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題 名 | 醫療團隊面臨撤除維生醫療之困境討論--案例報告=Discussion for Dilemma of Clinical Teams Confronting Withdrawal of Life-sustaining Treatments--A Case Report |
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作 者 | 高慶雲; 林佩瑩; 陳鵬升; | 書刊名 | 安寧療護 |
卷 期 | 19:1 2014.03[民103.03] |
頁 次 | 頁88-97 |
分類號 | 410.2、410.2 |
關鍵詞 | 安寧緩和醫療條例; 撤除維生醫療; 末期疾病; 善終; Hospice and Palliative Care Act; Withdraw of life-sustaining treatments; Terminal illness; Good death; |
語 文 | 中文(Chinese) |
中文摘要 | 2013年1月新的安寧緩和醫療條例修正條文實施後,降低了撤除維生醫療的限制,使得經兩位專科醫師認定之末期疾病患者,在一位最近親屬或醫療委任代理人同意下,得以撤除已施予之心肺復甦術或維生醫療。本文為一位末期腦梗塞性中風病人在依法撤除維生醫療過程中,專科醫師面臨疾病末期認定沒有共通準則可依循,撤除維生醫療前準備及撤除前後的用藥也缺乏足夠共識之困境。歐美學者報告可於撤除前給予家屬足夠心理支持,病人在撤除維生醫療前宜空腹空腹6小時,減少靜脈輸液給予,預防性藥物給予(利尿劑,類固醇,及鎮靜劑);撤除後維持症狀控制藥物:morphine、propofol、midazolam、furosemide(lasix)、scopalamin及methylprednisolone,或轉入緩和病房照顧等做法。緩和醫療團隊除依新公告之增修條文撤除末期病人維生醫療,應參考各國經驗研擬適合我國民眾之方針指引或共識,藉由完善撤除維生醫療過程,並配合國人傳統文化或醫療團隊與家屬討論的臨終照護模式給予病人及家屬個別化之臨終照護,以達病人善終。 |
英文摘要 | In the new era after revision of Taiwan's Hospice Palliative Care Act in Jan 2013, the legal criteria of withdrawal of life-sustaining treatmemts became easier. Patients with terminal illness, confirmed by two clinical specialists, could be withdrawed of CPR or life-sustaining treatments under signed approval of one immediate relative. This article reported the course of withdrawal of life-sustaining treatments for a patient with terminal condition of cerebral infarction, in which, medical specialists confronted the dilemma: lack of guidelines for determining terminal disease, and for preparation of withdrawal of life-sustining treatment and medical treatments before & after the withdrawal. Western scholars reported to provide sufficient psychologic support for the family before withdrawal of life-sustining treatment. For the patient, NPO (nil per os) for six hours and decrease intravenous fluid support before the withdrawal. Prophylatic medication prescription (diuretics, corticosteroid and tranquilizers ) and maintenance of medication : morphine, propofol, midazolam, furosemide (lasix), scopalamin and methylprednisolone after the withdrawal or transferral to hospice ward are recommended. Beside withdrawal of life-sustining treatment in terminal illness patient according to revision of Taiwan's Hospice Palliative Care Act in Jan 2013, by consulting domestic culture and other countries experience, hospice teams should make Taiwanese guidelines or consensus for the withdrawal to reach good death. |
本系統中英文摘要資訊取自各篇刊載內容。