臺灣博碩士論文加值系統

臺灣已邁入高齡化社會，根據衛生福利部統計資料，我國65歲以上老年人口之死亡比率逐年增加，如何讓老年人在走入生命末期的過程中保有尊嚴和自主醫療，是一項重要議題。本研究目的旨在探討老人簽署「預立安寧緩和醫療意願書」之經驗。採質性研究設計，深度訪談(in-depth interview)研究法，以立意取樣，於台北市某醫學中心進行收案，收案期間自2013年05月至2013年10月止。共13位受訪者，年齡介於65歲至89歲之間，平均73歲，於資料飽和後停止收案。結果發現受訪者選擇安寧緩和醫療並簽署意願書的心路歷程，共分為三階段，主題包括簽署前的醞釀、簽署的執行及簽署後的心聲，每一主題各包含數個次主題，說明老年人歷經簽署意願書前、中、後的想法及感受。受訪者從出現想要簽署的信念到實際執行簽署，均醞釀多年的歷程。受訪者認為活著要有品質，期望自己生命末期能不成為孩子的負擔、不受急救之苦、不浪費醫療資源；多數受訪者曾經歷想簽署意願書卻不清楚簽署管道的過程，當他們找到管道進行簽署後，對於完成這個思考多年的心願感到如釋重負，也為自己完成簽署的行動賦予正向意義，甚至主動表達願意參與簽署意願書的推廣工作。
透過對老人預先為自己選擇安寧緩和醫療經驗的瞭解，建議醫護人員應加強對老年人宣導選擇安寧緩和醫療之相關訊息、強化子女與老人對於末期醫療想法的溝通，及主動與老人進行末期醫療計畫之討論。此外，多數受訪者提出願意加入安寧緩和醫療推廣的行列，建議相關單位可邀請已完成簽署意願書的老人於安寧推廣活動中進行經驗分享。
本研究結果可協助臨床及社區醫護人員對於老人預先為自己選擇安寧緩和醫療的想法有更深入的了解，進而提升老年人末期醫療照護之品質。

According to statistics of the Health and Welfare Ministry, Taiwan, ROC, our coominity has become an agingsociety. The death rate of population in elderly over 65 years increases year by year. It is an important issue to let the elderly maintain the dignity and medical autonomy when they are into the end of life. The purpose of this study was to investigate the experiences of signed " consent form in palliative care " in the elderly. This study is designed as a qualitative research, by in-depth interview research methods, and purposive sampling. The participants were invited in a medical center in Taipei. A total of 13 participants, ages 65 to 89 years (mean 73 years), were recruited from May 2013 to October 2013.Our results showed that the mentality of choosing palliative care and has signed the consent form in participants, is divided into three stages, included brewing of signing consent form before, execution of signing the consent form, and described the heartfelt wishes after signing the consent form. Each stages contains a number of sub-themes , indicating of feelings of signing the consent form before, present and after. Participants appeared the beliefs to want to signed the consent form until the actual implementation, had brewing years of history. Participants believed that the quality of life should be have, expect the end of life can not become a burden on the child, do not first aid to Suffering , and not to waste the medical resources.Most of participants want to signing the consent form in the past, but unknown the pipeline. After participants found the pipeline in signing the consent form and signing done , they were feel relieved to complete the long cherished wishes. Participants completed the consent form to fill which give them the positive meaning, and even take the initiative to express willingness to sign the consent form to participate in the promotion.

Through from understand of preselecting palliative care in elderly, recommended of strengthen advocacy to choose the palliative care in relevant medical information for the elderly, and strengthen the communication between children and the elderly for end of life in medical care ideas, and take the initiative to discuss the end of life in medical care plan with elderly. In addition, the majority of participants are willing to join the ranks of those who made the promotion of palliative care. Therefore suggested the relevant units have been completed may be invited to sign a consent form for the elderly to share their experience in peace promotion activities.
The results of this study may assist in clinical and community health care workers for the elderly in advance of their choice idea for palliative care have a better understanding, and thus enhance the end of life quality in medical care for the elderly .

