癌末病人死亡恐懼之臨床情境：臨床佛教宗教師參與靈性照顧

Clinical Scenarios of Fear of Death in Patients with Terminal Cancer: Clinical Buddhist Chaplains Participate in Spiritual Care

台灣2000 年通過「安寧緩和醫療條例」成為亞太先進末期醫療立法的國家。施行至今，臨床實務上在病人、家屬與醫護三者之間，仍常有病情告知難以啓齒、預立指示推動困難及不放棄急救等情事發生，徵結在於死亡恐懼。本文以三名癌末個案為例，探討面對死亡無論病人、家屬與團隊成員皆有不同方式的因應，臨床上死亡恐懼成為必須面對的靈性課題。死亡恐懼與生俱來，人人皆有。其機轉在於世人所依持的生存法則，無法解決死亡問題，加上對未來的不確定性，於是產生不能接受死亡或逃避死亡的各種行為。過去在台大醫院緩和醫療病房將佛法應用在臨終病人的靈性照顧上，培訓臨床佛教宗教師加入安寧緩和照護團隊，為本土化靈性照顧的特色。病人在良好生活品質的基礎上做死亡準備，加上家屬的生與死教育，能協助病人在臨終過程中學習成長，達到善終。

Taiwan, passing the Hospice Palliative Act in 2000, has been playing an active and leading role in the field of end-of-life care in the Asia-Pacific region. So far in clinical practice, difficulties concerning truth telling, promotion of advance directives, and Do Not Resuscitate (DNR) execution have continued to exist and distress patients, families and medical personnel. The core issue is how to cope with fear of death. The article cited three cases with terminal cancer as examples to describe different coping patterns of death fear, thereby accentuating the need to address the spiritual dimensions in end-of-life care. Death comes with birth, so fear of death is natural and inevitable to virtually every living person. The problem is that the principles of survival embraced by people fail to address the issue of death. For patients, especially terminal patients, long-time belief in those survival rules plus uncertainty of prognosis and worry about the worst outcome results in various behaviors of unacceptance and avoidance in the face of death. At the National Taiwan University Hospital (NTUH) palliative care ward, Buddha Dharma has been applied to the spiritual care for terminal cancer patients. Clinical Buddhist chaplains in Taiwan are trained as an essential member of the palliative care team to provide indigenous spiritual care for terminal patients and spiritual guidance for their family members. With the participation of clinical Buddhist chaplains, terminal patients, with the assistance of their family members, are more capable of fostering spiritual growth during the dying process and initiating preparation for a good death based on a decent quality of life.