此篇文章描述父母面臨孩子瀕臨死亡時的心理壓力與決策困難的過程。病患為遭受嚴重創傷的年輕女性,接受緊急手術後因急性呼吸窘迫、嚴重低血氧放置葉克膜體外維生系統,亦因心跳停止接受過急救,為避免孩子感受苦痛,父母簽署了「不施行心肺復甦術同意書」。雖然不希望孩子受苦,但內心裡卻擔心如此等同讓病患放棄所有治療。由於心裡始終保有一絲希望,仍陸續接受手術、血管栓塞治療及連續性腎代替性療法。在「不要受苦」與「尋求恢復機會」的掙扎矛盾下,父母出現決策困難的狀況。作者採用觀察及會談方式蒐集資料,了解父母心理感受與病患的照護過程。整個治療過程中,發現家屬對於「不施行心肺復甦術同意書」內容並不甚了解,認為簽署同意書即等於完全不做任何醫療處置,產生讓病患「等死」的誤解。醫護人員採用召開多次家庭會議及個別會談之方式,讓家屬能了解病情進展與各項處置與措施之原因,即時掌握病況進展,也了解家屬心中感受與想法,澄清對於「不施行心肺復甦術同意書」錯誤的觀念,不會限於決策困境中。重症醫療團隊需學習帶領家屬如何面對死亡的到來,以「病人為中心」之思考,透過醫療團隊與家屬一同努力溝通協調,以病人最大利益的考量下所有決策,提早進行生命末期議題討論,化解不施行心肺復甦術同意書迷思,才能讓病人獲得善終,以達生死兩無憾之境界。
The decision for a Do Not Resuscitate directive (DNR) after major trauma in a young adult has always been a dilemma. We present a young female patient with major trauma who, after receiving emergent surgery, developed cardiac arrest with CPR and returned of spontaneous circulation (ROSC). Her parents signed a DNR to reduce suffering, yet they still accepted aggressive medical intervention in hope for a chance of survival. Severe injuries imposes high mortality and disability rate. Aggressive lifesaving procedures & medication bring the hope of cure. Meanwhile, patient suffered from the pain caused by those machines. When life comes to the end, DNR is one option to decrease all the discomfort physiologically & physically. However, it's often mistaken as "to give up this patient without making any effort" or "wait for death". "To strive for survival or to reduce suffering" is a critical issue. Family conferences with medical team are helpful to discuss care strategies with carers.