末期病人使用人工營養及水分的困境

The Dilemma of Artificial Nutrition and Hydration in Terminally Ill Patients

蕭凱鴻(Kai-Hung Hsiao) ； 葉修誠(Xiu-Ching Yeh) ； 蔡明學(Ming-Hsueh Tsai) ； 詹尚易(Shang-Yih Chan) ； 陳修聖(Shiou-Sheng Chen) ； 黃弘孟(Hung-Meng Huang) ； 黃勝堅(Sheng-Jean Huang)

《北市醫學雜誌》 15卷附冊 (2018/06) Pp. 46-53

https://doi.org/10.6200/TCMJ.201806_15(SP).0005

摘要

營養和水分是維持生命不可或缺的元素。然而，當生命只剩下幾天或數週的時候，有許多因素會導致病人無法進食、或進食能力下降，且惡病質(cachexia)的狀態也時有所見。是否要常規給予這些末期病患人工營養(artificial nutrition)和人工水分(artificial hydration)治療，成為醫療人員和家屬之間的倫理、法律、和臨床困境。本篇旨在回顧過去相關文獻，提供醫病共享決策(shared decision making, SDM)時的參考，並期待能進一步提升臨終醫療照護品質。

關鍵字

人工營養 ； 人工水分 ； 醫病共享決策 ； 死亡識能

並列摘要

Nutrition and hydration are essential elements for maintaining life. However, when life comes to the last days or weeks, many factors can lead to inability to eat or decrease of the ability to eat, and the cachexia state is sometimes seen. Whether artificial nutrition and hydration should be given to terminally ill patients regularly has become a plight of ethics, law and clinical concerns in between medical personnel and the patient's families. The purpose of this paper is to review relevant literatures and provide a reference for shared decision making in this issue and look forward to further improving the quality of end-of-life care.

並列關鍵字

artificial nutrition ； artificial hydration ； shared decision making ； death literacy