— 照護管理 · MEDIUM · MCQ —
一位患有末期失智症的高齡病人入院，檔案中沒有預立醫療指示。護理師應確認誰為法律上的決策者？
An elderly client with advanced dementia is admitted to the hospital. There is no Advance Directive on file. Who should the nurse identify as the legal decision-maker?
- AThe hospital ethics committee醫院倫理委員會
- BThe client's court-appointed legal guardian or healthcare proxy✓ 正解病人的法院指定法定監護人或醫療代理人
- CThe client's primary care physician病人的主治醫師
- DThe client's oldest child病人最年長的子女
— Explanation · 中文詳解 —
當病人失去決策能力且無預立指示時，法律效力最高的是法院指定的監護人或病人曾指定的醫療委任代理人（B）。若無這些職位，才會依各州/國法律規定的繼承順位（如配偶、子女）決定。醫師（C）或委員會（A）通常是在無代理人且意見衝突時才介入。
When a client lacks decision-making capacity and has no advance directive, the court-appointed legal guardian or designated healthcare proxy holds the highest legal authority to make medical decisions. While family members may serve as surrogates if no guardian exists, their priority varies by jurisdiction, whereas a legal guardian’s authority is definitive.
✦ 台美臨床差異
美國非常強調 Durable Power of Attorney (DPOA)；台灣則依《安寧緩和醫療條例》或《病人自主權利法》規定意願人或家屬順位。