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盧縣一 @ 第11屆第5會期社會福利及衛生環境委員會第21次全體委員會議
| Start Time | End Time | Text |
|---|---|---|
| 00:00:00,000 | 00:00:02,000 | 謝謝主席,有請市部長 |
| 00:00:06,000 | 00:00:08,000 | 好,趙薇好 |
| 00:00:08,000 | 00:00:13,000 | 今天要上台之前收到了幾個陳情號 |
| 00:00:13,000 | 00:00:16,000 | 就是關於我們全聯會他們反對的一個立場 |
| 00:00:16,000 | 00:00:20,000 | 之前有收到說關於那個ACP的部分 |
| 00:00:20,000 | 00:00:24,000 | 是不是有考慮到曾經有人提說要從醫療團隊 |
| 00:00:24,000 | 00:00:28,000 | 由非醫療團隊來做這樣的一個事情呢 |
| 00:00:29,000 | 00:00:36,000 | 應該是這麼講就是說在這一次的這個病主法的修法過程當中 |
| 00:00:36,000 | 00:00:39,000 | 那麼也有多位委員也提到 |
| 00:00:39,000 | 00:00:41,000 | 那麼如何讓他的可近性更高 |
| 00:00:41,000 | 00:00:48,000 | 因為這個安寧基本上安寧醫院的簽署是很多團體 |
| 00:00:48,000 | 00:00:51,000 | 民間團體都有共同在參與推動的 |
| 00:00:52,000 | 00:00:58,000 | 但是這個病主這個預立醫療決定的簽署之前有一個ACP |
| 00:00:58,000 | 00:01:03,000 | 有這個一個預立醫療招呼諮商的程序 |
| 00:01:03,000 | 00:01:09,000 | 這個程序一定是有醫療團隊有醫師有護理人員或心理社工這樣 |
| 00:01:09,000 | 00:01:17,000 | 能夠做這樣的這個條件符合這些條件的機構也有限 |
| 00:01:17,000 | 00:01:21,000 | 所以這造成在這個AD簽署上的另外一個瓶頸 |
| 00:01:21,000 | 00:01:32,000 | 所以在這一次修法當中確實也有委員期待希望讓能夠執行這個ACP的這個機構能夠更擴大 |
| 00:01:32,000 | 00:01:37,000 | 不過在這個不論未來我們怎麼樣的擴大呢 |
| 00:01:37,000 | 00:01:41,000 | 那麼有關於醫療的諮詢大概是免不了 |
| 00:01:41,000 | 00:01:45,000 | 因為這裡面牽涉到有一些醫療處置 |
| 00:01:45,000 | 00:01:48,000 | 什麼是這個微生設備 |
| 00:01:48,000 | 00:01:51,000 | 哪些是所謂的灌食 |
| 00:01:51,000 | 00:01:58,000 | 那麼這些我想他還是會有一些這個需要醫療諮詢的部分 |
| 00:01:58,000 | 00:02:04,000 | 那只是說未來如何讓這個以團隊然後更深入社區 |
| 00:02:04,000 | 00:02:09,000 | 那麼讓民眾有需要這個簽署的可侵性可以提高 |
| 00:02:09,000 | 00:02:11,000 | 這個是我們未來會來持續討論 |
| 00:02:11,000 | 00:02:13,000 | 因為區議會有這樣的表達 |
| 00:02:13,000 | 00:02:15,000 | 所以我想說校長部長知道 |
| 00:02:15,000 | 00:02:19,000 | 他們不太希望是交由非醫療團隊來執行所有的ACP |
| 00:02:19,000 | 00:02:22,000 | 因為就是他們對今天要討論這個議題 |
| 00:02:22,000 | 00:02:23,000 | 他們也持反對的立場 |
| 00:02:23,000 | 00:02:26,000 | 大概幾個訴求大概也了解 |
| 00:02:26,000 | 00:02:30,000 | 當然對於我想死這件事情國家如何來判斷 |
| 00:02:30,000 | 00:02:32,000 | 這是一個真正的自由的決定嗎 |
| 00:02:32,000 | 00:02:34,000 | 還是個被照顧不足家庭壓力啊 |
| 00:02:34,000 | 00:02:37,000 | 會因為他的環境逼出來一個選擇 |
