代理簽署父親DNR同意書：一位長子的經驗與角色再定位
Authors: 張洛菱 張洛菱 , 林秀珍 林秀珍 
Published: December 2024

<p>Do-not-resuscitate（DNR，不施行心肺復甦術），其內涵為在病人臨終時減少無效的積極醫療，以能善終。在臺灣，病人自主的精神尚未成熟，自主預立意願書不普遍，致使子女易陷入代理簽署DNR 同意書之困境。本研究旨在探究一位長子代理父親簽署DNR決策歷程與情緒經驗，並闡明長子角色在此過程中的影響與轉變。本研究透過立意與便利取樣，徵得一位研究參與者，進行半結構訪談，以主題分析法分析。研究發現代理簽署DNR涵蓋四個主題：（1）為何簽的是我？（2）「順」是「孝」的實踐－代理簽署DNR的決策因子；（3）親戚的不諒解與認知的擺盪－代理簽署DNR的矛盾經驗；（4）所以簽的是我－醫療背景和手足支持的保護因子。長子角色觀點在喪親歷程中的轉變則有兩個主題：（1）看見和覺察長子一人承擔的困境；（2）現代長子與手足並肩共同承擔。本研究結論如下：代理簽署DNR決策歷程的情緒經驗，可能會產生預期性的失落與矛盾的感受，而DNR的醫療決策，隱含傳統孝道觀念與現代倫理之間的衝突，在研究參與者的醫療背景與相互性孝道的觀念之下，評估個人需求和家庭福祉，而做出代理簽署DNR的決策，這也呼應了現代長子在處理孝道困境時的兼容方式。依據以上研究結果，本研究提出建議供後續研究與實務工作者參考。</p>
<p>&nbsp;</p><p>Do-not-resuscitate (DNR, meaning not to perform cardiopulmonary resuscitation), implies reducing ineffective aggressive medical treatments when a patient is near the end of life, allowing patients to pass away in a peaceful and dignified way. Moreover, it appears to be a common phenomenon and challenge for children to become surrogates to authorize DNR for their parents. In Chinese-speaking culture, it is often expected that the eldest son assumes the role as a primary decision-maker. The purpose of this study was to investigate the decision-making process and emotional experiences of an eldest son serving as a surrogate decision-maker for his father in signing a DNR consent form. Additionally, it aimed to shed light on the impact and transformation of the eldest son’s role in this process. This study employed qualitative research. A single research participant was recruited through purposive and convenience sampling for participation. A semi-structured interview was conducted, and the interview data were analyzed using thematic analysis. The study identified four key themes in the experiences of the participant&rsquo;s signing DNRs: (1) Why me?; (2) The influence of ’filial piety’ in decision-making; (3) Relatives’ incomprehension and cognitive swing &mdash; the contradictory experience of signing DNR as an agent; (4) So it is me who signed &mdash; The role of medical training background and sibling support in decision-making. The study also found two themes regarding the transformation of the eldest son’s role during the bereavement process: (1) The eldest son was the only one suffering from the burden of seeing and being aware of the dilemma; (2) The eldest son adopted the modern cultural perspective to involve his younger siblings to share the responsibility in the decision-making process. The study concluded as follows: the process of signing a DNR as a surrogate involved complex emotional experiences, including anticipatory feelings of loss and ambivalence. Medical decision-making regarding DNR often led to conflicts between traditional filial piety concepts and modern ethical considerations. The research participant, influenced by his medical training background and reciprocal filial piety, made his DNR decisions based on assessments of personal needs and family well-being. This approach aligned with the adaptive strategies employed by the eldest sons to navigate the traditional and modern filial piety dilemmas. Considering these findings, the study offers several suggestions for future research and mental health practitioners.</p>
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