失智症末期的安寧緩和醫療照護

Hospice-palliative Care for Terminal Patients with Dementia

周希諴(Hsi-Hsien Chou)

《應用心理研究》 55期 (2012/09) Pp. 115-153

摘要

安寧緩和醫療照護（hospice palliative care），包括安寧療護（hospice care）以及緩和醫療（Palliative medicine）兩部分。前者是一種人生及醫療哲學（社會科學），後者是一種專門緩和病症為主（非以治癒疾病為主）的專業醫學（自然科學）。所以安寧緩和醫療照護，是一種以照護末期病人為對象之醫療理念，並加以緩和醫學之專業醫療，讓病人在病程的最終階段，得以接受到既有人性化、又有科學化的醫療。對於我國失智症末期之病人而言，目前行政院衛生署已經公告全民健康保險之安寧療護，對於老年期及初老期器質性精神病態住院條件，其中有兩個必要收案條件。第一個收案之必要條件為：病患或家屬同意接受安寧療護，並簽署選擇安寧緩和醫療意願書或同意書。第二個必要條件則為：CDR臨床失智評分量表為－末期（CDR=5）者。由於如何將安寧緩和照護運用於失智症末期病人，在我國才剛剛立法通過，多數民眾以及醫療人員並不熟悉，本文將針對此種「新興醫療」，予以詳細介紹，以就如何給予失智症末期病人實施安寧緩和醫療之理念根據與臨床實務提供參考。

關鍵字

安寧療護 ； 緩和醫學 ； 末期 ； 失智症

並列摘要

Hospice-palliative care contains both hospice care and palliative medicine. The former stands for the philosophy of caring while the latter belongs to one of the modern medical sciences. ”Hospice-palliative care” mainly takes care of terminally ill patients by using professional knowledge and skills of modern palliative medicine to enable the terminally ill to pass away peacefully and with dignity. According to a public notice from the Department of Health in Taiwan, the national health insurance pays compensation and medical expenses to terminal patients with dementia under two conditions: If the patient or the patient's family agrees to accept hospice-palliative care and completes the related documents issued in the Legislative Yuan Announcement, or if the clinical dementia rating (CDR) score for the patient reaches five (CDR=5). The Hospice Palliative Care Regulation laws have been passed for years now, yet the majority of Taiwanese people and medical personnel are still not familiar the caring of terminal patients with dementia. This article introduces the legal methodologies of performing hospice-palliative care to terminal patients with dementia and their applications in the clinical practice.

並列關鍵字

hospice ； palliative medicine ； terminal ； dementia

參考文獻

王志嘉、楊奕華、邱泰源、羅慶徽、陳聲平(2003)。安寧緩和醫療條例有關「不施行，以及終止或撤除心肺復甦術」之法律觀點。臺灣家庭醫學雜誌。13(3)，101-108。

趙可式、陳清惠、顏妙芬(2002)。末期病患靈性之本質。護理研究。10(4)，237-245。

Advance Health Care Directive. (2012, March 15). Re: California Hospital Association Retrieved from http://www.calhospital.org/sites/main/files/file-attachments/Forms_3.pdf

Dementia G. (2010, March 1). Re: National Institute for Health and Clinical Excellence (NICE). Retrieved from http://www.nice.org.uk/nicemedia/pdf/CG042quickrefguide.pdf.

行政院衛生署（2001）：〈醫療管理法規，安寧緩和醫療條例〉。線上檢索於2012年01月25日，取自：http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=45&now_fod_list_no=1331&level_no=3&doc_no=21148