中文摘要…………………………………………………………………………… i
英文摘要……………………………………………………………………………ii
目次…………………………………………………………………………………iv
表次…………………………………………………………………………………vi
圖次…………………………………………………………………………………vii
第一章 緒論
第一節 研究動機與重要性…………………………………………………………1
第二節 研究目的……………………………………………………………………3
第三節 名詞解釋……………………………………………………………………3
第二章 文獻查證
第一節 「安寧緩和醫療意願」之簡介……………………………………………4
第二節 醫療自主決策………………………………………………………………15
第三節 老年人與醫療自主決策之現況……………………………………………17
第三章 研究方法
第一節 研究設計……………………………………………………………………22
第二節 研究對象之選取……………………………………………………………22
第三節 研究進行步驟………………………………………………………………23
第四節 訪談情境……………………………………………………………………23
第五節 倫裡考量……………………………………………………………………24
第六節 研究工具……………………………………………………………………25
第七節 研究資料分析………………………………………………………………25
第八節 嚴謹度………………………………………………………………………26
第四章 研究結果
第一節 受訪者基本屬性……………………………………………………………29
第二節 簽署前的醞釀………………………………………………………………31
第三節 簽署的執行…………………………………………………………………37
第四節 簽署後的心聲………………………………………………………………42
第五章 討論
第一節 簽署前的醞釀………………………………………………………………46
第三節 簽署的執行…………………………………………………………………50
第四節 簽署後的心聲………………………………………………………………52
第六章 結論、限制與建議
第一節 研究結論……………………………………………………………………55
第二節 臨床實務應用………………………………………………………………56
第三節 研究限制與未來研究建議…………………………………………………58
參考資料
中文部分……………………………………………………………………………59
外文部份……………………………………………………………………………72
附錄
附錄一 參與研究同意書………………………………………………………… 76
附錄二 個案基本資料表………………………………………………………… 77
附錄三 訪談指引………………………………………………………………… 78

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吳春桂、蘇玲華、黃勝堅、林芳如、黃美玲、林亞陵…林宏茂(2009)．DNR知情告知與決策對於重症生命末期照護之重要性．安寧療護雜誌，14(2)，172-185。[Wu, C. G., Su, L. H., Huang, S. J., Lin F. R., Lin, Y. L., ... & Lin, H. M. (2009). Discussion and decision making of DNR issue is important in end-of-life care for the critically. Journal of Hospice Palliative Care, 14(2), 172-185.]
吳瓊恩(1993)．決策問題與決策者的思惟傾向．中國行政評論，5(2)，1-36。[Wu, C. E. (1993). Decision problems and thinking of decision-makers. The Chinese Public Administration Review, 5(2), 1-36.]
胡文郁、楊嘉玲(2009)．生命末期之病情告知與預立照護計畫．護理雜誌，56(1)，23-28。[Hu, W. Y. & Yang, J. L. (2009). Truth telling and advance care planning. The Journal of Nursing, 56(1), 23-28.]
徐子恆、蔡世滋(2006)．非癌症疾病之緩和治療．慈濟醫學，18(4)，37-39。[Hsu, S. H. & Tsai, S. T. (2006). Non-cancer diseases of palliative treatment. Tzu Chi Medical Journal, 18(4), 37-39.]
柯文哲(2010)．葉克膜(ECMO)的倫理問題．澄清醫護管理雜誌，6(2)，4-7。。[Ko, W. J. (2010). Ethical issues of extracorporeal membrane oxygenation (ECMO). Cheng Ching Medical Journal, 6(2), 4-7.]
科薰貴(2009)．某大學三年級生善終概念之分析．安寧療護，14(1)，27-34）。[Ko, H. K. (2009). Analysis of Good Death Concept in Junior Students of an University). Journal of Hospice Palliative Care, 14(1), 27-34.]
翁益強(2011)．探討「預立選擇安寧緩和醫療意願書」與「不施行心肺復甦術同
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洪筱蘋 吳婉玲 陳俊銓(2006)．嘉義地區安寧療護機構醫療服務提供之比較分析．Taipei City Medical Journal, 3(12), 1-11.]
