如何以家庭會議協助重症病人生命末期決策

How to Hold A Family Conference to Succeed in Shared End-of-Life Decision Making in the Intensive Care Patient

黃馨葆(Sin-Bao Huang) ； 陳皇吉(Huang-Chi Chen) ； 蔡佩渝(Pei-Yu Tsai) ； 謝雅琪(Ya-Chi Hsieh) ； 林楷煌(Kai-Huang Lin) ； 蔡兆勳(Jaw-Shiun Tsai)

《安寧療護雜誌》 19卷3期 (2014/11) Pp. 268-281

https://doi.org/10.6537/TJHPC.2014.19(3).4

摘要

在2013年1月9日《安寧緩和醫療條例》第三次修法公布施行後，在許多醫療機構均產生討論撤除維生醫療之需要。於加護病房、呼吸照顧中心和急性病房，醫療團隊也常和病人或家屬討論病人之生命末期決策。對面臨生命末期之病人而言，對於生命末期議題及照顧目標相關討論之重要性可說是與日俱增。但在臨床實務上，第一線之臨床工作者常因家屬之間有不同意見，而無法形成有效之末期醫療決策。本文認為，對重症生命末期病人之決策，家庭會議（family conference）是最有效之溝通方式。醫病雙方可藉由家庭會議釐清治療目標、化解家屬間不同意見之衝突及進行維生醫療撤除之相關討論。本文說明如何以家庭會議進行生命末期決策之相關討論。

關鍵字

家庭會議 ； 不予 ； 撤除 ； 緩和醫療 ； 維生醫療

並列摘要

Since the third amendment of ＂Hospice and Palliative Care Act＂ on 9 Jan 2013, the need for withdrawal of life sustaining treatment is growing in many medical institutions. In many ICUs, respiratory care centers, and acute wards, the medical professionals also have the needs to discuss end-of-life decisions with the patients or surrogates. The importance for treatment goal and end-of-life issue discussion is increasing for the terminal patients. In fact, the clinical practitioners often failed to achieve valid end-of-life decisions for the different opinions among the patient's families. This essay emphasize that family conference is the most useful care model in communicating end-of-life care issues. Family conference could be used to clarify the treatment goal, resolute the conflict among the families, and discuss withdrawal of life sustaining treatments. This article gives the principle and specific details of how to hold a family conference to succeed in shared end-of-life decision making in the intensive care patient.

並列關鍵字

family conference ； withhold ； withdraw ； palliative care ； life-sustaining treatment