作者：
Daniel Fu-Chang Tsai (醫學院蔡甫昌-本所合聘教授), Yu-Chen Juang (健管所博士班行社組莊宇真同學), Chun-Tung Kuo (郭俊東-本所兼任次助理教授), Ping-Hsueh Lee & Duan-Rung Chen ✉️(陳端容-本所教師)
期刊名稱：BMC Medical Ethics
發表日期：2025.07.04
發表文章：
摘要/Abstract
台灣多數民眾願放棄末期維生治療，預立醫療決定簽署率仍偏低
台灣雖已立法保障病人自主決定醫療處置權，最新研究顯示，多數國人即使傾向在末期放棄維生治療，實際完成「預立醫療決定」（Advance Decision, AD）的比例仍極低。這項研究是由台大公衛學院與醫學院團隊合作，刊登於國際期刊《BMC Medical Ethics》。研究針對台灣20歲以上成年人進行全國電話調查，針對四種臨床情境，包括：不可逆昏迷、晚期運動神經元疾病（MND）、重度失智症等，是否接受維生治療如抗生素治療（例如肺炎）、洗腎、人工呼吸器、心肺復甦術（CPR）及鼻胃管灌食的決定。結果顯示多數民眾（約56.4%至79.3%）傾向放棄維生治療，尤其是在不可逆昏迷的情境中，拒絕治療比例最高。然而，特別的是，對於在疾病末期卻堅持鼻胃管灌食的比例，南部與東部居民顯著高於北部居民。文化價值與習俗因素值得進一步探討。
Background
Taiwan passed the Patient Right to Autonomy Act in 2016 and introduced a legal document called advance decision to address dilemmas in making life-sustaining treatment (LST) decisions for incompetent patients. However, the proportion of Taiwanese adults who have completed an advance decision remains low, and public preference trends are unclear.
Methods
A cross-sectional telephone survey was conducted among Taiwanese adults using a structured questionnaire to assess preferences regarding five types of LSTs across four hypothetical clinical scenarios (late-stage motor neuron disease, severe dementia, irreversible coma, and terminal cancer). Participants were categorized based on their preference patterns, and factors associated with each subgroup were analyzed.
Results
Of the 3188 individuals contacted, 2440 declined to participate, and 748 (24.3%) respondents were successfully interviewed. A total of 747 responses were included in the analysis. Latent class analysis identified four preference subgroups: pro-forgo (more than half of the respondents), neutral, aggressive, and motor-neuron-disease specific. Older age, higher education, and better quality of life were associated with a greater likelihood of belonging to the pro-forgo group, while being male, unmarried, currently not working, or not residing in northern Taiwan were associated with a lower likelihood.
Conclusions
Most respondents expressed a consistent preference to forgo LSTs in the hypothetical clinical scenarios. This suggests that the advance decision, implemented in 2019, may align with public needs. However, given the low completion rate and prevalent preference patterns, policymakers should increase efforts to ensure that those in need have access to appropriate resources and consider implementing a tiered signing process.
