的這個禁錮其實還是一個主因另外一塊就是財務所以才會是從財務面的地方我們跟健保署合作推廣面的部分的話我們會跟長照室合作因為目前看到願意簽署的都是人生經驗裡面有一些相關的所以目前大概是50歲以上是我們的一個target謝謝市長安寧療護的概念早在 |
| transcript.whisperx[100].start |
4097.645 |
| transcript.whisperx[100].end |
4118.691 |
| transcript.whisperx[100].text |
立法前台灣大概就已經開始在推動大概現在已經20年了而且使用率逐年增加那從2022年使用的大概達到6萬7病人死亡前的一年的安寧利用率的話大概30.4%那可是還是上市量能不足啦那所以 |
| transcript.whisperx[101].start |
4119.631 |
| transcript.whisperx[101].end |
4131.887 |
| transcript.whisperx[101].text |
整個他事實上是透過多種專業來對病人跟家屬做整體的輔導那他同時也是生理心理的一個醫療可是這個項目真的蠻燒錢的所以對醫院來說 |
| transcript.whisperx[102].start |
4134.73 |
| transcript.whisperx[102].end |
4163.158 |
| transcript.whisperx[102].text |
如果不是為了評鑑加分的話 誘因不大所以因此安寧病床的床位不多而採用安寧共照來替代所以112年全國有86家醫院共計915床到114年的時候變成是85家醫院大概910床整個需求多 床位少可是四病每一天大家都有人在排隊所以想問一下目前實際上的安寧病床到底病床數有多少 |
| transcript.whisperx[103].start |
4164.575 |
| transcript.whisperx[103].end |
4186.525 |
| transcript.whisperx[103].text |
是的 薛委員 剛剛您報的就是現在的就是910嗎 整個不多 所以就會有跨科的做安寧供照所以目前安寧供照對病人 特別是家屬的照護能夠達到安寧病房的水準嗎 衛福部怎麼去確保這個水準因為不一樣啊 |
| transcript.whisperx[104].start |
4187.265 |
| transcript.whisperx[104].end |
4202.325 |
| transcript.whisperx[104].text |
我想安寧共照是一個有一點點不得不的站在我們的文化跟民眾的需求所衍生出來的因為你如果叫他不要去住安寧病房這個就是一個很大的關卡但是他在 |
| transcript.whisperx[105].start |
4203.306 |
| transcript.whisperx[105].end |
4228.587 |
| transcript.whisperx[105].text |
其實安寧緩和醫療最好是越早啟動越好所以也許他已經在做緩和性的化療那個時代那個時候就應該有加入安寧緩和醫療團隊來跟你的病房跟你解說什麼叫安寧有時候你跟這個A病床的人說結果是B病床的人聽一聽說那我要去安寧病房所以那個越早啟動的時候讓真的 |
| transcript.whisperx[106].start |
4229.707 |
| transcript.whisperx[106].end |
4242.022 |
| transcript.whisperx[106].text |
病人可以規劃未來可以做的事情所以安寧的構造是非常重要的那安寧構造的團隊其實也花了非常大的心力他的效果當然是沒辦法像安寧病房這樣子整個團隊來給他 |
| transcript.whisperx[107].start |
4249.491 |
| transcript.whisperx[107].end |
4276.379 |
| transcript.whisperx[107].text |
各方面全方位的一個照顧所以當然怎麼樣讓需要安寧病房的人能夠住進來當然這一邊也要跟委員實際上報告雖然這麼多床但是很多醫院的安寧病床因為文化的問題他們可能還是希望病人還是希望跟家屬還是希望共照他們不太願意到安寧病房來的所以我們的你去分析各個醫院的占床率 |
| transcript.whisperx[108].start |
4277.139 |
| transcript.whisperx[108].end |
4293.292 |
| transcript.whisperx[108].text |
就知道其實更重要的更重要的是要去推展民眾的觀念可是基於病人自主醫療的權利保障跟善終的期望那又你整個安寧病房的量又不足 |
| transcript.whisperx[109].start |
4293.712 |
| transcript.whisperx[109].end |
4316.253 |
| transcript.whisperx[109].text |
使用率低的狀況這種現實問題我相信衛福部有義務也有能力要把整個政策建構更完整所以病人運營安寧緩和醫療書跟預訂醫療決定書這一整套的制度連結分級醫療體系的醫院跟社區兩端所以社區單這邊也可以看到有在宅 |
| transcript.whisperx[110].start |
4317.372 |
| transcript.whisperx[110].end |
4338.422 |
| transcript.whisperx[110].text |
在宅安寧跟我們的機構安寧這兩種在宅的醫療形式讓病人除了住院以外另外在社區中老那你的政策經費呢是111年的居家醫療的照護整合計畫的2.0113年是全民健康保險在宅急症急症照護的事辦計畫這兩個 |
| transcript.whisperx[111].start |
4340.703 |
| transcript.whisperx[111].end |
4364.467 |
| transcript.whisperx[111].text |
計畫在支撐所以想問的是在不論長照老人還是護理之家在住宿型機構籌組照護團隊的服務機構內的病人對於機構品質的提升一定有比較正面的影響對機構病人分級醫療各方面都有一些注意本來就是應該要大力推動的政策可是政府一直在考一直沒有把一個人考慮進來就是沒有考慮住宿機構來籌組照護團隊的經營的壓力這像 |
| transcript.whisperx[112].start |
4369.928 |
| transcript.whisperx[112].end |
4398.719 |
| transcript.whisperx[112].text |
服務對醫院來講就是賠錢在座了那對住宿型機構來講更是那醫生探視費呢健保支付如果給醫院1500為什麼給住宿型機構只有1200這有20%的落差是打擊士氣所以本期認為醫院跟住宿型機構各項的醫事人員的訪視費要一致啊你請你推動這項訴求那你同意嗎就是大家應該都是一致的 |
| transcript.whisperx[113].start |
4399.949 |
| transcript.whisperx[113].end |
4427.856 |
| transcript.whisperx[113].text |
那個因為他給幾戶方面跟委員報告這個我們已經通過下半年會來做這個安寧照護品質的平和平和之後按照他的程度分別加成10%20%跟30%那這個包含了住院的安寧安寧共照跟居家安寧都適用那另一方面我們下半年也會來檢討居家安寧的給付方式到底是要包月 |
| transcript.whisperx[114].start |
4428.396 |
| transcript.whisperx[114].end |
4439.902 |
| transcript.whisperx[114].text |
我們現在是論次那有沒有用包月的方式讓他更具彈性都會一來檢討那至於在給付方面也一定朝向不同工不同酬的方式來思考所以下半年會開始去做規劃 |
| transcript.whisperx[115].start |
4440.956 |
| transcript.whisperx[115].end |
4464.324 |
| transcript.whisperx[115].text |
因為病人在住宿型機構發生醫療糾紛的時候勢必會大幅增加所以機構背後一定要有強大的支持系統也就是綠色通道所以綠色通道除了提供緊急救援住院支援以外那人力技術也都是重要的一環所以衛福部是不是能夠確保機構具備有這項強大的後勤支援 |
| transcript.whisperx[116].start |
4465.711 |
| transcript.whisperx[116].end |
4492.925 |
| transcript.whisperx[116].text |
好我想這是很重要要去努力的方向我們會一定來努力所以最後麻煩我覺得我有三點訴求就是整個醫事的那個人員的支持方案面對病人的業質疑跟訴訟我覺得還是要提供一些支持那擴大獄力醫療照護的諮商的全額補助對象今天應該也得到你們的65歲以上都是 |
| transcript.whisperx[117].start |
4493.645 |
| transcript.whisperx[117].end |
4517.238 |
| transcript.whisperx[117].text |
那提高我們住宿型機構的人士園的紡織費所以是不是下半年如果在討論的時候可能要考慮一下我剛剛講的是不是答案是同樣的還預設通道的糾紛避免那個依舊的部分要為住宿型機構提供後勤的支持那麻煩這些是不是在後面提供兩週內提供給我書面報告好 謝謝我們就把計畫書提供給委員 謝謝好 謝謝 |
| transcript.whisperx[118].start |
4523.379 |
| transcript.whisperx[118].end |
4525.12 |
| transcript.whisperx[118].text |
接下來請蘇清泉、趙偉來做懸檔謝謝,謝謝劉朝偉的禮讓,我先講還有邢部長,還有那個石署長 |
| transcript.whisperx[119].start |
4546.476 |
| transcript.whisperx[119].end |
4571.434 |
| transcript.whisperx[119].text |
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 |
| transcript.whisperx[120].start |
4574.991 |
| transcript.whisperx[120].end |
4582.397 |
| transcript.whisperx[120].text |
現在剛才你說他是做假人的社會救急病那個時候他跟我講說他說 教育啊 社會醫院啊 我楊益心隨時會死啊2016年啊 他說因為他是肌肉的問題嘛我現在看他每天真的很痛苦 |
| transcript.whisperx[121].start |
4597.646 |
| transcript.whisperx[121].end |
4607.58 |
| transcript.whisperx[121].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,我聽到他應該讓他有選擇他要怎麼處理自己聽起來很有力,所以為了 |
| transcript.whisperx[122].start |
4615.806 |
| transcript.whisperx[122].end |
4643.022 |
| transcript.whisperx[122].text |
這個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年統計到2019年你在做立法,你在做教育部長你在教教育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 |
| transcript.whisperx[123].start |
4644.102 |
| transcript.whisperx[123].end |
4668.8 |
| transcript.whisperx[123].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 |
| transcript.whisperx[124].start |
4671.314 |
| transcript.whisperx[124].end |
4684.839 |
| transcript.whisperx[124].text |
這對手指教育醫師本色,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 |
| transcript.whisperx[125].start |
4687.062 |
| transcript.whisperx[125].end |
4708.629 |
| transcript.whisperx[125].text |
其實給病人都是最適當的一個治療最好的治療最適當的最適當的治療最好的照顧啦所以我們覺得說在其他法律方面的層面它到底它的意義何在這個部分我們會有思考我是很敬佩蘇醫師這個見解 |
| transcript.whisperx[126].start |
4711.84 |
| transcript.whisperx[126].end |
4728.314 |
| transcript.whisperx[126].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都沒要做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 |
| transcript.whisperx[127].start |
4732.097 |
| transcript.whisperx[127].end |
4733.759 |
| transcript.whisperx[127].text |
社會運動也是幫助很大喔 |
| transcript.whisperx[128].start |
4748.188 |
| transcript.whisperx[128].end |
4771.463 |
| transcript.whisperx[128].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臺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不好意思來講一下因為我們做 |
| transcript.whisperx[129].start |
4774.725 |
| transcript.whisperx[129].end |
4803.244 |
| transcript.whisperx[129].text |
做兩階段研究 剛開始的時候你要簽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 |
| transcript.whisperx[130].start |
4804.405 |
| transcript.whisperx[130].end |
4827.788 |
| transcript.whisperx[130].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 |
| transcript.whisperx[131].start |
4828.929 |
| transcript.whisperx[131].end |
4850.964 |
| transcript.whisperx[131].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 |
| transcript.whisperx[132].start |
4854.932 |
| transcript.whisperx[132].end |
4862.614 |
| transcript.whisperx[132].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 |
| transcript.whisperx[133].start |
4877.165 |
| transcript.whisperx[133].end |
4882.872 |
| transcript.whisperx[133].text |
我現在除了在參加 還未成 增加在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 那個日本現在是85.5啊 南米平均喔 |
| transcript.whisperx[134].start |
4895.52 |
| transcript.whisperx[134].end |
4911.835 |
| transcript.whisperx[134].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 因為怎樣咧散散的 又倒酒 又敲骨 又吃酒 那要怎麼死啦 |
| transcript.whisperx[135].start |
4914.235 |
| transcript.whisperx[135].end |
4919.997 |
| transcript.whisperx[135].text |
又愛排隊,又愛跨杯,又愛吃健康食品,又每天都吃老酒湯,每天都吃那些花瘦的納豆,什麼臭生豆,什麼凍吃,所以那種國家,我一般沒什麼避暗啦。 |
| transcript.whisperx[136].start |
4931.452 |
| transcript.whisperx[136].end |
4945.707 |
| transcript.whisperx[136].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 |
| transcript.whisperx[137].start |
4947.168 |
| transcript.whisperx[137].end |
4966.185 |
| transcript.whisperx[137].text |
走路囉,因為香港的地小人手,沒有摩托車什麼都沒有,所以都有走路,坐捷運坐公車,所以說走路是強迫走路嘛,我們台南市都騎摩托車,大家都騎摩托車,買一個菜市場也騎摩托車,香港都有走路,日本也很多都有走路,日本是有摩托車啦。 |
| transcript.whisperx[138].start |
4967.666 |
| transcript.whisperx[138].end |
4988.659 |
| transcript.whisperx[138].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 |
| transcript.whisperx[139].start |
4991.71 |
| transcript.whisperx[139].end |
5004.279 |
| transcript.whisperx[139].text |
他還在用的啊所以為什麼科技的進步會讓我們的壽命是可以解決的就是說癌症的標榜楊義新我前面有說我告訴你不要緊啦他不會把我嚇死我會跟大家報告的就是說 |
| transcript.whisperx[140].start |
5009.827 |
| transcript.whisperx[140].end |
5030.433 |
| transcript.whisperx[140].text |
以前沒有辦法醫治的,現在標靶藥什麼什麼生物製劑一直出來就可以延長壽命啦所以不要說動不動就要那些人塞DNA動不動,我看那些以前沒人的,現在都沒人了像以前來的,溫室的以前來的現在也拖很久,拖了很久對不對,不斷那些話,我感覺說全部叫他就要升職所以都在那裡瘋了有這個事情嗎,署長 |
| transcript.whisperx[141].start |
5039.062 |
| transcript.whisperx[141].end |
5065.407 |
| transcript.whisperx[141].text |
沒有 我當然你的專業還有間諜一定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 教育報告善終是五福靈門裡面最難達到的 |
| transcript.whisperx[142].start |
5066.807 |
| transcript.whisperx[142].end |
5087.101 |
| transcript.whisperx[142].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活到八二歲你現在如果去炒地硬貢 |
| transcript.whisperx[143].start |
5089.602 |
| transcript.whisperx[143].end |
5111.888 |
| transcript.whisperx[143].text |
阿公阿嬤十八歲他們都不會打破褲子大家十八歲他們就打破褲子所以可能大家期待但是你如果比較面對人生有時候很難講的你如果比較了解的話你也可以幫忙你的親戚朋友你自己有病的人互相都有這個面對死亡的一個怎麼樣做好 |
| transcript.whisperx[144].start |
5112.808 |
| transcript.whisperx[144].end |
5133.347 |
| transcript.whisperx[144].text |
善終的一個準備,這是好事啦所以我,教育他們都要講很多,所以你先給我一點時間來,想不想我幫你檢部署,建議啦你現在很大的一個希望就是說,把什麼包山包海全部都納進來,這也我給你勤賠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 |
| transcript.whisperx[145].start |
5139.772 |
| transcript.whisperx[145].end |
5156.777 |
| transcript.whisperx[145].text |
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,沒有塗藥的喔後來健保局給支付了一支支架付一萬五千點,點喔不是錢喔 |
| transcript.whisperx[146].start |
5160.944 |
| transcript.whisperx[146].end |
5185.293 |
| transcript.whisperx[146].text |
後來還有塗藥支架出來,塗藥支架要付差額那個開脊椎的那個Catch,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,一萬多點那現在像剛剛陳昭芝講的那種磷膠,那個開心臟外科是以前都是智慧嘛,你現在給他支付之後,付一個萬多點 |
| transcript.whisperx[147].start |
5187.822 |
| transcript.whisperx[147].end |
5208.74 |
| transcript.whisperx[147].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 |
| transcript.whisperx[148].start |
5211.31 |
| transcript.whisperx[148].end |
5229.022 |
| transcript.whisperx[148].text |
這樣我覺得這樣是對的啦你每一樣都把他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 |
| transcript.whisperx[149].start |
5230.22 |
| transcript.whisperx[149].end |
5255.757 |
| transcript.whisperx[149].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啦所以 署長你的行情 我很欽佩你的做法 我也很認同但是 留什麼空間 再來就是要這樣和解的時候你每天那種物品 也是要考慮啦署長你講一下 |
| transcript.whisperx[150].start |
5259.767 |
| transcript.whisperx[150].end |
5281.765 |
| transcript.whisperx[150].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 醫材也是如此所以健保秉持的就是第一個 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 |
| transcript.whisperx[151].start |
5282.586 |
| transcript.whisperx[151].end |
5298.22 |
| transcript.whisperx[151].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就是Type A從這個主動脈根部撕裂的這一 |
| transcript.whisperx[152].start |
5298.86 |
| transcript.whisperx[152].end |
5328.039 |
| transcript.whisperx[152].text |
這一種那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得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 |
| transcript.whisperx[153].start |
5328.379 |
| transcript.whisperx[153].end |
5344.996 |
| transcript.whisperx[153].text |
這些都會一起我們國家的先進指標就ZDP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R中間還剩多少 |
| transcript.whisperx[154].start |
5348.94 |
| transcript.whisperx[154].end |
5376.157 |
| transcript.whisperx[154].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說我的立場好不好好 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在困難裡的啦這大家共同努力啦好 謝謝 |
| transcript.whisperx[155].start |
5383.889 |
| transcript.whisperx[155].end |
5400.257 |
| transcript.whisperx[155].text |
因為醫界多數都支持ACP |
| transcript.whisperx[156].start |
5410.167 |
| transcript.whisperx[156].end |
5437.93 |
| transcript.whisperx[156].text |
這個服務的量要擴大也希望從經濟面來考量這個健保署還是衛福部要來支持這個是你們意見大家應該有的公司都有發聲明稿第二你講說現在醫療人進步沒有錯但是我們在公告第五款裡面寫得非常清楚楊委員是主提案人我也是提案人還有王委員對不對你也都大聲說我們自己當模型講其他經濟中央主管機關 |
| transcript.whisperx[157].start |
5439.416 |
| transcript.whisperx[157].end |
5457.406 |
| transcript.whisperx[157].text |
公告病人之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。所以我們要逼那個愚民,我們要逼健康愚民。 |
| transcript.whisperx[158].start |
5458.598 |
| transcript.whisperx[158].end |
5484.177 |
| transcript.whisperx[158].text |
我們逼不健康醫院就不用逼啊,人家最好要善終是要好走嘛,不要潘走嘛,不要在那裡用無效醫療,在那裡咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕咕� |
| transcript.whisperx[159].start |
5490.45 |
| transcript.whisperx[159].end |
5493.032 |
| transcript.whisperx[159].text |
主席好 我們一樣請邱部長來 請部長委員長部長好 |
| transcript.whisperx[160].start |
5499.417 |
| transcript.whisperx[160].end |
5526.894 |
| transcript.whisperx[160].text |
那還是同樣的話題就是我們病人自主這個權利法那麼我看到我們這個法案我們兩個有三個法案是兩個執政黨的我們的委員的版本那看到現在我沒有看到正院版那我看到衛福部的報告幾乎是對於主要條文都保留或者是反對那最後結論建議維持原條文我想請問一下部長為什麼衛福部不同意修法 |
| transcript.whisperx[161].start |
5530.339 |
| transcript.whisperx[161].end |
5552.063 |
| transcript.whisperx[161].text |
我想這個修法我們是用開放的態度啦但是基本上從以前修法的立法的整個過程當中我們覺得可能有很多更重要的事情是不是比修法更重要那個政府一直在做那修法的部分我是覺得我們是用 |
| transcript.whisperx[162].start |
5553.591 |
| transcript.whisperx[162].end |
5573.876 |
| transcript.whisperx[162].text |
開放的心胸來討論今天的會議是我們召委安排的我想這件事情應該是很多人的心聲我想召委也等不及了那我當然知道衛福部是很慎重那這個部分你還要凝聚多久多久才可以提出我們政院的版本還是都不提了 |
| transcript.whisperx[163].start |
5580.12 |
| transcript.whisperx[163].end |
5606.635 |
| transcript.whisperx[163].text |
因為這個是已經有立法了嘛那針對針對大家的一些意見然後是臨床上的一些可能需要調整的我也感謝委員提出了我覺得大家開放來討論這個事情是比較好開放來討論對然後因為武漢病毒法上路五年只有10.3萬人在簽署那比例只有0.45%那真正的執行率會更低 |
| transcript.whisperx[164].start |
5607.728 |
| transcript.whisperx[164].end |
5631.393 |
| transcript.whisperx[164].text |
然後當然這次修法的原因就是因為我們覺得這個成效是沒有很理想那當然就是希望能夠調整嘛能夠調整讓更多的人更方便我覺得宣傳更重要應該很多人都不太清楚這個東西這個是事實當然還有一個費用的問題啦這也是這一次修法的一個重點那我想 |
| transcript.whisperx[165].start |
5635.529 |
| transcript.whisperx[165].end |
5656.505 |
| transcript.whisperx[165].text |
今天審查的版本就是我們講的ACP的就費用太高讓家屬的這個卻步那導致也是導致成效不彰的主因那改由政府負擔那部長認為這個部分會增加預算那請問部長那政府既然不願意負擔能不能那有沒有其他的辦法呢 |
| transcript.whisperx[166].start |
5657.205 |
| transcript.whisperx[166].end |
5675.015 |
| transcript.whisperx[166].text |
好,我想我們包圍我們想逐步,剛剛健保署也有報告從去年到未來的五月我們都會一直在討論如何如何來開放的確是有讓更多來參與,那是不是這樣子就可以解決我們更多人來 |
| transcript.whisperx[167].start |
5676.096 |
| transcript.whisperx[167].end |
5692.349 |
| transcript.whisperx[167].text |
來那個從剛剛的幾位委員的報告裡面恐怕我們要做更多我覺得這個是這樣啦就是當然這是人民的自由啦然後當然對於政府來講他是也可以減輕我們一些的負擔啦那當然我們尊重每個人的想法不過我覺得這個剛剛我講那個宣傳啦 |
| transcript.whisperx[168].start |
5694.491 |
| transcript.whisperx[168].end |
5717.045 |
| transcript.whisperx[168].text |
因為真的確實不是很多人能夠了解到這一塊只是一些專業的人或者是有接觸到的才會知道那當然其實搞不好有些人有這個想法那我們當然不是鼓勵他們這樣這個當然是看個人意願不過我覺得這個是未來我們早晚都要面對的事情應該是來開放的用更開放的心態來去 |
| transcript.whisperx[169].start |
5718.626 |
| transcript.whisperx[169].end |
5745.018 |
| transcript.whisperx[169].text |
這個面對這個事情好嗎是的好那部長再來我們看到賴清德總統最近在2025年健康台灣全國論壇裡面提出健保的改革想法那他特別提到我們花蓮秀林鄉論人記仇的計畫成功他希望擴大辦理那部長你這邊也跟進將在花蓮台東擴大辦理這方向是確定的嗎跟委員報告因為 |
| transcript.whisperx[170].start |
5746.378 |
| transcript.whisperx[170].end |
5756.525 |
| transcript.whisperx[170].text |
那個花蓮秀林鄉他其實他的名字不叫做論人記者媒體都一直寫論人記者我想這個先修正一下因為要達到論人記者這個部分 |
| transcript.whisperx[171].start |
5758.479 |
| transcript.whisperx[171].end |
