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楊曜 @ 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 00:00:03,320 好 副總統我先跟你討論一下就是
00:00:04,100 00:00:07,940 台南一歲男童的不幸事件
00:00:08,200 00:00:10,500 那這裡就是
00:00:11,000 00:00:13,560 其實我也覺得
00:00:14,340 00:00:16,640 公部門並沒有辦法
00:00:17,140 00:00:19,200 阻止不幸事情的發生
00:00:19,200 00:00:23,300 因為我們沒有那麼多的人力可以去
00:00:23,540 00:00:24,820 不過是這樣子
00:00:25,080 00:00:25,600 就是說
00:00:26,320 00:00:30,160 無照保母你們通常
00:00:30,420 00:00:31,180 通常
00:00:31,700 00:00:32,720 有沒有可能
00:00:33,480 00:00:36,560 在什麼機緣或者什麼措施的
00:00:36,820 00:00:38,340 的實施下
00:00:38,860 00:00:39,880 是可以在
00:00:40,400 00:00:42,440 在不幸事件發生之前
00:00:42,700 00:00:44,500 就找出來的 有嗎
00:00:45,260 00:00:48,860 一般我們比較多是靠這個民眾的檢舉
00:00:48,860 00:00:49,880 這是第一個
00:00:50,140 00:00:52,180 就是說如果民眾有檢舉的話
00:00:52,900 00:00:55,900 各縣市政府的這個查核的人
00:00:55,900 00:00:57,760 他都會進行去做查核
00:00:57,760 00:00:58,540 那這個案件
00:00:58,800 00:00:59,880 就台南這個案件
00:01:00,140 00:01:01,940 是不是有經過檢舉
00:01:02,700 00:01:04,260 台南這個案件應該是
00:01:05,539 00:01:08,860 應該是發生事情之後才知道的
00:01:09,120 00:01:10,180 發生事情之後
00:01:10,940 00:01:11,980 那我
00:01:12,980 00:01:14,060 我想請問你
00:01:14,820 00:01:16,380 在你的認知裡面
00:01:16,640 00:01:20,460 為什麼家長願意把小孩子託付給
00:01:21,460 00:01:22,460 無照的保母
00:01:22,960 00:01:24,759 是不知道他無照
00:01:25,020 00:01:26,820 還是其他原因
00:01:27,059 00:01:28,619 通常大概有幾個原因
00:01:28,619 00:01:30,660 第一個是有可能是家長不知道
00:01:30,660 00:01:31,160 因為
00:01:31,419 00:01:33,220 所以這也是我們一直家長宣傳
00:01:33,220 00:01:36,220 要找到有登記的證的保母
00:01:36,220 00:01:37,780 那我們就是必須要加強
00:01:38,320 00:01:39,320 副長不好意思
00:01:39,619 00:01:40,899 我們就是必須要
00:01:41,160 00:01:42,940 要加強這部分的宣導
00:01:42,940 00:01:43,440 對
00:01:43,440 00:01:47,539 有照總是國家做過初步的把關
00:01:47,740 00:01:50,780 然後第二個是他可能是收費比較低廉
00:01:51,540 00:01:53,100 對於家長來講他會覺得
00:01:53,100 00:01:54,380 托育費用的負擔
00:01:54,640 00:01:55,380 這件事情
00:01:55,380 00:01:56,700 那收費低的部分
00:01:56,960 00:01:59,000 署裡面有沒有因應的對策
00:01:59,000 00:02:01,540 我們現在其實是有給
00:02:01,780 00:02:03,980 這個我們中央其實是有補助
00:02:03,980 00:02:05,380 托育補助的費用
00:02:05,380 00:02:05,880 對
00:02:05,880 00:02:08,340 那至少每一個家庭都可以得到1萬3
00:02:08,340 00:02:09,540 那如果是弱勢的
00:02:09,540 00:02:10,040 弱勢家庭
00:02:10,040 00:02:11,300 家庭可以得到更多
00:02:11,300 00:02:12,060 是
00:02:12,320 00:02:12,820 還有嗎
00:02:13,600 00:02:15,900 然後另外一個就是說
00:02:16,220 00:02:17,740 收託的時間