| 00:02:37,000 | 00:02:40,000 | 我覺得這是我們政府要去討論的問題 |
| 00:02:40,000 | 00:02:41,000 | 所以第一個就是想問說 |
| 00:02:41,000 | 00:02:43,000 | 法案已經經過我們國會審查 |
| 00:02:43,000 | 00:02:48,000 | 為何不知否已經有應該有的政策準備跟影響評估 |
| 00:02:49,000 | 00:02:50,000 | 有這方面的評估了嗎 |
| 00:02:51,000 | 00:02:54,000 | 當然這一次的是沒有行政院版本 |
| 00:02:54,000 | 00:03:01,000 | 因為我們認為還是很多的點需要再進一步的討論釐清 |
| 00:03:01,000 | 00:03:07,000 | 才能夠提出是不是要立法或者是立法的內容 |
| 00:03:07,000 | 00:03:11,000 | 當然針對這個委員所提出的這個 |
| 00:03:11,000 | 00:03:15,000 | 或者是黨團所提出的這個法案 |
| 00:03:15,000 | 00:03:19,000 | 那麼我們也認為這裡面還是有一些需要釐清 |
| 00:03:19,000 | 00:03:21,000 | 把它定位好的地方 |
| 00:03:22,000 | 00:03:24,000 | 這個要跟部長討論就是說 |
| 00:03:24,000 | 00:03:27,000 | 其實他的以後要講的評估範圍 |
| 00:03:27,000 | 00:03:28,000 | 這是適用對象嗎 |
| 00:03:28,000 | 00:03:29,000 | 痛苦的判斷 |
| 00:03:29,000 | 00:03:30,000 | 意識能力 |
| 00:03:30,000 | 00:03:31,000 | 預立決定 |
| 00:03:31,000 | 00:03:32,000 | 代理制度 |
| 00:03:32,000 | 00:03:33,000 | 醫師的權利義務 |
| 00:03:33,000 | 00:03:34,000 | 跟刑事民事責任 |
| 00:03:34,000 | 00:03:36,000 | 保險的效果 |
| 00:03:36,000 | 00:03:37,000 | 死亡證明 |
| 00:03:37,000 | 00:03:39,000 | 司法相驗這些藥品管理 |
| 00:03:39,000 | 00:03:41,000 | 我覺得這些都是很多要討論的地方 |
| 00:03:41,000 | 00:03:43,000 | 所以我在想說在討論這個之前 |
| 00:03:43,000 | 00:03:47,000 | 我覺得政府有沒有提供足夠的照護的一個選項 |
| 00:03:47,000 | 00:03:49,000 | 是不是應該要去充分的討論 |
| 00:03:49,000 | 00:03:51,000 | 因為我們常常覺得說 |
| 00:03:51,000 | 00:03:54,000 | 我們在提醒政府說面對這些重度失能 |
| 00:03:54,000 | 00:03:55,000 | 一個人的生命意願 |
| 00:03:55,000 | 00:03:56,000 | 有沒有被照顧 |
| 00:03:56,000 | 00:03:57,000 | 被陪伴 |
| 00:03:57,000 | 00:03:59,000 | 被支持產生不同的變化 |
| 00:03:59,000 | 00:04:01,000 | 所以我在我要問 |
| 00:04:01,000 | 00:04:02,000 | 部長就是說 |
| 00:04:02,000 | 00:04:04,000 | 如果病人的生命終結意願 |
| 00:04:04,000 | 00:04:05,000 | 主要是來自孤立 |
| 00:04:05,000 | 00:04:07,000 | 經濟困難 |
| 00:04:07,000 | 00:04:08,000 | 照護的資源不足 |
| 00:04:08,000 | 00:04:09,000 | 家庭的衝突 |
| 00:04:09,000 | 00:04:11,000 | 或擔心成了家人的負擔 |
| 00:04:11,000 | 00:04:13,000 | 我覺得我們要怎麼來 |
| 00:04:13,000 | 00:04:16,000 | 來介入這樣一個照護的一個警訊 |
| 00:04:16,000 | 00:04:17,000 | 是不是比較重要 |