5777.36 |
| transcript.whisperx[171].text |
不是不行而是要有很多的配套措施我們以前大概十年前也曾經在台灣七個地方來做有成功有但是當時因為專程制度沒有做好家庭意識制度也沒有建立所以的確比較多需要配套但是在秀園鄉這個有一點 |
| transcript.whisperx[172].start |
5779.178 |
| transcript.whisperx[172].end |
5794.441 |
| transcript.whisperx[172].text |
IDS的味道等一下請署長會補充那我們覺得說他成功為什麼他成功因為他的不管是流感的注射率預防保健的預防真的打啦或者是篩檢都比其他的地方還高 |
| transcript.whisperx[173].start |
5795.402 |
| transcript.whisperx[173].end |
5812.952 |
| transcript.whisperx[173].text |
那就是要不要有一個醫院 請派人去教育 去做整個前人的照顧那像這樣的模式 就有健康促進的成分在裡面那我想總統很希望真的能夠健康促進有47個地方嘛我的意思是說 為什麼只選電華臨台東來擴大辦理的意思 |
| transcript.whisperx[174].start |
5822.737 |
| transcript.whisperx[174].end |
5837.399 |
| transcript.whisperx[174].text |
我想我們一步一步來啦那既然發展台東也許他的區域是不是比較因為後面沒有像台北醫療資源你像我們苗栗他泰安其實人口也不多 |
| transcript.whisperx[175].start |
5838.52 |
| transcript.whisperx[175].end |
5860.122 |
| transcript.whisperx[175].text |
他也是偏鄉啦那我認為當然其實這個你們號稱不會增加健保的支出嘛當然我們這個IDS這個做調查比如說我們個人的病史飲食習慣等等就是我們未來要想要推動的一個叫這個精準醫療的部分嘛對不對不好意思我要先補充一下花蓮秀 |
| transcript.whisperx[176].start |
5861.303 |
| transcript.whisperx[176].end |
5879.481 |
| transcript.whisperx[176].text |
花蓮秀芸香這個齁 其實它也不叫做一般的IDS啦齁它叫做前人 前家 前社 社區的一個整合照顧的一個這一個是世界的趨勢 所以能夠在秀芸香做 我相信它是未來是我們一個典範那這個如果能夠放到各個地方去 我們樂觀其成齁 |
| transcript.whisperx[177].start |
5881.483 |
| transcript.whisperx[177].end |
5904.863 |
| transcript.whisperx[177].text |
那當然如果只有在秀營鄉也太可惜了啦因為它畢竟我們是希望這是我覺得不錯的一個政策啦那當然我們希望說我們西半部這邊也有很多偏鄉其實交通也非常不方便而且資源也非常的少那這部分我希望我們衛福部能夠盡快再納入好不好那個簡單那個署長回報一下 |
| transcript.whisperx[178].start |
5906.704 |
| transcript.whisperx[178].end |
5923.921 |
| transcript.whisperx[178].text |
跟邱委員報告就是說它跟IDS不同是IDS是以醫療為主那這個全人全社區整合照護計畫呢它是以家戶做單位然後導入這個預防保健健康促進等等這些整合的照護啦所以它明顯的可以降低這個 |
| transcript.whisperx[179].start |
5924.862 |
| transcript.whisperx[179].end |
5949.795 |
| transcript.whisperx[179].text |
迷病率 住院率這些重症的發生這個在偏遠地區其實是很好的模式因為畢竟就醫比較遠他是把家裡的資料 等於建立家裡的資料要建立家戶資料 他的重點在建立家戶資料一般IDS是有團隊去然後你有需要來看病的就來看那他這個不一樣他這個有點就是類似把你們的病史啊幹嘛全部都是把它做資料也就是我們講的要來一種精準 |
| transcript.whisperx[180].start |
5952.816 |
| transcript.whisperx[180].end |
5968.581 |
| transcript.whisperx[180].text |
醫療的一個概念其實這個我認為在全國來推動的時候是不是也能夠節省我們健保的支出因為其實很多吃了這個藥不行然後又換了一家醫院每一次去重複對病人也好 |
| transcript.whisperx[181].start |
5969.781 |
| transcript.whisperx[181].end |
5991.316 |
| transcript.whisperx[181].text |
對我們政府的健保的負擔也好都不是一個好的事情這是我們常看到的就是說有些人吃了過敏有些人吃了身體不適或者是各年會產生比如說有一些藥會產生副作用等等的這些都是一個我認為是個人的這是醫療浪費的一個非常大的一個漏洞 |
| transcript.whisperx[182].start |
5992.316 |
| transcript.whisperx[182].end |
6018.017 |
| transcript.whisperx[182].text |
那我們今年其實也在西部這邊的幾個山地鄉比較偏遠地區也有擴大事辦像北區就是在桃園復興鄉我現在看到你那個圖就是我看到就是我們原民的這個對不對原民部落嘛所以我剛剛會講泰安的原因就在這裡啦那你希望說其實有很多地方真的也需要這個這樣的一個照顧好不好好謝謝 |
| transcript.whisperx[183].start |
6019.998 |
| transcript.whisperx[183].end |
6035.843 |
| transcript.whisperx[183].text |
那再來問一個就比較短一點是那個我們加熱鹽上市就是我們煙害防治法在112年3月公佈實施那審查已經兩年了那我們審查這個結果這個其實沒有結果是什麼原因 |
| transcript.whisperx[184].start |
6039.083 |
| transcript.whisperx[184].end |
6054.277 |
| transcript.whisperx[184].text |
我想我們非常注意到這個審查的進度我想國健署這邊真的都是按照時程其實常常要補資料然後又有一個時程所以有很多溝通我希望啦現在還沒有 |
| transcript.whisperx[185].start |
6054.917 |
| transcript.whisperx[185].end |
6079.379 |
| transcript.whisperx[185].text |
還沒有完全到最後決定的我希望啦就是說根據國際研究指出青少年使用加熱菸的盛行率是成年人的這個兩倍並且有將近九成的年輕吸菸者他第一次接觸都是這種加味菸品當然我認為說我們要開放當然我希望我們衛福部這邊的配套能夠把它準備得更完善一些 |
| transcript.whisperx[186].start |
6080.154 |
| transcript.whisperx[186].end |
6100.235 |
| transcript.whisperx[186].text |
因為現在這個加熱菸還沒上市,我看到那個電子菸的器具、工具現在滿街都是啊,它現在不是違法嗎?沒有人取締啊?有有有,我們非常熱爭起立我怎麼沒看到咧?沒有聽到起立的成果可不可以報告一下? |
| transcript.whisperx[187].start |
6103.508 |
| transcript.whisperx[187].end |
6119.157 |
| transcript.whisperx[187].text |
跟委員報告一下 有關於這個煙害防治法3月22號上路之後那我們目前對於電子煙跟違法加熱煙的稽查取締的部分 不管是中央跨部會跟地方都合力在做這一塊的執法 |
| transcript.whisperx[188].start |
6119.577 |
| transcript.whisperx[188].end |
6134.123 |
| transcript.whisperx[188].text |
那目前截至114年這個1月截止大概裁罰的件數大概有4500多件裁罰金有大概4.5億那我們中央也會定期再召開這個跨部會的這個查緝的相關 |
| transcript.whisperx[189].start |
6135.003 |
| transcript.whisperx[189].end |
6150.051 |
| transcript.whisperx[189].text |
那我跟你講,加熱菸如果未來核准上市,我想該有的教育宣導跟我們的管理機制,我想大家要吳衛福部這邊要盡快的來擬定,好不好?不要讓這個事情變成影響公共健康的一個問題,好不好?是,是,謝謝好,謝謝,謝謝部長委員在這邊宣告 |
| transcript.whisperx[190].start |
6160.165 |
| transcript.whisperx[190].end |
6172.702 |
| transcript.whisperx[190].text |
莊立雄委員詢答結束之後我們休息十分鐘接下來請王育民委員來做詢答你如果要加提案說明就一起會增加時間剛剛有宣布謝謝因為我沒有辦法提案說明 |
| transcript.whisperx[191].start |
6173.407 |
| transcript.whisperx[191].end |
6192.988 |
| transcript.whisperx[191].text |
好謝謝我們的召委今天排這個很重要的病毒法他的整個修正的條文那我想有關於病毒法這個是我們當時在2019年1月正式實施之後我們是亞洲第一步就是以病人為主體 |
| transcript.whisperx[192].start |
6194.009 |
| transcript.whisperx[192].end |
6222.305 |
| transcript.whisperx[192].text |
然後提供很完整的一方面去尊重醫療自主一方面去保障這個善終權益所以這個法我覺得整個亞洲地區來講台灣我們走在前面這個的確是我們應該要好好的來推動的那這六年來其實事情下來呢有出現一些的狀況跟問題就是說當時這個利益非常良善的法案但是上路之後 |
| transcript.whisperx[193].start |
6222.965 |
| transcript.whisperx[193].end |
6225.728 |
| transcript.whisperx[193].text |
事實上這個整個執行的醫療簽署率其實並不高如果累計的話現在大概跟我們成人的比例站起來大概只有0.5%所以也代表說我們六年了應該回過頭來檢討我們有哪些地方可以好好的來 |
| transcript.whisperx[194].start |
6238.9 |
| transcript.whisperx[194].end |
6267.636 |
| transcript.whisperx[194].text |
改變那我想當時推動這部法案非常用力的楊玉新委員那他雖然現在離開立法院但是他很關注這個法後續的實施所以基本上我想我跟劉建國委員我們其實都跟他有保持這個互動所以討論之後我們提出了這樣的一個修法的版本那很重要的幾個點第一個當然就是在這個醫療費用的部分這個是現在很多人 |
| transcript.whisperx[195].start |
6268.351 |
| transcript.whisperx[195].end |
6289.651 |
| transcript.whisperx[195].text |
可能覺得在醫療費用他其實是自己要負擔2000到3500那這個也會阻礙一些人就是說可能礙於費用他沒有辦法來做這個預理醫療的簽署所以費用的部分政府是使得來支應這個是這一次修法的重點那當然 |
| transcript.whisperx[196].start |
6290.41 |
| transcript.whisperx[196].end |
6302.876 |
| transcript.whisperx[196].text |
會希望說是不是健保這邊可以來給予支應所以這個部分這個是很大的一個重點另外一個就是現在可以進行這個育立醫療照護諮商的單位除了原來在醫療機構裡面的區醫院跟診所之外那是不是應該可以去開放一樣是很專業的團體包括這個有一些護理機構長照機構 |
| transcript.whisperx[197].start |
6317.544 |
| transcript.whisperx[197].end |
6344.569 |
| transcript.whisperx[197].text |
心理治療所心理諮商所還有社工事務所也都可以來參與因為主要是現在的這個等待的時間是比較長的就是醫院裡面能提供的量能其實也是比較低的所以這個部分也希望可以來開放那另外就是要實施病毒法怎麼樣真正去落實這個原來病人的意願那關係人也不可以再去妨礙醫師執行這個是在第4條 |
| transcript.whisperx[198].start |
6347.643 |
| transcript.whisperx[198].end |
6375.793 |
| transcript.whisperx[198].text |
裡面有提出來修訂那另外病毒法裡面第14條裡面特別去修訂就是不要讓這個執行的醫療機構或醫師再去擔負這個刑事行政的責任原來就有規定那現在再增加一個是民事的責任所以我想這一次委員提出這樣的一個修法就是希望說讓我們這麼亞洲第一的我們的病毒法就是可以真正的落實 |
| transcript.whisperx[199].start |
6376.792 |
| transcript.whisperx[199].end |
6405.399 |
| transcript.whisperx[199].text |
然後去符合到他原來的這個我們希望病人自主而且呢可以善終這樣的一個目標那所以這個謝謝莊委給我提案說明的時間那接下來我們就請那個部長是不是我們針對這個議題我們好好的來討論一下第一個就是我想請教部長事實上你剛剛的發言我發現你也是非常支持這一個善終醫療這樣的一個方向 |
| transcript.whisperx[200].start |
6406.155 |
| transcript.whisperx[200].end |
6423.631 |
| transcript.whisperx[200].text |
那但是病毒法實施到現在你可以看到他的這個施行率的確是不高那所以這個就衛福部部長的角度的話第一個我要問你說你滿意現在的這個育立醫療的人數嗎就是你是不是覺得他應該還有成長的空間嗯 |
| transcript.whisperx[201].start |
6427.136 |
| transcript.whisperx[201].end |
6452.323 |
| transcript.whisperx[201].text |
我們當然希望他人數一個成長因為其實各個醫院已經都準備團隊在那邊準備服務了啦所以其實量能是有但是就是民眾有沒有意願那這個真的剛剛也有委員提到怎麼樣做生命的教育加強生命的教育讓大家能夠來注重這個他自然就覺得這個去簽有意義 |
| transcript.whisperx[202].start |
6453.263 |
| transcript.whisperx[202].end |
6480.13 |
| transcript.whisperx[202].text |
那這個也是驅動的原因可能不止完全是經費的問題當然經費的確是一個原因但是如果生命交易夠讓大家知道這是重要的我相信這更大的驅動力我覺得都要啦就是說讓民眾可以有這個比較好的認知願意接受另外一方面就是去排除他的那個障礙跟門檻那我想 |
| transcript.whisperx[203].start |
6480.57 |
| transcript.whisperx[203].end |
6502.875 |
| transcript.whisperx[203].text |
今天為什麼很具體的在這個法案裡面就是希望可以把這個經費放進來因為我想這個很多團體在第一線推他們的確發現民眾覺得說我很願意簽但是你還要我自己自掏腰包再多花3500塊我要花時間然後我要花錢才能完成這個程序我覺得他的確是增加了他的困難度了 |
| transcript.whisperx[204].start |
6503.295 |
| transcript.whisperx[204].end |
6526.352 |
| transcript.whisperx[204].text |
所以這個部分呢這次才會有修法希望說在預算的部分是不是政府的力量可以就像宣導你今天去宣導也是政府的力量協助來宣導那今天要民眾再次多出這個錢我覺得政府相對也是有這個責任如果我們要去推動的話應該可以就是多增加這一個補助的項目那當然你們原本原本有對外說 |
| transcript.whisperx[205].start |
6530.385 |
| transcript.whisperx[205].end |
6555.714 |
| transcript.whisperx[205].text |
2026年要全民免費你知不知道這件事媒體上面有報導原本衛福部是有打算2026年是要全民免費的那當時你們這樣的一個目標跟方向其實對於整體的推動是很好的一個方向但是後來為什麼又縮回來了你們現在限縮到5月開始你們只有65歲以上的重大傷病跟65歲以上的多重慢性病 |
| transcript.whisperx[206].start |
6556.374 |
| transcript.whisperx[206].end |
6565.508 |
| transcript.whisperx[206].text |
就是原本你們其實是有一個很大的目標跟理想就是說就推動全民免費為什麼後來這個政策又縮回來 |
| transcript.whisperx[207].start |
6570.374 |
| transcript.whisperx[207].end |
6590.071 |
| transcript.whisperx[207].text |
我想可能觀念上也不是錢免免費,我是說其實如果能夠早一點立下一些衣族其實未來在做默契的時候選擇好的對象真的可以節省醫療費用這節省的醫療費用可能遠大於你這個諮商的費用 |
| transcript.whisperx[208].start |
6591.492 |
| transcript.whisperx[208].end |
6617.443 |
| transcript.whisperx[208].text |
所以這種健康投資是值得來評估但是在可能我想國家的財源一定或者健保的財源有限那什麼才是排比較重要的大家可以來討論大家可以討論譬如說剛剛說剛剛時事處長有提什麼藥品都想進來想提高價錢我們的健保就是這樣子今年已經是最大的大家的努力是像多了700多億 |
| transcript.whisperx[209].start |
6621.644 |
| transcript.whisperx[209].end |
6646.569 |
| transcript.whisperx[209].text |
可能還是有很多很多的要努力的空間所以近來他對財務的衝擊是怎麼樣這個的確是我們用開放的胸心用關懷的心那這部分我可以拜託部長你們回去再研議一下你們現在是開放到65歲但是事實上這個重大傷病就是說你為什麼要用一個年紀來限制這個重大傷病 |
| transcript.whisperx[210].start |
6647.549 |
| transcript.whisperx[210].end |
6676.496 |
| transcript.whisperx[210].text |
可不可以就是以重大傷病或多重慢性病為前提你們去估算一下這樣的人口大概有多少如果你沒有辦法一步到位就是你任何年齡來你完全都免費但是至少我覺得當人開始生病的時候這個問題跟他就是越接近也越需要那你們可不可以再去估另外一部分的經費就是說只要他領有重大傷病卡或是多重慢性病他就可以因為他已經在這個健保體系 |
| transcript.whisperx[211].start |
6677.316 |
| transcript.whisperx[211].end |
6698.695 |
| transcript.whisperx[211].text |
如果他有意願你們就可以補助這部分會多花你們多少錢因為事實上你們現在所設定的一年健保支出3.6億不是一個非常大筆的數額那你如果再擴大一點的話你的總經費會增加多少我是覺得這部分的經費坦白講不是在你所有的健保預算裡面他真的不是最大筆 |
| transcript.whisperx[212].start |
6699.736 |
| transcript.whisperx[212].end |
6727.865 |
| transcript.whisperx[212].text |
可不可以請署長回應一下我看署長其實也很用力在推動這一點我要肯定那你可不可以你自己有沒有估算過這個都經過精算其實65歲我們先講重大傷病重大傷病大概是100萬人那麼這個65歲以上大概是50萬那麼底下這個65歲以上多重慢性病這邊大概在100多130萬左右所以兩個合起來是180萬 |
| transcript.whisperx[213].start |
6729.345 |
| transcript.whisperx[213].end |
6749.562 |
| transcript.whisperx[213].text |
所以光是180萬的人全部做一個人3000塊的話是54億啦那所以我們只是想說因為也不會一下子全部的180萬一年通通做完不可能所以我們才說那這樣我們健保應該還可以支撐這樣的費用那當然如果做的多了我們再爭取預算那也不要 |
| transcript.whisperx[214].start |
6750.542 |
| transcript.whisperx[214].end |
6759.027 |
| transcript.whisperx[214].text |
這個影響到整個健保的財務所以我們大概是這樣的方式先擴大到這個65歲以上的重大傷病跟多重慢性病這個涵蓋的範圍是180萬人 |
| transcript.whisperx[215].start |
6762.132 |
| transcript.whisperx[215].end |
6788.677 |
| transcript.whisperx[215].text |
對好來因為其實這我們跟健保署有討論過就現況而言的宣導策略然後簽署的高峰會在60歲以上是然後所以才會是說錢用在刀口上然後至於是說一些宣導策略如果有做一些改善的話其實擴大的這部分我們兩邊會密切的合作還有長照是這邊會一起好你剛說的是60對不對啊你現在設定65有沒有可能放寬到60 |
| transcript.whisperx[216].start |
6790.576 |
| transcript.whisperx[216].end |
6804.993 |
| transcript.whisperx[216].text |
我們先執行一步我想我們後面還會進入到主條我拜託衛福部一件事就是你去精算一下你的版本好不好你現在6560跟50你就提供這三種版本到底在你的健保經費裡面 |
| transcript.whisperx[217].start |
6806.154 |
| transcript.whisperx[217].end |
6827.04 |
| transcript.whisperx[217].text |
可能要多少因為我也可以理解很多東西可能很難一步到位但是如果在你們現行要擴大的可以再更擴大的話我覺得這個因為你們剛剛已經講了事實上這件事情一方面是保障病人本身一方面對你整個健保剛剛部長也有講如果越多人去預例這樣子的一個的這個 |
| transcript.whisperx[218].start |
6830.245 |
| transcript.whisperx[218].end |
6853.522 |
| transcript.whisperx[218].text |
去預列這個醫療的這個確認的話那事實上未來再節省你的健保支出那個其實是會有個反饋機制你知道嗎你簽越多事實上你未來要支付的可能就是越少因為你一些無效醫療他會提前去終止所以你應該用一個比較大的水庫的概念來看待這件事而不是只有看說我現在要多支出3.6億10億你應該去精算每一個有簽署的你將來節省的醫療的 |
| transcript.whisperx[219].start |
6859.186 |
| transcript.whisperx[219].end |
6873.974 |
| transcript.whisperx[219].text |
無效的醫療支出可能會有多少你這樣算下來之後你就知道說它反而這邊越增加不是越增加你的健保支出而可能是越節省未來整個醫療的無效支出我覺得你們要有這樣的概念來看待這件事情 |
| transcript.whisperx[220].start |
6874.56 |
| transcript.whisperx[220].end |
6902.132 |
| transcript.whisperx[220].text |
所以我想這是很重要也是一直我們在研議的方向但是我剛剛有報告過其實簽了ADE以後到最後的話大概有七成是吻合的那是早期喔後來慢慢的吻合率比較低為什麼後來做ACP的過程比較變成比較不像引擎所以品質也很重要因為品質之後你才能夠復活到最後真的是在做的時候 |
| transcript.whisperx[221].start |
6902.867 |
| transcript.whisperx[221].end |
6920.204 |
| transcript.whisperx[221].text |
跟當時簽AD是吻合的 不然的話幹嘛當時簽AD變成生命交易而已啊所以我們不但要生命交易 還要有真的能夠協助在他真正到末期的時候有一個很好的一個他合乎他的質量這個我同意啊 所以這個也是過程當你們去檢討的財務方面的部分我們來好啊 我希望你們提出一個財務評估的報告了那另外一個 |
| transcript.whisperx[222].start |
6927.13 |
| transcript.whisperx[222].end |
6954.663 |
| transcript.whisperx[222].text |
這個就是說要不要開放其他機構可以進來做這個諮商你們反對你們在報告裡面就是反對那我也看到醫師公會幾大團體他們其實也是反對但是這件事情我是覺得有討論的空間就是說如果他們做到等同的水準我們應該不是從各團體它的出發點而是從一個病人他可以得到服務如果他可以得到同品質的諮商的 |
| transcript.whisperx[223].start |
6955.343 |
| transcript.whisperx[223].end |
6972.269 |
| transcript.whisperx[223].text |
這樣的一個品質那是不是可以去要求就是說你可以要求那些其他想參與的這些專業團體你要達到我這樣的要求就是你這個諮商過程你要達到我的標準而不是一開始就去否決掉說不行啊你們通通不能進來我覺得這件事情剛剛部長您在講說是開放的態度嘛在這件事情的討論 |
| transcript.whisperx[224].start |
6976.75 |
| transcript.whisperx[224].end |
6980.633 |
| transcript.whisperx[224].text |
我是蠻希望你也是秉持一個比較開放的態度而不是一開始就直接否決了應該是可以有討論的空間這個可不可以再演繹因為討論法條還有時間你們回去再想想看好不好那個意思是要不要回應一下來市長 |
| transcript.whisperx[225].start |
6993.524 |
| transcript.whisperx[225].end |
7007.962 |
| transcript.whisperx[225].text |
簡單回應一下就是說現在講的執行場域其實我們覺得病人在哪裡這件事情會是比較重要所以我們才會覺得是說以現階段直接的是說要修法改擴大場域這件事情不如是說我們回過頭來在我們 |
| transcript.whisperx[226].start |
7009.924 |
| transcript.whisperx[226].end |
7018.046 |
| transcript.whisperx[226].text |
目前設定的TARGET這邊在執行的過程當中有沒有什麼可以去做調整的我們目前的方向上面會是這樣為什麼因為在做諮商的過程當中我必須對醫療介入措施對這個疾病的癒後要有很清楚的描述那個諮商的誇題才會好 |
| transcript.whisperx[227].start |
7028.129 |
| transcript.whisperx[227].end |
7052.324 |
| transcript.whisperx[227].text |
現階段的大家的各自的專業其實是因為太鑽了所以對Horizontal這一塊怎麼樣去講的醫療接觸措施對幾半年以後其實我們會覺得是說這個地方還需要一些共識這樣子的話才會有好的品質所以部長其實有特別講的是說現階段其實需要凝聚更多的共識以上好那如果是這樣子的話我覺得你們該去研議因為像護理機構跟長照機構其實會有蠻多是 |
| transcript.whisperx[228].start |
7055.446 |
| transcript.whisperx[228].end |
7071.332 |
| transcript.whisperx[228].text |
他可能要育立一組這樣的一個病人而且他本身其實也有醫事人員所以像這一個或許就是你們第一步可以優先去考量的就是說跟醫療更接近的更相近的他不見得都是在醫院這些人都是在護理之家他可能就在長照機構裡面那你這個就不開放嗎你還要他回到那個診所嗎或者是回到醫院才可以去做這樣的一個 |
| transcript.whisperx[229].start |
7082.257 |
| transcript.whisperx[229].end |
7093.99 |
| transcript.whisperx[229].text |
諮商嗎我覺得剛剛市長講一句話很好病人在哪裡你就應該是以這個為前提吧對不對所以這一塊我覺得是有討論空間部長你怎麼表示一下 |
| transcript.whisperx[230].start |
7094.881 |
| transcript.whisperx[230].end |
7118.016 |
| transcript.whisperx[230].text |
我想以病人為中心是我們的目標但是我剛剛有報告過如果在品質上面或者他討論的內容AD討論的內容需要怎麼樣的專業人員當時會有一個諮商為什麼需要那些人其實是有原因的那這樣的品質如果能夠維護品質那當然我們以病人為中心 |
| transcript.whisperx[231].start |
7119.497 |
| transcript.whisperx[231].end |
7140.216 |
| transcript.whisperx[231].text |
來調整我們就可以來討論了好我希望是以病人為中心而不是說團體之間各有成見說什麼團體不行那最後一個問題我問你就是說最近有一個有民間有醫師他們做一個調查就是說86%的民眾支持自主善中然後他們 |
| transcript.whisperx[232].start |
7142.116 |
| transcript.whisperx[232].end |
7157.136 |
| transcript.whisperx[232].text |
就是提出來是一個PAD那衛福部你們對於他這樣子的一個調查跟他們的倡議你們的立場是什麼就是說他們的進一步是說醫師他可以給藥但是病人呢 |
| transcript.whisperx[233].start |
7157.937 |
| transcript.whisperx[233].end |
7177.47 |
| transcript.whisperx[233].text |
決定自己要不要服藥就是說醫師協助死亡就是台大公衛研究他們做出來的這一塊在台灣有討論空間嗎還是這只是民間的倡議 衛福部怎麼看待這件事情好的我們一切要以專業跟人性的關懷來看這件事情所以 |
| transcript.whisperx[234].start |
7178.976 |
| transcript.whisperx[234].end |
7203.625 |
| transcript.whisperx[234].text |
支持自主善終這應該是要百分之百吧大家也要善終能夠自主性的那我們怎麼樣真正讓他有自主性怎麼樣讓他善終才是重要的事情那我只提醒一點就是說當澳洲在提倡所謂的讓他縮短生命的一個措施 |
| transcript.whisperx[235].start |
7205.205 |
| transcript.whisperx[235].end |
7217.853 |
| transcript.whisperx[235].text |
來減少他痛苦這件事情我不想把它講成安樂死其實就是這種味道什麼叫安樂死就是intention因為他太痛苦了所以你想要把他縮短生命但是你 |
| transcript.whisperx[236].start |
7219.037 |
| transcript.whisperx[236].end |
7236.149 |
| transcript.whisperx[236].text |
所以澳洲馬上宣布就是說如果今天社會關注這個議題首先你應該去看看末期病人你是不是都把他照顧好了讓他不痛了讓他不要那麼辛苦讓他不要覺得他是家人的累贅讓家屬也可以安心的來照顧病人 |
| transcript.whisperx[237].start |
7237.169 |
| transcript.whisperx[237].end |
7257.078 |
| transcript.whisperx[237].text |
如果你這樣的話他要珍惜每一天的生命啊怎麼會去想要去縮短生命所以他們說應該要先去推安寧環的醫療如果你把安寧環冒起病人的安寧環的醫療照顧好的話推得好的話不是沒有發生安樂死這個爭議就變成比較個案事件所以我們台灣我們台灣如果真的 |
| transcript.whisperx[238].start |
7257.958 |
| transcript.whisperx[238].end |
7272.815 |
| transcript.whisperx[238].text |
推自主三中的時候還有一個很重要的工作你有沒有把安寧緩和醫療把病人照顧好如果把病人照顧好的話我們再來談下一個沒辦法解決的時候我們是不是有更加能夠讓他自主我們再來談 |
| transcript.whisperx[239].start |
7274.136 |
| transcript.whisperx[239].end |