00:02:17,740 00:02:20,380 因為有些家長可能他工作的時間比較長
00:02:20,900 00:02:22,780 那這個不過我們其實
00:02:22,780 00:02:25,780 一般我們的保母其實他也可以拖24小時
00:02:27,100 00:02:28,380 副老師這樣子
00:02:28,380 00:02:31,300 我向來不是很喜歡檢討
00:02:31,580 00:02:32,340 不幸事件
00:02:33,060 00:02:34,780 那可是我們必須要
00:02:35,060 00:02:36,300 藉由不幸事件
00:02:36,580 00:02:38,220 來精進我們日後的
00:02:38,580 00:02:39,260 的方式
00:02:39,580 00:02:40,620 那
00:02:41,100 00:02:43,260 家長選擇
00:02:43,620 00:02:44,820 無照保母的
00:02:45,380 00:02:46,380 可能
00:02:47,660 00:02:49,060 署裡面這邊也都知道
00:02:49,060 00:02:50,260 那我們就是
00:02:50,660 00:02:53,220 你剛剛講的那三個原因大概
00:02:54,859 00:02:56,459 我的想法大概也這樣子
00:02:56,820 00:02:57,459 所以
00:02:57,739 00:02:58,940 所以你們看
00:02:59,100 00:03:00,900 看要怎麼去做處理
00:03:01,260 00:03:03,299 總是要防止
00:03:03,299 00:03:04,579 因為小孩子
00:03:04,579 00:03:06,260 特別是兩歲以下其實是
00:03:06,459 00:03:07,820 最需要保護的好不好
00:03:07,820 00:03:08,420 是 好
00:03:09,060 00:03:10,220 請副長請回
00:03:10,220 00:03:10,820 OK 謝謝
00:03:10,820 00:03:12,100 主席我請一下部長
00:03:12,620 00:03:14,019 部長有請副市長
00:03:14,820 00:03:15,820 部長好
00:03:17,820 00:03:18,620 楊委員好
00:03:18,620 00:03:19,140 部長好
00:03:19,140 00:03:20,940 部長我們今天討論安樂死
00:03:20,940 00:03:21,940 那
00:03:21,940 00:03:22,940 我就先
00:03:22,940 00:03:24,739 先跟你討論一下
00:03:24,739 00:03:26,340 我們的安寧醫療制度
00:03:27,620 00:03:29,140 我們就是
00:03:29,140 00:03:30,940 現行制度
00:03:30,940 00:03:32,340 為了要保障
00:03:32,340 00:03:34,140 生命末期照顧品質的
00:03:34,540 00:03:35,540 的
00:03:35,540 00:03:36,540 的部分
00:03:36,540 00:03:38,140 我們大概有可以
00:03:38,140 00:03:39,140 可以
00:03:39,820 00:03:42,540 醫療接近書
00:03:42,540 00:03:43,140 對不對
00:03:43,140 00:03:43,540 對
00:03:43,540 00:03:44,740 病除法規定了
00:03:45,060 00:03:46,860 那還有另外一個就是
00:03:46,860 00:03:48,260 安寧醫療
00:03:48,260 00:03:50,660 安寧緩和醫療醫院書
00:03:50,660 00:03:51,660 安寧
00:03:51,660 00:03:53,660 安寧醫療的部分
00:03:53,660 00:03:54,660 我
00:03:54,660 00:03:56,660 我有一個問題想要
00:03:56,660 00:03:58,660 想要跟部長討論一下
00:03:58,660 00:04:00,660 現在全台灣只有
00:04:00,660 00:04:02,660 873床
00:04:02,660 00:04:03,660 安寧病床
00:04:03,660 00:04:04,660 我這個數據
00:04:04,660 00:04:06,660 應該差不多
00:04:08,660 00:04:09,660 這樣子夠嗎
00:04:10,660 00:04:12,660 很明顯的是不夠的
00:04:13,579 00:04:15,579 跟我們說明
00:04:15,579 00:04:17,579 因為我們這個安寧
00:04:17,579 00:04:19,579 我們分成三類
00:04:19,579 00:04:21,579 一個就是像您說的
00:04:21,579 00:04:22,580 那個是住院安寧
00:04:22,580 00:04:24,580 就是一個特定的病房
