末期病人照顧之倫理困境及社工倫理思辨

The Ethical Dilemma and Social Work Ethical Justification for Terminal Medical Care

蔡長穎(Tsai Chang yin)

《當代社會工作學刊》 11期 (2021/02) Pp. 130-167

摘要

台灣於2000／06《安寧緩和醫療條例》公佈施行。2002／11／22『安寧緩和醫療條例』修正案，於立法院三讀通過，明訂『末期病人符合第一項、第二項規定不施行心肺復甦術之情形時，原施予之心肺復甦術，得以終止或撤除』。2009／09健保將安寧緩和照護的給付範圍，從癌症及漸凍人擴大到8大疾病。2013／01《安寧緩和醫療條例》三度修法，末期病人經醫師確診、家屬同意就可以不施行、終止或撤除心肺復甦術或維生醫療。2016／01《病人自主權利法》公佈。2019年1月6日實施。本文試舉臨床案例凸顯末期照顧之倫理兩難議題，並進一步釐清末期病人於面臨之生命倫理議題。在末期照顧中，病人自主、家屬價值與醫療價值間之對立關係，本文亦希望透過對倫理議題的的釐清與探討，澄清並理解病人、家屬與醫護團隊彼此的經驗，期望能達成醫護人員間對預立醫囑的共識，提昇終末病人自主權益，尊重其對生命權與人性尊嚴之價值，及親屬的照護與支持。

關鍵字

安寧緩和照護 ； 醫療療社會工作 ； 臨終倫理 ； 病人自主

並列摘要

Taiwan was promulgated and implemented in 2000/06. 2002/11/22 The amendment to the ＂Easy Relief Medical Regulations＂ was passed by the court in Sanli, and the original cardiopulmonary resuscitation was performed when the final patient met the first and second provisions without performing cardiopulmonary surgery. Can be terminated or removed.＂ 2009/09 Health Insurance will extend the coverage of tranquillity care from cancer and gradual freezing to 8 major diseases. 2013/01 The Third Anniversary Amendment to the Law on Restoration and Rehabilitation, the final patient may not perform, terminate or withdraw the cardiopulmonary or surviving medical treatment after the doctor's diagnosis and family consent. 2016/01 The Patient Autonomy Rights Act was promulgated. Implemented on January 6, 2019. This article attempts to highlight the ethical dilemma of end-of-life care in a clinical case, and further clarify the role of medical social workers in the team and what bioethical issues are faced. In the final care, the relationship between patient autonomy, family value and medical value, this paper also hopes to clarify and understand the experience of patients, family members and medical teams through the clarification and discussion of ethical issues, and hope to reach a medical staff. The consensus on pre-established medical advice, enhance the independent rights and interests of the terminal patients, respect their value to the right to life and human dignity, and the care and support of relatives.

並列關鍵字

Palliative Care ； Medical Social Work ； Death Ethics ； Patient Autonomy