好死不易在台灣

It May Not Be Easy to Have a Good Death in Taiwan

郭正典(Cheng-Deng Kuo)

《佛學與科學》 7卷2期 (2006/07) Pp. 79-86

https://doi.org/10.30162/BS.200607.0006

摘要

發展醫療技術的原始目的為了要拯救病人的生命及減輕病人的痛苦，而不是要拖延病人的死亡及增加病人的痛苦，如果醫療處置只會增加病人及其家屬的痛苦而與實益，則從人道的立場及醫學的目的來看，這些醫療處置就不應該被用在病人身上。如果醫護人員只知道救治病人，而不問病人是否還有救治希望，則這時候的醫療到底是在延長病人的壽命，還是在延長病人死亡的時間，就值得大家思考了。
並不是所有病人都要治療到底的，若在開始治療前就認定病人已無治療意義而不給予延命治療，此稱為「治療的限制」；若病人經過積極治療後病情仍一路惡化，死亡已可預見時，醫師在徵得家屬的同意後停止治療，此稱為「治療的撤除」。「治療的限制與撤除」不是安樂死。安樂死是企圖經由致命的、治療的操作以結束病人的生命，但「治療的限制與撤除」則是醫師不使用或中止延命治療的使用，讓病人自然死。
「安寧緩和醫療條例」讓我國的醫師可以限制及撤除已經用在末期病人身上的延命治療，使末期病人及已與治療意義的病人能早日脫離苦海，達到心靈及肉體的解脫。但是，由於民智未開，法律的限制也頗嚴格，還不完善，以至於許多人辛苦一輩子後還不一定能得個善終，這是很令人遺憾的。

關鍵字

治療的限制 ； 治療的撤除 ； 無效 ； 臨終悲劇 ； 好死

並列摘要

The primary purposes of developing medical technologies are to rescue the lives and alleviate the painful sufferings of the patients, instead of prolonging the death and increasing the sufferings of them. If medical interventions can only increase the sufferings of the patients and their families without benefits, then those medical interventions should not be applied to the patients from the viewpoints of humanity and the purpose of medicine. If medical personnel know only the application of emergency and critical care interventions to the patients without inquiring into the appropriateness of performing such interventions, then it is worthy of thinking whether the medical treatment is prolonging the life or the death of the patients.
Not all patients are to be treated endlessly. When the patient is considered as hopeless and the life-sustaining treatments are regarded as futile, then the life-sustaining treatments are withheld from the very beginning. This is called the withholding or limitation of treatment. If death is foreseeable in the near future despite aggressive treatment, then the physician discontinues the treatment given to the patient after convincing the family the hopeless situation. This is called the withdrawal of treatment. The withholding and withdrawal of treatment is not the equivalent to euthanasia which is the attempt to terminate the life of the patient by using lethal intervention, whereas the withholding and withdrawal of treatment is trying to let the patient die naturally by limiting or removing the life-sustaining treatments.
The ”Hospice Palliative Care Act” of Taiwan allows physician to legally withhold and withdraw the life-sustaining treatments in terminally ill patients so that they can get rid of the painful sufferings caused by futile treatments and attain peace in both mind and body. It is a pity that some patients still cannot enjoy a good death after a life-long hard working because of inadequate education of the general population and the strict restrictions of the law.

並列關鍵字

Withholding of treatment ； withdrawal of treatment ； futility ； end-of-life tragedy ； good death