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安寧緩和療護的道德研究與探討

中華民國一○一年六月
壹、摘要

本論文的寫作目的,主要是要探討安寧緩和療護的存在所引起道德方面上的爭議。雖然安寧病房之所以會存在,是不想讓那些得了絕症或治療過程極其痛苦的病患繼續受苦,因而放棄治療,讓他們能夠儘可能安詳的走完最後一程;但是從另一個觀點來看,安寧照護也可以被視為消極的間接殺人;若病人無法接受臨終事實,但醫護人員及家屬共同決定不告知臨終事實,依社會工作「案主自決」原則,顯有違專業倫理;當病患意願與醫療理性相左時,如何進行溝通等諸如此類議題,正相繼衝擊安寧緩和醫療團隊、臨終為不可逆事件,即使病人不願或不肯接受實情,但知的權利仍不應輕言剝奪;醫護人員及家屬應如何協商,讓病患有機會參與重大決策,不致覺得只能自己孤獨面對死亡?這些情形非常值得我們探討。
貳、何謂安寧緩和療護
根據世界衛生組織(WHO)的規範,安寧緩和醫療照顧提供罹患無法治癒疾病的病人,積極性的全方位照顧。緩和醫療照顧是肯定生命,視死亡為自然的過程,不提早也不延後死亡,積極提供疼痛及其他窘迫症狀的緩解,提供支持系統,幫助病人盡可能提升生命品質,幫助家人度過病人生病與其身後期間所遭遇的種種壓力。
叄、安寧療護的目的
安寧療護服務的目的是為生命走到末期病患及家屬提供專業團隊服務,經由完整的身、心、靈之關懷與醫療,減輕末期病患的身體疼痛、不適應症及心理壓力,對病患及家屬提供心靈扶持,輔導其接受臨終事實,陪伴病患安詳走完人生最後一程,協助家屬面對病患死亡,達到生死兩相安的境界。 安寧療護以維護末期病人的生活品質和尊嚴為主,大林慈院家醫科陳世琦醫師透露了一般醫院在診療時常常只著重結果,但是卻忽略了病人的感受。「從參與安寧療護以來,一直在學習,也深受感動。」大林慈院家醫科林名男主任表示,希望提供的安寧療護,能夠盡力改善病人的生活品質,讓病人了無遺憾地往生,而家屬也能安心。 「不是放棄,而是勇敢面對生命不可逆的進程。」長期在花蓮慈院心蓮病房服務的家醫科謝至鎠醫師,在花蓮慈院海報展上也說明了安寧療護的重要性,過去進「安寧病房」往往被誤解為「等死」,但事實上,安寧療護是藉由藥物的使用、芳香療法、中西醫照護、藝術治療等方式,用心傾聽患者的心聲,尊重每一個生命,不延長也不縮短患者的生命,讓病人在臨終的過程中帶著尊嚴。

肆、安寧照顧的重要措施 安寧照顧主要對象是末期病人,在國內僅用於癌末病人的使用;
在國外除了癌末患者之外,還包括了愛滋病的病人。這些病人除了
要面對死亡的問題之外,還必須面對身心痛苦的問題。這些問題安
寧照顧又是如何來解決。我們由前述緩和照護的定義,提供了六種措施來解決末期病人的各種問題。
(一)舒適的照護 現代醫療體糸中,無論是在手術、診斷及急救等,皆是重視病情的治癒或延續病人的生命。癌症患者在初期時,有些可以藉著手術及放射性治療而痊癒。但是,病患到了末期時,癌細胞轉移其他部位,不管醫護人員用多先進的醫療技術,也是沒辦法讓病人復原。所以對醫護人員來說容易產生極大的挫折感,而這些絕症的病人,很容易是被放棄的一群。當醫療對末期病人無效時,並不代表對他們的關懷也無效。安寧照顧重視對病人的關心及照顧,強調以照護(care)為主,並且是舒適的照護。另外,安寧照顧在硬體上有舒適的設備,備有洗澡機、休閒室、陽光室、祈禱室、佛堂、咖啡廳、意樂治療室及兒童遊樂區等設施。裏面的設備盡可能不讓病人有住在醫院的感覺,而讓病人感受像居家的環境。在軟體的設備中,安寧照顧有醫療團隊的關心,這些照護跟普痛的醫院不同。這個醫療團隊在面對病人的照護時,以非病人(nonpatient)的態度去照顧病人,尤其重視護理上翻身、洗澡、等細微照護(安寧照顧在照護上對病人有特殊的照護技巧)。所以,癌末病人在安寧照顧受到非常親切及舒適的照護。安寧照顧除了醫院的安寧病房之外,還有日間照護、居家照護(home care)等。這些照護皆是為了配合病人或是家屬的需要,而設置的。其中,居家照顧是由居家護理師安排醫師和護士,定期到病人的家中照顧。這樣的照護是為了想待在家中的病人,或是家屬照顧方便而設置的。
(二)疼痛及症狀的控制…...

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