DNR知情告知與決策對於重症生命末期照護之重要性

Discussion and Decision Making of DNR Issue is Important in End-of-Life Care for the Critically Ill

吳春桂(Chun-Kuei Wu) ； 蘇玲華(Ling-Hwa Su) ； 黃勝堅(Sheng-Jean Huang) ； 林芳如(Fang-Ru Lin) ； 黃美玲(Mei-Ling Huang) ； 林亞陵(Ya-Ling Lin) ； 蔡紋苓(Wen-Lin Tsai) ； 林宏茂(Hong-Mau Lin)

《安寧療護雜誌》 14卷2期 (2009/07) Pp. 172-185

https://doi.org/10.6537/TJHPC.2009.14(2).5

摘要

自安寧緩和照護理念的萌芽至安寧緩和條例之立法完成，經過數年之醫療團隊與病人家屬之努力及養成教育之深耕，安寧病房已經獲得國人之肯定與認同。然而，不論是末期慢性疾病、或者是急重症生命末期照護，國內學者及臨床家仍然有不同的意見。無論如何，2002年安寧緩和條例修訂之後，針對生命末期心肺復甦術之不予及撤除給予明文規定，至此末期病患得以避免不必要之急救。實務上，DNR爲生命末期不可避免之議題；因此，面對醫療極限，如何提供病患及家屬正確對等醫療訊息，滿足病患與家屬的需求，實爲現代高品質重症醫療之重點。透過溝通醫療訊息之充份告知及病人、家屬參與醫療決策過程中，得以共同學習成長。調查研究更發現DNR的議題雖然愈來愈受重視，但是大部分的簽署均爲晚期DNR。於生命末期照護，醫療團隊的確面臨倫理與法律之困境，無效醫療因此運應而生。然而，善終及尊嚴的走完生命歷程是國人之傳統文化。當醫療已至極限，治癒已經不可能，陷於現代高科技之叢林之迷失，如何開創更人性化與生活品質照護之精緻化，讓病人免於痛苦及無謂的死亡過程延長，家屬免於煎熬，生死二相安，實爲醫學應反省的課題。

關鍵字

生命末期 ； 不施予心肺復甦術 ； 決策

並列摘要

From the beginning of the idea of palliative cares to the establishment of ”Nature Death Act” at Legislative Yuan in Taiwan, the hospice care is accepted by Taiwan people after the efforts and cooperation among the patients, their family and medicine team. About the end-of-life care of chronic or acute diseases, there are still different opinions among scholars and clinicians. However, after modification of ”Nature death act” in 2002, withdraw and withhold of CPR at end of life was applied, and unnecessary resuscitation might be avoid. Actually, DNR is always a hot issuer at end of life. Facing the medicine limitation, it is very important in modern high quality medicine about address appropriate medical information and meeting the needs of patients and their family. The patients, their family and medical team can growth together by good communication. Many studies revealed that the issue of ”DNR” was valued more and more, but most actions for DNR were still too late. Medical team really faced the dilemma of ethics and law, so medical futility was produced.

並列關鍵字

end-of-life ； do not resuscitate DNR ； decision making