7288.617 |
| transcript.whisperx[239].text |
好 那所以回到我們的病主法我們真的 因為已經通過了法律我們就應該要好好的施行 好好的落實那我們重點應該先擺在這邊所以希望部長你們回去再好好研議今天委員提出非常多的議題 |
| transcript.whisperx[240].start |
7290.7 |
| transcript.whisperx[240].end |
7312.088 |
| transcript.whisperx[240].text |
就是不要像你們今天的報告,好像鐵板一塊每一橋都不可以,每一橋都是緩疫我覺得可以,你剛剛講一句話很好,你是開放的那我們就用開放的態度,大家好好的來研議以病人最好的為原則,以病人為中心我們看這個法可以怎麼樣修得更好,好不好?好的,謝謝好,謝謝王委員,謝謝好,謝謝張浩偉,謝謝王委員,謝謝部長 |
| transcript.whisperx[241].start |
7320.758 |
| transcript.whisperx[241].end |
7333.807 |
| transcript.whisperx[241].text |
來 接下來請楊瓊英委員來做巡檔謝謝主席 楊瓊英發言 邀請部長 |
| transcript.whisperx[242].start |
7341.146 |
| transcript.whisperx[242].end |
7353.695 |
| transcript.whisperx[242].text |
今天這個議題我們從2019年實施病人自主權利法是亞洲第一部保障病人自主權利的一個法律那當然透過了預例醫療照護的諮詢 |
| transcript.whisperx[243].start |
7356.917 |
| transcript.whisperx[243].end |
7382.454 |
| transcript.whisperx[243].text |
的諮商的過程當中患者跟家人深度的去溝通那經由醫護人員給予專業的意見在家人及親友的見證下完成預立醫療的這個決定那病人有權利決定人生最後的醫療處置避免讓自己不可逆昏迷或者成為永久的這個職務人但是我們看到就是說病人自主法 |
| transcript.whisperx[244].start |
7383.434 |
| transcript.whisperx[244].end |
7399.518 |
| transcript.whisperx[244].text |
自主權利法上路了5年之後呢 迄今約大概僅有10萬人簽署那簽署率大概是0.45%那簽署率就已經這麼低了 在簽署之後會去執行的一定會更低 一定會更低 |
| transcript.whisperx[245].start |
7401.639 |
| transcript.whisperx[245].end |
7415.424 |
| transcript.whisperx[245].text |
在這樣的一個情況之下本席想要請教部長也就是說我們看到目前的障礙許多的民眾還有很多人根本不知道什麼是日立醫療的一個決定 |
| transcript.whisperx[246].start |
7417.364 |
| transcript.whisperx[246].end |
7442.899 |
| transcript.whisperx[246].text |
那第二個就是說甚至有一些年輕的朋友他知道但是我們的民風比較保守年輕的朋友他也不敢給長輩講也不敢給長輩講這也是因素之一那所以在整個生死話題當中因為我們比較保守他會視為一個禁忌那請問政府你剛剛頻頻點頭就是說我說是還有很多人不知道 |
| transcript.whisperx[247].start |
7443.839 |
| transcript.whisperx[247].end |
7462.293 |
| transcript.whisperx[247].text |
這個法令那你們要怎麼樣去宣傳讓病人他了解自己擁有的一個尊嚴善終的一個權利請做說明好謝謝委員的關心我想這個是非常重要的一個討論的議題那這個部分其實 |
| transcript.whisperx[248].start |
7463.732 |
| transcript.whisperx[248].end |
7478.157 |
| transcript.whisperx[248].text |
醫事師有做相當深入的研究,等一下簡單報告那您委員提到說我們的文化的確是你也很了解我們民眾我在30多年前在日本那間研究所的時候我就是做這方面的研究 |
| transcript.whisperx[249].start |
7479.042 |
| transcript.whisperx[249].end |
7494.837 |
| transcript.whisperx[249].text |
那其實當時的結論就是我們台東方人跟俄美人不太一樣 俄美人都用尖叫的啦嚇下來啦我們台灣人喔 北部他就給我們嚇黑啦用講的就好 一個眼神可能就是齁但是這樣子也造成敵人臨床上 |
| transcript.whisperx[250].start |
7495.638 |
| transcript.whisperx[250].end |
7518.057 |
| transcript.whisperx[250].text |
最後的選擇是很不穩定的您也說在這方面非常專精但是每一個國家的樣態不一樣特別提出我們的民風所以也針對這些的問題點面向點那我們要怎麼樣去做既然一個法通過當然我們希望能夠執行之 |
| transcript.whisperx[251].start |
7519.458 |
| transcript.whisperx[251].end |
7538.752 |
| transcript.whisperx[251].text |
人民來自己來選擇但是如果說我們一個法通過連民眾都不知道那政府有責任喔來請做說明我們要怎麼樣宣導讓人民可以知道好 那宣導絕對是要做的那至於說它的原因先實際比較低的原因意思是有一直做研究可不可以簡單請他講一下好 請做說明 |
| transcript.whisperx[252].start |
7540.487 |
| transcript.whisperx[252].end |
7565.102 |
| transcript.whisperx[252].text |
我先簡單講一下其實有兩大原因一個是民眾的認知就誠如剛剛委員講的另外一塊是費用然後民眾認知部分的話其實在做宣導的部分我們大概第一件事情其實也歡迎現場的立委就是說我們的1月1月是病主日然後6月是我們的棄捐然後10月是病安寧所以我們大概就是跟那個病 |
| transcript.whisperx[253].start |
7566.002 |
| transcript.whisperx[253].end |
7589.825 |
| transcript.whisperx[253].text |
契捐病毒中心這邊合作也就是說每一年其實在1月6月10月的時候會有帶狀的一個宣導活動要跟你討論的是部長還在這裡目前我們所做的步驟就是如此但是他的答案是不盡理想所以部長我再請部長部長就這個宣導的方式你們去研擬 |
| transcript.whisperx[254].start |
7590.686 |
| transcript.whisperx[254].end |
7603.94 |
| transcript.whisperx[254].text |
什麼樣的方式不要我們回我們質詢的時候你就依照目前所做本期已經告訴你目前你所做的方法已經達不到你所預估的成效所以你們有精進的空間嘛好不好好好去討論第二個議題市長剛才說的有就是費用問題是資商 |
| transcript.whisperx[255].start |
7609.345 |
| transcript.whisperx[255].end |
7637.601 |
| transcript.whisperx[255].text |
諮商是病人自主權利法的一個最重要的核心是不是所以在這樣的一個情況之下那麼諮商的費用那到底要怎麼處理有委員提案是希望由公家來處理剛剛在討論說這個經費我們似乎要循序漸進開放的態度請教部長你的看法好我們就逐步逐步漸進嘛你現在逐步你預計要怎麼做 |
| transcript.whisperx[256].start |
7639.465 |
| transcript.whisperx[256].end |
7669.225 |
| transcript.whisperx[256].text |
你逐步預計要怎麼做我們一直在開放從去年7月開放然後5月6月開放比較更多的人你預計5月份再開放什麼呢就有180萬個人是是沒關係我們也贊同循序漸進要迎合我們的預算而且還要有社會的面向那你認為你在5月今天就5月1號了嗎那你預計你5月份你會再繼續怎麼做呢請做說明 |
| transcript.whisperx[257].start |
7671.707 |
| transcript.whisperx[257].end |
7692.421 |
| transcript.whisperx[257].text |
來 市長請回答沒關係 市長細節部分細節部分的話就是我們健保署這邊的話會開放連同門診有包括失智類似像這樣有65歲以上的病人其實是可以接受這樣子的一個諮商服務是由健保這邊會做一個處理我們的設定點是在65歲以上嘛失智 |
| transcript.whisperx[258].start |
7694.602 |
| transcript.whisperx[258].end |
7719.741 |
| transcript.whisperx[258].text |
有重大傷病 他其實有五大類的一個重大傷病嗎對 有五大類的疾病就六十五歲以上 從五月份開始是嗎本期就是希望部長 本期希望說我們讓社會大眾會知道政府到底在做什麼那民眾有什麼樣的權益我們循序漸進都OK那主要的是讓病人他能夠非常的有尊嚴這是大家共同的一個目標嘛 |
| transcript.whisperx[259].start |
7721.943 |
| transcript.whisperx[259].end |
7749.854 |
| transcript.whisperx[259].text |
接下來最後一個議題本席跟你討論今天是5月1號那麼台大醫院工會前天發出的聲明部長你有瞭解到這個問題嗎因為他說院方日前針對於勞動節進行出勤的調查他只有兩個選項一個選項是同意到院工作但是選擇移到國定假日第二個選項是同意到院方工作但是以加班的方式來 |
| transcript.whisperx[260].start |
7751.575 |
| transcript.whisperx[260].end |
7771.027 |
| transcript.whisperx[260].text |
但是沒有依照勞基法明文規定依法休假一日當天不到院工作這是工會所提出的您知道這個事情嗎?報告員我了解而且台大的回應是說他這個表單是針對來上班的人讓他選擇是要用補假的方式或者是加班 |
| transcript.whisperx[261].start |
7772.328 |
| transcript.whisperx[261].end |
7789.873 |
| transcript.whisperx[261].text |
會問的方式來處理這是台大醫院的回應當然我們會去進一步的了解一定要了解清楚因為公會非常清楚的就是說兩個選項沒有第三項依法的選項那是已經來上班的人那是已經來上班那誰敢不來上班呢 |
| transcript.whisperx[262].start |
7790.871 |
| transcript.whisperx[262].end |
7807.218 |
| transcript.whisperx[262].text |
當然以權力來講他是可以不來上班啊以權力來講可以不來上班 這個有錄音錄影部長這是您說的更是 部長我們還是要好好的去溝通因為我們知道這個問題的重點是在於 |
| transcript.whisperx[263].start |
7808.839 |
| transcript.whisperx[263].end |
7830.571 |
| transcript.whisperx[263].text |
醫護人員的休假的權益 怎麼樣去增補人力 增列津貼這才是真正的要解決醫護人力不足的問題 本市當然不希望我們的工會跟院方大家有所爭執 這樣子對病人也不好我們希望達到三全其美 但是你必須要好好的去照顧這些醫護人員 |
| transcript.whisperx[264].start |
7832.052 |
| transcript.whisperx[264].end |
7858.003 |
| transcript.whisperx[264].text |
當然當然所以我也希望你詳細去給他查清楚因為公會既然提出了這樣的方向又在今天的五一勞動節我們也希望可以讓我們的勞工大家可以快樂嘛好好的來工作嘛這是在醫院裡面也是你非常重要的一個面向嘛好你去查清楚然後給本席說明資料好的好的我會請台大再說明清楚好謝謝好謝謝袁偉謝謝部長 |
| transcript.whisperx[265].start |
7863.304 |
| transcript.whisperx[265].end |
7876.419 |
| transcript.whisperx[265].text |
重新公告這個廖偉強委員執行完之後我們休息十分鐘不然我再提醒一下好不好我們當然要提高服務量人剛才王委員、楊委員都有提到要提高服務量人也要兼顧品質對不對 |
| transcript.whisperx[266].start |
7879.411 |
| transcript.whisperx[266].end |
7902.783 |
| transcript.whisperx[266].text |
那個毓力毓揚的智商嘛,對不對?那剛剛市長是答覆未來期許目標2萬,每年2萬變成4萬嘛那你2萬要變成4萬要怎麼變嘛?你用什麼方法變嘛?除了健保署現在擴大65歲重大疾病等剛剛署長已經跟委員會報告,那是180萬人 |
| transcript.whisperx[267].start |
7905.643 |
| transcript.whisperx[267].end |
7930.919 |
| transcript.whisperx[267].text |
不包含健康的,不包含其他自願要來做的,對不對那裡180萬,即便那裡除以4萬,原本是除以2萬,你要90年才做得完你除以4萬,還要45年才做得完,你們怎麼去提高服務的量呢然後做一個諮商要做多久時間,然後到目前為止要去做諮商的掛號要掛一個多月 |
| transcript.whisperx[268].start |
7933.946 |
| transcript.whisperx[268].end |
7938.888 |
| transcript.whisperx[268].text |
請面對事實啦講清楚啦不能這樣處理啦請莊委員謝謝趙委面對事實就發起來了請衛福部邱部長還有我們趙副司副司長來 |
| transcript.whisperx[269].start |
7957.517 |
| transcript.whisperx[269].end |
7960.399 |
| transcript.whisperx[269].text |
還有請我們石崇良署長委員好部長好柏中是你算這兩天我都給你額漏了你知不知道每次問我說會額漏部長怎麼樣我說這個 |
| transcript.whisperx[270].start |
7977.182 |
| transcript.whisperx[270].end |
7995.415 |
| transcript.whisperx[270].text |
有學術的經驗,做到高雄,還有台灣大學,還有東京大學,還有哲學立法院,我最主要是勇於認識,為人誠懇,所以我不要說是財是所,意思是我幫你按讚,這樣就對了,但是我的目的就是,你下去沒有特色, |
| transcript.whisperx[271].start |
8000.386 |
| transcript.whisperx[271].end |
8012.056 |
| transcript.whisperx[271].text |
我昨天練書練到兩點因為針對今天委員的垂行重點都是我們國家的重要方向我必須要來拜讀我給你推薦一本很好讀的,我那本有夠讚叫做《核廢料蘭嶼儲存場設置真相調查報告書》這本寫的 |
| transcript.whisperx[272].start |
8023.818 |
| transcript.whisperx[272].end |
8029.987 |
| transcript.whisperx[272].text |
這差不多63頁調查報告書63頁然後附件加一加一共是746頁我一禮拜我一禮拜都把它拆掉我從第一頁到最後一頁我都把它拆掉連附件我都看連我辦公室都看 |
| transcript.whisperx[273].start |
8039.039 |
| transcript.whisperx[273].end |
8052.215 |
| transcript.whisperx[273].text |
那我今天本席要來跟你就教的就是說啊倒也不是醫院的硬體的一個建設啦是在講說蘭嶼的醫療這個嚴重的不足這應該柏中你也應該都知道啦我來跟你講一個故事啦就是說 |
| transcript.whisperx[274].start |
8056.243 |
| transcript.whisperx[274].end |
8060.106 |
| transcript.whisperx[274].text |
民國60年 1971年的時候 核一廠動工那時候動工之後 叫你說你就有一些核廢料會造出來所以那個時候就評估五種核廢料儲存方式第一款叫做 |
| transcript.whisperx[275].start |
8072.355 |
| transcript.whisperx[275].end |
8095.112 |
| transcript.whisperx[275].text |
廢礦坑 後來就去找 找到金瓜石但是呢 礦坑太潮濕 居民會使用礦坑的水源所以打岔就沒用第二種就是舊日均地下屯兵地 台中結果呢 那個深度 地面大概二十公尺而已那坑道狹窄 汽車也沒有在裡面運作 所以又打岔 |
| transcript.whisperx[276].start |
8096.033 |
| transcript.whisperx[276].end |
8109.599 |
| transcript.whisperx[276].text |
第三個就新竹 想要放大清山來但是交通不方便 又打岔第四個呢 東沙島 是要投海 海拋還是啦 離菲律賓一百二十公里而已走那邊就趕走啦 走那邊國際國際會說你還笑 我怎麼跟你說這個啊 但是喔 來了 重點來了設在離島 蘭嶼跟澎湖等14個方案 |
| transcript.whisperx[277].start |
8122.392 |
| transcript.whisperx[277].end |
8126.675 |
| transcript.whisperx[277].text |
我告訴你這就是說,不然蘭嶼有夠衰,因為在離本島最近,還有鋼靠,還有紅酒,最主要成本最低,所以它就中獎了,蘭嶼就中獎了。所以我要跟部長說明的就是說,在蘭嶼如果蓋一間便宜,那不是叫做選項, |
| transcript.whisperx[278].start |
8143.854 |
| transcript.whisperx[278].end |
8147.959 |
| transcript.whisperx[278].text |
那叫做政府的責任1971年到現在 你看這麼久時間過了2018年 2016年 我看蔡總統 這個以前很聽你的 |
| transcript.whisperx[279].start |
8160.768 |
| transcript.whisperx[279].end |
8167.232 |
| transcript.whisperx[279].text |
跟蘭嶼人道歉2018年核廢料蘭嶼儲存場的設置真相調查報告書就是我建議的一本書出爐同年也提供給住在蘭嶼的居民一些健檢當然政府階段也有補充一些我給你看一下這個歷史研究給你看一下就是在2019年的時候 |
| transcript.whisperx[280].start |
8186.602 |
| transcript.whisperx[280].end |
8191.373 |
| transcript.whisperx[280].text |
原民會那時候就照一本書所以我為什麼叫保證你要去看現在跟你說的都不用說什麼對一個總統對一個總統都官方的文件 |
| transcript.whisperx[281].start |
8196.92 |
| transcript.whisperx[281].end |
8202.624 |
| transcript.whisperx[281].text |
他就說不然來建議提升 叫做分院 部立台東區的分院就對了就是說這裡要設一個病院再來就開始台東的衛生局就開始去協調要怎麼用地然後呢 再來2022年就開始說 原民會跟台東管政府來協調原民保留地要怎麼整修 連監察院後來也去了 |
| transcript.whisperx[282].start |
8220.555 |
| transcript.whisperx[282].end |
8235.562 |
| transcript.whisperx[282].text |
我這裡有一張 監察院去做什麼 你知道嗎監察院調查主管機關 救蘭嶼 達悟族人 權益維護的重大建設政策規劃跟執行是否投射的時候去履刊啦 履刊要做什麼 你知道嗎醫院設置的問題從頭到尾都在講說蘭嶼就是要設醫院啦這都要修正 你知道嗎我是要叫石崇亮署長你起來 董事長你就是署長嘛 |
| transcript.whisperx[283].start |
8248.972 |
| transcript.whisperx[283].end |
8256.338 |
| transcript.whisperx[283].text |
蘭嶼就是要設分院嘛這有什麼好講的有什麼好爭辯的所以我現在要講的就是說以前國民黨夭壽國民黨以前真的很夭壽要放十萬趟 |
| transcript.whisperx[284].start |
8271.553 |
| transcript.whisperx[284].end |
8275.237 |
| transcript.whisperx[284].text |
我2011年我背小英蔡英文總統去蘭嶼啦我去看到的現場慘不忍睹啦以前有人騙說要去罐頭工廠說去下去後 齁 青年就就業結果有去罐頭工廠嗎 有大咖的罐頭 55高輪的 都放合會了不對 你可能不記得齁 |
| transcript.whisperx[285].start |
8299.366 |
| transcript.whisperx[285].end |
8312.813 |
| transcript.whisperx[285].text |
我就說你要去因為你叫做衛福部部長我覺得你要去要去看一下說當年的政府怎麼去讀讀不然莫名其妙2018年蔡英文不會去道歉嘛不是啦 做總統後面道歉的就是說當初要去這個蘭嶼要放這個核廢料儲存場沒有蘭嶼的人知道 人家騙那產生的是什麼 |
| transcript.whisperx[286].start |
8327.93 |
| transcript.whisperx[286].end |
8342.079 |
| transcript.whisperx[286].text |
你如果說要顧老百姓的健康就很簡單啊藍瑜那個核肺療藏你給他刷照啊可不可能 不可能啊十碗湯要刷一堆第二天就是 有人刷照啊可不可能 也不可能啊兩種都不可能那怎麼辦那就政府的責任就來了你來人顧健康嘛 |
| transcript.whisperx[287].start |
8352.062 |
| transcript.whisperx[287].end |
8357.984 |
| transcript.whisperx[287].text |
我就不管說什麼蔡英文有沒有承諾什麼賴清德總統有沒有承諾 兩件事政府就是該做不然你合理吧 你特赤人嘛那個石中梁署長我這樣講合理吧合理喔 你也頂頭喔 欸 趙復師合理喔 你們都說合理喔你們就互相在推啦那些小外星人喔 叫做你趙復師的啦 |
| transcript.whisperx[288].start |
8376.493 |
| transcript.whisperx[288].end |
8383.735 |
| transcript.whisperx[288].text |
我們如果去賣他之後 他有話說的啦 他們就撒來撒去啦所以我有具體要求啦 柏中 盡量訂案啦盡量齁 你們整個新建計劃盡量出來 匡列預算啦稍微對不起 王委員我不是說結凍 我在說這個歷史這件事說得清楚你譬如說齁 我說我們屏東就好了 我們過去屏東好東西 |
| transcript.whisperx[289].start |
8403.359 |
| transcript.whisperx[289].end |
8416.751 |
| transcript.whisperx[289].text |
蔡英文都要 總統都要屏東 蘇貞昌院長也要屏東我覺得各個縣市去照顧 全國都照顧 合理你說賴總統現在在說健康台灣對不對偏鄉醫療你要提升啊我記錄給你聽啦我們屏東隆總 屏東隆總喔 才94億去好了嗎屏東部立醫院 才36億 |
| transcript.whisperx[290].start |
8430.097 |
| transcript.whisperx[290].end |
8433.678 |
| transcript.whisperx[290].text |
起好了嘛 現在在起嘛屏東旅遊醫院 起電館八樓 第二席一樓蘇貞昌院長怎麼說你知道嗎 一次大會 要人給人 要錢給錢經費無上限 我不跟你說 我不跟你說 你看 Google 你看 Google 蘇貞昌經費無上限 台東勒 |
| transcript.whisperx[291].start |
8454.025 |
| transcript.whisperx[291].end |
8457.246 |
| transcript.whisperx[291].text |
過去政府的不當的政策 荼毒整個蘭嶼我們不用騎個便宜的人所以我現在不是在跟你說 蓋醫院是不是選項 不是我講的是 在蘭嶼蓋醫院是叫做責任而且無可推卸的一個責任啊你這樣在那裡討論在那裡討論來討論去 上來上去快去啦 |
| transcript.whisperx[292].start |
8479.336 |
| transcript.whisperx[292].end |
8488.099 |
| transcript.whisperx[292].text |
醫護會不是這樣說?不是你自己起床把我扯一下而已嗎?你不是要起床把我托回來嗎?據理承諾的嗎?醫護會要替他報告,報告現在的進度啦不不,我又不替他進度,這叫責任我請部長據理承諾 |
| transcript.whisperx[293].start |
8495.339 |
| transcript.whisperx[293].end |
8524.015 |
| transcript.whisperx[293].text |
好 我想我們醫護會因為當時是土地的問題也沒有上來上去因為從108年其實在部內裡面就一直討論醫院的一個興建的一個計畫去評估然後土地當時是有問題的譬如說原來的土地那邊說不可以 那森林所在的地我們就亂去別的地方大量管政部在找當然現在有些地方看起來已經克服的差不多 |
| transcript.whisperx[294].start |
8524.355 |
| transcript.whisperx[294].end |
8539.557 |
| transcript.whisperx[294].text |
都扣有差不多沒問題的嘛我們現在就是今天提一個醫院新建的計畫來提公建計畫在這當中我們也一直在補充補充應該有的量能啦今年創的開備啦 |
| transcript.whisperx[295].start |
8546.642 |
| transcript.whisperx[295].end |
8561.67 |
| transcript.whisperx[295].text |
我們15筆土地裡面上面就是有2筆是被佔用的啦那另外這些土地其實是還需要我不跟你佔用那是什麼去排除,我說你的新建計劃我現在跟他說新建計劃,我告訴你你不給他具體答案,待會兒陳映會給你問得越嚴重我沒得騙你 |
| transcript.whisperx[296].start |
8566.772 |
| transcript.whisperx[296].end |
8573.775 |
| transcript.whisperx[296].text |
因為我們還是需要跟地方在這邊需要他的量比如說他的衛生索你告訴我 時間要當時我不敢 藍瑜在那裡我不敢退陳映萌但是我自己做我對台東的關心可以嘛你屏東旅遊醫院人家這樣開始去去白樓 怕卡住去白樓三年六個月喔 |
| transcript.whisperx[297].start |
8594.056 |
| transcript.whisperx[297].end |
8600.719 |
| transcript.whisperx[297].text |
去八樓 燈館八樓 地下一樓 開一個515喔你這要去多大 要三樓嗎三樓而已耶屏東旅遊院是137個床位耶你這要幾個床位不會超過40個吧好 那個細節是不是我簡單問你嘛 我要突顯出來嘛我要突顯出來嘛 你這幾個床位37吧 30幾吧 |
| transcript.whisperx[298].start |
8622.503 |
| transcript.whisperx[298].end |
8633.658 |
| transcript.whisperx[298].text |
離了三十幾屏東旅遊醫院一百三十七個蓋地上八樓 地下一樓三年半五月五年你這個比較有貴賺錢啦具體承諾不定好不好今年新建計劃提出來 |
| transcript.whisperx[299].start |
8639.619 |
| transcript.whisperx[299].end |
8652.222 |
| transcript.whisperx[299].text |
好 好 好 可以齁 你自己說的喔 待會請問你幾位要出來 我來講 謝謝好 謝謝莊瑞雄委員的質詢接下來我們請廖偉祥委員質詢謝謝主席 有請部長好 請邱部長 |
| transcript.whisperx[300].start |
8668.695 |
| transcript.whisperx[300].end |
8680.409 |
| transcript.whisperx[300].text |
委員好部長好今天我們討論這個議題是非常有意義的是那我想要請教一下部長可不可以簡單的用一句話來告訴國人什麼是我們今天討論的育立醫療 |
| transcript.whisperx[301].start |
8684.008 |
| transcript.whisperx[301].end |
8704.308 |
| transcript.whisperx[301].text |
毅力醫療就是希望民眾們能夠早一點來討論未來當他進入到幾種狀況不管是末期或者是足人或永久性的傷害沒辦法恢復的情況之下他的一個醫療的選擇有哪些他先做自主性的選擇 |
| transcript.whisperx[302].start |
8705.53 |
| transcript.whisperx[302].end |
8726.227 |
| transcript.whisperx[302].text |
對所以簡單來講因為為什麼要先開這個頭我想很多人對於這個題目可能不是很清楚所以育立醫療就是簡單來講就是在自己還能夠清楚表達的時候先和醫療團隊討論然後寫下萬一將來遇到重大疾病或者是沒有辦法清楚表達的時候 |
| transcript.whisperx[303].start |
8727.168 |
| transcript.whisperx[303].end |
8748.643 |
| transcript.whisperx[303].text |
可以想要接受或拒絕哪些維持生命治療或人工營養的正式決定確保自己的醫療選擇能被尊重嘛簡單來講我們要做一個這個開頭也算是宣講宣導一下所以我們針對於這件事情啊現行的這個我們今天要討論的吳懷呼就是跟 |
| transcript.whisperx[304].start |
8749.463 |
| transcript.whisperx[304].end |
8776.725 |
| transcript.whisperx[304].text |
成效到底是怎麼樣然後以及為什麼成效不佳它的障礙有哪些可能包含著費用包含著宣傳不佳包含著國人觀念那所以第一個就是想要問現在育立醫療照護的這個諮商ACP是採取類似自費的制度那它是成為民眾參與的比較大的障礙那根據媒體的報導或者是叫做不完全統計從最便宜可能有2000元 |
| transcript.whisperx[305].start |
8778.146 |
| transcript.whisperx[305].end |
8784.209 |
| transcript.whisperx[305].text |
到最貴8000元等等還有價格不低那收費標準也比較混亂一點那根據統計2023年全台簽署這個育歷醫療決定就是AD的部分人數僅佔成年人口的可能0.35%那剛剛也有人講到0.45%總之就是蠻低的 |
| transcript.whisperx[306].start |
8797.316 |
| transcript.whisperx[306].end |
8819.503 |
| transcript.whisperx[306].text |
所以簡單來講推行這個很好的政策但是成效不佳那當然顯見的剛剛有講到第一個障礙可能跟費用有關那有關於這個部分嘉義的陽明醫院的院長謝錦祥有指出ACP的人力成本高昂那現行的健保未納入給付導致醫院這個轉嫁成本至民眾形成經濟篩選的現象 |
| transcript.whisperx[307].start |
8821.864 |
| transcript.whisperx[307].end |
8848.992 |
| transcript.whisperx[307].text |
而且此問題在非都會區更嚴重那六都簽署的量佔總數的72%而且其中的台北市呢佔36%那也凸顯了這個城鄉資源的差距所以目前這個ACP是納入健保給付的現行事辦計劃是涵蓋剛剛有提到幾種比如說比較嚴重的病患癌末、前途失智或是公告重症居家照護等四大類 |
| transcript.whisperx[308].start |
8849.972 |
| transcript.whisperx[308].end |
8870.498 |
| transcript.whisperx[308].text |
那我們就想要請問像這個部分未來我們是不是要擴大至全民因為我剛剛也有委員說2026年的時候你們過去有宣示說2026年要擴大至全民但是今天的書面報告又提到尚需要深入的政策研議與詳細的預算規劃然後帶各界達成共識及實務運作更趨完備再行通盤監討修正 |
| transcript.whisperx[309].start |
8878.78 |
| transcript.whisperx[309].end |
