華人儒、釋、道文化觀點探討台灣護理之家老年住民簽署自身預立醫療指示文件的現況與困境

Chinese culture, which has developed from Confucianism, Buddhism, and Taoism, is one of the few greats extant of four ancient civilizations and has its advantage to keep Chinese people survival until today. For issues related to prepare for the death, previous researchers thought that most of elderly residents wanted to transfer their autonomy of end-of-life care decision making to their family because of the notions of filial piety and familism from Confucianism and the idea of allowing nature to take its course from Taoist. However, lately in clinical situation, authors found that it was not only by the influence of the notions from Confucianism and Taoism, but also by the thought of Karma from Buddhism. Due to the cultural influences as above, the difficulty for the long-term care facility to implement the advance care planning (ACP) was that the attitude of most of the elderly residents toward signing their own advance directives (ADs) was passive or even turned it down. Therefore, our suggestions for carrying out ACP in long term care facilities are: 1.Health professionals must actively ask and listen to residents about how their diseases affect their quality of life. 2. Health professionals need to introduce ADs documents with the notion of good death from culture perspectives of Taoism, Confucianism, and Buddhism to the elderly residents and their families. 3. Health professionals should discuss end of life care with older residents and their family separately by playing a mediating role in coordinating and communicating between them. 4. Before implementing ACP, health professionals must help elder residents understand what the true meaning for them to have ADs documents and hospice palliative care. 5. When elder residents sign their own ADs documents, health professionals must assist them to have the hospice home care to manage their uncomfortable symptoms to have the good death at the end of life.