失智患者拒食行為之倫理相關議題

Food Refusal in People with Dementia: Ethical and Practical Issues

失智老人隨著人口老化而逐年增加。根據文獻報告，脫水與營養不良是造成失智老人死亡的兩大主因。而餵食或進食困難與失智老人營養不良有關。然而，在失智老人之餵食困難中以拒食行為最常發生也最困擾照顧者。失智老人由於智能上的缺失，對於營養及進食往往無法表達及選擇他們的需要，家屬難以區分其拒食是因為腦部受損影響進食能力還是老人希望以拒食方式結束生命，常掙扎於尊重老人自主放棄餵食還是強迫餵食以維持存活的矛盾決策中。這樣的痛苦掙扎在面對末期失智老人則更加的困難。除了家屬以外，醫護人員也同樣面臨相同的挑戰及倫理道德困境。因此，本文章將以失智老人的拒食行為來探討可能面臨的臨床照顧困境及倫理相關議題。According to the previous studies, dehydration and malnutrition are two major causes of death among people with dementia. Feeding difficulty is associated with malnutrition among people with dementia. The most frequent feeding difficulty as well as a formidable challenge to family caregivers is refusing to eat. People with dementia have difficulty in expressing their needs due to cognitive impairment. Caregivers could not recognize whether their refusal to eat is a wish to die or the result of the brain lesion of dementia with difficulty in taking food. Caregivers struggle with keeping people with dementia alive by forcing to eat or respecting their wishes for giving up feeding. Nursing staff also face the same ethical issues. The purpose of this article is to discuss the ethical and practical issues in food refusal of people with dementia.