2 Autonomy l Nonmaleficence l Justice l Beneficence

倫理原則 2 自主原則（Autonomy） l 不傷害原則（Non-maleficence） l 正義原則（Justice） � l 行善原則（Beneficence） l 誠信原則（Veracity) l 保密原則(Confidentiality) l 研究倫理 l 尊重人格（Respect for persons)

阿茲海默症的病程 4 初期輕中期重度知能減退生活功能障礙行為問題安養照護機構死亡 Feldman H, Gracon S. In: Clinical Diagnosis and Management of Alzheimer’s Disease. 1996: 230 -

阿茲海默症知能治療之藥物 27 l To treat or not to treat Ach. E-I的藥效約持續6～ 12個月 Cost–effective？傷心路走兩回, Temporary partial “awakening”

輕中度失智症患者的能力評估（Competence） 34 l l l l Decision-making abilities: abilities to understand, appreciate, reason, and make a choice Task-specific or situation-specific: bank account vs. consenting a simple medical treatment Fluctuate over time Absence of gold standard, expert opinion 病識感（insight, awareness of disease）失智的嚴重度，MMSE只有＜ 19或＞ 23才較能區別能力的有無 Mac. CAT-T (Mac. Arthur Competency Assessment Tool): semi-structured interview Karlawish JHT, et al. Neurology 2005; 64: 1514 -9

東西方觀點不同 39 l 波士頓（A special dementia care unit） Advanced decision-making focusing on patient’s wishes or patient comfort No-tube-feeding Relieving discomfort Die in dignity and peaceful l 香港（a long-term care unit） Life preservation l 台灣（115位照顧者的門診問卷） 61% preferred aggressive care 3% preferred palliative care Pang MCS, et al. J Nutr Health Aging 2007; 11: 495 -501 Chen WT, et al. J Geriatr Psychiatry Neurol 2002; 15: 16 -9