對急重症病人生命末期之照護

End-of-Life Care in Intensive Care Unit

翁益強(Yih-Chyang Weng)

《榮總護理》 29卷3期 (2012/09) Pp. 220-224

https://doi.org/10.6142/VGHN.29.3.220

摘要

「緩和療護」（palliative care）協助急重症病人之生命末期照護是現今的醫療趨勢，尤其在「無效醫療」（medical futility）認定遇到困難時，緩和療護建議透過召開個案倫理討論會，以追求善終（good death）為宗旨，運用「臨床倫理思辨四象限」為架構，經醫療團隊討論思辨後來形成共識。但要避免將末期病人基本需求被醫療團隊以共識之名停止給予，而引起倫理上的「滑坡效應」與醫療人員不安；以及熟悉國內「安寧緩和醫療條例」與「人體器官移植條例」中「腦死判定準則」規範，在認定無效醫療中不違法。另外召開家庭會議方式與運用同理心溝通技巧來獲得病人及/或家屬對無效醫療的共識，也是緩和療護的重點。若醫療團隊與病人及/或家屬一直無法達成共識，可試著「限時嘗試治療成效」（time-limited trials）來解決此臨床困境。最後強調無效醫療的認定只是善終追求的起點，因為末期病人還有許多其他身體症狀需要處置或社、心、靈需求需要幫助，甚至醫療團隊要開始討論病人有無臨終回家意願或最後臨終地點，以及宣告死亡可能的流程，若能適時轉介其他專業人員或團隊介入可能讓生命末期照護事半功倍。希望急重症醫療人員對病人生命末期照護，能透過緩和療護的幫助，提升工作的動力與自我價值的實現。

關鍵字

緩和療護 ； 無效醫療 ； 滑坡效應 ； 安寧緩和醫療條例 ； 限時嘗試治療成效

並列摘要

End-of-life care in intensive care unit trends toward palliative care in modern time. For dealing with medical futility, we can reach a consensus through health care team meeting with the focus of ”good death” and ”the four boxes of clinical ethics”. To avoid ”the slippery slope” in ethics due to the issue of withholding or withdrawing the ordinary treatment, and not to violate ”Hospice Care Regulations” and ”Regulations on Human Organ Transplantation” are also important. Thereafter, ways to come to an agreement with patient and family requires empathic communication during family meetings. If communication becomes difficult, ”time-limited trials” is another approach. It should be minded that no argument about medical futility launches palliative care into cares of other symptoms, psychosocial and spiritual needs, favored death point, and announcement of death. Sometimes, it is not easy to manage above, but inviting other specialists or other medical teams may smooth the processes. By incorporating palliative care with end-of-life care in intensive care unit can help to empower personnel and achieve self-values.

並列關鍵字

palliative care ； medical futility ； the slippery slope ； hospice care regulations ； time-limited trials