醫師應有主動拒絕實施心肺復甦術以維護病人善終的勇氣

Physicians Should Actively involve in Providing Good Death to Terminal Patients

陳榮基(Rong-Chi Chen)

《安寧療護雜誌》 18卷1期 (2013/03) Pp. 51-61

https://doi.org/10.6537/TJHPC.2013.18(1).5

摘要

安寧緩和醫療條例自2000年立法，經過2012年的第三度修法，賦予國民自行簽署（預立）選擇安寧緩和醫療意願書，抉擇在罹患末期疾病時（需經兩位專科醫師確診），不做心肺復甦術（cardiopulmonary resuscitation, CPR），而且不幸被插管急救無效時，可以順利拔管撤除維生醫療（life-sustaining treatments, LST）的權力。一位家屬代表簽署同意書，也可阻止醫師插管急救及/或要求拔管撤除維生醫療。對於沒有家屬的病人，醫師應照會安寧團隊共同評估，作維護病人最大利益的決定，必要時可以不插管也可以拔管。醫療人員應該秉持醫學倫理及法律的規範，以愛心救治病人，以慈心協助病人善終。醫院應推廣預立選擇安寧緩和醫療意願書並做健保卡註記，醫師診治臨終的末期病人，應慎重評估，以同理心與家屬商量，共同決定插管與否，及適時拔管。

關鍵字

安寧緩和醫療 ； 心肺復甦術 ； 維生醫療 ； 善終 ； 不予與撤除

並列摘要

In 2000 Taiwan passed the Hospice Palliative Care Act (a natural death act). In 2012 the Act was revised for the third time. This law provides our citizens the right of giving advance directives in medical decision regarding withholding cardiopulmonary resuscitation (CPR) and withdrawing the uneffective life-sustaining treatments (LST) at the final stage of life. With two physicians (specialists) agreeing that the patient is in terminal condition of an incurable disease, the attending physician should respect the patient's or the family member's signed wish of withholding CPR and/or withdrawing life-sustaining treatments. Physicians should protect patients' right of securing good death in the final stage of life by providing hospice palliative care.

並列關鍵字

Hospice palliative care ； CPR/DNR ； Life-sustaining treatments ； Good death ； Withhold/withdraw