末期腎衰竭家屬抉擇撤除血液透析之歷程

The Decision Making Process of ESRD Families During the Dialysis Withdrawal Period

血液透析不僅造成國家醫療的負擔，也必須承受透析所帶來的痛苦。因此，雖其是為生命的延續，亦是死亡延緩的處置。當透析引發之負擔已超越其利益時，撤除透析是一適當的選擇；然撤除個體血液透析抉擇需考量倫理及法律的議題，決策者多為家屬代理人，但國內顯少探討家屬決議撤除血液透析的歷程，這段期間可能充滿矛盾、擔憂、罪惡感及愧疚感、不一致的衝突，唯有透過醫療團隊有效率的溝通、解決衝突、陳述預後照護，方能達成一共識，邁向緩和照護。本文以一案例討論此歷程，並提出未來待努力的方向。

Hemodialysis is a financial burden to the state and families and the cause of much suffering in patients. It is a life prolonging therapy and death-delaying treatment. When the burdens of therapy substantially outweigh its benefits, withdrawal from dialysis is an appropriate option. However, considering the ethical and legal concerns of doing such is something families must face. There has been little research and little understanding of the process of decision-making within families in Taiwan. The process is full of conflicts, worries, guilt, shame, and lack of consensus. Effective communication with the medical team to resolve the conflict and describe the prognosis is necessary in order to reach a consensus and move toward palliative care. The article uses a case report and discusses the process. Finally, the author suggests an approach to making the situation better in the future.