台灣的末期病人有機會壽終正寢嗎？－在宅往生課題之探討

Is It Possible for People to Die Peacefully at Home in Taiwan ?-Home Death Issues of Terminal Patients

翁瑞萱(Ruey-Shiuan Ueng) ； 徐愫萱(Su-Hsuan Hsu) ； 洪香蓮(Shiang-Lien Hung) ； 劉旭華(Hsu-Hua Liu) ； 李佩璇(Pei-Hsuan Lee) ； 洪毓謙(Yu-Chien Hung) ； 賴俊夫(Chun-Fu Lai) ； 劉嘉仁(Chia-Jen Liu) ； 黃勝堅(Sheng-Jean Huang) ； 施至遠(Chih-Yuan Shih)

《安寧療護雜誌》 18卷3期 (2013/11) Pp. 320-329

https://doi.org/10.6537/TJHPC.2013.18(3).6

摘要

讓末期病人在希望的地點死亡，為生命末期照護重要的品質指標。世界衛生組織也建議在規畫生命末期照護時，應考量病人本身喜好的末期照護與死亡地點。根據之前研究顯示，大多數的癌症末期病人希望在家中死亡，但很多人無法完成這個心願。善終為華人文化中的「五福」（長壽、富貴、康寧、好德、善終）之一，而在家中死亡即被視為達成善終的重要因子。根據我國死亡登記資料，目前約五成的民眾在家中死亡。然而，實際在家中死亡的比例應較此數據為低，因為許多病人常常是在瀕死階段或已死亡才辦理出院返家。面對我國目前社區安寧照護體系過度集中於大型醫院，建立社區安寧照護體系已刻不容緩，才有機會讓更多的病人在自己喜好的地點死亡。

關鍵字

生命末期照護 ； 在宅往生 ； 安寧療護 ； 社區醫療

並列摘要

Enabling people to die in their preferred place is important to deliver high quality end-of-life care. The World Health Organization also recommended that planning for care at the end of life should be responsive to patient's choice for place of care and death. Previous studies about the preferences for place of death in western countries have shown that the majority of terminal cancer patients wish to die at home, but many do not accomplish this cherished desire. In the traditional Chinese belief, Good death is commonly recognized as one of the Five Blessings (longevity, wealth, health, love of virtue, a good death). Moreover, death at home is also believed to be a major ingredient of a good death. According to the death registration, approximately 49% of people in Taiwan die at home currently. However, the actual home death rate would be much lower because some of the terminally ill patients discharged from hospital and returned to home at the last hour of life or even death. Current palliative care system in Taiwan is facing the challenge of over-centralization. Therefore, establishing community-based palliative care system should be encouraged to allow more people die in their preferred place.

並列關鍵字

end-of-life care ； go home to die ； palliative care ； community medicine