安寧療護的佛教用語與模式

1967 年，英國聖克里斯多福安寧醫院（St. Christopher's Hospice），以醫療團隊合作方式，全程照顧癌症末期病人，並輔導家屬度過喪親(bereavement)時期。如今，Hospice 的名稱引用於現代的醫療機構，作為照顧癌症末期病人設施的通稱，在世界各地發展。此種起源於基督宗教文化為背景之安寧療護(HospiceCare)運動，傳到東方宗教文化圈時，東方國家除了接受、引進其理念與方法之外，同時由於本土化的需求，也會發展出適合該國文化背景的用語與模式。例如，日本佛教界則以古印度梵語Vihara（休養所、僧坊）來取代淵源於基督宗教的Hospice（安寧院）的用語，並揭示如下「體會無常、尊重意願與生命」三項理念表達佛教臨終關懷(Terminal Care)的特色。此外，「全人」、「全家」、「全程」、「全隊」是安寧照顧之「四全」。一般說到「全人照顧」時，大都是指「身、心、靈」完整的醫療照顧。起源於基督宗教「身、心、靈」全人觀點之「靈性照顧」(Spiritual Care)的理念，則是建立於「離」身心之外，別有超越身體與思想之「靈性」存在的主張。對此，若配合佛教教義，我們可提出「覺性照顧」（care of awareness）之「四念住」可作為佛教臨終關懷的參考模式。因為，「即」身心之斷滅說，或者「離」身心之「靈性」說，都是與佛教「不即不離」身心之「無我論」、「緣起論」不同的。依據此種「不常不斷」中道思想，使臨終者的學習認識自己的「身、受、心、法」等四方面，使「覺性」（念，awareness）敏銳且穩定（住）。若就「生死與不生不死」的臨終關懷的論題，佛教的四種真理（四諦）──知苦（苦諦）、斷集（苦集諦）、證滅（苦滅諦）、修道（苦滅道諦），是佛教臨終關懷的基本態度。此外，從臨床經驗得知，佛教的「慈、悲、喜、捨」（四無量心）有助於「覺性照顧」運用。

關鍵字

安寧療護；靈性照顧；覺性照顧；生死學；四念住

並列摘要

In 1967, St Christopher's Hospice in England began providing complete medical team cooperative care for patients in the final stages of cancer, and counseling family members through the period of bereavement. Now the name Hospice is used in modern medical organizations as a general term for care for patients in the final stages of cancer, and as such has spread around the world. When the hospice care movement, with its roots in Christendom, reached the Oriental religious cultural sphere, Asian countries imported concepts and methods while adapting them to local cultural needs, developing terms and models suitable for each region's cultural background. For example, Buddhists in Japan use the ancient Sanskrit term 「 vihara 」 (resting place, monastery) in place of the word 「 hospice 」, with its roots in Christianity. Buddhist terminal care concepts are evident in their teaching to 「 comprehend the passing of all things, respect wishes, respect life 」. In addition, they emphasize Four Wholes: the whole person, the whole family, the whole course of the disease, the whole medical team. Usually, reference to caring for the whole person implies caring for the patient's body, mind, and spirit. Spiritual care originating in Christian concepts of body, mind, and spirit is based on the belief that aside from the body, there is a soul that transcends body and mind. If we combine Buddhism with this, we may promote a care of awareness, with Four Establishment of Mindfulness as reference for Buddhist Terminal Care. Buddhism passes both the concept of Materialism and the concept that the soul exists independently of body and mind: Buddhism teaches that the ego has no true existence (anatma), and idea of Conditioned Geneses (pratitya-samutpada). Using this covenant that nothing is eternal, nothing is separated, the patient may become acquainted with his own body, sense, mind, and dharma, so that awareness is sharp but settled. As to the terminal topic of life and death, neither life nor death, Buddhist care is founded on the Four Noble Truths: suffering (duhka), the accumulation of suffering (samudaya), extinguishing suffering (nirodha), and the cultivation to extinguish suffering (marga). In addition, experience shows that Buddhism's Four Immeasurable States of Mind - immeasurable mercy, immeasurable pity, immeasurable joy, and immeasurable relinquishing - definitely helps patients comprehend their experience.