加護病房護理師收到了一名患有大規模蜘蛛膜下腔出血的 72 歲男性入院報告。轉診機構報告指出，該病患已經立有具法律約束力的預立醫療指示 (Advance Directive)，並指定了一名醫療委任代理人 (DPAHC)。當病患抵達時，他已經插管、昏迷且無法做決策。病患的大兒子抵達現場並要求立即拔除呼吸器，宣稱：『我是長子，現在由我做決定。』而指定的 DPAHC 是病患的小女兒。護理師的法定職責為何？
An intensive care nurse receives an admission report regarding a 72-year-old male with a massive subarachnoid hemorrhage. The transferring facility reports the client has an established legally binding Advance Directive and a designated durable power of attorney for health care (DPAHC). When the client arrives, he is intubated, comatose, and unable to make decisions. The client's oldest son arrives and demands the immediate removal of the ventilator, stating, 'I am the oldest son, I make the decisions now.' The designated DPAHC is the client's youngest daughter. What is the nurse's legal requirement?
- ACollaborate with hospital risk management to establish an ethics committee review explicitly bridging the severe sibling conflict.與醫院風險管理部門合作，建立明確處理嚴重手足衝突的倫理委員會審查機制
- BInform the son that the designated youngest daughter legally possesses sole and absolute medical decision-making authority.告知兒子，指定的小女兒在法律上擁有單獨且絕對的醫療決策權正確答案
- CDefer the immediate medical decision regarding life support strictly to the oldest son, following standard hierarchical next-of-kin protocols.遵循標準的法定親屬順序規定，將有關生命支持系統的即時醫療決策完全交由長子負責
- DExplain that the customized Advance Directive document absolutely overrides any living human surrogate, maintaining the ventilator indefinitely.解釋說，客製化的預立醫療指示絕對凌駕於任何活體代理人之上，並無限期維持呼吸器運作
- B告知兒子，指定的小女兒在法律上擁有單獨且絕對的醫療決策權
本題測驗生前預立醫療指示與醫療代理人排序 (Advance Directives / DPAHC)。醫療保健持久授權書 (Durable Power of Attorney for Health Care, DPAHC 或稱 Health Care Proxy) 是一項由病患在意識清醒時，親自簽署指定的最高合法醫療替代決策者。在美國法律下，一旦病患失去決策能力 (Incapacitated)，這名『指定代理人 (Designated Proxy)』的醫療決策權力是至高無上的，它絕對凌駕於傳統的親屬順位法則 (Spouse -> adult children -> parents)。因此，即使大兒子是長子，他在法律上無權干涉。護理師必須立刻澄清，病患的小女兒才是唯一擁有拔管與否的法定決策權者（選 B 正確）。選項 C 錯誤，傳統血緣順序在 DPAHC 存在時即失效。選項 D 錯誤，DPAHC 的目的就是讓活人（代理人）來解讀預立指示並做隨機應變。選項 A 尋求倫理委員會介入，通常是代理人之間平級且爭吵不休時才用，此處代理人明確是小女兒，無須開會。
- A與醫院風險管理部門合作，建立明確處理嚴重手足衝突的倫理委員會審查機制
倫理委員會處理極度模稜兩可且未能解決的代理人衝突，但在這個案例中，法定權限明確且清晰地落在受命的女兒身上。
- B · 正確答案告知兒子，指定的小女兒在法律上擁有單獨且絕對的醫療決策權
DPAHC 的法定確認會將全部且排他的醫療決策代理權直接轉移給該特定個人，剝奪了所有其他親屬的權力。
- C遵循標準的法定親屬順序規定，將有關生命支持系統的即時醫療決策完全交由長子負責
當存在有效的指定代理人文件時，傳統的近親層級順序在法律上即宣告徹底過時且無效。
- D解釋說，客製化的預立醫療指示絕對凌駕於任何活體代理人之上，並無限期維持呼吸器運作
雖然會參考醫療指示，但活著的受命代理人才能主動解讀它，並握有撤除機械通氣的動態權力。
美國的醫療委任代理（DPOA-HC）由病人於具決定能力時親自指定，其代理權優先於法定親屬；未指定時依州法的代理人順位（常見為配偶、成年子女、父母，各州不同）。台灣《病人自主權利法》與《安寧緩和醫療條例》亦設有醫療委任代理人制度，概念相近。實際順位依州法及機構政策確認。
English explanation
This question tests advance directives and the hierarchy of medical decision-makers (Advance Directives / DPAHC). The Durable Power of Attorney for Health Care (DPAHC, also called Health Care Proxy) is the highest legal substitute decision-maker, personally signed and designated by the patient while still competent. Under U.S. law, once the patient becomes incapacitated, this 'designated proxy's' medical decision-making authority is supreme and absolutely overrides the traditional next-of-kin order (Spouse -> adult children -> parents). Therefore, even though the eldest son is the firstborn, he has no legal right to interfere. The nurse must immediately clarify that the patient's younger daughter is the only person with the legal authority to decide on extubation (B is correct). Option C is wrong, because the traditional blood-kin order is voided once a DPAHC exists. Option D is wrong, because the very purpose of a DPAHC is to allow a living person (the proxy) to interpret the advance directive and adapt to changing circumstances. Option A, involving the ethics committee, is typically used only when proxies of equal standing disagree and cannot reach consensus; here, the proxy is clearly the younger daughter, and no meeting is necessary.
最近修訂：2026-10-06