孫效智(2012)．安寧緩和醫療條例中的末期病患與病人自主權．未發表的碩士論文．
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財團法人醫院評鑑暨醫療品質策進會(2013，08月27日)．102年度醫學中心任務指標基準評分說明．取自http://www.tjcha.org.tw/admin/Upload/F712B540-8EC3-476D-AF0C-F7EF2CD50D6E/102年度醫學中心任務指標基準評分說明-102年8月27日衛部醫字第1020162495號函備查.pdf [Taiwan Joint Commission on Hospital Accreditation. (August 27,2013). 2013 Description the benchmark index of medical center task. Retrieved from http://www.tjcha.org.tw/admin/Upload/F712B540-8EC3-476D-AF0C-F7EF2CD50D6E/102年度醫學中心任務指標基準評分說明-102年8月27日衛部醫字第1020162495號函備查.pdf]
張依婷(2010)．劃破纏缚之繭：重新編織生命的死亡意義．未發表的碩士論文，台中市：東海大學宗教研究所。[Chang, Y. T. (2010). Breaking from the Constraint of the Meaning of Death. Unpublished master's thesis. Taichung City: Graduate Institute of Religion.]
張宜玲(2009)．童話故事中的老人智慧與Erikson生命階段統觀的敘述：重返自性的曼陀羅之旅．未發表的博士論文．高雄市：師範大學成人教育研究所。[Chang, I. L. (2009). The wisdom of elders in children’s picture books and The call of Erikson’s life cycle completed：The self journey of mandala. Unpublished doctoral dissertation. Kaohsiung city: Graduate institute of adult education, National Kaohsiung Normal University ,.]
國科會高瞻自然科學教學資源平台(2011)．要花多少錢延長生命？．取自http://highscope.ch.ntu.edu.tw/wordpress/?p=34336[The Platform of High-Scope Propram. (2011). How much is it to extending the life?. Retrieved from http://highscope.ch.ntu.edu.tw/wordpress/?p=34336]
陳宇菁(2006)．加護病房家屬代理病人的DNR決策．未發表的碩士論文．台北市：國立台北護理學院護理系研究所。[Ching, C. Y. (2006). Surrogated DNR decision-making by family members of ICU patients. Unpublished master's thesis. Taipei: National Taipei University of Nursing Institute.]
陳亭儒、胡文郁(2011)．善終之概念分析．長庚護理，22(1)，46-52。[Chen, T. Y. & Hu, W. Y. (2011). Concept analysis of good dying. Chang Gung Nursing, 22(1), 46-52.]
陳昭妤(2010)．子女代理簽署父母不予急救同意書之心路歷程．未發表的碩士論文．台中市：中國醫藥大學護理學系研究所。[Chen, C.Y. (2010). The experience of adult children in singing parent’s DNR (do not resuscitate) consent. Unpublished master's thesis. Taichung City: China Medical University Department of Nursing Institute.]
陳榮基(2008)．DNR不等於安寧緩和醫療．台灣醫界，51(4)，36-39。[Chen R. C.
(2008). DNR is not equal to the Palliative Care. Taiwan Medical Journal, 51(4), 36-39.]
陳榮基、蘇宛農(2008)．「DNR意願註記健保IC卡登錄」宣導．安寧療護雜誌，
13(3)，343-347。[Chen, R. C. & Su, W. N. (2008). Promoting of DNR willingness
to log in Health Insurance IC cards. Journal of Hospice Palliative Care, 13(3), 343-347.]
黃松林(2004)．反壓迫實務與老人社會照顧．社區發展季刊，106，123-132。[Huang, S. L. (2004). Anti-oppressive practice social care for the elderly. Community Development of Quarterly, 106, 123-132.]
黃冠能(2003)．安寧緩和社會工作臨終倫理態度初探．未發表的碩士論文．台北市：國立台灣大學社會工作研究所。[Huang, K.N. (2003). The dying ethical attitudes in Palliative of social work study. Unpublished master's thesis. Taipei city: National Taiwan University Department of Social Work.]
黃麗續(2009)．從DNR分析看無效醫療的界線和醫療的極限．未發表的碩士論文．嘉義縣：南華大學生死學系。[Huang, L.H. (2009). The boundary of the medical futility and the extreme limit of the medicine--an aspect of DNR analysis. Unpublished master's thesis. Chiayi county: Department of Life-and-Death Institute.]
黃馨葆、蔡兆勳、陳慶餘、邱泰源(2011)．生命末期照顧如何達到好的成本效益．安寧療護雜誌，16(2)，205-216。[Huang, S. B., Tsai, J. S., Chen, C. Y., Chiu, T. Y. (2011). How to Optimize Cost-Effectiveness in End-of-Life Care
. Journal of Hospice Palliative Care, 16(2), 205-216.]