8890.062 |
| transcript.whisperx[309].text |
那我是覺得說那這個好像是跟你們原本預期的有很大的差距所以想要請問部長那你們現在具體的規劃跟配套細節到底是什麼遇到了什麼困難 |
| transcript.whisperx[310].start |
8891.018 |
| transcript.whisperx[310].end |
8914.526 |
| transcript.whisperx[310].text |
好 我想如果能夠全民都來簽署這是非常好的理想那這當然牽涉到我們也檢討為什麼低的因素當然諮商費用是一個對 剛剛講過 費用一個重點那剛剛您一開始就幫忙先導真的很感謝我必須要再先導一下如果能夠簽討這個異例異組其實是愛的表現什麼叫愛的表現呢 |
| transcript.whisperx[311].start |
8920.481 |
| transcript.whisperx[311].end |
8936.856 |
| transcript.whisperx[311].text |
就是愛你的家人因為你的子女到最後不曉得這個爸爸到底要不要插管要不要做什麼很痛苦如果你能夠事先表示好的話讓醫療人員能夠按照爸爸媽媽的一個心願去做 |
| transcript.whisperx[312].start |
8938.306 |
| transcript.whisperx[312].end |
8955.606 |
| transcript.whisperx[312].text |
所以就是你去做好屹立一族其實是愛你家人的一個表現啦這個不是金錢所能衡量的那當然那個醫術師也做了很多的一個規劃健保署也一直在努力啦當然這個要配合財務的規劃啦 |
| transcript.whisperx[313].start |
8957.408 |
| transcript.whisperx[313].end |
8974.922 |
| transcript.whisperx[313].text |
對 謝謝所以我再進一步問因為剛剛有提到目前規劃大概是目前有的這個事辦是大概180萬人大概是54億然後要分階段那你們現在有沒有比較具體的實施的方式因為其實很重要的一點就是剛剛你們都有提到 |
| transcript.whisperx[314].start |
8976.644 |
| transcript.whisperx[314].end |
8983.029 |
| transcript.whisperx[314].text |
這個其實是健康投資所以你做得好其實這個應該是絕對長期對於健保的財務是更好的對於整個財務的狀況應該是更好的所以你的問題是你們應該要具體的去可不可以給本席報告因為你們目前就只講到這180萬元無私益的 |
| transcript.whisperx[315].start |
8998.2 |
| transcript.whisperx[315].end |
9016.695 |
| transcript.whisperx[315].text |
那這只是短期你們擔心短期一下子衝擊很大可是剛剛也講到不可能180萬人都去用嘛你要包含宣導還有包含觀念所以我在想這全民試用的部分是不是應該儘速推動你才有可能才有可能達到這個所謂的健康投資然後也可以在這個整個財務的狀況之下更加的有餘裕 |
| transcript.whisperx[316].start |
9020.158 |
| transcript.whisperx[316].end |
9046.592 |
| transcript.whisperx[316].text |
我們一定循序漸進就好像說所以我知道你循序漸進但是部長我希望你們可以給本席一個具體的你們評估目前的衝擊以及你們打算的目標你到底在幾年你現在這一兩年你打算這樣子180萬人那明年達到多少什麼時候全民適用是不是可以在2026年達到你們所謂的標準或者是你做不到你要到2027年因為我想我們就在這裡做一個 |
| transcript.whisperx[317].start |
9047.372 |
| transcript.whisperx[317].end |
9063.323 |
| transcript.whisperx[317].text |
做一個這個宣示所以希望請部長給我們一個具體的規劃不要用剛剛所謂說還要再討論還要再通盤檢討這樣子去拖延時間我相信你也是想要推動這個所以我覺得也要給自己一個目標去鞭策好不好 |
| transcript.whisperx[318].start |
9063.763 |
| transcript.whisperx[318].end |
9076.389 |
| transcript.whisperx[318].text |
那再來喔因為剛剛有講到費用的部分啦所以就回扣到這個納入健保的部分所以剛剛有說有甚至有這個很多的有一個65歲的阿姨啊這個媒體訪問啊這國際旅遊的這個領隊啊她退休之後其實她的這個財務狀況應該還不錯而且她觀念也算是比較開放但她還是不懂她就說她還是不懂為什麼要花錢去了解與選擇自己怎麼死 |
| transcript.whisperx[319].start |
9088.715 |
| transcript.whisperx[319].end |
9107.666 |
| transcript.whisperx[319].text |
那最後也是聽到是免費他才去報名所以這在證明了剛剛就說這個要趕快把你們的目標達成然後另外呢目前醫院也採取這個團體諮商所以現在就講到觀念的部分雖然說他可以降低人均成本也是一個調整的方式可是現行的團體諮商很多都是 |
| transcript.whisperx[320].start |
9108.386 |
| transcript.whisperx[320].end |
9125.368 |
| transcript.whisperx[320].text |
數位平身的這個陌生人一體參加整個氣氛其實也是有點像是大型團購現場就會比較覺得跟我們國人的觀念有所衝擊因為他對於生死的事情可能不像是國外可以接受這個陌生人一起的這種形式這部分是不是也有可以調整的空間 |
| transcript.whisperx[321].start |
9128.864 |
| transcript.whisperx[321].end |
9153.781 |
| transcript.whisperx[321].text |
謝謝委員指教其實所以我們去年有針對團體智商這邊然後開始做一些算是輔導作業發現是說如果是家族朋友一起的這一種效果最好對沒錯然後所以在這個地方我們其實已經開始針對醫院有做團體這邊有做一些輔導然後有一些給一些建議然後這些具體的建議要轉成文字變成衛福部這邊出的一些 |
| transcript.whisperx[322].start |
9154.221 |
| transcript.whisperx[322].end |
9159.989 |
| transcript.whisperx[322].text |
所謂的建議或指引的部分的話應該是今年下半年才會逐步的討論不過已經有發現我們輔導團隊已經有發現相關的問題以上很好對這就是我要跟你們講的這個問題要 |
| transcript.whisperx[323].start |
9167.183 |
| transcript.whisperx[323].end |
9181.779 |
| transcript.whisperx[323].text |
盡速的把它推動然後可以請到所有你們的具體的檢討報告和詳細的文字內容提供給本席辦公室好沒問題那再來就是全台約200多家的醫療機構有ACP服務可是全台的77%的鄉鎮市區是沒有諮商據點分佈不均 |
| transcript.whisperx[324].start |
9185.629 |
| transcript.whisperx[324].end |
9208.126 |
| transcript.whisperx[324].text |
那今天的報告有提出要擴大ACP的規模但沒有具體寫到措施是什麼所以我們在想這部分是不是要針對偏鄉地區可不可以結合長照或銀髮關懷據點開設這種行動的諮商站那也參考這個日本的在宅醫療聯繫的模式與精神由巡迴的團隊提供服務也是一種推廣的方式 |
| transcript.whisperx[325].start |
9209.327 |
| transcript.whisperx[325].end |
9231.061 |
| transcript.whisperx[325].text |
是不是可以這個都可以演繹演繹要做嘛要去做而且最重要是要維護他當時簽ACP的品質那我們也希望多利用到我們社區的醫療團隊是社區的醫療團隊我們鼓勵他們接受一定的訓練以後現在的接受比便利商店更多 |
| transcript.whisperx[326].start |
9231.561 |
| transcript.whisperx[326].end |
9250.193 |
| transcript.whisperx[326].text |
所以部長我今天提出的問題都希望你們儘速研議完之後給本席一個報告因為我們都是針對剛剛講的三大方向提出的現在的困境要告訴部長請你們趕快去做出評估跟推動那再來還有一個也是觀念的部分民眾對於這個病毒存在三大誤解32%認同認為是這個安樂死28%擔心簽署後 |
| transcript.whisperx[327].start |
9256.917 |
| transcript.whisperx[327].end |
9281.855 |
| transcript.whisperx[327].text |
遭放棄治療那19%認為是違反宗教教義然後此外還有家屬介入決策的傳統文化還很深那在2022年的高雄榮總的案例也顯示38%的AD簽署者遭親屬反對執行這都是實務上面你們要去克服的問題那另外我主要是要講那現行的法規的這個部分 |
| transcript.whisperx[328].start |
9282.375 |
| transcript.whisperx[328].end |
9295.785 |
| transcript.whisperx[328].text |
第九條要求二等親的家屬參與諮商那是不是會造成這個反而造成家庭壓力那也是不是可以修法允許這個獨居者經社工評估後可以免除親屬認同 |
| transcript.whisperx[329].start |
9298.786 |
| transcript.whisperx[329].end |
9313.941 |
| transcript.whisperx[329].text |
先補充一下就是剛剛委員推行獨居者這部分其實目前如果獨居者自己簽左右的切結書其實醫院還是可以進行諮詢因為實務面就看到現在獨居長者其實相對逐步在增加當中這個在 |
| transcript.whisperx[330].start |
9314.922 |
| transcript.whisperx[330].end |
9334.119 |
| transcript.whisperx[330].text |
已經做了相關的處理然後進一步我們在講的是其實要善終的部分的話剛剛委員有特別講到周圍親友特別是家人的阻止的這件事也是當初在立法的時候為什麼希望家屬一起參與透過家屬參與的時候在最後那一個決定 |
| transcript.whisperx[331].start |
9335.78 |
| transcript.whisperx[331].end |
9363.069 |
| transcript.whisperx[331].text |
才比較容易尊重病人的一個自主就是當初在設計的時候有這樣子的一個考量但是結果論就是我剛剛講出來就是結果論所以還是一樣費用宣導跟觀念還是有很大的問題和精進的空間其實你們要去檢討這個部分所以我最後就要跟你們講到一件事情就是剛剛也有提到宣傳的部分我們有很多的政策宣傳宣導衛教說實在的內容都偏向深色難懂然後也很無趣 |
| transcript.whisperx[332].start |
9363.729 |
| transcript.whisperx[332].end |
9374.413 |
| transcript.whisperx[332].text |
所以要做到好的效果蠻難的所以要請問部長一下如果某一個政令或是衛教宣導在你們臉書上要破千萬次的瀏覽量平均要花多少經費抓一個數字可以嗎我不知道請委員指教你抓不出來一個數字對不對其實以你們過去的你們過去的這些你看都才1.9萬次3208次1.6萬次其實都很少所以應該要去想更 |
| transcript.whisperx[333].start |
9393.101 |
| transcript.whisperx[333].end |
9411.869 |
| transcript.whisperx[333].text |
更好更創意的方式所以我現在就告訴你一件事現在南投有一間醫院有一個小編他打破了宣導的困難內容無聊的刻板印象讓在他的衛教的宣導影片有很好的效果他大概的成績像下面半年內追蹤數增加了4.5萬單月瀏覽次數突破了數千萬互動也破了100多萬 |
| transcript.whisperx[334].start |
9416.531 |
| transcript.whisperx[334].end |
9442.37 |
| transcript.whisperx[334].text |
所以你剛剛可能你們不曉得狀況可是你們在宣導上面的經費是非常高的所以我們在省經費預算的時候都知道可是這個小編他卻說他的薪水就是三萬元打死甚至沒有額外的花媒體採購的費用那院長這就是一個妥妥的人才所以他一PO出他三萬打死的時候他馬上一堆人下面挖角他然後可以印證這樣的人在我們的業界一定是很搶手 |
| transcript.whisperx[335].start |
9443.351 |
| transcript.whisperx[335].end |
9471.244 |
| transcript.whisperx[335].text |
那釋逢今天是五一勞動節那我覺得當然講說這樣的薪水叫做壓榨可能過於沉重但現實面就是你們在這方面的宣導可能只靠這樣的熱情的小編是沒辦法留他太久所以我們是不是可以請我們的部長去了解一下這個案子然後也要真的下定決心讓這個在醫療體系裡面的行政人員這些人才應該要有更好的待遇才不會白白流失這個人才可以嗎 |
| transcript.whisperx[336].start |
9471.584 |
| transcript.whisperx[336].end |
9487.808 |
| transcript.whisperx[336].text |
我們一定珍惜人才所以要改善他們的待遇這才是今天這個質詢的重要的重要的這個意義謝謝部長好謝謝好謝謝廖瑞祥委員的質詢我們現在休息10分鐘 |
| transcript.whisperx[337].start |
9509.183 |
| transcript.whisperx[337].end |
9517.687 |
| transcript.whisperx[337].text |
因為它是先弄那個,它們這樣,因為它是比較圓的那它就放畫,放畫一起這樣,然後這個板子,然後這個畫跟這個板子 |
| transcript.whisperx[338].start |
9529.917 |
| transcript.whisperx[338].end |
9530.738 |
| transcript.whisperx[338].text |
好好吃著吃著 |
| transcript.whisperx[339].start |
9552.276 |
| transcript.whisperx[339].end |
9552.516 |
| transcript.whisperx[339].text |
謝謝大家 |
| transcript.whisperx[340].start |
10105.68 |
| transcript.whisperx[340].end |
10106.641 |
| transcript.whisperx[340].text |
好 請各位回座 繼續開會 |
| transcript.whisperx[341].start |
10132.455 |
| transcript.whisperx[341].end |
10135.278 |
| transcript.whisperx[341].text |
好 謝謝主席 是不是要請邱部長請部長委員好 |
| transcript.whisperx[342].start |
10141.96 |
| transcript.whisperx[342].end |
10169.64 |
| transcript.whisperx[342].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 |
| transcript.whisperx[343].start |
10171.981 |
| transcript.whisperx[343].end |
10187.661 |
| transcript.whisperx[343].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中並不是只有年紀大的人在想對我來講我就是那 |
| transcript.whisperx[344].start |
10188.442 |
| transcript.whisperx[344].end |
10192.405 |
| transcript.whisperx[344].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 |
| transcript.whisperx[345].start |
10211.436 |
| transcript.whisperx[345].end |
10228.889 |
| transcript.whisperx[345].text |
你要給我還保障不要給我放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ACP的執行場域去委託代理人的資格放寬等等 |
| transcript.whisperx[346].start |
10240.658 |
| transcript.whisperx[346].end |
10269.855 |
| transcript.whisperx[346].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 |
| transcript.whisperx[347].start |
10271.075 |
| transcript.whisperx[347].end |
10280.82 |
| transcript.whisperx[347].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 |
| transcript.whisperx[348].start |
10294.246 |
| transcript.whisperx[348].end |
10301.169 |
| transcript.whisperx[348].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 |
| transcript.whisperx[349].start |
10315.094 |
| transcript.whisperx[349].end |
10337.706 |
| transcript.whisperx[349].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 做不下去啊 |
| transcript.whisperx[350].start |
10340.583 |
| transcript.whisperx[350].end |
10354.756 |
| transcript.whisperx[350].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 |
| transcript.whisperx[351].start |
10358.819 |
| transcript.whisperx[351].end |
10382.07 |
| transcript.whisperx[351].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 |
| transcript.whisperx[352].start |
10385.702 |
| transcript.whisperx[352].end |
10408.531 |
| transcript.whisperx[352].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毒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 |
| transcript.whisperx[353].start |
10409.882 |
| transcript.whisperx[353].end |
10415.688 |
| transcript.whisperx[353].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 |
| transcript.whisperx[354].start |
10422.343 |
| transcript.whisperx[354].end |
10437.015 |
| transcript.whisperx[354].text |
但DNR離這個病毒法的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年他其實有讓無效醫療和臨終關懷扶上檯面 |
| transcript.whisperx[355].start |
10450.385 |
| transcript.whisperx[355].end |
10476.297 |
| transcript.whisperx[355].text |
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 |
| transcript.whisperx[356].start |
10479.398 |
| transcript.whisperx[356].end |
10507.846 |
| transcript.whisperx[356].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 |
| transcript.whisperx[357].start |
10509.161 |
| transcript.whisperx[357].end |
10534.283 |
| transcript.whisperx[357].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 |
| transcript.whisperx[358].start |
10538.027 |
| transcript.whisperx[358].end |
10554.54 |
| transcript.whisperx[358].text |
只有看到那個summary沒有仔細看裡面的內文好他說他指出病毒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毒法的理想性 |
| transcript.whisperx[359].start |
10555.54 |
| transcript.whisperx[359].end |
10578.049 |
| transcript.whisperx[359].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 |
| transcript.whisperx[360].start |
10579.409 |
| transcript.whisperx[360].end |
10595.598 |
| transcript.whisperx[360].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 |
| transcript.whisperx[361].start |
10600.54 |
| transcript.whisperx[361].end |
10627.722 |
| transcript.whisperx[361].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 |
| transcript.whisperx[362].start |
10628.462 |
| transcript.whisperx[362].end |
10650.621 |
| transcript.whisperx[362].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有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 |
| transcript.whisperx[363].start |
10651.562 |
| transcript.whisperx[363].end |
10658.329 |
| transcript.whisperx[363].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 |
| transcript.whisperx[364].start |
10671.283 |
| transcript.whisperx[364].end |
10685.852 |
| transcript.whisperx[364].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 |
| transcript.whisperx[365].start |
10687.653 |
| transcript.whisperx[365].end |
10713.121 |
| transcript.whisperx[365].text |
這個可能在大家可行性上有疑慮然後呢在楊秀儀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利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 |
| transcript.whisperx[366].start |
10715.081 |
| transcript.whisperx[366].end |
10729.466 |
| transcript.whisperx[366].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 |
| transcript.whisperx[367].start |
10731.966 |
| transcript.whisperx[367].end |
10751.702 |
| transcript.whisperx[367].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% |
| transcript.whisperx[368].start |
10756.767 |
| transcript.whisperx[368].end |
10767.191 |
| transcript.whisperx[368].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%然後楊秀宇認為說 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 你可以告訴我嗎博帝你知道嗎 市長你知道嗎 |
| transcript.whisperx[369].start |
10779.946 |
| transcript.whisperx[369].end |
10796.193 |
| transcript.whisperx[369].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 |
| transcript.whisperx[370].start |
10796.713 |
| transcript.whisperx[370].end |
10822.996 |
| transcript.whisperx[370].text |
在整個過程當中產生了一個質疑所以在願意資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 |
| transcript.whisperx[371].start |
10824.412 |
| transcript.whisperx[371].end |
10837.108 |
| transcript.whisperx[371].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 |
| transcript.whisperx[372].start |
10839.551 |
| transcript.whisperx[372].end |
10854.403 |
| transcript.whisperx[372].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師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覺得可是我們要討論修法要讓這個法律更更更進階來討論它的問題發生在哪裡但何以如此啊 |
| transcript.whisperx[373].start |
10869.173 |
| transcript.whisperx[373].end |
10884.169 |
| transcript.whisperx[373].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 |
| transcript.whisperx[374].start |
10887.785 |
| transcript.whisperx[374].end |
10906.743 |
| transcript.whisperx[374].text |
因為此時此地和當時當地不同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 |
| transcript.whisperx[375].start |
10908.144 |
| transcript.whisperx[375].end |
10919.234 |
| transcript.whisperx[375].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 |
| transcript.whisperx[376].start |
10925.359 |
| transcript.whisperx[376].end |
10940.756 |
| transcript.whisperx[376].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 |
| transcript.whisperx[377].start |
10942.398 |
| transcript.whisperx[377].end |
10953.391 |
| transcript.whisperx[377].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 |
| transcript.whisperx[378].start |
10957.935 |
| transcript.whisperx[378].end |
10983.333 |
| transcript.whisperx[378].text |
就是說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於ACP跟AD的簽署率的低我剛剛講過DNR大家 |
| transcript.whisperx[379].start |
10986.295 |
| transcript.whisperx[379].end |
10994.364 |
| transcript.whisperx[379].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維生醫療大家都簽啦 十個有高的都有簽啦 |
| transcript.whisperx[380].start |
10998.027 |
| transcript.whisperx[380].end |
11017.475 |
| transcript.whisperx[380].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 |
| transcript.whisperx[381].start |
11018.115 |
| transcript.whisperx[381].end |
11028.341 |
| transcript.whisperx[381].text |
要回到臨終照護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 |
| transcript.whisperx[382].start |
11039.62 |
| transcript.whisperx[382].end |
11060.373 |
| transcript.whisperx[382].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 |
| transcript.whisperx[383].start |
11068.989 |
| transcript.whisperx[383].end |
11093.676 |
| transcript.whisperx[383].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 |
| transcript.whisperx[384].start |
11094.716 |
| transcript.whisperx[384].end |
11120.055 |
| transcript.whisperx[384].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會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 |
| transcript.whisperx[385].start |
11121.125 |
| transcript.whisperx[385].end |
11148.417 |