00:04:24,580 00:04:26,580 專門在提供安寧的
00:04:26,580 00:04:28,580 另外有安寧共照
00:04:28,580 00:04:29,580 就是病人不動
00:04:29,580 00:04:31,580 團隊動的概念
00:04:31,580 00:04:33,580 照會安寧團隊來照顧
00:04:33,580 00:04:34,580 不是不是
00:04:34,580 00:04:36,580 在住院的時候
00:04:36,580 00:04:37,580 叫做安寧共照
00:04:37,580 00:04:38,580 在一般病床
00:04:38,580 00:04:39,580 一般病床
00:04:39,580 00:04:41,580 然後安寧團隊來提供安寧的
00:04:42,500 00:04:44,500 第三種還是居家安寧
00:04:44,500 00:04:46,500 所以我們現在健保的幾乎
00:04:46,500 00:04:48,500 有這三種的樣態
00:04:50,500 00:04:52,500 我自己接到的案子
00:04:52,500 00:04:54,500 其實我們接獲
00:04:54,500 00:04:57,500 多次癌症病人家屬的陳情
00:04:57,500 00:05:01,500 就是病患已經被告知
00:05:01,500 00:05:03,500 走到生命末期
00:05:03,500 00:05:05,500 必須要轉安寧病房
00:05:05,500 00:05:07,500 接受安寧醫療
00:05:07,500 00:05:08,500 可是呢
00:05:08,500 00:05:11,500 其實大概都必須要等很久
00:05:12,420 00:05:14,420 所以部長剛剛講的
00:05:14,420 00:05:16,420 第二個方案就是
00:05:16,420 00:05:17,420 病人不動
00:05:17,420 00:05:18,420 醫生動
00:05:18,420 00:05:19,420 那個叫
00:05:19,420 00:05:21,420 安寧共照
00:05:21,420 00:05:23,420 安寧共照的部分
00:05:23,420 00:05:25,420 必須要求醫院
00:05:25,420 00:05:27,420 趕快去強化
00:05:27,420 00:05:30,420 這個是算量能就比較大
00:05:30,420 00:05:32,420 因為不受限於病床的限制
00:05:32,420 00:05:34,420 它也比較即時性
00:05:34,420 00:05:36,420 它不是專屬病房
00:05:36,420 00:05:38,420 可是還是一樣可以得到
00:05:38,420 00:05:40,420 安寧醫療繁核醫療
00:05:41,340 00:05:43,340 這個我們會來強化
00:05:43,340 00:05:45,340 也要讓病患家屬知道
00:05:45,340 00:05:47,340 有這種選擇
00:05:47,340 00:05:49,340 這個還不錯
00:05:49,340 00:05:51,340 另外一個就是
00:05:51,340 00:05:53,340 部長剛剛講的
00:05:53,340 00:05:55,340 居家療護或是社區化的
00:05:55,340 00:05:57,340 安寧居家療護
00:05:57,340 00:06:03,340 這個其實推廣的怎麼樣
00:06:03,340 00:06:06,340 其實這個越來越被大家接受
00:06:06,340 00:06:07,340 就是居家啦
00:06:07,340 00:06:08,340 因為現在
00:06:09,260 00:06:11,260 其實多數的病人
00:06:11,260 00:06:13,260 還是希望在家善終
00:06:13,260 00:06:15,260 如果能夠在熟悉的環境
00:06:15,260 00:06:17,260 跟家人告別
00:06:17,260 00:06:19,260 這個是最好的
00:06:19,260 00:06:21,260 心理跟情緒上會更
00:06:21,260 00:06:23,260 比醫院更好
00:06:23,260 00:06:25,260 不過必須要你們大力
00:06:25,260 00:06:27,260 讓一般的民眾知道
00:06:27,260 00:06:29,260 有這個選項
00:06:29,260 00:06:31,260 也必須要落實到
00:06:31,260 00:06:33,260 可以跟醫院
00:06:33,260 00:06:35,260 很難要求到同屬
00:06:35,260 00:06:37,260 同屬的屬性
00:06:38,180 00:06:40,180 同等
00:06:40,180 00:06:42,180 可是落差不要那麼大
00:06:42,180 00:06:44,180 還有就是
00:06:44,180 00:06:46,180 這個可能會