曾月華(2006)．生前預囑臨床實施之討論：論臨終老人的醫療處遇「權利」與醫病關係「權力」之探討．未發表的碩士論文．嘉義縣：國立中正大學社會福利研究所。[Tseng, Y. H. (2006). Exploring of living wills in clinical performance: the"power" for the clinical implementation and the "rights" for the doctor-patient relationship of medical treatment for dying elderly. Unpublished master's thesis. Chiayi county: Department of Social Welfare Institute.]
曾韻如、邱泰源、胡文郁、程劭儀、姚建安、陳慶餘(2005)．老年癌末病人善終之評估．安寧療護雜誌，10(1)，13-23。[Tseng, Y. J., Chiu, T. Y., Hu, W. Y., Cheng, S. Y., Yao, C. A. & Chen, C. Y. (2005). Good death assessment of geriatric patients with terminal cancers Taiwan Journal of Hospice Palliative Care. , 10(1), 13-23.]
彭孟津(2010)．社區老人之死亡態度與對預立醫療指示之認知與看法．未發表的碩士論文．台北市：國立台北護理健康大學護理研究所。[Peng, M. C. (2010). Attitudes toward death and advance directive among community-dwelling elderly. Unpublished master's thesis. Taipei: National Taipei University of Nursing Institute.]
莊曉青、廖廷萱、許碧珊(2008)．老人醫療自主權．當代醫學，35(3)，245-248。[Juang, S. C., Liau, T. S. & Hsu, B. S. (2008). Medical care autonomy in elderly. Contemporary Medicine, 35(3), 245-248.]
楊琇茹(2004)．從病患自主權看病患家屬參與醫療決定之權限．未發表的碩士論文．桃園縣：中原大學財經法律研究所。[Yang, H. J. (2004). An analysis of patient family's. authority to Participate in medical decision-making. Taoyuan County：Department of financial and economic Institute.]
楊嘉玲、陳慶餘、胡文郁(2008)．醫療預立指示．安寧療護雜誌，13(1)，30-41。[Yang, J. L., Chen, C. Y. & Hu, W. Y. (2008). Advance medical directives. Journal of Hospice Palliative Care, 13(1), 30-41.]
維基文庫(2010)．尚書/洪範，取自http://zh.wikisource.org/zh-hant/%E5%B0%9A%E6%9B%B8/%E6%B4%AA%E7%AF%84 [Wikisource(2010). Shang Shu / Hong Fan. Retrieved from http://zh.wikisource.org/zh-hant/%E5%B0%9A%E6%9B%B8/%E6%B4%AA%E7%AF%84]
維基百科(2013)．五福，取自http://zh.wikipedia.org/wiki/%E4%BA%94%E7%A6%8F [Wikipedia(2013). five fortunes. Retrieved from http://zh.wikipedia.org/wiki/%E4%BA%94%E7%A6%8F]
趙可式(2012，8月)．不予及撤除/終止維生醫療綜論-醫療照護的抉擇過程指引．台灣安寧緩和醫療/護理學會聯合主辦，2012醫生不醫死？撤除維生醫療指引之臨床運用．台北、台灣：台北榮民總醫院。[Chao, C. S. (August, 2012). Neither nor termination of life support medical comprehensive Discussion - health care decision process guidelines. Taiwan palliative care / Nursing Association jointly organized, 2012 Do not doctors treat the death? Removal of the clinical use of invasive medical guidelines. Taipei Taiwan: Taipei Veterans General Hospital]
趙可式(1997)．台灣癌症末期病患對善終意義的體認．護理雜誌，44(1)，48-55。[Chao, C. S. (1997). The meaning of good dying for terminally ill cancer patients in Taiwan. Journal of Nursing, 44(1), 48-55.]
趙可式(2010)．臨終病人的安寧療護．取自http://www.kwnc.edu.mo/20120416conference/pdf/2012_04_16.pdf [Chao, C. S. (2010). Hospice and palliative care of the terminal patients. Retrieved from http://www.kwnc.edu.mo/20120416conference/pdf/2012_04_16.pdf]
劉嘉年、楊銘欽、楊志良(2001)．台灣成年民眾死亡前三個月健保醫療費用支出之影響分析．台灣醫誌，20(6)，451-462。[Liu,C. N., Yang, M. C., Yaung, C. L. (2001). Factors affecting the expenditure of NHI by adult beneficiaries in their last three months of life in Taiwan. Journal of the Formosan Medical Association, 20(6), 451-462.]
