Making End-of-Life Decisions: Revisit Chinese Cultural Perspectives

華人文化對生命末期決策的影響

羅玉岱(Yu-Tai Lo)

《安寧療護雜誌》 15卷2期 (2010/07) Pp. 187-195

https://doi.org/10.6537/TJHPC.2010.15(2).4

摘要

協助病患與家屬作出生命末期相關決策是從事緩和醫療工作者重要卻困難的責任。由於不同的文化觀點會影響生命末期決策的方式與偏好，本文討論傳統華人文化影響生命末期決策的三個面向：(1)由家庭而實行自主權的特殊模式，(2)困難重重的病情告知，以及(3)生命末期對維生性治療之偏好。文中提出許多近年的證據指出，即便華人文化價值有別於西方文化，但末期病患對擁有生命末期決策的自主權、了解病情、與獲得舒適的末期照顧的這些需求，中西方並無明顯差異。要提供適切文化的安寧緩和醫療照護，臨床工作者除了解文化對生命末期決策的影響外，更應致力幫助家屬了解病患在生命末期的需要，藉由不斷的溝通與協調，讓家屬得以尊重病患之自主權，而使病患獲得其喜好的末期照顧。

關鍵字

生命末期 ； 決策 ； 自主權 ； 病情告知 ； 華人文化

並列摘要

Helping patients and families to make end-of-life decisions is an important, yet difficult responsibility of palliative care. Various cultural perspectives on priorities in life and death issues lead to different preferences and styles of end-of-life decision-making. This article introduces and discusses three specific aspects of Chinese culture related to end-of-life decision-making: (1) family vs. personal autonomy, (2) difficulties in truth telling, and (3) life-sustaining treatment preferences. Although Chinese people value their traditional culture and connect it with health beliefs, recent evidence has suggested that most Chinese patients wish for information needs, autonomy on decision-making and comfort care at the end of their lives. Healthcare professionals should help families to inquire into and respect their patient's preferences for information and autonomy. If healthcare professionals make an effort to understand differing cultural beliefs, have frank and frequent conversations with both patients and their families, and maintain an open and flexible attitude, they will be able to provide culturally sensitive end-of-life care and improve end-of-life quality for Chinese patients around the world.

並列關鍵字

end-of-life ； decision-making ； autonomy ； truth telling ； Chinese culture