| transcript.whisperx[385].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 |
| transcript.whisperx[386].start |
11150.038 |
| transcript.whisperx[386].end |
11154.7 |
| transcript.whisperx[386].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 |
| transcript.whisperx[387].start |
11170.086 |
| transcript.whisperx[387].end |
11190.025 |
| transcript.whisperx[387].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 那要有好的藥門檻那麼高 要自己自費買不起 |
| transcript.whisperx[388].start |
11194.485 |
| transcript.whisperx[388].end |
11206.348 |
| transcript.whisperx[388].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 |
| transcript.whisperx[389].start |
11223.123 |
| transcript.whisperx[389].end |
11250.131 |
| transcript.whisperx[389].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 |
| transcript.whisperx[390].start |
11251.431 |
| transcript.whisperx[390].end |
11259.136 |
| transcript.whisperx[390].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 |
| transcript.whisperx[391].start |
11279.517 |
| transcript.whisperx[391].end |
11301.44 |
| transcript.whisperx[391].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 |
| transcript.whisperx[392].start |
11302.481 |
| transcript.whisperx[392].end |
11323.368 |
| transcript.whisperx[392].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% |
| transcript.whisperx[393].start |
11326.889 |
| transcript.whisperx[393].end |
11355.937 |
| transcript.whisperx[393].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 |
| transcript.whisperx[394].start |
11359.025 |
| transcript.whisperx[394].end |
11386.111 |
| transcript.whisperx[394].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 |
| transcript.whisperx[395].start |
11388.131 |
| transcript.whisperx[395].end |
11397.635 |
| transcript.whisperx[395].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 你的處長怎麼說 李建德怎麼說 |
| transcript.whisperx[396].start |
11411.087 |
| transcript.whisperx[396].end |
11418.889 |
| transcript.whisperx[396].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 |
| transcript.whisperx[397].start |
11434.81 |
| transcript.whisperx[397].end |
11443.37 |
| transcript.whisperx[397].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 |
| transcript.whisperx[398].start |
11444.457 |
| transcript.whisperx[398].end |
11468.966 |
| transcript.whisperx[398].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再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 |
| transcript.whisperx[399].start |
11470.046 |
| transcript.whisperx[399].end |
11477.658 |
| transcript.whisperx[399].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譬如說有那種 |
| transcript.whisperx[400].start |
11479.767 |
| transcript.whisperx[400].end |
11502.793 |
| transcript.whisperx[400].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比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現在告訴你說你的次長憑什麼他一個人說安樂時、斷食三中都不會成為衛福部的政策選項 |
| transcript.whisperx[401].start |
11504.349 |
| transcript.whisperx[401].end |
11523.899 |
| transcript.whisperx[401].text |
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 |
| transcript.whisperx[402].start |
11526.679 |
| transcript.whisperx[402].end |
11530.361 |
| transcript.whisperx[402].text |
90%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要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 |
| transcript.whisperx[403].start |
11545.626 |
| transcript.whisperx[403].end |
11560.615 |
| transcript.whisperx[403].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要去開啟社會溝通和對話對不對哪有可能你們一個次長就來說不可能 那我無愛我都無愛這樣都不用做了嗎 |
| transcript.whisperx[404].start |
11574.764 |
| transcript.whisperx[404].end |
11598.696 |
| transcript.whisperx[404].text |
我們幾十年來都一直在對話那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他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 |
| transcript.whisperx[405].start |
11600.578 |
| transcript.whisperx[405].end |
11620.024 |
| transcript.whisperx[405].text |
有沒有說過醫師協助自殺其實也是安樂死的一種我現在就是在講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 |
| transcript.whisperx[406].start |
11629.227 |
| transcript.whisperx[406].end |
11640.493 |
| transcript.whisperx[406].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 Physician |
| transcript.whisperx[407].start |
11650.29 |
| transcript.whisperx[407].end |
11674.927 |
| transcript.whisperx[407].text |
Physician Assisted Dying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我們說那樣不可能,我們不愛,我們不接受 |
| transcript.whisperx[408].start |
11679.534 |
| transcript.whisperx[408].end |
11684.557 |
| transcript.whisperx[408].text |
那你現在是怎樣 像林淑芬講的我自己吃到75歲 我自己下去煮飯你是要這樣子 |
| transcript.whisperx[409].start |
11689.721 |
| transcript.whisperx[409].end |
11714.499 |
| transcript.whisperx[409].text |
你知道我走出門 你知道多少人給我陳情立委啊 你就快讓他安樂死 合法化你就趕快立這個法律我告訴他什麼 你知道嗎我不知道怎麼定這個法律啦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 |
| transcript.whisperx[410].start |
11718.022 |
| transcript.whisperx[410].end |
11731.55 |
| transcript.whisperx[410].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來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 |
| transcript.whisperx[411].start |
11747.291 |
| transcript.whisperx[411].end |
11774.371 |
| transcript.whisperx[411].text |
我們可以繼續來我今天不是在講病毒法為什麼病毒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毒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 |
| transcript.whisperx[412].start |
11775.111 |
| transcript.whisperx[412].end |
11799.333 |
| transcript.whisperx[412].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計畫成果在哪裡 |
| transcript.whisperx[413].start |
11802.304 |
| transcript.whisperx[413].end |
11823.818 |
| transcript.whisperx[413].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用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 |
| transcript.whisperx[414].start |
11825.081 |
| transcript.whisperx[414].end |
11838.67 |
| transcript.whisperx[414].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剛梁秀儀主導這個政策 |
| transcript.whisperx[415].start |
11849.597 |
| transcript.whisperx[415].end |
11859.664 |
| transcript.whisperx[415].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 你要開支 你是政府 你要去做研究不是只說學者研究一分 這樣就好了我現在要聽學者 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 |
| transcript.whisperx[416].start |
11874.588 |
| transcript.whisperx[416].end |
11888.062 |
| transcript.whisperx[416].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接下來請黃修文委員來做詢問 |
| transcript.whisperx[417].start |
11904.083 |
| transcript.whisperx[417].end |
11904.504 |
| transcript.whisperx[417].text |
謝謝主席 我們請部長 |
| transcript.whisperx[418].start |
11918.792 |
| transcript.whisperx[418].end |
11938.166 |
| transcript.whisperx[418].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育立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 |
| transcript.whisperx[419].start |
11938.926 |
| transcript.whisperx[419].end |
11954.776 |
| transcript.whisperx[419].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 |
| transcript.whisperx[420].start |
11957.778 |
| transcript.whisperx[420].end |
11971.991 |
| transcript.whisperx[420].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 |
| transcript.whisperx[421].start |
11973.251 |
| transcript.whisperx[421].end |
11995.666 |
| transcript.whisperx[421].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 |
| transcript.whisperx[422].start |
11996.647 |
| transcript.whisperx[422].end |
12013.72 |
| transcript.whisperx[422].text |
抗生素那個時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 |
| transcript.whisperx[423].start |
12016.002 |
| transcript.whisperx[423].end |
12041.577 |
| transcript.whisperx[423].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10萬3千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10萬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 |
| transcript.whisperx[424].start |
12045.679 |
| transcript.whisperx[424].end |
12072.99 |
| transcript.whisperx[424].text |
對嗎5月1號就今天開始嗎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喔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這個說明 |
| transcript.whisperx[425].start |
12073.55 |
| transcript.whisperx[425].end |
12097.881 |
| transcript.whisperx[425].text |
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剛剛第一階段是70%可是後來發現幾年以後再做一次 |
| transcript.whisperx[426].start |
12098.686 |
| transcript.whisperx[426].end |
12104.039 |
| transcript.whisperx[426].text |
吻合力比較低為什麼我們專家的研究就是因為諮商的品質降低 |
| transcript.whisperx[427].start |
12105.349 |
| transcript.whisperx[427].end |
12123.815 |
| transcript.whisperx[427].text |
時尚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去要求品質嘛要求品質你現在給他幾戶當然是要求品質啊如果沒做好品質這個大概就不用說了 |
| transcript.whisperx[428].start |
12131.237 |
| transcript.whisperx[428].end |
12145.558 |
| transcript.whisperx[428].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指標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 |
| transcript.whisperx[429].start |
12147.625 |
| transcript.whisperx[429].end |
12167.724 |
| transcript.whisperx[429].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 |
| transcript.whisperx[430].start |
12169.005 |
| transcript.whisperx[430].end |
12187.9 |
| transcript.whisperx[430].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了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 |
| transcript.whisperx[431].start |
12188.36 |
| transcript.whisperx[431].end |
12203.44 |
| transcript.whisperx[431].text |
一年大概2萬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4萬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 |
| transcript.whisperx[432].start |
12204.221 |
| transcript.whisperx[432].end |
12233.403 |
| transcript.whisperx[432].text |
有去居家做的這一塊然後我們覺得是說這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示範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以上 |
| transcript.whisperx[433].start |
12234.063 |
| transcript.whisperx[433].end |
12244.57 |
| transcript.whisperx[433].text |
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議事那如果家人反對呢 |
| transcript.whisperx[434].start |
12245.529 |
| transcript.whisperx[434].end |
12268.056 |
| transcript.whisperx[434].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 |
| transcript.whisperx[435].start |
12269.785 |
| transcript.whisperx[435].end |
12294.225 |
| transcript.whisperx[435].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 |
| transcript.whisperx[436].start |
12295.566 |
| transcript.whisperx[436].end |
12314.137 |
| transcript.whisperx[436].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 |
| transcript.whisperx[437].start |
12314.617 |
| transcript.whisperx[437].end |
12341.472 |
| transcript.whisperx[437].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 |
| transcript.whisperx[438].start |
12343.133 |
| transcript.whisperx[438].end |
12367.234 |
| transcript.whisperx[438].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 |
| transcript.whisperx[439].start |
12369.737 |
| transcript.whisperx[439].end |
12383.633 |
| transcript.whisperx[439].text |
家屬跟這個醫師可能也許或者是病人本身也許如果會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說我可能 |
| transcript.whisperx[440].start |
12384.273 |
| transcript.whisperx[440].end |
12407.421 |
| transcript.whisperx[440].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 |
| transcript.whisperx[441].start |
12408.021 |
| transcript.whisperx[441].end |
12432.203 |
| transcript.whisperx[441].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公司還是會回到了尊重病人自主的一個狀況以上 |
| transcript.whisperx[442].start |
12433.885 |
| transcript.whisperx[442].end |
12454.731 |
| transcript.whisperx[442].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 |
| transcript.whisperx[443].start |
12456.703 |
| transcript.whisperx[443].end |
12478.847 |
| transcript.whisperx[443].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 |
| transcript.whisperx[444].start |
12479.307 |
| transcript.whisperx[444].end |
12505.769 |
| transcript.whisperx[444].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 |
| transcript.whisperx[445].start |
12506.59 |
| transcript.whisperx[445].end |
12535.814 |
| transcript.whisperx[445].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 |
| transcript.whisperx[446].start |
12536.555 |
| transcript.whisperx[446].end |
12539.023 |
| transcript.whisperx[446].text |
那有沒有就是醫療糾紛的這種狀況出現 |
| transcript.whisperx[447].start |
12543.639 |
| transcript.whisperx[447].end |
12568.246 |
| transcript.whisperx[447].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 |
| transcript.whisperx[448].start |
12569.446 |
| transcript.whisperx[448].end |
12584.582 |
| transcript.whisperx[448].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 |
| transcript.whisperx[449].start |
12586.264 |
| transcript.whisperx[449].end |
12615.263 |
| transcript.whisperx[449].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過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 |
| transcript.whisperx[450].start |
12616.604 |
| transcript.whisperx[450].end |
12642.863 |
| transcript.whisperx[450].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 |
| transcript.whisperx[451].start |
12643.783 |
| transcript.whisperx[451].end |
12667.973 |
| transcript.whisperx[451].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 |
| transcript.whisperx[452].start |
12670.296 |
| transcript.whisperx[452].end |
12686.518 |
| transcript.whisperx[452].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 |
| transcript.whisperx[453].start |
12688.78 |
| transcript.whisperx[453].end |
12715.3 |
| transcript.whisperx[453].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 |
| transcript.whisperx[454].start |
12716.661 |
| transcript.whisperx[454].end |
12735.727 |
| transcript.whisperx[454].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 |
| transcript.whisperx[455].start |
12737.389 |
| transcript.whisperx[455].end |
12758.525 |
| transcript.whisperx[455].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和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 |
| transcript.whisperx[456].start |
12759.085 |
| transcript.whisperx[456].end |
12781.036 |
| transcript.whisperx[456].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 當然土法不足以自省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 謝謝好 謝謝郭委員 謝謝部長 |
| transcript.whisperx[457].start |
12790.93 |
| transcript.whisperx[457].end |
12792.613 |
| transcript.whisperx[457].text |
來請王委員來謝謝主席麻煩邱部長邱部長 |
| transcript.whisperx[458].start |
12808.067 |
| transcript.whisperx[458].end |
12834.026 |
| transcript.whisperx[458].text |
委員好柏定今天真的是舌戰所謂的不是舌戰啦齁我意思是說讓大家討論啦這個真的是重要的議題因為進入到這個超高齡社會謝謝主席來這個議題謝謝是是啊啊我也知道你是在臨床上其實有很豐富的經驗也算是救命的專家所以今天這個機會好讓柏定來討論今天就是針對病毒法 |
| transcript.whisperx[459].start |
12837.867 |
| transcript.whisperx[459].end |
12853.394 |
| transcript.whisperx[459].text |
未來在落實上面這個人數還有品質可以兼顧不要說他就要增加這個比例然後就在這個品質上是無法兼顧這個就是今天我們要討論的地方其實我們也知道 |
| transcript.whisperx[460].start |
12855.795 |
| transcript.whisperx[460].end |
12877.405 |
| transcript.whisperx[460].text |
在這個討論的前提就是有這幾個重點包括我們是要以人為本以人為本前幾天賴總統也在健康台灣全國論壇上面我強調以人為本的醫療基本上還需要重視的就是推動安寧照護跟尊嚴善中的支持跟肯定這就是我們今天討論的主題 |
| transcript.whisperx[461].start |
12879.346 |
| transcript.whisperx[461].end |
12897.073 |
| transcript.whisperx[461].text |
可是我們也看到數據就是病俗法已經實施了5年還是有不到1%的民眾來簽署這方面的處理需求可能曾經大家都已經分析得很清楚包括可見性不足諮商費一開始的時候是自費 |
| transcript.whisperx[462].start |
12898.153 |
| transcript.whisperx[462].end |
12914.594 |
| transcript.whisperx[462].text |
後來才有健保的部分的處理還有就是民眾他剛才黃鄉委員有提醒民眾在這個接受度的部分到底會不會有根據他對知識對這個生命的理解能不能接受還有 |
| transcript.whisperx[463].start |
12915.936 |
| transcript.whisperx[463].end |
12933.636 |
| transcript.whisperx[463].text |