| 00:04:17,000 | 00:04:18,000 | 對 我覺得 |
| 00:04:18,000 | 00:04:20,000 | 剛剛委員有秀到您的下一張 |
| 00:04:20,000 | 00:04:23,000 | 我覺得那個下的標題非常好 |
| 00:04:23,000 | 00:04:26,000 | 要真正的自主而不是無奈 |
| 00:04:26,000 | 00:04:28,000 | 所以這個就是在各國在推動 |
| 00:04:28,000 | 00:04:30,000 | 這個安樂石討論的時候 |
| 00:04:30,000 | 00:04:33,000 | 都會討論到的議題 |
| 00:04:33,000 | 00:04:36,000 | 這個到底這個是真正他的 |
| 00:04:36,000 | 00:04:39,000 | 這個自主的決定呢 |
| 00:04:39,000 | 00:04:42,000 | 還是其實是還有一些社會上 |
| 00:04:42,000 | 00:04:45,000 | 或者是這個醫療上可以協助 |
| 00:04:45,000 | 00:04:47,000 | 或者是在經濟社會 |
| 00:04:47,000 | 00:04:51,000 | 那麼家庭支持等等各方面 |
| 00:04:51,000 | 00:04:53,000 | 那麼未盡完善 |
| 00:04:53,000 | 00:04:54,000 | 所以這個我想 |
| 00:04:54,000 | 00:04:58,000 | 這個痛苦無可忍受 |
| 00:04:58,000 | 00:05:02,000 | 這個如何去劃定這一條界線 |
| 00:05:02,000 | 00:05:04,000 | 確實是有它的難度 |
| 00:05:04,000 | 00:05:05,000 | 剛剛聽到部長報告 |
| 00:05:05,000 | 00:05:07,000 | 大概有兩萬或者是四萬的 |
| 00:05:07,000 | 00:05:10,000 | 分別在病人自主權利 |
| 00:05:10,000 | 00:05:14,000 | 或者是AACP這個部分 |
| 00:05:14,000 | 00:05:17,000 | 那我想說我們想要知道說 |
| 00:05:17,000 | 00:05:19,000 | 其實這個困難點是什麼 |
| 00:05:19,000 | 00:05:20,000 | 還有可近性 |
| 00:05:20,000 | 00:05:23,000 | 其實我們常常在看這個的時候 |
| 00:05:23,000 | 00:05:26,000 | 我們沒有辦法看到說所得 |
| 00:05:26,000 | 00:05:28,000 | 有沒有一所得一地區 |
| 00:05:28,000 | 00:05:29,000 | 或者是疾病分類 |
| 00:05:29,000 | 00:05:30,000 | 獨居的狀態 |
| 00:05:30,000 | 00:05:31,000 | 身心障礙 |
| 00:05:31,000 | 00:05:32,000 | 或是原住民的身分 |
| 00:05:32,000 | 00:05:34,000 | 來取得這個不同的AACP |
| 00:05:34,000 | 00:05:37,000 | 跟AED這個安寧服務的差異 |
| 00:05:37,000 | 00:05:38,000 | 我覺得這個部分 |
| 00:05:38,000 | 00:05:39,000 | 是不是我們政府 |
| 00:05:39,000 | 00:05:41,000 | 應該先去了解這方面的 |
| 00:05:41,000 | 00:05:44,000 | 一個所謂的趨勢或者是分布 |
| 00:05:44,000 | 00:05:46,000 | 跟委員說明 |
| 00:05:46,000 | 00:05:49,000 | 我們剛剛我講的這個 |
| 00:05:49,000 | 00:05:51,000 | 四萬五跟兩萬六是指 |
| 00:05:51,000 | 00:05:52,000 | 今年新簽署的 |
| 00:05:52,000 | 00:05:54,000 | 事實上累積到現在 |
| 00:05:54,000 | 00:05:57,000 | 簽署這個安寧緩和醫療的 |
| 00:05:57,000 | 00:05:58,000 | 大概是一百多萬人 |
| 00:05:58,000 | 00:06:01,000 | 一百五十五萬人超過了 |
