台灣安寧療護的發展與前瞻

Development and Prospects of Hospice Palliative Care in Taiwan

安寧療護是一種高科技加高人性的現代醫療，台灣近年來發展高科技醫療，漸漸趨向「去人性」的醫療氛圍。「安寧療護」強調「高人性與高科技整合」，以「人」為導向，而非以「疾病」為導向的醫療，希望能影響整個醫療大環境。安寧療護以服務、教育、政策三路並進推展。提供住院、居家與共同照護，以高品質的四全照顧，服務受苦的重症末期病人及其家屬。安寧療護專業領域有許多知識、技術、及態度，需針對團隊角色，依入門、在職及專家師資不同的程度培育，並教育民眾。政策方面從1995年開始行政院衛生署訂定各種制度，到「安寧緩和醫療條例」立法通過。發展至今已有安寧照顧協會、安寧緩和醫學、護理學會等有組織的人，做有制度的事，希冀能源遠流長。未來將因應安寧療護之需求，朝以下方向努力：一、服務對象擴及其他重症末期病人；二、安寧療護業務在衛生署希有適切之歸屬、管理、監督、經費挹注單位；三、本土服務模式；四、服務模式的擴展；五、學術、研究、與教學之整合與精進；六、納入長期照護系統，並提升照護的品質，以因應病人之需求。

Hospice palliative care is an approach to healthcare that integrates high technology and highly humanized care. Service, education, and policymaking are the three critical areas of focus in the development of this specialty of care. Under hospice palliative care, holistic, high quality services covering in-patient care, homecare, and shared care are provided for terminally ill patients and their families. Healthcare team members must be taught not only knowledge but also skills and attitudes that reflect their responsibilities and level of competence. General public education is important also. Regulations and relevant policies have been implemented by Department of Health (DOH) since 1995. The Natural Death Act was legislated in 2000. Members of Healthcare team concerned regarding the proper development of hospice palliative care in Taiwan have organized to, ”do the right things and do things right.” The future vision of hospice palliative care embraces: 1. Expanding services to other life threatening illness such as terminal liver, renal, respiratory and heart diseases; 2. Securing appropriate DOH supervision and funds; 3. Developing a care model appropriate to the needs of Taiwan's culture; 4. Expanding the limits of service models; 5. Integrating services and enhancing expertise among those charged with delivering services, conducting research, and education; 6. Integration into the long term care system and enhancing quality.