我們目前的現場執行的確有他的一些在處理上他要求比較嚴謹的地方那我們也知道如果依照今天早上部長的報告是以比較採像暫時不修法來做討論的話那就是要改善我們的政策 |
| transcript.whisperx[464].start |
12934.036 |
| transcript.whisperx[464].end |
12952.668 |
| transcript.whisperx[464].text |
那改善的政策呢就會包括有沒有機會來提高這個至上的可敬性擴大大家意計畫擴大健保給付跟強化政策宣傳那剛剛那個林書偉也有提到這部分怎麼來加強那真的要修改法律的話那應該要注意哪一些的事情 |
| transcript.whisperx[465].start |
12953.976 |
| transcript.whisperx[465].end |
12974.531 |
| transcript.whisperx[465].text |
那的確我們知道從今天開始就會擴大這個獄力一族的這些給付對象希望能夠在未來的一年裡面能夠增加兩萬人為目標來讓有更多的民眾來做這方面的處理那這方面的處理當然就會需要有比較相關的配套剛剛提到的政策 |
| transcript.whisperx[466].start |
12975.631 |
| transcript.whisperx[466].end |
12995.576 |
| transcript.whisperx[466].text |
我現在先請教一個問題剛剛部長有討論到其實如果能夠善用我們目前的安寧照護條例的一些條件的話事實上是也可以讓這個品質得到很好的照顧模式有民眾參加過這個屬於我們的這個病毒法的 |
| transcript.whisperx[467].start |
12996.596 |
| transcript.whisperx[467].end |
13008.065 |
| transcript.whisperx[467].text |
同意簽署以後同時又有參加那你知道我條例這些內容的不知道有沒有百分比上的數據可以呈現市長或是有沒有相關的數據 |
| transcript.whisperx[468].start |
13011.727 |
| transcript.whisperx[468].end |
13037.579 |
| transcript.whisperx[468].text |
這邊我沒有手邊沒數據我要再確認一下我覺得如果能夠知道有這個數據的話如果一個人一個民眾他願意同時同意這兩點的話我相信未來照顧在品質上或者是在跟家屬的溝通上是有他一定的這種不會造成大家在做臨床決策上的困擾我們也希望能夠看到這個數據 |
| transcript.whisperx[469].start |
13038.993 |
| transcript.whisperx[469].end |
13053.096 |
| transcript.whisperx[469].text |
好 我們再整理一下OK 好 那在馬雲部裡面這邊來處理所以針對未來要再利用這個部分提高的話希望能夠增加2.5萬人部長覺得這個機會大嗎這個樂觀還是不樂觀嗯 |
| transcript.whisperx[470].start |
13062.076 |
| transcript.whisperx[470].end |
13088.894 |
| transcript.whisperx[470].text |
市長我們相對樂觀的原因是因為過去的這五年我們發現是說簽署這個AD就是去做ACP智商AD的人其實過去都有一些生命情境是有相關經驗的才有這樣子的意願所以是說這次那個健保署針對的這個其實像有重大傷病或者是在我們那個加一整合計畫或者是全市全社區照顧計畫 |
| transcript.whisperx[471].start |
13089.994 |
| transcript.whisperx[471].end |
13106.062 |
| transcript.whisperx[471].text |
這邊大概都跟基層醫師這邊有相對密切關係長期信任信賴關係的所以第一個65歲以上是過去的他過去Potential Target裡面的熱於就是比較多去簽意願的人 |
| transcript.whisperx[472].start |
13106.502 |
| transcript.whisperx[472].end |
13134.498 |
| transcript.whisperx[472].text |
然後那個基層這邊是我們更希望能夠擴大的這一塊因為訓練的人數多了然後只是是說踏出這一步能夠盡可能的來做他協助他的病人來簽署AD的這件事情的話是我們今年下半年也希望跟健保署一起合作希望能夠擴大的然後我們這邊也會有輔導團隊大概先做示範看看那個怎麼輔導讓大家基層這邊更勇於跨出第一步這是我們 |
| transcript.whisperx[473].start |
13134.918 |
| transcript.whisperx[473].end |
13163.02 |
| transcript.whisperx[473].text |
所以我們相對而言是對增加兩萬再提高這件事情我們是樂觀的 以上好很期待這個樂觀可以有機會變成一個事實那如果我們希望讓這個樂觀更有機會的話那有沒有可能在以不修母法的前提之下針對我目前的這幾個相關的管理辦法來做處理包括說因為我們現在知道依照現在的管理辦法就是要求相對嚴謹嘛你就要 |
| transcript.whisperx[474].start |
13163.88 |
| transcript.whisperx[474].end |
13190.624 |
| transcript.whisperx[474].text |
有200床以上等等的一些限定條件我們也針對護理機構或者是長照機構目前的話是無法如果現在以不修法為前提之下要做這個調整的話有沒有可能在辦法裡面去跟以護理或者是長照機構是跟醫院本身是有附設的條件的情形之下他們可以做同等的服務模式 |
| transcript.whisperx[475].start |
13191.688 |
| transcript.whisperx[475].end |
13214.994 |
| transcript.whisperx[475].text |
我要講的是說過去這邊的這個管理辦法裡面在處理的一個是特殊專長的診所或醫院他的人員組成的資格其實並沒有說我講的是像護理社心這些一定要專屬在那家機構所以大家在社區裡面怎麼做協作的方式其實在過去的5年裡面我們有處理過然後 |
| transcript.whisperx[476].start |
13216.234 |
| transcript.whisperx[476].end |
13235.4 |
| transcript.whisperx[476].text |
為什麼要不同的角度然後為什麼一定要就是醫療機構的原因是因為在解釋這一段的時候有很多對於疾病的預後對於後來的介入措施這個產生的一些衝擊好處壞處這個一定要相當臨床經驗的人所以在現行的狀況下面的時候那 |
| transcript.whisperx[477].start |
13236.02 |
| transcript.whisperx[477].end |
13261.593 |
| transcript.whisperx[477].text |
從不同的角度因為像譬如說社新這些的他們對於病人的同理心得更高度所以我們才覺得是說用協作的方式其實可以達成目前是說可不可以擴大領域因為不需要這些人專屬在哪一家醫院也可以或者是用協作的方式避典我寫個例子好了我寫個例子譬如說以部立基隆醫院為例它自己有一個複測長照機構這複測長照機構依照現況可以做這個服務嗎 |
| transcript.whisperx[478].start |
13265.154 |
| transcript.whisperx[478].end |
13291.333 |
| transcript.whisperx[478].text |
他的醫師團隊可以他可以進到那個輻射機構裡面因為就是說健保署他在擴大這個計畫的時候我們要的ACP簽例的簽出來的AD要醫藥機構蓋章然後像以剛剛那個委員在講的布利基隆醫院外展的服務到他的輻射的護理之家然後評估完以後這件事情其實現況是可以的 |
| transcript.whisperx[479].start |
13291.493 |
| transcript.whisperx[479].end |
13307.029 |
| transcript.whisperx[479].text |
是所以如果說依照剛剛的說明看起來的話依照目前的管理辦法事實上是可以做好外展就能夠增加這個量能而且可以維持品質ok了解好那我們期待這方面在執行上可以更落實 |
| transcript.whisperx[480].start |
13308.19 |
| transcript.whisperx[480].end |
13314.515 |
| transcript.whisperx[480].text |
那我們知道那如果真的是要修法的話那有一些增點包括說這個開放這個諮商機構的條件跟範圍還有就是有關於這個人員的資格跟訓練 |
| transcript.whisperx[481].start |
13323.101 |
| transcript.whisperx[481].end |
13344.08 |
| transcript.whisperx[481].text |
當然也希望這個人員在做服務的時候都要有實務的經驗因為畢竟這是跟生命有直接相關的一種服務模式所以這個經驗上也必須要能夠堅持還有就是法源這個裁員到底是要政府編列預算啊或者是要透過健保的模式還有剛剛一直在討論的就是那個現場決策機制 |
| transcript.whisperx[482].start |
13345.982 |
| transcript.whisperx[482].end |
13368.944 |
| transcript.whisperx[482].text |
怎麼樣才能夠讓他可以在一定的品質之下不要造成這個醫病或者是醫師跟這個他的家人之間的一些處理上的一些干擱所以看起來如果要往修法方向的話似乎要進入主條討論之前如果有一個公聽會應該更能夠引起大家不同的意見或者是需求 |
| transcript.whisperx[483].start |
13369.705 |
| transcript.whisperx[483].end |
13389.405 |
| transcript.whisperx[483].text |
那召委剛好也是相關有認為需要修法那是不是也麻煩召委這邊等一下看能不能也讓大家知道說那我們委員會是不是需要再舉辦一個公聽會來再收集更多的一些想法跟意見當作未來修法的一個參考 |
| transcript.whisperx[484].start |
13390.866 |
| transcript.whisperx[484].end |
13409.977 |
| transcript.whisperx[484].text |
這個是我針對第一部分跟這個部長討論那後面很快的就針對醫療資訊的傳播正確性跟部長也來討論一下我們也知道今天其實有很多委員一直在討論說這個預例一組安寧緩和安樂死如果將來有需要討論的時候 |
| transcript.whisperx[485].start |
13411.158 |
| transcript.whisperx[485].end |
13433.64 |
| transcript.whisperx[485].text |
那這方面其實大家的資訊非常非常的多元非常的很難一下子去搞懂這幾個概念上的問題所以未來有沒有機會請布里這邊針對於這個相關的資訊能夠提供更為透明而且是正確至少民眾在做這方面的認知的時候是有所本的 |
| transcript.whisperx[486].start |
13434.461 |
| transcript.whisperx[486].end |
13453.483 |
| transcript.whisperx[486].text |
那這方面如果能夠處理到的話我相信對於未來在溝通的時候會有更好的一些引導方面那我們也知道其實最後就是有關於剛剛針對這個資訊的透明還有正確性真的非常非常的重要因為我們目前也知道 |
| transcript.whisperx[487].start |
13455.004 |
| transcript.whisperx[487].end |
13469.871 |
| transcript.whisperx[487].text |
比較屬於針對學者或者是臨床很希望針對我們這個健保是否能夠在現有的制度之下能夠持續永續那他們發出一些看法那他偷到一個 |
| transcript.whisperx[488].start |
13471.651 |
| transcript.whisperx[488].end |
13495.462 |
| transcript.whisperx[488].text |
這個頂尖的期刊結果大家也發現說原來這個資訊不是那麼樣的完整或者是不是那麼樣的一個正確的情形下會導致可能國外或者是這個期刊的這個讀者可能對於台灣這個醫療體制是會造成不當的認知那部長這邊也希望能夠有更有效去處理這個部分 |
| transcript.whisperx[489].start |
13495.862 |
| transcript.whisperx[489].end |
13501.039 |
| transcript.whisperx[489].text |
那這邊部長不知道能不能夠再做簡短的處理的方式讓我們知道 |
| transcript.whisperx[490].start |
13501.428 |
| transcript.whisperx[490].end |
13522.277 |
| transcript.whisperx[490].text |
好 前面這一張PowerPoint跟這一張回應一下第一個就是不管是安寧環的醫療的內容或者是說大家關心的醫師誰是自殺等等的相關的議題我覺得應該要更多的對話那我們也有在做這方面的努力那希望那個讓各位對 |
| transcript.whisperx[491].start |
13527.1 |
| transcript.whisperx[491].end |
13546.589 |
| transcript.whisperx[491].text |
對這個名詞的內容能夠更加了解來保護自己那第二個部分這個部分因為我們這位年輕的醫師他引用的引用的數據錯誤我們的Omicron的死亡率是0.16%他用一個58%這樣子那不是很可怕了嗎 |
| transcript.whisperx[492].start |
13554.13 |
| transcript.whisperx[492].end |
13574.675 |
| transcript.whisperx[492].text |
這樣的錯誤也寫出去我們也覺得Lancet在審查當中因為它有reference英文已經寫得很清楚我覺得他們的審查真的也是我也覺得說沒有仔細去看一下因為那個的確是很不合理那其他的數據當然有所錯誤所以然後因為錯誤的 |
| transcript.whisperx[493].start |
13575.956 |
| transcript.whisperx[493].end |
13585.644 |
| transcript.whisperx[493].text |
的一個數據導致於錯誤的解讀導致於錯誤的結論我想中醫大非常嚴肅的開了兩次的協助的理委員會 |
| transcript.whisperx[494].start |
13586.983 |
| transcript.whisperx[494].end |
13615.297 |
| transcript.whisperx[494].text |
正是在前天晚上就發出要求撤稿衛福部也是在昨天的下午也是做了一個論述也呈現我們台灣健保其實的成就以及我們醫療體系醫療防疫體系的努力希望能夠不但要求撤稿也希望讓刊登出來能夠讓期間的讀者知道台灣的努力這樣才對得起我們過去醫療人員 |
| transcript.whisperx[495].start |
13617.082 |
| transcript.whisperx[495].end |
13623.444 |
| transcript.whisperx[495].text |
提及政府的努力好 謝謝部長大家繼續努力好 謝謝下一位請劉建國召委發言 |
| transcript.whisperx[496].start |
13646.842 |
| transcript.whisperx[496].end |
13661.698 |
| transcript.whisperx[496].text |
謝謝主席,特別跟主席回報一下剛剛有講說提案委員,如果要提案要增加時間我要給王委員,也希望你可以給我提案更多時間第二件事情,這個法律基本上 |
| transcript.whisperx[497].start |
13663.32 |
| transcript.whisperx[497].end |
13679.715 |
| transcript.whisperx[497].text |
坦白講是應該行政跟立法院有一定程度的共識因為大家都知道這個必須要來推嘛是一個好的法律包含部長在當委員的時候也積極的參與甚至於很多的記者會相關的這樣的一個場合 |
| transcript.whisperx[498].start |
13680.202 |
| transcript.whisperx[498].end |
13687.552 |
| transcript.whisperx[498].text |
都有表達這個意願嘛對於病毒法這樣的一個推動這樣的一個力道的一個作為 |
| transcript.whisperx[499].start |
13697.285 |
| transcript.whisperx[499].end |
13709.351 |
| transcript.whisperx[499].text |
所以一定會有共識的時候我們才會積極來推動要產生共識當然有很多的一個方式第一個委員會第二個公聽會第三個相關的一些協調會我們到時候都還會邀請公部門還有一個醫界 |
| transcript.whisperx[500].start |
13713.013 |
| transcript.whisperx[500].end |
13727.712 |
| transcript.whisperx[500].text |
還有病團大家一起包含原有的這個提案的嚴委員包含孫教授等等等大家一起來共同來面對來處理但是今天有一個最大最大的共識我想基本上那病除法這個法律 |
| transcript.whisperx[501].start |
13728.653 |
| transcript.whisperx[501].end |
13754.826 |
| transcript.whisperx[501].text |
是要繼續推下去然後所謂的ACP跟簽署AD必須要提高量能這個也不是開今天委員會才產生的結果是剛剛透過部長 透過司長自己本身都有答覆相關委員的這樣垂詢的過程裡面我們所得到的這樣的一個答案也就是說從本法實施到現在 |
| transcript.whisperx[502].start |
13756.107 |
| transcript.whisperx[502].end |
13777.012 |
| transcript.whisperx[502].text |
每一個人都非常清楚將近六年時間那不到一趴不到0.05趴的這樣的不到0.05的這樣的一個簽署的人數到成儒部長所回應委員相關委員的答詢說這個吻合率我不曉得這個吻合率的定義什麼叫吻合率那當然也有其他委員在追尋 |
| transcript.whisperx[503].start |
13778.172 |
| transcript.whisperx[503].end |
13800.415 |
| transcript.whisperx[503].text |
真正有照當時簽署的AD然後去執行的這個執行率又是幾%我目前為止是沒有聽出任何答案但是部長有特別提到希望這個簽署AD的時候我們希望更嚴謹我們要提高這樣的品質要提高品質是從ACP就必須要來處理了 |
| transcript.whisperx[504].start |
13801.636 |
| transcript.whisperx[504].end |
13826.164 |
| transcript.whisperx[504].text |
但剛剛黃委員也有詮詢不過我並沒有聽出司長針對部長所講的所謂的簽署ACPAC所謂的這個預例醫療的照顧諮商的如何提高品質反而我是聽到司長答詢過程裡面是針對如何提高服務的量能包含從醫院的附屬機構婦女之家然後可以外展諸如此類 |
| transcript.whisperx[505].start |
13826.884 |
| transcript.whisperx[505].end |
13836.192 |
| transcript.whisperx[505].text |
的這個方向去討論嘛對不對所以到底部長講的這個如何提高這個ACP的醫療照護諮商的品質要如何提高很抱歉我從早上一直聽到現在我並沒有聽到這是第一點 |
| transcript.whisperx[506].start |
13843.999 |
| transcript.whisperx[506].end |
13866.156 |
| transcript.whisperx[506].text |
那第二點 我有沒有聽到所謂的已經簽署的疫力醫療決定書之後它的執行率到底是多少因為我只聽到吻合率是七成嘛那第三點 這是一個不爭的事實我想各位今天所有的委員應該多數啦多數都覺得說這個ACP的諮商的會用希望以後公部門重建保署 |
| transcript.whisperx[507].start |
13866.876 |
| transcript.whisperx[507].end |
13877.92 |
| transcript.whisperx[507].text |
等等等來做相關的指引那我們從去年的7月已經有做部分的這樣的一個病症的還有病人的指引那今天5月1號又擴大65歲重大疾病等嘛那因為我聽到 |
| transcript.whisperx[508].start |
13883.382 |
| transcript.whisperx[508].end |
13900.831 |
| transcript.whisperx[508].text |
這樣的一個發展我當然非常樂觀其成也看到蠻欣慰就是衛福部積極要來面對這個事情處理這個事情甚至要把ACP的相關的幾乎從健保裡面擴大相關的這些對象但是問題來了當 |
| transcript.whisperx[509].start |
13903.758 |
| transcript.whisperx[509].end |
13930.046 |
| transcript.whisperx[509].text |
當我們市長講說每年兩萬多人我們要提高到四萬多人要增加兩萬五千人基本上我當然是支持但你如何去提高你如何去提高因為剛剛市長所講的幾個面向基本上你要有百分之一百五十的成長還是百分之一二五的成長我是覺得市長是不是要講明確一點你的方法 |
| transcript.whisperx[510].start |
13931.432 |
| transcript.whisperx[510].end |
13951.521 |
| transcript.whisperx[510].text |
這個法律是正確的這個法律往前走的過程裡面它的執行力它的預期目標我們沒有辦法去在時間內達到那我們現在想要快速的去達到那你把設定一年要增加兩萬五的人這個來參與這個醫療的招募諮商的這個人數你如果去達標 |
| transcript.whisperx[511].start |
13958.496 |
| transcript.whisperx[511].end |
13986.862 |
| transcript.whisperx[511].text |
我希望你可以明確跟委員會說清楚這是第一點第二點你必須要給委員會一個適宜因為剛剛署長講說5月1號開始擴大65歲65歲的重大疾病等那兩類人數就高達180萬還不包含還不包含他原有的在去年開放的給付的對象 |
| transcript.whisperx[512].start |
13989.912 |
| transcript.whisperx[512].end |
14011.777 |
| transcript.whisperx[512].text |
也不包含身心健康主動要來簽署的主動要諮商加簽署的都不包含我再簡單的比喻說如果180萬照現金每年執行然有做ACP到簽署的這是兩個層次問題啦我們講說ACP就好2萬180萬除以2萬要幾年才可以完成 |
| transcript.whisperx[513].start |
14022.711 |
| transcript.whisperx[513].end |
14044.739 |
| transcript.whisperx[513].text |
如果變成四萬五要錢才可以完成不包括去年開始補助的部分不包括健康的主動要來簽署的要來接受要來要諮商的這是第二件事情那第三件事情這不是我說的吧很清楚北一聯講的 |
| transcript.whisperx[514].start |
14050.046 |
| transcript.whisperx[514].end |
14062.491 |
| transcript.whisperx[514].text |
部長應該很清楚嘛 今天開這個會我想牧產單位應該提供給相關資料給你當病處法開始正式實施的時候平均啦 要去做諮商的要掛多久一到三個月一到三個月我這邊有北藝連的這樣的一個對外的說法我有這個花蓮慈濟醫院的說法那如果是這個樣子 |
| transcript.whisperx[515].start |
14077.782 |
| transcript.whisperx[515].end |
14101.514 |
| transcript.whisperx[515].text |
你如果兩萬變成到四萬五要怎麼解決要怎麼處理現在姑且都不修法我們知道這個法律的目標方向是正確但是在執行上執行率就偏低的情況之下你要如果透過行政的作為透過相關的補助 |
| transcript.whisperx[516].start |
14104.041 |
| transcript.whisperx[516].end |
14113.751 |
| transcript.whisperx[516].text |
透過你所講的只有擴大一個小的範圍或怎樣如果讓你可以提升這樣的服務量能兼顧到品質今天是因為有這樣的情況所以才有委員主動的來提供應該朝向修法的這樣的一個範疇來做處理 |
| transcript.whisperx[517].start |
14128.3 |
| transcript.whisperx[517].end |
14147.014 |
| transcript.whisperx[517].text |
當然啦 當然修啊是不是可以可以就一步到位那也到位必啦但是可能有一些原有在執行的過程裡面我們就開始檢視的第幾條第幾條是不是應該有一些修正有一些放寬甚至有一些必須要更嚴謹 |
| transcript.whisperx[518].start |
14148.52 |
| transcript.whisperx[518].end |
14175.708 |
| transcript.whisperx[518].text |
剛剛黃委員有特別提到如果已經簽了預立醫療決定書到時候病患家屬有意見的情況之下要怎麼處理我坦白講這條文裡面規範得很清楚如果病患本身已經無意識的情況之下就是要照當時病患所簽的醫院人所簽的預立醫療決定書去執行法律有明文規定 |
| transcript.whisperx[519].start |
14177.193 |
| transcript.whisperx[519].end |
14190.252 |
| transcript.whisperx[519].text |
他可不可以發生在第七款第十四條的第一項裡面的第一款跟第五款因為他可能是默契但是他意識清楚有可能他想要復活他想要變化他想要出來裡面的營養他要去改變嘛對我看也有可能啊 |
| transcript.whisperx[520].start |
14193.897 |
| transcript.whisperx[520].end |
14219.144 |
| transcript.whisperx[520].text |
但是如果他是在第二款的這個第三款的植物人第二款的昏迷不可逆的情況之下他要怎麼去跟你變他要怎麼跟你再還回他的家屬怎麼可以不依照病患當時還是清楚的情況之下簽訂的預立醫療決定書去做任何改變那有可能火力就定在這邊啊 |
| transcript.whisperx[521].start |
14224.236 |
| transcript.whisperx[521].end |
14241.125 |
| transcript.whisperx[521].text |
所以我現在是今天從早一直聽到現在,我覺得到底是,大家覺得這些事情是必須要做的,也覺得這個遷鎖量是不足的,這個好像應該大家都沒有爭議嘛,但是我們怎麼擴大這個量能,有很多的方式管道。 |
| transcript.whisperx[522].start |
14246.862 |
| transcript.whisperx[522].end |
14272.477 |
| transcript.whisperx[522].text |
除了行政的作為 除了健保 健保署那修法裡面 難道不是也是解決之一嗎對不對 但是你們好像就把修法 馬上就把它關起來這個我覺得不太對吧我個人感覺不太對嘛不然我最後再講一個啦今天衛福部 坦白講就是要做利益眾生的事情嘛 |
| transcript.whisperx[523].start |
14273.51 |
| transcript.whisperx[523].end |
14297.405 |
| transcript.whisperx[523].text |
對不對,我們要利益什麼益,要利益什麼眾生很多人都提到,臺灣人口結構就是叫做生不如死嘛CBBC會比較少嘛,對於2021現在也適當啊再來,我們需要善終的病患,如果一直做無效的醫療他就一定叫做生不如死啦,這是另外一種狀態嘛,對不對 |
| transcript.whisperx[524].start |
14300.716 |
| transcript.whisperx[524].end |
14327.284 |
| transcript.whisperx[524].text |
那今天我們明明知道病出華來整個實施過程裡面就是為了要讓這些病患還是健康的人未來可能遇到這14條的第一款到第五款的其中一款的情況之下都未雨綢繆的面對自己未來的人生的生命的規劃更有尊嚴更能夠善終我們要降低這種無效醫療這也是 |
| transcript.whisperx[525].start |
14329.245 |
| transcript.whisperx[525].end |
14343.478 |
| transcript.whisperx[525].text |
這也是在利益眾生嘛那也是利益家屬嘛不要到最後讓家屬就剛剛委員提到的病患本身可能有所還回還是說家屬有很多的意見我們就是要利益眾生讓家屬不要去尊重當時這個病人自主所簽訂的醫療決定書了嘛對不對 |
| transcript.whisperx[526].start |
14355.026 |
| transcript.whisperx[526].end |
14366.83 |
| transcript.whisperx[526].text |
這也是在利益啊 不管是利益家屬 不管是利益這個病患也是利益在健保署啊 為什麼這麼講我覺得用補助這兩個字實在是太沉重了 也不夠專業但我們知道 這個法來實施的情況之下就是可以朝向降低所謂的無效醫療嘛 |
| transcript.whisperx[527].start |
14378.393 |
| transcript.whisperx[527].end |
14397.022 |
| transcript.whisperx[527].text |
降低無效醫療也就等同於叫做降低健保給付嘛降低健保費用嘛我們去做個評估雖然一年兩萬多到現在十萬就像部長所講的五合率就像執行率到底降低了多少的無效醫療 |
| transcript.whisperx[528].start |
14398.967 |
| transcript.whisperx[528].end |
14421.432 |
| transcript.whisperx[528].text |
來換算我們今天2500到3500的這樣的擴大相關的群組的補助加總起來 加減起來到底還是幾戶無效一人的幾戶大過於我們現在做這些ACP的智商的費用多過多少 還是少了多少還是我們必須要在幾年內可以把這樣趕過來 |
| transcript.whisperx[529].start |
14423.581 |
| transcript.whisperx[529].end |
14431.264 |
| transcript.whisperx[529].text |
所以我想為政者基本上開源節流這樣的一個作為跟智慧啦跟應變這是必要的條件啦所以我們不能一直在說我們要做這件事就給健保負擔多少給健保支付多少我們可能不會管理所以我們現在一百八十萬人一個人三千就五十四億對 |
| transcript.whisperx[530].start |
14447.284 |
| transcript.whisperx[530].end |
14468.654 |
| transcript.whisperx[530].text |
你必須要是休息調整但是問題是你去度薪多少出來等你一百八十萬人 比較適合來簽嗎然後醫療證書也都簽嗎對不對 好 但是也真的度到像你講的穩合率或執行率差不多20%就好 還是20%我們抓到30%那可以減少多少的無效醫療的費用 |
| transcript.whisperx[531].start |
14471.325 |
| transcript.whisperx[531].end |
14494.361 |
| transcript.whisperx[531].text |
不是很清楚啦,我們台灣人平均臥床的時間,這都外界講的,那正確數字是多少?是七年?是八年?是六年?七八年嘛對不對?七八年都在那裡,給他做那個不好的醫療,要花多少錢?多少人?要多花多少錢?給多少人就好喔?但是現在多少人要給他?是要兩千五、三千五的ACP的智商費用 |
| transcript.whisperx[532].start |
14496.647 |
| transcript.whisperx[532].end |
14515.122 |
| transcript.whisperx[532].text |
這個要你們很專業的去做評估今天在這個委員會我們大家可以好好來討論你們提供出來更精準的數字就像ACP我再請教一下ACP育育醫療照顧諮商算不算一個醫療行為部長我講這麼多你可以先回應我一句話嗎 |
| transcript.whisperx[533].start |
14522.457 |
| transcript.whisperx[533].end |
14550.297 |
| transcript.whisperx[533].text |
