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題名:對急重症病人生命末期之照護
書刊名:榮總護理
作者:翁益強
作者(外文):Weng, Yih-chyang
出版日期:2012
卷期:29:3
頁次:頁220-224
主題關鍵詞:緩和療護無效醫療滑坡效應安寧緩和醫療條例限時嘗試治療成效Palliative careMedical futilityThe slippery slopeHospice care regulationsTime-limited trials
原始連結:連回原系統網址new window
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  • 被引用次數被引用次數:期刊(7) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:7
  • 共同引用共同引用:49
  • 點閱點閱:7
「緩和療護」(palliative care)協助急重症病人之生命末期照護是現今的醫療趨勢,尤其在「無效醫療」(medical futility)認定遇到困難時,緩和療護建議透過召開個案倫理討論會,以追求善終(good death)為宗旨,運用「臨床倫理思辨四象限」為架構,經醫療團隊討論思辨後來形成共識。但要避免將末期病人基本需求被醫療團隊以共識之名停止給予,而引起倫理上的「滑坡效應」與醫療人員不安;以及熟悉國內「安寧緩和醫療條例」與「人體器官移植條例」中「腦死判定準則」規範,在認定無效醫療中不違法。另外召開家庭會議方式與運用同理心溝通技巧來獲得病人及/或家屬對無效醫療的共識,也是緩和療護的重點。若醫療團隊與病人及/或家屬一直無法達成共識,可試著「限時嘗試治療成效」(time-limited trials)來解決此臨床困境。最後強調無效醫療的認定只是善終追求的起點,因為末期病人還有許多其他身體症狀需要處置或社、心、靈需求需要幫助,甚至醫療團隊要開始討論病人有無臨終回家意願或最後臨終地點,以及宣告死亡可能的流程,若能適時轉介其他專業人員或團隊介入可能讓生命末期照護事半功倍。希望急重症醫療人員對病人生命末期照護,能透過緩和療護的幫助,提升工作的動力與自我價值的實現。
End-of-life care in intensive care unit trends toward palliative care in modern time. For dealing with medical futility, we can reach a consensus through health care team meeting with the focus of "good death" and "the four boxes of clinical ethics". To avoid "the slippery slope" in ethics due to the issue of withholding or withdrawing the ordinary treatment, and not to violate "Hospice Care Regulations" and "Regulations on Human Organ Transplantation" are also important. Thereafter, ways to come to an agreement with patient and family requires empathic communication during family meetings. If communication becomes difficult, "time-limited trials" is another approach. It should be minded that no argument about medical futility launches palliative care into cares of other symptoms, psychosocial and spiritual needs, favored death point, and announcement of death. Sometimes, it is not easy to manage above, but inviting other specialists or other medical teams may smooth the processes. By incorporating palliative care with end-of-life care in intensive care unit can help to empower personnel and achieve self-values.
期刊論文
1.賴維淑、楊婉萍、施雅蘭、趙可式(20090400)。運用安寧療護理念於癌末病人之出院準備服務。護理雜誌,56(2),94-100。new window  延伸查詢new window
2.邱泰源、胡文郁、蔡甫昌、周玲玲、姚建安、陳慶餘(19981100)。緩和醫療照顧的倫理困境。臺灣醫學,2(6),633-640。new window  延伸查詢new window
3.趙可式(19960300)。臨終病人照護的倫理與法律問題。護理雜誌,43(1),24-28。new window  延伸查詢new window
4.蔡甫昌、方震中、楊尚儒、顏瑞昇、石崇良(20080300)。急診醫療倫理議題探討。臺灣醫學,12(2),221-230。  延伸查詢new window
5.Jones, D. A.(2011)。Is there a logical slippery slope from voluntary to non voluntary euthanasia?。Kennedy Institute Ethics Journal,21(4),379-404。  new window
6.McIntosh, B.(2008)。Medical futility。Northeast Florida Medicine Supplement,59,23-27。  new window
7.Quill, T. E.、Robert, H.(2011)。Time-limited trials near the end of life。The Journal of the American Medical Association,306(13),1483-1484。  new window
8.蔡甫昌、李明濱(20021200)。當代生命倫理學。醫學教育,6(4),381-395。new window  延伸查詢new window
9.蔡甫昌(20060100)。重症加護病患照護之倫理議題。臺灣醫學,10(1),105-114。  延伸查詢new window
圖書
1.Jonsen, A. R.、Siegler, M.、Winslade, W. J.(2010)。Clinical ethics: A practical approach to ethical decisions in clinical medicine。New York:McGraw-Hill Medical Publishing Division。  new window
2.Beauchamp, Tom L.、Childress, James F.(2009)。Principles of Biomedical Ethics。Oxford University Press。  new window
其他
1.國民健康局(20100528)。安寧療護--尊重生命,http://www.bhp.doh.gov.tw/BHPnet/Portal/PressShow.aspx?No=201005280003。  延伸查詢new window
 
 
 
 
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