| 00:06:01,000 | 00:06:04,000 | 那至於說這個AED的話 |
| 00:06:04,000 | 00:06:06,000 | 累積到現在有簽署的 |
| 00:06:06,000 | 00:06:09,000 | 大概也十五萬五千人超過了 |
| 00:06:09,000 | 00:06:12,000 | 所以這個是逐步逐步的在增加 |
| 00:06:12,000 | 00:06:15,000 | 那因為這兩邊這個 |
| 00:06:15,000 | 00:06:17,000 | 不一樣的地方是因為 |
| 00:06:17,000 | 00:06:22,000 | 我們現在這個安寧醫院的話 |
| 00:06:22,000 | 00:06:24,000 | 在線上也可以簽署了 |
| 00:06:24,000 | 00:06:27,000 | 我們也有提供一些 |
| 00:06:27,000 | 00:06:29,000 | 線上的一些資訊 |
| 00:06:29,000 | 00:06:31,000 | 然後理解之後就可以簽署 |
| 00:06:31,000 | 00:06:33,000 | 但是ACP的範圍又更大 |
| 00:06:33,000 | 00:06:34,000 | 更往前 |
| 00:06:34,000 | 00:06:39,000 | 所以它需要有一個ACP的過程 |
| 00:06:39,000 | 00:06:41,000 | 那我想那個是一個瓶頸 |
| 00:06:41,000 | 00:06:43,000 | 這兩個一比較就可以知道 |
| 00:06:43,000 | 00:06:46,000 | 但是也因為它的決定 |
| 00:06:46,000 | 00:06:49,000 | 更advance 更前進 |
| 00:06:49,000 | 00:06:51,000 | 所以它當然需要一個 |
| 00:06:51,000 | 00:06:53,000 | 更嚴謹的過程 |
| 00:06:53,000 | 00:06:56,000 | 那我們現在也在這個 |
| 00:06:56,000 | 00:07:01,000 | 除了這個經濟的條件把它打破 |
| 00:07:01,000 | 00:07:04,000 | 我們已經健保也開始給付了 |
| 00:07:04,000 | 00:07:06,000 | 過去完全都是自費 |
| 00:07:06,000 | 00:07:09,000 | 那現在也開始針對部分的對象 |
| 00:07:09,000 | 00:07:11,000 | 健保也有給付 |
| 00:07:11,000 | 00:07:13,000 | 那現在再來下一步就是 |
| 00:07:13,000 | 00:07:15,000 | 怎麼把量能ACP的量能擴大 |
| 00:07:15,000 | 00:07:19,000 | 可能這是我們下一步要來處理的 |
| 00:07:19,000 | 00:07:21,000 | 所以我想說是不是應該去調查 |
| 00:07:21,000 | 00:07:23,000 | 那個原因就是沒有參與這個 |
| 00:07:23,000 | 00:07:24,000 | 醫療決定的原因 |
| 00:07:24,000 | 00:07:26,000 | 比如說是不是資訊不足 |
| 00:07:26,000 | 00:07:28,000 | 還是剛剛你講的費用不負擔 |
| 00:07:28,000 | 00:07:30,000 | 增生的時間是不是太長 |
| 00:07:30,000 | 00:07:31,000 | 院所的距離 |
| 00:07:31,000 | 00:07:33,000 | 家屬參與的困難度 |
| 00:07:33,000 | 00:07:35,000 | 還是所在地根本就沒有這樣 |
| 00:07:35,000 | 00:07:36,000 | 那個服務量能 |
| 00:07:36,000 | 00:07:39,000 | 我覺得這個部分還是要去做統計 |
| 00:07:39,000 | 00:07:41,000 | 最後就是面對這樣的一個法案 |
| 00:07:41,000 | 00:07:43,000 | 說是不是政府應該來建立 |
| 00:07:43,000 | 00:07:45,000 | 分階段可落實的一個政策 |
| 00:07:45,000 | 00:07:47,000 | 不是一步到位 |
| 00:07:47,000 | 00:07:48,000 | 比如說以後是不是法院需要 |
| 00:07:48,000 | 00:07:50,000 | 介入比較困難的一個案件 |
