預約善終

Advanced Life Planning for Good Death

華人的文化傳統中，對於「死亡」充滿了害怕及恐懼，多數家屬及醫護人員仍然避諱與病人談論死亡議題，使得「不得好死」的悲劇每天都在醫療機構中真實上演。不予（Withhold）與撤除（Withdrawal）的掙扎、認知與執行上不一致等，使得醫護人員在與病人和家屬討論預立醫療照顧計畫時更顯得困難，無法充分尊重病人之生命自決權。全台灣每年15萬死亡人口中，有3萬人身體插著各式各樣的維生醫療器材，但由於法律規定嚴苛，大部分病人苦於無法撤除，只能沒有尊嚴的延緩壽命，修法通過可以讓這些遭受極度痛苦的病人，以更人性化、有尊嚴的方式離開人世，讓病人善終，讓家人了無遺憾。面對人生最後一段路，大多數人都希望「好走」。本文從安寧緩和醫療條例發展歷程，探討何謂生命末期無效醫療，以及為何要預立醫療照護計畫，進而說明推動DNR的困境，最後以臨床實例與大家分享非安寧病房執行安寧照護與勸說DNR的現況，期望更多護理同儕一起加入協同病人預約善終，為自己選擇一條平安、尊嚴的旅程。

Because of fear and horror of death in traditional Chinese culture, most family members and medical staff avoid dialogues and discussion about death with patients at the end-of-life stage. This leads to tragedies such as 'dying like a dog' occurring in hospitals every day. Patients at the end of life, family members struggling with withholding and/or withdrawing treatments, and inconsistent recognition and execution of medical equipment withhold and with drawal make it more difficult for care providers to have discussions about advanced care planning with them. This prevents the patient's right to self-determination to be fully honored with respect. Among the 150,000 deaths annually in Taiwan, 30,000 deaths exist with a variety of life sustaining medical equipments at death. Due to strict laws in medical treatments, most terminally ill patients suffer from the inability of withdrawing these medical equipment, and thereafter, extending their lives without dignity. With the approval of an amended law, patients with extreme suffering and pain will be allowed to die with humanization and dignity. Patients can have a good death and families will have no regrets anymore. Most people want to have good death at the end of life. This article probes end-of-life null medical treatments, reasons for advanced medical care planning, and the dilemma of outreaching DNR (do not resuscitate). Finally, clinical case studies share the current status in outreaching DNR and implementing hospice in non-hospice wards. Hopefully, with nurses' efforts in outreaching advanced care planning for patients, patients at the end-of-life can choose a peaceful journey with respect and dignity.