人生旅程，尊嚴自主 Autonomy and Dignity on the Life Journey

1

我會想要知道身體的狀況嗎?

Would I like to know the condition of the body?

想要

I need it.

讓我再想想

Let me think for a while.

不需要

I don't need It.

2

我想要找哪些人討論我的狀況?(可複選)

Who would I like to talk about my condition? (one or more answers)

家人

Family

朋友

Friends

醫療團隊

Medical team

我還不想找別人討論

Leave me alone

3

我希望誰來陪伴我?(可複選)

Who do I want to accompany me? (one or more answers)

家人

Family

朋友

Friends

寵物

Pets

宗教人員

Religious personnel

醫療團隊

Medical team

我想要獨處

Leave me alone

1

我最害怕的事?(可複選)

What is the thing I am most afraid of? (one or more answers)

痛苦到受不了

Unbearable pain

生活完全需要別人來幫忙

Completely dependent in daily life

沒辦法再做喜歡的事情

Can't enjoy my favorite hobby

不知什麼時候死亡來臨

I do not know when the death will come

2

我最擔心的事?(可複選)

What is the thing I am most worried about? (one or more answers)

拖垮我的家人

Dragging family down

我還有很多責任

I have a lot of responsibility

我變得很難看

I become ugly

維持生命治療： 1. 心肺復甦術 2. 機械式維生系統-呼吸器 3. 輸血 4. 抗生素 5. 洗腎

Life Sustaining Treatments: 1. Cardiopulmonary Resuscitation 2. Mechanical Maintenance System - Ventilator 3. Blood Transfusion 4. Antibiotics 5. Hemodialysi

1

我希望接受維持生命治療嗎?(如右所列)

Would I like to acceptLife Sustaining Treatments?(as right side list)

我不希望

I do not want

我希望再嘗試一段時間

I want to try it for a while

我希望接受

I want to accept it

我還無法做決定

I can't make the decision right now

鼻胃管、點滴

Nasogastric Tube, Intravenous Infusion

2

我希望接受人工營養醫療照護嗎?(如右所列)

Would I like to acceptArtificial Nutrition ?(as right side list)

我不希望

I do not want

我希望再嘗試一段時間

I want to try it for a while

我希望接受

I want to accept it

我還無法做決定

I can't make the decision right now

1

被照顧的地點?

Place to being cared?

家裡

Home

安養機構

Nursing home

醫院

Hospital

家人決定

By my family's decision

2

善終的地點?

Location of death?

家裡