如果諮商應該不屬於醫療行為但是諮商的內容是在討論醫療行為是啦沒有錯嘛一樣嘛我今天要去買一個醫療的保險嘛我今天要去買一個醫療防癌的保險嘛那我在跟你討論醫療保險你賣我醫療保險的商品的內容的時候是不是叫醫療行為相對是不是在討論未來你可能遇到什麼狀況要接受什麼醫療的時候我這個 |
| transcript.whisperx[534].start |
14551.38 |
| transcript.whisperx[534].end |
14557.908 |
| transcript.whisperx[534].text |
癌症的還是相關的醫療保險要幾戶嘛所以在資商的範圍裡面我們要如果講說它叫做醫療行為 |
| transcript.whisperx[535].start |
14562.259 |
| transcript.whisperx[535].end |
14566.602 |
| transcript.whisperx[535].text |
他在討論醫療,沒有錯啊,他是不是醫療行為跟保險稍微不一樣啦,譬如我舉個例子譬如說病人說你人工輸液營養有1條嘛,上面是維持生命的治療 |
| transcript.whisperx[536].start |
14581.972 |
| transcript.whisperx[536].end |
14596.794 |
| transcript.whisperx[536].text |
一定你們不說什麼叫做維持生命治療 那就很難了是從壓胸 插管 打強心劑然後漸漸到要不要用抗生素 要不要用那個這些東西 |
| transcript.whisperx[537].start |
14597.875 |
| transcript.whisperx[537].end |
14616.113 |
| transcript.whisperx[537].text |
說實在的我是花了30年照顧過2萬個默許病人在安寧病房這30年來慢慢還是學到的所以的確是相當的深奧啦這個品質是無止境我們要去成長所以討論的這個部分的確是需要有專業人員 |
| transcript.whisperx[538].start |
14618.646 |
| transcript.whisperx[538].end |
14645.142 |
| transcript.whisperx[538].text |
來表達然後譬如說人工輸液好了在什麼時候不應該去是不是應該用鼻胃管的是不是應該去開個胃躁揉的或者打部分的營養劑或者是前營養劑這其實都是要針對病人的一個狀況這個我相信在ACP的時候一定會去討論人家病人一定會去問問的時候我們要如何回答不然怎麼簽下去 |
| transcript.whisperx[539].start |
14646.536 |
| transcript.whisperx[539].end |
14673.662 |
| transcript.whisperx[539].text |
主席是這樣啦這法叫做病人自主決定法嘛對不對我們現在補助諮商會的是針對有病症的嘛對不對沒有錯嘛過去是不給付過去不給付在署長之前是把他認定ACP不是醫療行為所以不給付那現在給付了就叫做醫療行為署長就笑了 |
| transcript.whisperx[540].start |
14674.844 |
| transcript.whisperx[540].end |
14680.819 |
| transcript.whisperx[540].text |
這第一點那第二點我們是針對病患的時候或許部長講這樣是一個範疇那像身體健康的 |
| transcript.whisperx[541].start |
14683.069 |
| transcript.whisperx[541].end |
14706.175 |
| transcript.whisperx[541].text |
我是身體健康的我要做醫療諮商的他還是會問後面那我要勾對不對我要勾我要不要接受同意我到時候不做維持生命治療他一定會問你不管是健康的一定會問啊那個是遇到14條第一項裡面的1到5款的情況之下 |
| transcript.whisperx[542].start |
14706.815 |
| transcript.whisperx[542].end |
14718.585 |
| transcript.whisperx[542].text |
在那個當下發生的時候才會有所謂的醫療行為嘛但我在諮商的時候怎麼會有醫療行為所以要有專業的一個要有專業的說明啦是 專業的說明就是有提供育育醫療照護諮商治醫療機構管理辦法第四條嘛講得很清楚嘛 對不對諮商機構應組成育育醫療這個照護諮商團隊與像解身諮商團隊 |
| transcript.whisperx[543].start |
14731.335 |
| transcript.whisperx[543].end |
14758.841 |
| transcript.whisperx[543].text |
至少包括現在人員嘛第一個醫師一人應具有專科醫師資格嘛對不對第二護理人員一人應具有兩年以上臨床實務經驗嘛第三心理師或社工人員一人應具有兩年以上實務經驗但是這個第二條第二項諮商機構的就前項第二款或第三款人員則依設置第一項人員應完成中央主管公告 |
| transcript.whisperx[544].start |
14760.721 |
| transcript.whisperx[544].end |
14782.588 |
| transcript.whisperx[544].text |
治癒醫療照護諮商訓練課程也就是說他還是必須要不管你是醫師不管你是護理師不管你是社卿人員你還是要完成所謂的諮商訓練課程嘛對不對醫師四個小時嘛護理社工心理六到十一個小時嘛今天今天今天這個當時這個管理辦法 |
| transcript.whisperx[545].start |
14785.543 |
| transcript.whisperx[545].end |
14798.068 |
| transcript.whisperx[545].text |
那個時代定下來的情境嘛好我們現在都是一樣依照這樣去執行啊沒有錯啊但是不講現狀遇到什麼狀況當北醫連這麼講當花蓮慈濟這麼講的時候當相關的醫院這麼樣的醫療緊繃的情況之下醫師還要來做這些事情 |
| transcript.whisperx[546].start |
14814.81 |
| transcript.whisperx[546].end |
14821.535 |
| transcript.whisperx[546].text |
你覺得現狀對醫師是好對想要去做ACP的對象是好這個大家在討論我們有訂建我們有說一定醫師非做不做不可是現今的狀況掛一個號從開始實施開始實施到1080到現在喔就是平均要去掛的就是一個月等到三個月啊現在5月1號 |
| transcript.whisperx[547].start |
14844.652 |
| transcript.whisperx[547].end |
14851.876 |
| transcript.whisperx[547].text |
署長這邊在支付65歲以上的180萬人當然不可能180萬人馬上做也不可能馬上18萬1萬8就好了你怎麼做下去你做不下去啦 |
| transcript.whisperx[548].start |
14860.595 |
| transcript.whisperx[548].end |
14882.367 |
| transcript.whisperx[548].text |
你絕對做不去嘛你現在擴展以後 其實場地 場域也擴展很大診所也都可以做的嘛診所可以做 我堅持我支持啊 可以啊所以應該是那個場域喔擴展到很大啦 沒錯你是醫生啦 會保健也對不對全國的醫術國會律師隊 台北市醫術國會律師隊這兩屆立委 還撲書 |
| transcript.whisperx[549].start |
14886.775 |
| transcript.whisperx[549].end |
14901.384 |
| transcript.whisperx[549].text |
你開清掃,我來幫你支撐,對不對?跟你看一個備份,你怎麼選擇?我當然會預約時間,譬如說我...預約嘛,對,預約嘛。我預約時間,我可以看望鏡,普通人現在都這樣啦,可以看望鏡。阿,月報約一段時間,有的是去做居家,月報有的是去刷店,他也可以約在月報,看兩三個房子,這樣來解決他的可能,因為這個有社區醫療群, |
| transcript.whisperx[550].start |
14916.451 |
| transcript.whisperx[550].end |
14918.012 |
| transcript.whisperx[550].text |
我覺得部長我們有一起到過日本參觀過 |
| transcript.whisperx[551].start |
14939.151 |
| transcript.whisperx[551].end |
14959.759 |
| transcript.whisperx[551].text |
不只是日本這個都蠻受到他們那個就是日本的那個評鑑制度跟我們不一樣嘛對不對他們那些評鑑師去列舉的就是優良的很棒的這些互惹人性互惹更好的這樣的一個級別的產道機構我們都有去參訪過嘛那甚至有美國的這個NGO團體特別到日本去認證這種機構都是Top的啦 |
| transcript.whisperx[552].start |
14969.042 |
| transcript.whisperx[552].end |
14987.694 |
| transcript.whisperx[552].text |
他們的長照機構很多都是多資種一起進入嘛他們在機構裡面可以申請健保幾戶也一併可以處理可以接受保險也一併可以來做雙種處理嘛那我就不清楚吧你當然也可以要你自己想到要開放更寬的這個範疇開放到診所那為什麼長照機構不行 |
| transcript.whisperx[553].start |
14993.161 |
| transcript.whisperx[553].end |
15015.18 |
| transcript.whisperx[553].text |
我就不清楚了,長照機構絕對不是像蘇委員所講的,人家說這幾天在想說,你連廟都會開放嗎?可以外展服務到長照機構外展可以到長照機構嘛,對不對?你們開宗明義,你們答覆我們的公文,你們答覆我們的報告書裡面,你寫到這三個外國,我就看不到了你把地高調到地十四條,你把我混到一團 |
| transcript.whisperx[554].start |
15017.161 |
| transcript.whisperx[554].end |
15045.926 |
| transcript.whisperx[554].text |
我不清楚你為什麼要把這種事情混在一塊啊你至始至終坦白講你對金鑄環境環核准之護理機構、長照機構、心理治療所、心理治療所、社工室、事務所或法人的這個提供的預立醫療諮商、照護諮商這是一件事情,就一個句號嘛你在講經一位醫師診斷後末期這是在講第十四條的第一項的第一款嘛 |
| transcript.whisperx[555].start |
15049.98 |
| transcript.whisperx[555].end |
15077.875 |
| transcript.whisperx[555].text |
你為什麼要把兩件事情放在一塊我們要解釋的是說過去我們在機構管理這邊透過醫療機構的外展服務然後那像診所端的其實他的相關的設計人員沒有其實可以不用他自己所謂的專任的這件事情所以在目前的制度執行上面其實有他的彈性空間在然後這一次的擴大的部分的話其實我們也希望用這樣子的量能來做一個擴大 |
| transcript.whisperx[556].start |
15078.775 |
| transcript.whisperx[556].end |
15103.159 |
| transcript.whisperx[556].text |
然後那我們意思是這邊的話其實是很多的醫師受完訓之後他其實是怎麼樣去提供這樣服務我們現在看到的落差的弱點是在不敢去提供服務所以我們會有那個輔導團隊來協助提供服務這樣子增加量能的部分我們覺得是增加量能的嘛 對不對你現在答覆跟我要做的事情目標是一致嘛 |
| transcript.whisperx[557].start |
15104.18 |
| transcript.whisperx[557].end |
15124.938 |
| transcript.whisperx[557].text |
寬寡上的落差我覺得是還是有啦 還是有我尊重啦 但是這兩件事情是不一樣的東西你把它放在一塊就不對嘛我簡單講一下第九條第一項第一款的修正我們是在就像你講的嘛我們要增加的諮商的這個機構嘛不增加目前醫療機構的執行負擔嘛 |
| transcript.whisperx[558].start |
15126.943 |
| transcript.whisperx[558].end |
15154.631 |
| transcript.whisperx[558].text |
我的想法是這樣 我不曉得想法是不是這樣 這第一啦那第二 我們這次的計劃是針對現在在臨床上遭遇到有困難有障礙的地方來進行處理所以因此必須回歸到現今的醫療現場狀況嘛你現在已經是做得起沒嘛 這樣嘛醫事人力真的有這麼充裕嗎 部長所以剛剛有特別提到 台北四年一目前關牌ACP就高達一到三個月啊你可以馬上徵詢嘛 台北執行院也要一個月啊 |
| transcript.whisperx[559].start |
15156.105 |
| transcript.whisperx[559].end |
15179.708 |
| transcript.whisperx[559].text |
跟你講就開始送到現在就是要一到三個月啊有改善了嗎有改變了你先保護我這個嘛有嗎我要講的是說過去一直大家來講的困境就是對醫院而言incentive也不夠量也不夠的情況下面要開更多的門診的這件事所以我才會覺得是要開更多的門診對因為排隊塞車所以要開更多的門診 |
| transcript.whisperx[560].start |
15182.27 |
| transcript.whisperx[560].end |
15195.179 |
| transcript.whisperx[560].text |
我們沒有我在講是說過去一直在大家在講的是困境所以我們才會什麼樣的困境你講的困境跟我認知的困境不就不一樣嗎 |
| transcript.whisperx[561].start |
15196.293 |
| transcript.whisperx[561].end |
15222.681 |
| transcript.whisperx[561].text |
所以我才會是說委員在這邊講的第一個是說塞車這個問題所以我們才會是說如果直覺的反應是開門診的這件事情那為什麼不善用基層的這一塊而且人都學過我沒有反對你要開放基層這一塊啊我從頭到尾沒有反對啊是你在反對我要擴大這些機構啊你不能講是你在反對我反而說我在反對你啊亂講啊 |
| transcript.whisperx[562].start |
15225.546 |
| transcript.whisperx[562].end |
15231.591 |
| transcript.whisperx[562].text |
自始至終我到現在跟你在對話的過程裡面誰反對你 看到證書所我第一次看到一個報告顯成這樣我第一次看到 柏中你如果做過兩天的事 你覺得看過這種報告 |
| transcript.whisperx[563].start |
15250.778 |
| transcript.whisperx[563].end |
15266.501 |
| transcript.whisperx[563].text |
你中間許十幾條你回應我兩條 除了你給我英文不是只有針對回答我 包括王委員你怎麼回其餘條文僅部分文字及配合實務運作修正無影響執行上的成效我就看你怎麼樣檢視你的執行上的成效了你 市長今年你要增加到四萬五喔我們說四萬呢 |
| transcript.whisperx[564].start |
15280.27 |
| transcript.whisperx[564].end |
15284.455 |
| transcript.whisperx[564].text |
好啦 減五千也沒關係啦我看你要逼死誰啊我看你要逼死誰啊現在已經是五月一號了第二劑過一半了你要從兩萬多變成四萬百分之一百啊擴大診所 我支持 |
| transcript.whisperx[565].start |
15304.798 |
| transcript.whisperx[565].end |
15314.307 |
| transcript.whisperx[565].text |
醫療機構延伸到護理之家外展我也支持 都沒有跟你反對那我請教一下講這些護理機構 床照機構 心理治療所 心理治療師你為什麼要反對我們在講的是協作的部分大家本來都是可以一起參與的因為本來在那個團隊裡面就會有這樣子的職類的人其實大家一起協作是沒有問題的啊是啊 沒有問題的啊 那你講啊 |
| transcript.whisperx[566].start |
15334.648 |
| transcript.whisperx[566].end |
15352.689 |
| transcript.whisperx[566].text |
這個你答覆嘛,有關修正條文,因為程序對象會用自應多方面,愛各界達成共識,所以我們所有委員的提案,提的所有的修正條文,就是沒有一條適用嘛,沒有一條符合要讓整個ACP的服務量能提升。 |
| transcript.whisperx[567].start |
15353.686 |
| transcript.whisperx[567].end |
15364.435 |
| transcript.whisperx[567].text |
我們所修的每一條就是讓要簽署AD的這個量能可以提升我們所修的每一個條文對ACP的品質也沒辦法提升 |
| transcript.whisperx[568].start |
15366.801 |
| transcript.whisperx[568].end |
15382.993 |
| transcript.whisperx[568].text |
AD也沒有辦法提升沒辦法增加對 那沒關係那我們就拭目以待嘛我們就要看你意思思健保署如果今天在5月以後不再擴大我就要看你如何去達標嘛達到你講的嘛那你現在設定這個標兩萬多變成4萬是什麼標是最低標還是中標還是你自己設定的標 |
| transcript.whisperx[569].start |
15395.119 |
| transcript.whisperx[569].end |
15416.673 |
| transcript.whisperx[569].text |
這剛剛講的5月要開始的180萬,你如何把相關的去執行的這樣的一個目標,存給委員會啊,多久可以完成啊。不包含這個啊,包含其他的7月份,包含健康的,要來盡早接受育育醫療照護諮商的對象。 |
| transcript.whisperx[570].start |
15424.644 |
| transcript.whisperx[570].end |
15450.507 |
| transcript.whisperx[570].text |
我想我們是非常開放的態度,如果臨床上真的需要改善的或需要修訂的,我們都是完全開放的態度來處理請委員放心,我們都可以來討論、來看怎麼樣修正但是最重要就是達到量跟值的一個提升,來照顧我們的病人 |
| transcript.whisperx[571].start |
15451.792 |
| transcript.whisperx[571].end |
15466.402 |
| transcript.whisperx[571].text |
好 沒錯 我想大家都要做對的事情 要做好的事情 要做利益中心的事情嘛 對不對但是不通記名就有偏見啦也不通記名就叫自己自己很厲害 |
| transcript.whisperx[572].start |
15469.264 |
| transcript.whisperx[572].end |
15478.809 |
| transcript.whisperx[572].text |
我認為當各位議員提出相關的手法案的時候,我認為經濟機關應該是先去面對,不然我就必須提出更好的手法,可以達成他們的目標。我簡單說,你們到現在連目標也沒有定。 |
| transcript.whisperx[573].start |
15488.795 |
| transcript.whisperx[573].end |
15508.736 |
| transcript.whisperx[573].text |
你如果說就變成四萬了,你如果變成四萬,你人家是有辦法擴大到所有你講的這樣的一個範疇什麼時候開始執行,什麼時候可以到位,沒有勒,也完全沒有勒然後我今天講說你這樣會不會造成更緊繃的醫療能力,會不會你這個要去思考啊,你們都來自醫界啊 |
| transcript.whisperx[574].start |
15510.863 |
| transcript.whisperx[574].end |
15517.91 |
| transcript.whisperx[574].text |
我這是善意提醒啦好謝謝謝謝劉建國召委的充分發言也謝謝部長跟市長的答詢下一位請陳培韻發言謝謝主席我可以直接請那個社家屬的人嗎謝謝 |
| transcript.whisperx[575].start |
15540.6 |
| transcript.whisperx[575].end |
15546.565 |
| transcript.whisperx[575].text |
那部長可以休息一下 但是還是要請部長聆聽就好了 不用上台沒關係好 社交署 謝謝好 組長無安我想快速跟您討論一下關於兒童托育服務法因為我知道現在修法在即 我想要先確認一下現在進度是已經送進院會了嗎 |
| transcript.whisperx[576].start |
15563.499 |
| transcript.whisperx[576].end |
15581.016 |
| transcript.whisperx[576].text |
下一張委員好我是我們科長好是科長已經送進院會了嗎關於兒童托育服務法行政院已經審查完畢了那後續會走程序來送立法院好所以看起來已經定案了嗎那可能後續我們辦公室的很多研究可能只能在後續修法的 |
| transcript.whisperx[577].start |
15582.577 |
| transcript.whisperx[577].end |
15602.021 |
| transcript.whisperx[577].text |
協商當中討論不過沒關係我還是要提出幾個觀點我不確定在你們現行的版本裡面我們其實看不到一些進度來第一個我們認為關於所謂的不適應保姆這件事情其實在之前的凱凱案的時候我們做了一些加成管理跟修法的部分那我認為可是還有更多優秀的保姆他需要被獎勵所以我今天會分兩個部分第一個是關於不當對待的處罰目前我們在你們的版本托育人員相關違反相關規定的版本裡面 |
| transcript.whisperx[578].start |
15610.723 |
| transcript.whisperx[578].end |
15625.32 |
| transcript.whisperx[578].text |
有把這個違反的情節分成所謂違法情節重大或者是違法尚非情節重大或者是違法情節輕微者我很好奇你們到時候要怎麼定義這個東西是在相關執法或行政命令當中說明嗎因為這個樣態我認為非常的複雜 |
| transcript.whisperx[579].start |
15628.971 |
| transcript.whisperx[579].end |
15641.894 |
| transcript.whisperx[579].text |
而我們會定相關的執法那另外針對調查人員會來做培訓好所以調查員的培訓你們想像中什麼樣的人可以來幫這些調查員上課什麼樣的專家學者哪一些領域的 |
| transcript.whisperx[580].start |
15643.727 |
| transcript.whisperx[580].end |
15660.005 |
| transcript.whisperx[580].text |
有一些是法律專家也會有實務的工作者我們這邊會參考目前教育部在培訓教保人員的這些不當對待人員的調查人員的訓練來去做規劃好所以調查人員確定有培訓因為所謂調查人員是種子調查員之後他們就可以去做後續的調查對不對 |
| transcript.whisperx[581].start |
15663.148 |
| transcript.whisperx[581].end |
15668.394 |
| transcript.whisperx[581].text |
好可是如果在現場第一時間的判斷的樣態非常複雜我認為我們行政機關還是要先主動的來想像這個樣態會是什麼當然因為現在修法在即我認為還有很多事情要討論我只是先做出善意的提醒好第二個 |
| transcript.whisperx[582].start |
15678.246 |
| transcript.whisperx[582].end |
15695.101 |
| transcript.whisperx[582].text |
我們看到現在很多保姆不當行為目前的處置辦法呢就是他有被抽檢到發現說他把小孩丟在家裡然後他就跑去買菜了或者是讓小孩趴睡而目前這個抽檢的狀況呢他都只是留下一個記錄他也沒有辦法公開甚至我們也沒有把這個違法的 |
| transcript.whisperx[583].start |
15695.922 |
| transcript.whisperx[583].end |
15708.308 |
| transcript.whisperx[583].text |
我們以為是事情很小這些違法的樣態呢做成對於這個保姆的評價的內容我認為這個很有問題那很多專家學者也已經提出建議我不知道你們後續在這件事情上的態度是什麼 |
| transcript.whisperx[584].start |
15710.065 |
| transcript.whisperx[584].end |
15737.688 |
| transcript.whisperx[584].text |
呃這個部分就像委員的簡報所看到我們在我們的托法的第8條已經明定我們未來會有針對托育服務的內容跟其他事項去訂定一個實施準則讓第一線還有我們的相關執法人員對於這個樣態的部分有更明確的一個那個證定沒錯就是你說這個實施準則可是我要說的是所謂好的服務樣態你們會寫嗎這個大家都會列可是哪些是不能踩的紅線我認為應該要寫清楚 |
| transcript.whisperx[585].start |
15738.578 |
| transcript.whisperx[585].end |
15758.083 |
| transcript.whisperx[585].text |
我們會參考那個教育部目前的定法跟我們拖鷹的食物的一個操作來去定這個執法或者是你們應該也要跟地方居托中心討論他們在過去收集相關的違法的案例當中有哪些樣態是你們認為生物主管機關所不能接受的我們也才可以跟一般人民交代可以嗎 |
| transcript.whisperx[586].start |
15758.903 |
| transcript.whisperx[586].end |
15765.091 |
| transcript.whisperx[586].text |
好OK好很積極來再來我們講到獎勵的部分目前各縣市托育費用的調整狀況說實話22個縣市都不一樣 |
| transcript.whisperx[587].start |
15769.781 |
| transcript.whisperx[587].end |
15799.001 |
| transcript.whisperx[587].text |
薪水的狀態也不一樣加薪的幅度也不一樣可是目前之所以會產生這個困境是因為這些保姆的薪資是由中央交給地方政府自行訂定所以產生個性是落差很大有沒有機會帶回中央來討論如何設定一個好的薪資集聚或者是調薪的邏輯跟原則讓願意留在這個產業照顧小孩的這些保姆們他們會覺得這件事情是有意義跟有價值的 |
| transcript.whisperx[588].start |
15799.861 |
| transcript.whisperx[588].end |
15813.112 |
| transcript.whisperx[588].text |
像我自己現在服務的馬祖六年來一次都沒有漲可是高雄六年就調薪了三次那當然跟當地的物價水準有關也跟服務的樣態有關可是我認為我們中央還是要有一些態度不知道這件事情你怎麼看 |
| transcript.whisperx[589].start |
15814.606 |
| transcript.whisperx[589].end |
15843.285 |
| transcript.whisperx[589].text |
我們在未來的托法已經會明訂有關保姆的收費項目的部分會由中央統一訂那收費的數額的部分因為還是考量到各地方政府他的物價指數等等的部分會由地方政府來去訂這個價格那我們之前也有透過相關的會議去要求各地方政府因為現行我們的管理辦法其實就有明訂地方政府要定期去依照狹內的物價指數去訂這個可是因為沒有他們沒有做到嘛所以 |
| transcript.whisperx[590].start |
15845.386 |
| transcript.whisperx[590].end |
15861.596 |
| transcript.whisperx[590].text |
對所以後續所以我們剛剛有提到我們有在相關的聯繫會議要求地方政府要回到他們自己的托育委員會去檢視他們保姆的一個定價的一個合理性好 我覺得要更積極啦好 我們有相關辦法但是縣市政府如果不做我們好像也沒有辦法對不對 |
| transcript.whisperx[591].start |
15862.557 |
| transcript.whisperx[591].end |
15879.74 |
| transcript.whisperx[591].text |
好再来我们也希望可以建立优良保姆的奖励跟公开机制目前的平台上面我们可以查到的是所谓有证照的合法保姆可是我认为在过往我们都没有奖励所谓优秀的保姆这件事情有没有机会在未来的平台上可以注记所谓的优良保姆名单建立奖励机制 |
| transcript.whisperx[592].start |
15880.861 |
| transcript.whisperx[592].end |
15898.827 |
| transcript.whisperx[592].text |
這個我們後續可以再跟地方政府再討論看什麼樣的一個資訊可以再揭露出來讓家長選擇好那要揭露資訊他就有搭配相關辦法所以我想後續這個都再來討論好最後一個家外安置的兒少受到居家推育的照顧目前我們要看到很多 |
| transcript.whisperx[593].start |
15899.747 |
| transcript.whisperx[593].end |
15917.907 |
| transcript.whisperx[593].text |
被居家托育的孩子他可能就是原生家庭出了狀況嗎那你們目前現在做法呢不管他是到寄養家庭或者是安置機構他其實還會有居家托育的部分目前中央有訂定地方政府所謂運用居托人員照顧家外安置兒童處理的原則可是我們認為這個原則現在有些問題想要跟你們討論第一個 |
| transcript.whisperx[594].start |
15920.209 |
| transcript.whisperx[594].end |
15949.949 |
| transcript.whisperx[594].text |
因為這些孩子都是身心受過傷的他的照顧難度比較高雖然居托的保姆有搭配相關的職能培訓可是居托中心的仿事員並沒有相關的職能跟培訓所以比起所謂的兒少保社工我們認為這些仿事員缺乏所謂家外安置相關的評估照顧狀況跟理解這個風險的能力所以我們也懷疑甚至我們擔心很多轉介單位很容易把個案視為是一般的居托案 |
| transcript.whisperx[595].start |
15950.689 |
| transcript.whisperx[595].end |
15977.786 |
| transcript.whisperx[595].text |
也就是原本这些身心受伤的孩子他就被评估为一般居家托育案件而不会完整的揭露所谓安置儿童跟原生家庭的资讯那我们如何考虑到这个被安置儿少的特殊性他不应该一体直接适用所谓居托寄有的规范这些事情听起来有困难但是我认为在凯凯案身上我们应该要学到这个教训所以我想问一下这件事情有没有机会往下讨论我们是直接建议修改处理原则的三四五 |
| transcript.whisperx[596].start |
15980.249 |
| transcript.whisperx[596].end |
16006.124 |
| transcript.whisperx[596].text |
因為這個涉及到委員這邊有具體的一個修正的建議最後我們再跟委員辦公室再來做討論這麼多具體的建議我們希望可以在一個月內積極跟社家署展開相關會議討論雖然說你們說已經送到院會後續要走相關程序但我認為在後續修法會議當中我們看到現場所反映出來的狀況我們真的還是要改善入法好嗎好 謝謝社家署 謝謝主席好 謝謝陳培文委員的發言謝謝社家署的答詢 |
| transcript.whisperx[597].start |
16007.515 |
| transcript.whisperx[597].end |
16027.108 |
| transcript.whisperx[597].text |
下一位 仰號委員發言請謝謝主席 主席請一下邱部長請邱部長委員好 部長好 |
| transcript.whisperx[598].start |
16029.023 |
| transcript.whisperx[598].end |
16049.094 |
| transcript.whisperx[598].text |
部長我先確認幾個問題因為我們病人自主潛力法上路那麼久了台灣簽署的人數未達一趴到底最主要的原因是什麼當然我們這個原因應該是有多重因素 |
| transcript.whisperx[599].start |
16058.346 |
| transcript.whisperx[599].end |
16080.597 |
| transcript.whisperx[599].text |
當然過去的調查會顯現說因為他的費用比較費用的因素是一個因素但是是不是一個絕對的因素在有待觀察這樣子好那我就先講費用因為部長講到費用是健保不給付對不對從去年開始7月 |
| transcript.whisperx[600].start |
16088.43 |
| transcript.whisperx[600].end |
16097.434 |
| transcript.whisperx[600].text |
住院的那5月又擴展到65歲上的一個多重疾病我是這樣子建議啦齁我向來主張 |
| transcript.whisperx[601].start |
16103.823 |
| transcript.whisperx[601].end |
16127.177 |
| transcript.whisperx[601].text |