00:06:46,180 00:06:48,180 會有乘鄉差異的問題
00:06:48,180 00:06:50,180 會有乘鄉差異的問題
00:06:50,180 00:06:52,180 這個都要
00:06:52,180 00:06:54,180 所以跟文說明
00:06:54,180 00:06:56,180 我們今年的健保
00:06:56,180 00:06:58,180 也把居家安寧的給他提高
00:06:58,180 00:07:00,180 因為這個要團隊
00:07:00,180 00:07:02,180 到家裡面
00:07:02,180 00:07:04,180 所以成本是比較耗時
00:07:04,180 00:07:06,180 好高成本
00:07:07,100 00:07:09,100 另外也用這個
00:07:09,100 00:07:11,100 就是潤質記仇方案
00:07:11,100 00:07:13,100 做的好的我們再加成給他
00:07:13,100 00:07:15,100 費用再加成
00:07:15,100 00:07:17,100 就是希望把品質拉高
00:07:17,100 00:07:19,100 像董言提的這樣
00:07:19,100 00:07:21,100 品質好的我們加成
00:07:21,100 00:07:23,100 兩成還是三成
00:07:23,100 00:07:25,100 人生的最後一段路
00:07:25,100 00:07:27,100 對病患來講
00:07:27,100 00:07:29,100 對家屬來講
00:07:29,100 00:07:31,100 都是一段煎熬
00:07:31,100 00:07:33,100 我們盡量把它做好
00:07:33,100 00:07:35,100 最後因為今天我們有討論安樂死
00:07:36,020 00:07:38,020 把安樂死的議題
00:07:38,020 00:07:40,020 拿來當作公投
00:07:40,020 00:07:42,020 這個是一項
00:07:42,020 00:07:44,020 還蠻荒謬的事情
00:07:44,020 00:07:46,020 因為這個
00:07:46,020 00:07:48,020 有太多專業的東西
00:07:48,020 00:07:50,020 包括憲法到底
00:07:50,020 00:07:52,020 有沒有保障到
00:07:52,020 00:07:54,020 死亡權
00:07:54,020 00:07:56,020 然後死亡權
00:07:56,020 00:07:58,020 憲法基本權力
00:07:58,020 00:08:00,020 能不能主動放棄
00:08:00,020 00:08:02,020 這個要探討的問題很多
00:08:02,020 00:08:04,020 我希望
00:08:04,020 00:08:06,020 所以部長能不能用
00:08:06,020 00:08:08,020 比較簡單的
00:08:08,020 00:08:10,020 講法透過這個委員會
00:08:10,020 00:08:12,020 講一下
00:08:12,020 00:08:14,020 我們現在其實已經
00:08:14,020 00:08:16,020 已經有
00:08:16,020 00:08:18,020 有抑鬱安寧反而
00:08:18,020 00:08:20,020 醫療的
00:08:20,020 00:08:22,020 和維生醫療的
00:08:22,020 00:08:24,020 意願書
00:08:24,020 00:08:26,020 也有抑鬱醫療決定書
00:08:26,020 00:08:28,020 這兩個
00:08:28,020 00:08:30,020 加起來
00:08:30,020 00:08:32,020 跟安樂死
00:08:32,020 00:08:34,020 現在
00:08:34,020 00:08:36,020 討論的安樂死之間
00:08:36,020 00:08:38,020 的差距在哪裡
00:08:38,020 00:08:40,020 不同在哪裡
00:08:40,020 00:08:42,020 其實我們走的是
00:08:42,020 00:08:44,020 尊嚴善終
00:08:44,020 00:08:46,020 如果簡單國外的分法
00:08:46,020 00:08:48,020 我們現在所推動的都叫做
00:08:48,020 00:08:50,020 Nature death
00:08:50,020 00:08:52,020 就是讓這個病情自然的
00:08:52,020 00:08:54,020 不要再多
00:08:54,020 00:08:56,020 不必要的這個
00:08:56,020 00:08:58,020 侵入性處置讓病人能夠
00:08:58,020 00:09:00,020 安寧的儀式
00:09:00,020 00:09:02,020 另外這個安樂死
00:09:02,020 00:09:04,020 現在法案所提出來
00:09:04,020 00:09:06,020 主動加工死亡
00:09:06,020 00:09:08,020 Cistic death
