- 期刊
從醫療結構看現代臨終關懷
Contemporary Terminal Care : A perspective Focus in Medical Hierarchical Structure
摘要
醫療科技的進步，使得罹患末期疾病的人得以延長生命，然而由於醫療體系的專業化與科層組織，其焦點放在醫療症狀處置與疾病治療，並未考慮關於「人」的家庭結構受疾病之衝擊以及照護問題，視死亡為醫療的失敗，企圖征服死亡，因此末期疾病的病人到了臨終階段必須承受一套制式的急救處置，不但無法挽回生命，反而讓病患及家屬承受極大的痛苦。現代臨終關懷即是企圖在科層理性主導的醫療體系下，改變以救治為主的傳統醫療觀，轉為以照顧為本位的新時代之照護觀點。然而現今以科技理性為主的醫療體系結構，與臨關懷以人－家庭為系統性的照護理念，是如此不同的結構體系，使得現代臨終關懷面臨衝擊與挑戰。本文藉由探討分析醫療體系與家庭結構在個體面對末期疾病之不同對應方式。臨終關懷的照護理念可否在科層組織結構下發展其新的進路；科層專業的醫療處置結構下，可否發展出兼顧照顧、關懷病人－家屬為一整體的照護模式，不再以有限的科學企圖征服死亡，讓死亡以真實的面貌呈現於社會，死亡不再是神秘面紗後不可碰觸的，而是生命的自然結果。
並列摘要
With the improvement in medical technology, the terminal ill patient’s life is extended further more. However, the contemporary medical institute with its professional breakdown and hierarchical organizational structure, focus only on the intervention of patient’s physical symptom and the disease itself. It does not concern the impact of the disease on patient’s family function and the care of patient-the human being as is. It is common thinking for medical professions to take patient’s death as failure and try to conquer the death. Therefore, terminal ill patient in their dying stage still have to suffer from standard resuscitation procedure. It does not save the life at last; on the contrary, it let patient and his/her family suffers drastically till last moment. Contemporary terminal care is attempting itself, in prevailing hierarchical medical organization, to transform the disease intervention oriented traditional perspective into a new age of patient care centered viewpoint. Current treatment to patient as predominantly based on medical technology as compared to treating the patient-family as a system for ideal terminal care is so different that the contemporary terminal care is facing an overwhelming impact and ever increasing challenge in medical institute. This paper is attempting to explore and analyze the difference for the ways in coping with terminal ill for patient as placed in the context of medical hierarchical organization and family functional structure. We will no longer trying to conquer the death with limited technological capability. Let the death no longer be mystically veiled and untouchable. Let the death present it self as It is –the end result of natural life.