生命末期的另一個照護議題：周產期安寧照護

Alternative Issue of End-of-Life Care: Perinatal Hospice

陳馥萱(Fu-Hsuan Chen) ； 余玉眉(Yu-Mei Yu Chao)

《安寧療護雜誌》 17卷3期 (2012/11) Pp. 329-339

https://doi.org/10.6537/TJHPC.2012.17(3).7

摘要

面對胎兒異常，大多數父母會選擇終止妊娠，但其實在國外已發展周產期安寧照護以協助繼續懷孕的婦女與家庭接受胎兒的出生與死亡，此為另一個生命末期的照護議題，值得醫護人員的關注，我國因文化信念與國情之不同，在獲知胎兒有致命性異常時，大多數父母會選擇終止妊娠，但這個決定常讓許多父母帶著深重的罪惡感自我療傷，筆者建議國人應改變觀念，認同胎兒的生命能持續懷孕至足月的價值，若仍決定終止妊娠者，在決定終止妊娠之前至少有十數天時間也可以應用周產期安寧照護的理念提供婦女與家庭相關的協助，本文依胎兒異常對家庭的衝擊、我國周產期安寧照護需求，並以國外周產期安寧照護發展及現況，參考安寧照護的理念，以「診斷確立至抉擇是否繼續懷孕」、「待產至胎兒娩出」、「胎兒死亡後」等三個階段分別對照護的內容進行說明，期望本文可引發對此生命末期照護議題的關注，並建議我國亦能發展符合我文化需求的照護模式。

關鍵字

周產期死亡 ； 周產期失落 ； 周產期安寧照護 ； 預立醫療照護計劃 ； 生命末期照護

並列摘要

Perinatal hospice care is an alternative option for the woman with fetal anomaly and her family to be able to accept the fetal birth and death. Most parents with fetal anomaly choose termination under our traditional Chinese culture. However, they are usually suffering from a deeply guilty during decision-making and self-healing process. Perinatal hospice care will be helpful during decision-making process and after termination.This article expounds the impact of fetal anomalies on the family, and perinatal hospice needs in Taiwan. Further, we describe three stages of preinatal hospice care, which are ”establish diagnosis to decide termination or not”, ”delivering the fetus” and ”after fetal death”. This article is trying to trigger the concern of issues of end-of-life care. It also suggests that perinatal hospice care should be modified to develop a care model in accordance with our cultural needs.

並列關鍵字

perinatal death ； perinatal loss ； perinatal hospice ； advance care planning ； end-of-life care