潘淑滿(2003)．深度訪談法．潘淑滿，質性研究理論與應用(133-158)．台北：心理。[Pan, S. M. (2003). Depth interviews method. Pan, S. M., Qualitative Research Theory and Applications (133-158). Taipei：Shin Li.]
衛生福利部(2011a，1月)．100年度衛生教育主軸宣導計畫重點工作與策略．取自http://www.kles.tnc.edu.tw/classweb/UploadDocument/1175_100%A6~%AB%D7%BD%C3%A5%CD%B1%D0%A8%7C%A5D%B6b%AB%C5%BE%C9%ADp%B5e%AD%AB%C2I%A4u%A7@%BBP%B5%A6%B2%A4(%AE%D6%A9w%AA%A9).pdf [Ministry of Health and Welfare. (January, 2011). 2011 The focus and strategy of the health education promotion plan. Retrieved from http://www.kles.tnc.edu.tw/classweb/UploadDocument/1175_100%A6~%AB%D7%BD%C3%A5%CD%B1%D0%A8%7C%A5D%B6b%AB%C5%BE%C9%ADp%B5e%AD%AB%C2I%A4u%A7@%BBP%B5%A6%B2%A4(%AE%D6%A9w%AA%A9).pdf]
衛生福利部(2011b，10月7日)．2011世界安寧緩和醫療日 安寧療護 全人照護．取自http://www.mohw.gov.tw/CHT/Ministry/DM2_P.aspx?f_list_no=7&fod_list_no=4513&doc_no=41306 [Ministry of Health and Welfare. (October 11,2011). World Hospice Palliative Care Day 2011, The hospice and holistic health care. Retrieved from http://www.mohw.gov.tw/CHT/Ministry/DM2_P.aspx?f_list_no=7&fod_list_no=4513&doc_no=41306]
衛生福利部(2013，10月4日)．2013世界安寧緩和醫療日-讓安寧緩和醫療更普及．取自http://www.mohw.gov.tw/cht/Ministry/DM1_P.aspx?f_list_no=10&fod_list_no=0&doc_no=32925[Ministry of Health and Welfare. (October 4, 2013). 2013 World Palliative Care Day - make the palliative care more widely. Retrieved from http://www.mohw.gov.tw/cht/Ministry/DM1_P.aspx?f_list_no=10&fod_list_no=0&doc_no=32925]
衛生福利部中央健康保險署(2009，12月11日)．多用安寧療護，維護醫療環保．http://www.nhi.gov.tw/Resource/webdata/Attach_14713_2_12_多用安寧療護，維護醫療環保.pdf [National Health Insurance Administration, Ministry of Health and Welfare . (December 11, 2009). We should utilize hospice care more and maintain medical resources well. Retrieved from http://www.nhi.gov.tw/Resource/webdata/Attach_14713_2_12_多用安寧療護，維護醫療環保.pdf]
衛生福利部中央健康保險署(2013，5月23)．安寧緩和醫療條例相關法條及相關同意書及意願書．取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=712&WD_ID=902&webdata_id=3651[National Health Insurance Administration, Ministry of Health and Welfare. (May 23, 2013). Related regulations and Consent form in Palliative Care Act. Retrieved from http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=712&WD_ID=902&webdata_id=3651]
衛生福利部法規檢索系統(2000，6月，7)．安寧緩和醫療條例．取自http://mohwlaw.mohw.gov.tw/Chi/FLAW/FLAWDAT01.asp?lsid=FL013632
衛生福利部法規檢索系統(2010，8月，12)．公告修正「預立選擇安寧緩和醫療意願書」、「不施行心肺復甦術（Do Not Resuscitate）同意書」、「醫療委任代理人委任書」及「選擇安寧緩和醫療意願撤回聲明書」等四種表單參考範例．取自http://mohwlaw.mohw.gov.tw/Chi/FLAW/FLAWDAT01.asp?lsid=FL013632 [Ministry of Health and Welfare, Republic of China. (August 12, 2010) Correction Notice "foreordained choose palliative care consent form," "do not resuscitate (Do Not Resuscitate) Consent", "appoint a medical proxy form" and "choose hospice palliative care wishes to withdraw Declaration" and other four reference Sample forms. Retrieved from http://mohwlaw.mohw.gov.tw/Chi/FLAW/FLAWDAT01.asp?lsid=FL013632]
衛生福利部法規檢索系統(2013，1月，9)．安寧緩和醫療條例．取自http://mohwlaw.mohw.gov.tw/Chi/FLAW/FLAWDAT0202.asp [Ministry of Health and Welfare, Republic of China. (January 9, 2013) Hospice Palliative Care Act. Retrieved from http://mohwlaw.mohw.gov.tw/Chi/FLAW/FLAWDAT0202.asp]