把錢花在前端上像我覺得預防醫學多花一點錢後續的醫療支出就減少那也一樣就是就是疫力醫療可以減少以後很多很多無益無效的醫療所以我是主張盡量放寬 |
| transcript.whisperx[602].start |
16130.953 |
| transcript.whisperx[602].end |
16146.938 |
| transcript.whisperx[602].text |
免費的健保給付的對象這個是我的主張第二個問題就是好像是劉金國委員的資料通常是對的所以假如說預約要立醫療 |
| transcript.whisperx[603].start |
16152.937 |
| transcript.whisperx[603].end |
16169.519 |
| transcript.whisperx[603].text |
醫療簽署必須要那麼久的時間會不會也是影響簽署人數的一個很重要的因素部長覺得會不會因為他是預約還是預約得上所以到底 |
| transcript.whisperx[604].start |
16172.63 |
| transcript.whisperx[604].end |
16197.298 |
| transcript.whisperx[604].text |
過去的研究裡面等候時間比較沒有在前面幾名前面幾名大概有兩大因素一個是費用一個是民眾認知就是醫院的問題這是兩大因素然後其他的以等候時間這邊的話有出現過可是它並沒有在前面所以它可能是一個影響因素可能不是主要影響因素以上就是說對於 |
| transcript.whisperx[605].start |
16199.098 |
| transcript.whisperx[605].end |
16222.295 |
| transcript.whisperx[605].text |
疫力醫療決定的認知可能是一個因素對不對然後費用是一個因素那費用剛才我們講過了那有關疫力醫療的認知的問題還是要加強宣導因為我覺得像我個人就還蠻支持大家都去做疫力醫療的因為這個可以避免很多困擾 |
| transcript.whisperx[606].start |
16225.748 |
| transcript.whisperx[606].end |
16253.809 |
| transcript.whisperx[606].text |
那假如說是真的也有部分的地區是必須要等候很久才能夠看到門診我想要請教一個問題就是我們簽署屹立醫療的時候呢是必須要我先問好了屹立醫療的簽署到底是不是醫療行為 |
| transcript.whisperx[607].start |
16257.554 |
| transcript.whisperx[607].end |
16272.966 |
| transcript.whisperx[607].text |
你到底是不是醫療行為簽AD這個動作簽署這個鉤嘛 簽名這個應該不算醫療行為啦石川署長說不算那不算醫療行為 |
| transcript.whisperx[608].start |
16276.122 |
| transcript.whisperx[608].end |
16297.021 |
| transcript.whisperx[608].text |
那我問一下就是因為簽署的時候我們必須要有醫師護理師然後心理諮商師社工等等我想問一下醫師到底在醫療的時候他的角色是什麼他扮演什麼角色 |
| transcript.whisperx[609].start |
16298.885 |
| transcript.whisperx[609].end |
16306.395 |
| transcript.whisperx[609].text |
部長你懂我的問題嗎?我想這個辦法是過去定出來的啦,也不是我...那我現在,以我的個人經驗來講,那個在...因為... |
| transcript.whisperx[610].start |
16315.947 |
| transcript.whisperx[610].end |
16331.095 |
| transcript.whisperx[610].text |
說實在在開辦,譬如說某個醫院,像台大醫院在開辦這個諮商門診也是我們幫忙去設立的,當然我也會去看幾次裡面的角色醫師,因為他有兩大類,一個是說維持生命的治療 |
| transcript.whisperx[611].start |
16333.456 |
| transcript.whisperx[611].end |
16350.126 |
| transcript.whisperx[611].text |
第二就是人工的營養輸益所以我現在一個民眾我同意到時候不用維持生命治療他一定會問你這是什麼東西 |
| transcript.whisperx[612].start |
16352.078 |
| transcript.whisperx[612].end |
16376.732 |
| transcript.whisperx[612].text |
那你當然就會跟他講說這包括鴨胸啊那這個可能是護理師就可以像我啦 保定沒關係我也不想佔用太多時間因為我們現在是修法的大體詢問所以我是說大家想一想看要怎麼讓醫療更 |
| transcript.whisperx[613].start |
16381.494 |
| transcript.whisperx[613].end |
16401.039 |
| transcript.whisperx[613].text |
更可見性提高一點啦我覺得應該是很多人都會因為現在的人就是人生終須一別嘛假如可以自己做決定的時候到我有法定的 |
| transcript.whisperx[614].start |
16404.478 |
| transcript.whisperx[614].end |
16432.596 |
| transcript.whisperx[614].text |
規定的事項成就的時候我可以自己做決定這個我想很多人接受啦我們看透過這一次的修法能不能讓更多的人願意願意參與的人很方便就參與那不知道資訊的人讓他知道資訊好不好其他我們大概就是修法的時候再來做討論啦我還是要講一個健保的問題 |
| transcript.whisperx[615].start |
16437.027 |
| transcript.whisperx[615].end |
16456.256 |
| transcript.whisperx[615].text |
部長總統拋出了健保不同工不同酬的想法保證你立場是什麼我想我支持啊應該那個尤其比較手術比較複雜的我大力支持而且我覺得風險醫療糾紛的風險越高的科別報酬也要不投 |
| transcript.whisperx[616].start |
16465.441 |
| transcript.whisperx[616].end |
16483.174 |
| transcript.whisperx[616].text |
我覺得我們不應該再放任讓五大皆空就是說不能夠所有的給付都一樣然後醫師的人員每年控款一千三 |
| transcript.whisperx[617].start |
16484.437 |
| transcript.whisperx[617].end |
16510.4 |
| transcript.whisperx[617].text |
然後讓這些人自由選擇科別那比較高風險工作繁重然後必須要緊急的像急診讓這些科別一直沒有人投入這個對於台灣高齡化發展趨勢這麼迅速的社會是很危險的一個現象 |
| transcript.whisperx[618].start |
16512.872 |
| transcript.whisperx[618].end |
16535.993 |
| transcript.whisperx[618].text |
這個你們能不能趕快把它訂出來有啊 一直在努力要不要市長報告我們謝謝委員關心確實我們今年先從急診症開始所以急診的診察費還有護理費急性一般病床ICU這些我們都先調高今年一共預注42億 |
| transcript.whisperx[619].start |
16537.634 |
| transcript.whisperx[619].end |
16566.875 |
| transcript.whisperx[619].text |
那另外接下來這個產科也是從今天5月1號開始夜間假日出來執行業務也加成30%所以這個都是相對風險高投入心力辛勞的接下來還有兒童重症那我們逐科逐科的會去討論調整現在你們調整的方向就是只有就內外婦兒急診的部分來做提高嗎 |
| transcript.whisperx[620].start |
16567.535 |
| transcript.whisperx[620].end |
16586.062 |
| transcript.whisperx[620].text |
目前是這樣但是之後還會一直每一個外科啊什麼都是會對我的意思是有的要提高有的要減少這個沒有什麼好迴避的我大概也不怕被罵因為我覺得台灣的社會不應該不應該發展成這個樣子 |
| transcript.whisperx[621].start |
16591.071 |
| transcript.whisperx[621].end |
16608.929 |
| transcript.whisperx[621].text |
我今天因為我也不想再用太多時間,下一次有機會的時候我們再來看看到底為什麼醫學系出來的時候,是不是我們在分科的時候就必須要做控管 |
| transcript.whisperx[622].start |
16610.53 |
| transcript.whisperx[622].end |
16623.622 |
| transcript.whisperx[622].text |
補充你聽我的意思嗎這個都有空管都有空管只是依照這個國家的需求只是後來受過內外負額的專科醫師跑去做其他的業務 |
| transcript.whisperx[623].start |
16626.049 |
| transcript.whisperx[623].end |
16647.503 |
| transcript.whisperx[623].text |
是不是這樣子當然也是有不是 部長假如講說我們現在就是在分科的時候就已經有比例的分配這個我是不知道假如有那就表示有一些人他是受外科的訓練可是他可能去開假移有時候有那個容額給他問題是遭不到足額遭不到足額 |
| transcript.whisperx[624].start |
16651.59 |
| transcript.whisperx[624].end |
16668.995 |
| transcript.whisperx[624].text |
就是學生不願意台大外科29、20個跟R2的學生第二年就17個不是 我的意思是說我們也必須要從這裡就做控管因為我覺得這十幾年來我們對這個問題就是 |
| transcript.whisperx[625].start |
16678.766 |
| transcript.whisperx[625].end |
16699.451 |
| transcript.whisperx[625].text |
口號喊得太多可是實際做出來因應的措施太少這個對於台灣整體的社會跟國民的就義權益是一個很大的損害其他的因為我不大想再用太多時間其他的我們下次再做討論好 謝謝部長 謝謝署長 謝謝市長 謝謝主席 |
| transcript.whisperx[626].start |
16702.854 |
| transcript.whisperx[626].end |
16705.656 |
| transcript.whisperx[626].text |
真正前委員不在,蔡議員不在,圖權級委員不在,核心組委員不在,請前委員來做詢問 |
| transcript.whisperx[627].start |
16729.115 |
| transcript.whisperx[627].end |
16749.528 |
| transcript.whisperx[627].text |
謝謝主席,我們慢慢請邱部長還有林青鳳執行長跟社交組的組長部長好,等一下不好意思,那個社長,你是趙護士,抱歉趙護士,護士長 |
| transcript.whisperx[628].start |
16754.039 |
| transcript.whisperx[628].end |
16772.072 |
| transcript.whisperx[628].text |
那社家署先看要做哪裡一下我看到趙護師陳副司長是不是是是是部長我先請教你大概多久見檢一次兩年吧 |
| transcript.whisperx[629].start |
16775.903 |
| transcript.whisperx[629].end |
16794.612 |
| transcript.whisperx[629].text |
兩年 還可以 那那個執行長呢也是兩年 那個我們副市長呢也是兩年 你們都還蠻標準的那如果我這樣請教 如果你們住在十萬桶的核廢料旁邊你們覺得你要多久見檢一次十萬桶的核廢料旁邊你幾歲人可能每天都會有點緊張 |
| transcript.whisperx[630].start |
16804.832 |
| transcript.whisperx[630].end |
16817.597 |
| transcript.whisperx[630].text |
會想要多健檢幾次嗎還是標準就好了一定會 頻率想要高一點頻率想要高一點那我再請教就是從1982年從這個核廢料儲存在蘭嶼那政府幫蘭嶼的這個居民健檢幾次1982年 |
| transcript.whisperx[631].start |
16828.079 |
| transcript.whisperx[631].end |
16836.607 |
| transcript.whisperx[631].text |
這個數目有沒有對啊你如果兩年一次的話或者我說政府應該要幫忙他們健檢幾次但卻健檢了幾次我跟委員報告就是說10708年是有針對全對沒錯我知道你講的是這個蘭嶼居民健康檢查的這個專案的一個計畫嘛對不對就是107年11月14號到108年3月12號 |
| transcript.whisperx[632].start |
16855.222 |
| transcript.whisperx[632].end |
16875.107 |
| transcript.whisperx[632].text |
好那就是這麼短的時間幾個月而已而且看起來是一次性所以這個核廢料是長期儲存在蘭嶼但是呢我們政府對於這個蘭嶼居民的這個健檢卻像是一夜情過了就沒了所以 |
| transcript.whisperx[633].start |
16877.165 |
| transcript.whisperx[633].end |
16902.5 |
| transcript.whisperx[633].text |
剛剛部長點出一個很重要的事情就是說那個核廢料是長期儲存在蘭嶼嘛你如果住在旁邊你也會想要多健檢幾次嘛對不對 頻率想要高一點嘛所以我們政府應該對於這個蘭嶼居民的健康的這個風險的監測應該是一個持續性而不是一次性 |
| transcript.whisperx[634].start |
16903.26 |
| transcript.whisperx[634].end |
16919.438 |
| transcript.whisperx[634].text |
的这个状态所以我不知道我这样提醒部长有没有认同我认同好谢谢那再来我就再继续讨论就是说刚才我们很感谢那个我们任仰台东的庄瑞雄总站委员说 |
| transcript.whisperx[635].start |
16920.799 |
| transcript.whisperx[635].end |
16936.363 |
| transcript.whisperx[635].text |
國民黨夭壽他用騙的方式把10萬桶的55加侖的核廢料大罐頭丟在蘭嶼但是民進黨政府也不能只有甜言蜜語我原住民也說你好笑白浪 |
| transcript.whisperx[636].start |
16939.505 |
| transcript.whisperx[636].end |
16951.96 |
| transcript.whisperx[636].text |
105年8月1號蔡英文總統特別代表政府向蘭嶼亞美族人道歉說過去的政府在他們不知情的情況下將核廢料存放在蘭嶼 |
| transcript.whisperx[637].start |
16954.963 |
| transcript.whisperx[637].end |
16977.881 |
| transcript.whisperx[637].text |
當然在109年6月的時候呢本席也特別陪同了我們現在的賴清德總統也是時任的副總統特別到前往蘭嶼像這個我們去關心了地方的建設文化還有這個醫療我們特別去看了這個衛生所好像時署長那時候也有去嗎 |
| transcript.whisperx[638].start |
16979.723 |
| transcript.whisperx[638].end |
17000.095 |
| transcript.whisperx[638].text |
那時候陣容還蠻龐大的當時特別亞美族大家非常尊敬的一位齊老他們稱作是資政他向賴清德總統表示就是說希望當地的醫療要加強當地的醫療資源 |
| transcript.whisperx[639].start |
17004.438 |
| transcript.whisperx[639].end |
17014.62 |
| transcript.whisperx[639].text |
那我們的賴清德總統也跟他講回應說我們來其實政府就是要來解決問題的所以才會有後續 |
| transcript.whisperx[640].start |
17016.448 |
| transcript.whisperx[640].end |
17028.794 |
| transcript.whisperx[640].text |
我們大家歷經了幾位部長還有我們相關各部門大家不斷的在討論說我們要怎麼樣來加強蘭嶼的醫療資源然後怎麼樣來擴大這個衛生所的量能然後怎麼樣擴大要怎麼蓋這個醫療院所 |
| transcript.whisperx[641].start |
17040.139 |
| transcript.whisperx[641].end |
17049.127 |
| transcript.whisperx[641].text |
我有看你們紀錄你們也是很認真在討論只不過是最近就突然慢下來了所以今天前天我還特別打電話致電給新上任的吳清美鄉長我就請教她說如果我們到衛福部到蘭嶼 |
| transcript.whisperx[642].start |
17061.256 |
| transcript.whisperx[642].end |
17067.02 |
| transcript.whisperx[642].text |
就特別在這個衛生所這個附近那一塊地那15塊地那邊把它蓋這個醫療院所你們反應怎麼樣有沒有諮商同意權的問題哇那鄉長突然那個語調高八度他說 |
| transcript.whisperx[643].start |
17077.928 |
| transcript.whisperx[643].end |
17106.61 |
| transcript.whisperx[643].text |
我們非常的期待非常的歡迎資商統一權是公所要辦理的所以如果鄉長都這麼講了這有什麼問題那現在的問題就是我要來請教你們就是說你們的這個興建計畫到底什麼時候要提出因為提出之後還要抱怨這都需要時間的因為這個整個事情已經討論了六年了所以我請教部長 |
| transcript.whisperx[644].start |
17107.85 |
| transcript.whisperx[644].end |
17129.67 |
| transcript.whisperx[644].text |
你今年可以提出嗎?新建計畫剛剛你有答應專委員說今年可以提出我想我們從108年看布裡面就針對這個一直在評估那中間也碰到土地轉移原來在某一塊那不行又轉移到衛生所這一塊那衛生所這一塊上面也有 |
| transcript.whisperx[645].start |
17133.352 |
| transcript.whisperx[645].end |
17158.019 |
| transcript.whisperx[645].text |
所以當時我們是想說土地那個的問題那土地的問題如果能夠解決我想我們應該原來的規劃我覺得你們要回去講那個土地怎麼樣我就會覺得這落入一個雞生蛋蛋生雞的那個陷阱啦其實不管怎麼樣我都覺得你們同步去準備嘛你不報這個興建計畫你怎麼 |
| transcript.whisperx[646].start |
17160.08 |
| transcript.whisperx[646].end |
17174.319 |
| transcript.whisperx[646].text |
有錢去採購那個土地 要怎麼去辦理所以我也 我們如果先不去講那個細節啦 我就問我就問說你的興建計畫 你什麼時候提出嘛 |
| transcript.whisperx[647].start |
17176.341 |
| transcript.whisperx[647].end |
17205.007 |
| transcript.whisperx[647].text |
跟委員報告我們其實一直都是往在我們讓那個蘭嶼的醫療的量能夠增加也增加他的醫療的使用的空間因為現在看起來在這個部分裡面衛生署的功能其實已經到一個瓶頸那我們當然現在現在因為等於我們要抱一個貢獻計畫就是第一個要土地取得第二個就是說我們要知道說當地的需求是什麼醫師科別然後裡面還有因為他最主要地方這邊也跟我們提過說他要把衛生所 |
| transcript.whisperx[648].start |
17205.607 |
| transcript.whisperx[648].end |
17231.449 |
| transcript.whisperx[648].text |
還有他的長照站要合在剛剛提到的這些也都沒有問題啊是 我們就是要跟地方現在難得有園民會啦 縣政府啦 公所大家都非常的配合就差你們什麼時候要提出抱怨嘛對啊 你說那麼多你們前面不是剛剛 我剛剛有坐在下面聽啊你們答應那個莊委員說今年會送出來嘛 |
| transcript.whisperx[649].start |
17232.39 |
| transcript.whisperx[649].end |
17235.193 |
| transcript.whisperx[649].text |
他有提醒你們說我等下上來會追問幾月我們趕快了解那針對需求我們來提問不是我覺得你們在大小眼啊剛剛跟莊委員講說今年會送出嘛我就問一下幾月而已你連今年會送出的答案你都捨不得給我是因為他比較兇嗎還是怎麼樣 |
| transcript.whisperx[650].start |
17260.219 |
| transcript.whisperx[650].end |
17270.315 |
| transcript.whisperx[650].text |
我們今年底以前送出來好了今年底以前送出 那所以今年底幾月份你十月可以嗎 十月已經算年底了 |
| transcript.whisperx[651].start |
17271.77 |
| transcript.whisperx[651].end |
17299.858 |
| transcript.whisperx[651].text |
因為那個院還要核定嘛還需要時間因為前面已經等你們很久了監察院什麼那個都討論很久了趕快去了解整個醫療需求然後那個土地的狀況我們趕快再我給你們一個目標好不好10月好不好我們抓10月份那也留兩個月給行政院去讓他們趕快我們趕看看今年能不能給他核定嘛 |
| transcript.whisperx[652].start |
17300.888 |
| transcript.whisperx[652].end |
17324.105 |
| transcript.whisperx[652].text |
我們是有示威來寫出計畫拜託啦那所以就是說剛剛那個土地我知道你們有那個兩筆佔用嘛還有一筆那個私人的我想那個費用應該也沒有很高啦而且齁我現在要講一下就我再替大家問一下就那你們那個預算編列齁傳輸規模大概是怎麼樣可以講一下嗎 |
| transcript.whisperx[653].start |
17327.028 |
| transcript.whisperx[653].end |
17343.485 |
| transcript.whisperx[653].text |
因為這個部分還沒有跟我們像蘭嶼或是我們台東衛生局這邊談他們的需求所以我們會加緊腳步來跟他們談那需要多少的當然我們按照一些設施標準還有當地的所以現在不能講是不是那床數能不能講你們的規劃理想中 |
| transcript.whisperx[654].start |
17344.385 |
| transcript.whisperx[654].end |
17366.53 |
| transcript.whisperx[654].text |
當時我們是大概有預估是20床啦 當時是有你還蠻誠實的 20床我有聽說 因為我本來有聽到35這個數字後來了解15床是洗腎用的 所以你還蠻老實的那20床就很夠用了嗎 這個是大概預估到比如說幾年還是我們要有遠見一點 有沒有要未雨綢繆 |
| transcript.whisperx[655].start |
17367.99 |
| transcript.whisperx[655].end |
17395.627 |
| transcript.whisperx[655].text |
因為不只蘭嶼的居民嘛因為那個我舉個例子啦我剛才一直在講那個這個屏東就是恆春那個旅遊醫院重建醫療大樓這件事情那當時的那個蘇貞昌院長我真的很佩服他他就很霸氣的講說我們當地五萬居民但是你不能用五萬的量能去看因為他還有四百萬人次的這個 |
| transcript.whisperx[656].start |
17397.448 |
| transcript.whisperx[656].end |
17406.694 |
| transcript.whisperx[656].text |
遊客後來他拍板定案用600萬的規模去看600萬人次的規模去看那一樣啊這邊床數以這個你們專業但是有遠見的評估20床夠不夠 |
| transcript.whisperx[657].start |
17414.301 |
| transcript.whisperx[657].end |
17431.816 |
| transcript.whisperx[657].text |
你不一定要今天給我答案我也不敢講我就請你們就是說要有遠見的去規劃那即便你如果說有把握說他都不會碰壁我會把他照顧得好好的你剩10床我也沒有意見但是那不可能啦 |
| transcript.whisperx[658].start |
17435.153 |
| transcript.whisperx[658].end |
17447.206 |
| transcript.whisperx[658].text |
所以我覺得這個預算的編列是一個態度的問題啦我們真的很羨慕很羨慕就是說有這樣的一個院長要蓋幾間便衣在他的家鄉 |
| transcript.whisperx[659].start |
17448.707 |
| transcript.whisperx[659].end |
17467.699 |
| transcript.whisperx[659].text |
我現在只是做立法委員 我沒有當院長 不然我就會拍板訂案說你要蘭嶼蓋醫院 我要人給人 我要錢給錢經費無上限 這都是蘇貞昌院長以前講過的話我也希望說那個部長你有這樣子的豪氣 後來可能可以做議長這樣好不好 |
| transcript.whisperx[660].start |
17471.761 |
| transcript.whisperx[660].end |
17494.766 |
| transcript.whisperx[660].text |
我們一定會努力來符合因為我們去思考這個經費要怎麼樣的匡列你可以這樣子想像就是說不要多我如果一桶55加侖的合費要放在你家旁邊就好或者你家裡面你覺得政府要給你多少錢才能夠補償你你這樣去想一想 |
| transcript.whisperx[661].start |
17496.241 |
| transcript.whisperx[661].end |
17523.175 |
| transcript.whisperx[661].text |
對不對 可能你一毛錢都不想要因為健康無價嘛所以這個有時候預算無上限也合理啦好 那再來我就請教你們在這個部長的心目中就是說這樣的規劃你希望什麼時候可以動工啟用我們總要有一個目標啊不然永遠都會講說土地怎麼樣啦然後預算怎麼樣啊 對不對 |
| transcript.whisperx[662].start |
17525.816 |
| transcript.whisperx[662].end |
17549.004 |
| transcript.whisperx[662].text |
可以規劃一下嗎?我們要有願景跟委員報告因為這個部分我們會報行政院那行政院這邊就是他們的公建計畫是有他們一定的流程所以我是說我們先不要就是說我們不要糾結在那邊啦我們要完成這件功德無量的事情 |
| transcript.whisperx[663].start |
17550.188 |
| transcript.whisperx[663].end |
17569.7 |
| transcript.whisperx[663].text |
你的人生理想規劃中在我們過去在蓋部立院差不多都要兩年到三年啦這個部分等於是裡面還要有所謂的細部計畫那我可以從今年開始往後算三年嗎應該經費還沒有下來因為這個要到行政院我知道啊那我是說你要有願景啊 |
| transcript.whisperx[664].start |
17571.311 |
| transcript.whisperx[664].end |
17585.302 |
| transcript.whisperx[664].text |
不然那個今年你們那個五六月大概衛福部又要報要準備明年的這個規劃那個預算的規劃嘛對不對你要有願景嘛不然你怎麼弄你們都老鳥了要用公正計劃我知道啦你不用抓個時程嗎 |
| transcript.whisperx[665].start |
17596.618 |
| transcript.whisperx[665].end |
17618.512 |
| transcript.whisperx[665].text |
就是你總是有計劃嘛我現在講的很簡單的事情你現在我要講問你的理想上我沒有說你也不是院長我不可能我明天還會問院長啦所以院長說什麼時候他說了算我現在是問你的計劃你的規劃嘛院長一定會問你啊你要給你要講出一個答案讓他參考啊 |
| transcript.whisperx[666].start |
17619.736 |
| transcript.whisperx[666].end |
17633.138 |
| transcript.whisperx[666].text |
不然遙遙無期 如果說公建計畫在那邊核准大概要三年我們在過去的醫院的經驗是這樣順利的話就是三年我想就是說很壓縮我們給自己很有壓力的我們努力 |
| transcript.whisperx[667].start |
17635.65 |
| transcript.whisperx[667].end |
17660.518 |
| transcript.whisperx[667].text |
來達成這個事那我們就是大概預估三年的時間那我這樣也知道我明天跟院長對話的時候我也可以很清楚知道怎麼跟他討價還價給他設定一個期程所以我想就是說我們今天大家可以了解這樣的一個願景我們一直有持續在推動那 |
| transcript.whisperx[668].start |
17661.792 |
| transcript.whisperx[668].end |
17668.303 |
| transcript.whisperx[668].text |
也最後就是要提醒再回頭講最前面那個健檢那個事情我覺得那個是政府的疏忽 |
| transcript.whisperx[669].start |
17670.067 |
| transcript.whisperx[669].end |
17696.167 |
| transcript.whisperx[669].text |
我們核廢料並沒有馬上要給人家移走還不曉得要放多久搞不好這輩子就一直放在那邊所以給人家提供的那個健檢我覺得也不能只是一次性所以那個核廢料的這個健康風險我也希望說這個部分能夠納入這個醫院的功能然後要設置這個長期的這個健康監測的這個機制都是要有的 |
| transcript.whisperx[670].start |
17697.087 |
| transcript.whisperx[670].end |
17723.938 |
| transcript.whisperx[670].text |
那另外要提醒最後要提醒就是說畢竟我們在這個醫院醫療院所我想醫療院所這樣比較好一點在完成之前起碼要有三年的時間那在這個完成之前這中間我們是不是可以做點什麼有什麼樣的機制可以補強這中間的一個空白還有過去彌補這個健檢的不足 |
| transcript.whisperx[671].start |
17725.919 |
| transcript.whisperx[671].end |
17738.784 |
| transcript.whisperx[671].text |
所以這個部分你們是不是可以一併來快速的這個部分三年的配套機制可能就不是要讓你考慮很久你是不是可以在兩個月內提出來這個沒有問題 |
| transcript.whisperx[672].start |
17741.286 |
| transcript.whisperx[672].end |
17756.946 |
| transcript.whisperx[672].text |
我想我們今天要求大概是這樣我想蘭嶼的居民也包括我的族人我們的陽美族人也在那邊其實真的受了非常多的委屈我今天必須要講 |
| transcript.whisperx[673].start |
17758.228 |
| transcript.whisperx[673].end |
17777.847 |
| transcript.whisperx[673].text |
不管是過去的政黨誰很夭壽但是今天是民進黨執政我們不能只有說好聽的話我們要有具體的行動去實現去顧到他們的這個醫療平權這個很重要的一個權利我們大家一起努力 謝謝我們會努力 謝謝 |
| transcript.whisperx[674].start |
17785.063 |
| transcript.whisperx[674].end |
17811.903 |
| transcript.whisperx[674].text |
好本日會議詢問全部結束那委員圖全集陳清輝所提書面諮詢列入紀錄刊登公報現在作為下決議第一說明及詢問完畢第二委員執行未及答覆或請補充資料者請相關機關兩周內以順便答覆委員另要求期限者從其所定第三並來自主權力法部門條本修正草案等三案另折起繼續審查那本次會議到此結束現在散會 |