重症病患之生命末期照護

End-of-Life Care in Critical Illness

蔡翊新(Yi-Shin Tsai) ； 林亞陵(Ya-Ling Lin) ； 黃勝堅(Sheng-Jean Huang)

《安寧療護雜誌》 12卷3期 (2007/08) Pp. 312-320

https://doi.org/10.6537/TJHPC.2007.12(3).5

摘要

我國自安寧病房的設立及安寧緩和醫療條例實施後，二十年來癌症末期病患可獲得身、心、靈之照顧與社會全人得照顧。不過對於非癌症末期病患，尤其是重症病患之緩和療護(palliative care)則尚無共識。無論中外，都同意善終是屬於生命的一部份。因此，所有生命末期病患不論病因爲何，均接受高品質的照護。以往加護單位的醫療團隊傳統的目標是治癒疾病及恢復生理正常功能，而現今也將目標拓展至面對醫療極限使無法挽救的病患可以獲得善終。因此，除了加強醫療專業人員醫療知識與科技能力外，同時也應該加強讓病患可以死的無痛苦、死的有尊嚴的認知。依台灣法律，面對生命末期，目前實務上只能做到施心肺復甦術的不予。雖然法律允許撤除，但實務上幾乎是不可行。從倫理的角度，延長死亡過程，在有限的醫療資源下，就會有生命失去被救治的機會而被犧牲。高水準之生命末期病患照顧應符合以病患及家屬爲中心之決策模式、有良好溝通機制、維持繼續之照護、給予病患舒適之處理及避免苦痛之發生、給予情緒之安撫與實質之照護及靈性的支持。如此，不僅能夠節省有限的醫療資源，同時能夠空出加護病房拯救更多的生命。近年來，國外的報告，在加護病房中撤除生命支持系統後死亡的案例持續的增加中。雖然不同國家，不同文化之間有所差異，然而這是國際間的趨勢。如何在加護病房發展出一個優良的文化及硬體環境，達成高品質的重症生命末期照護，實在是目前臺灣重症醫學的一大目標。

關鍵字

重症 ； 生命末期 ； 緩和醫療 ； 不予 ； 撤除

並列摘要

In past two decades, palliative care was already well developed at the hospice in Taiwan. However, it is still immature in the field of intensive care unit (ICU) care. The goal of palliative care in ICU is to improve quality of dying and death (to pursue ”good death”). The intensive care ICU traditionally has focused on prolonging survival and curing disease with advanced technology. However, it is increasingly clear that the principles of palliative care must be integrated into the ICU to ensure high-quality end-of-life care. By the law of Taiwan it is now allowed to withhold life sustaining system for dying patient; but it is almost impossible in withdrawal. Data suggest that attention to these areas early in ICU care improves the overall quality of critical care, in general, and facilitates specific decision-making around end-of-life (EOL) care. However, several domains of palliative care should noted: patient/family-centered, shared decision making, good communication, pain and non-pain symptom management, spiritual support and bereavement support as they apply to the ICU setting. It became an international trend to withhold or withdrawal of organ systems support in the EOL care of ICU. To improve the quality of ICU care in Taiwan, It is important to make palliation as a regular setting in ICU.

並列關鍵字

critical illness ； palliative care ； end-of-life ； withhold ； withdrawal