頁籤選單縮合
題 名 | 治療的限制與撤除=The Withholding and Withdrawal of Treatment |
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作 者 | 郭正典; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 4:4 2002.10[民91.10] |
頁 次 | 頁310-317 |
分類號 | 410.1619 |
關鍵詞 | 治療的限制; 治療的撤除; 無益; 雙重效果原則; 安樂死; 希波克拉底誓言; 存疑的好處; Critical care; Withholding of treatment; Withdrawal of treatment; Futility; Doctrine of double effect; Euthanasia; The Hippocratic Oath; Benefit of the doubt; |
語 文 | 中文(Chinese) |
中文摘要 | 醫療技術是為了減輕病人的痛苦而發展出來的,不是被用來增加病人的痛苦的。如果明知某些醫療處置只有增加病人及其家屬的痛苦而於事無補時,從人道立場及醫學目的的角度來看,這些醫療處置就不應該被用在病人身上。此外,醫療資源是有限的,若把許多寶貴的重症醫療資源浪費在已無治療意義的病人身上,卻讓後到的急重症病人無法接受適當的治療,那也是很不人道的。 若在開始治療前就認定病人已無治療意義,而不給予延命治療,此稱為「治療的限制」。若病人經過積極治療後病情仍一路惡化,死亡已可預見時,醫師在徵得家屬的同意後直接停止用藥、關掉呼吸器,然後拔除氣管内管,此稱為「治療的撤除」。「治療的限制與撤除」不是安樂死。安樂死是企圖經由致命的、治療的操作以結束病人的生命,但「治療的限制與撤除」則是醫師不使用或中止延命治療的使用,讓病人自然死。 我國的限制及撤除治療直到最近幾年才得以合法地施行。民國八十九年六月七日公告實施的「安寧緩和醫療條例」容許末期病人在事先寫下不願接受侵襲性治療意願的情形下拒絕心肺復甦術及其他只能減輕痛苦或維持生命徵候的治療,但病人須有兩位醫師證明確為無法治癒的末期病人。民國九十一年十一月二十二日立法院院會三讀通過的「安寧緩和醫療條例部分條文修正案」讓醫師可以在有末期病人或最近親屬簽署意願書的情況下,合法地撤除已經用在病人身上的延命治療,讓末期病人及已無治療意義的病人死得有尊嚴,也讓後到的急重症病人有機會可以獲得適當的救治。 |
英文摘要 | Medical technologies are developed to alleviate the sufferings of the patients rather than to increase them. If some medical interventions can only increase the sufferings of the patients and their families, then those medical interventions should not be applied to the patients from the viewpoints of humanity and the purpose of medicine. In addition, medical resources are limited. It is inhuman to waste precious medical resources on those patients who are deemed hopeless so that the next emergent or critical patient cannot be treated properly. When the patient is considered as hopeless and the life-sustaining treatments are regarded as futile, the life-sustaining treatments are not given to the patients from the very beginning. This is called the withholding of treatment. If death is foreseeable despite aggressive treatment, the physician discontinues the medicine, turns off the ventilator and removes the endotracheal tube of the patient after convincing the family the hopeless situation. This is called the withdrawal of treatment. The withholding and withdrawal of treatment is not the same as euthanasia. The euthanasia is the doing that attempts to terminate the life of the patient by using lethal therapeutic intervention, whereas the withholding and withdrawal of treatment is trying to let the patient die naturally by limiting and removing the use of life-sustaining treatment. In Taiwan, the withholding and withdrawal of treatment became lawful only recently. The "Peaceful Alleviation Medical Draft Provision" enacted on June 7, 2000 allows terminally ill patients to avert the use of cardiopulmonary resuscitation and to refuse those treatments which are merely intended to alleviate the pain or maintain the vital signs, if they have stated in advance their aversion to these invasive, aggressive emergency medical treatment. The patients must be certified as "terminally ill" by at least two doctors. The amendment passed on Nov. 22, 2002 allows doctors to legally remove life-supporting devices from terminally ill patients who chose to die in a more dignified manner after a legal revision, if the patients or their family members have expressed their intentions in a written statement. The amended law can ease the pain of terminally ill patients before they die, help save medical resources so that the next emergent or critical patient can have the chance of being treated properly. |
本系統中英文摘要資訊取自各篇刊載內容。