| 00:07:50,000 | 00:07:53,000 | 或者是說要去研議的時候 |
| 00:07:53,000 | 00:07:55,000 | 是不是將不同的制度分層比較 |
| 00:07:55,000 | 00:07:57,000 | 來看看哪些是適用 |
| 00:07:57,000 | 00:07:59,000 | 程序保障跟它的法律效果 |
| 00:07:59,000 | 00:08:02,000 | 我覺得這些部分可能都應該是 |
| 00:08:02,000 | 00:08:04,000 | 分階段來實施的 |
| 00:08:04,000 | 00:08:07,000 | 好 跟委員說明確實這個 |
| 00:08:07,000 | 00:08:11,000 | 這個簽署AD會不會有地域 |
| 00:08:11,000 | 00:08:13,000 | 還有這個落差 |
| 00:08:13,000 | 00:08:15,000 | 不平等的這些落差 |
| 00:08:15,000 | 00:08:17,000 | 那因為過去都是比較自願性自費的 |
| 00:08:17,000 | 00:08:19,000 | 我們比較沒有這個資料 |
| 00:08:19,000 | 00:08:21,000 | 但是因為我們從去年開始 |
| 00:08:21,000 | 00:08:23,000 | 納入健保給付 |
| 00:08:23,000 | 00:08:24,000 | 那這個就有資料了 |
| 00:08:24,000 | 00:08:27,000 | 所以我會請健保來分析一下 |
| 00:08:27,000 | 00:08:29,000 | 那麼過去所簽署的這一些 |
| 00:08:29,000 | 00:08:31,000 | AD的對象 |
| 00:08:31,000 | 00:08:33,000 | 有沒有地域落差 |
| 00:08:33,000 | 00:08:35,000 | 或者是年齡什麼什麼 |
| 00:08:35,000 | 00:08:38,000 | 再做進一步的一些分析之後 |
| 00:08:38,000 | 00:08:42,000 | 來調整這個後續推動的政策 |
| 00:08:42,000 | 00:08:44,000 | 講到現在 |
| 00:08:44,000 | 00:08:45,000 | 從我們的研談當中 |
| 00:08:45,000 | 00:08:47,000 | 應該就可以隱約的知道 |
| 00:08:47,000 | 00:08:49,000 | 我們是支持這個法案的 |
| 00:08:49,000 | 00:08:52,000 | 當然就醫生的一個角色的立場來看 |
| 00:08:52,000 | 00:08:54,000 | 那其實可是我們面對這樣一個 |
| 00:08:54,000 | 00:08:56,000 | 比如說他有一個刑事責任 |
| 00:08:56,000 | 00:08:57,000 | 醫療責任保險的效果 |
| 00:08:57,000 | 00:08:58,000 | 死亡證明 |
| 00:08:58,000 | 00:09:00,000 | 司法相應藥品管理病例 |
| 00:09:00,000 | 00:09:02,000 | 資料治理這些種種的這些 |
| 00:09:02,000 | 00:09:04,000 | 項目要去考量的時候 |
| 00:09:04,000 | 00:09:06,000 | 我會覺得這是真的是要 |
| 00:09:06,000 | 00:09:09,000 | 會同法務部經管會內政部相關機關 |
| 00:09:09,000 | 00:09:11,000 | 做個跨部會的評估的平台 |
| 00:09:11,000 | 00:09:14,000 | 不然把重彈幕只有在衛福部的話 |
| 00:09:14,000 | 00:09:16,000 | 我會覺得你們太辛苦了 |
| 00:09:16,000 | 00:09:18,000 | 謝謝謝謝委員 |
| 00:09:18,000 | 00:09:20,000 | 好那我們就把這件事情 |
| 00:09:20,000 | 00:09:22,000 | 來分階段直播的完成 |
| 00:09:22,000 | 00:09:24,000 | 謝謝謝謝委員 |
| 00:09:24,000 | 00:09:26,000 | 好謝謝盧縣議召委發言 |
| 00:09:26,000 | 00:09:28,000 | 接下來請陳昭之委員發言 |