衛生福利部統計處(2012，6月27日)．民國100年主要死因分析．取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2622 [Ministry of Health and Welfare. (June 27, 2012) Analysis of the leading causes of death in 2011. Retrieved from http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2622]
衛生福利部全國愛心關懷服務網(2012，10月12日)．2012世界安寧緩和醫療日 老有安寧～善別善終．取自http://wecare.mohw.gov.tw/care_content.aspx?data_id=5390 [National Caring Service Network, Ministry of Health and Welfare. (October 12,2012). World Hospice Palliative Care Day 2012, The elderly have hospice and good death. Retrieved from httphttp://wecare.mohw.gov.tw/care_content.aspx?data_id=5390]
衛生福利部國民健康署(2010，6月11日)．推廣安寧療護-捍衛身體自主權，保障生命尊嚴．取自http://www.hpa.gov.tw/BHPnet/Web/News/News.aspx?No=201006110001 [Health Promotion Administration, Ministry of Health and Welfare. (June 11,2010). Promotion of hospice - to defend the autonomy of the body to protect the dignity of life. Retrieved from http://www.hpa.gov.tw/BHPnet/Web/News/News.aspx?No=201006110001]
衛生福利部國民健康署健康九九網站(2010a，5月29日)．安寧療護-尊重生命．取自http://health99.hpa.gov.tw/Hot_News/h_NewsDetailN.aspx?TopIcNo=5666 [Health 99 website, Health Promotion Administration, Ministry of Health and Welfare. (May 29,2010). Hospice-respect for life. Retrieved from http://health99.hpa.gov.tw/Hot_News/h_NewsDetailN.aspx?TopIcNo=5666]
衛生福利部國民健康署健康九九網站(2010b，5月29日)．預立選擇安寧緩和醫療及不施行心肺復甦術-讓終點更有尊嚴．取自http://www.health99.doh.gov.tw/txt/HealthyHeadlineZone/HealthyHeadlineDetai.aspx?TopIcNo=5667[Health 99 website, Health Promotion Administration, Ministry of Health and Welfare. (May 29,2010). Advance Palliative care and do not resuscitate- more dignified in the end of life. Retrieved from http://www.health99.doh.gov.tw/txt/HealthyHeadlineZone/HealthyHeadlineDetai.aspx?TopIcNo=5667]
賴和賢、邱泰源、胡文郁、張皓翔、陳慶餘(2005)．善終服務之文獻複查．安寧療護雜誌，10(2)，174-185。[Lai, H. H., Chiu, T. Y., Hu, W. Y., Chang, H. H., Yao, C. A., Chen, C. Y. (2005). Literature review of good death service. Journal of Hospice Palliative Care, 10(2), 174-185. ]
蔡甫昌、潘恆嘉、吳澤玫、邱泰源、黃天祥(2006)．預立醫療計畫之倫理與法律
議題．台灣醫學，10(4)，517-536。[Tsai, F. C., Pan, H. J., Wu, T. M., Chiou, T. Y. & Huang, T. S. (2006). Issues for ethical and legal of advance care planning. Taiwan Medical, 10(4), 517-536]
蔡佩真、許祖維、張玉仕(2008)．國際安寧緩和醫療政策發展初探．社區發季刊，
123，268-281。[Tsai, P. J., Hsu, T. W. & Chang, Y. S. (2008). An overview of the currently hospice palliative care policy. Community Development of Quarterly, 123, 268-281.]
蔡淑華(2010)．重症末期病患家屬簽署DNR心路歷程之敘事分析．未發表的碩
士論文．台中市：中國醫藥大學護理學系研究所。[Tasi, S. H. (2010). Narrative analysis of families’ experience in giving DNR consent for the critically ill patients. Unpublished master's thesis. Taichung City: China Medical University Department of Nursing Institute.]
謝伶瑜(2011)．醫護人員預立醫囑知識與相關因素之探討．長庚護理，22(2)，
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謝碧朱(2012，5月)．安寧緩和照護之醫護倫理和刑事責任的探討．未發表的碩
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