00:09:08,020 00:09:10,020 我們不要講加工死亡
00:09:10,020 00:09:12,020 因為加工死亡有立場
00:09:12,020 00:09:14,020 就是
00:09:14,020 00:09:16,020 一般來講就是
00:09:16,020 00:09:18,020 主動式的安樂死
00:09:18,020 00:09:20,020 那我們現在的
00:09:22,020 00:09:24,020 照部長的講法
00:09:24,020 00:09:26,020 我理解看看
00:09:26,020 00:09:28,020 是不是
00:09:28,020 00:09:30,020 我們現在
00:09:30,020 00:09:32,020 醫療決定書
00:09:32,020 00:09:34,020 就相
00:09:34,020 00:09:36,020 類似於
00:09:40,020 00:09:42,020 一種
00:09:42,020 00:09:44,020 安樂死的方式
00:09:44,020 00:09:46,020 對 如果真的要講
00:09:46,020 00:09:48,020 它就是比較屬於消極性的
00:09:48,020 00:09:50,020 安樂死
00:09:50,020 00:09:52,020 沒有再加工
00:09:52,020 00:09:54,020 沒有阻斷的部分
00:09:54,020 00:09:56,020 不需要拖命
00:09:56,020 00:09:58,020 其實我覺得
00:09:58,020 00:10:00,020 安樂死的部分
00:10:00,020 00:10:02,020 當然還必須要透過
00:10:02,020 00:10:04,020 很專業的公聽會
00:10:04,020 00:10:06,020 然後很嚴密的
00:10:06,020 00:10:08,020 的審查跟討論
00:10:10,020 00:10:12,020 那我是希望
00:10:12,020 00:10:14,020 部裡面就
00:10:14,020 00:10:16,020 就醫療決定書
00:10:16,020 00:10:18,020 的部分多加宣廣
00:10:18,020 00:10:20,020 宣導
00:10:20,020 00:10:22,020 其實
00:10:22,020 00:10:24,020 我這樣講好了
00:10:24,020 00:10:26,020 我是一個
00:10:28,020 00:10:30,020 陪伴媽媽
00:10:30,020 00:10:32,020 十年的人
00:10:32,020 00:10:34,020 我大概
00:10:34,020 00:10:36,020 除了在台北過夜
00:10:36,020 00:10:38,020 我是每天必須要
00:10:38,020 00:10:40,020 跑五十公里往返
00:10:40,020 00:10:42,020 看我媽媽的
00:10:42,020 00:10:44,020 我覺得人生到了
00:10:44,020 00:10:46,020 最後一段路確實
00:10:46,020 00:10:48,020 有很多病人
00:10:48,020 00:10:50,020 其實他是
00:10:50,020 00:10:52,020 並不想續命的
00:10:52,020 00:10:54,020 只是說
00:10:54,020 00:10:56,020 我們應該要怎麼處理
00:10:56,020 00:10:58,020 才算是尊重
00:10:58,020 00:11:00,020 尊重
00:11:00,020 00:11:02,020 人的尊嚴
00:11:02,020 00:11:04,020 然後兼顧
00:11:04,020 00:11:06,020 家屬的情感
00:11:06,020 00:11:08,020 還有病人的意願
00:11:08,020 00:11:10,020 那這個我覺得
00:11:10,020 00:11:12,020 安樂死的討論
00:11:12,020 00:11:14,020 可能還要很長的時間
00:11:14,020 00:11:16,020 希望部裡面這邊
00:11:16,020 00:11:18,020 可以就
00:11:18,020 00:11:20,020 醫療決定書的部分
00:11:20,020 00:11:22,020 多加推廣
00:11:22,020 00:11:24,020 我們先來落實這個
00:11:24,020 00:11:26,020 對
00:11:26,020 00:11:28,020 因為很多人
00:11:28,020 00:11:30,020 會想做
00:11:30,020 00:11:32,020 可能也不知道
00:11:32,020 00:11:34,020 還必須要經過門診
00:11:34,020 00:11:36,020 花一點時間
00:11:36,020 00:11:38,020 花一點精力
00:11:38,020 00:11:40,020 多加宣導
00:11:40,020 00:11:42,020 謝謝主席