說與不說－－失智症病情告知的倫理兩難

To Tell or Not to Tell: The Ethical Dilemma of Truth-Telling and Diagnosis of Dementia

病情告知是從事診斷與治療時重要的溝通過程，告知實情往往在尊重病人自主與不傷害兩倫理原則間權衡與取捨。失智症是一種慢性、漸進性認知功能退化症候群，目前尚無法有效地治療，伴隨情緒控制、語言技巧與社會行為之惡化，常使得失智症病情告知或不告知出現兩難的困境，時至今日仍然沒有標準的答案或做法。本文建議以倫理情境作為告知過程中的指南，臨床中藉由對話、溝通建立共識，透過醫療人員間共同討論失智症病情，且依照其個別性來做彈性判斷，以「人」為本，以家庭為整體，以病人為中心，繞著家屬角色、伴著倫理角色，進行情緒滴定的過程，並理解這些被時間困住的長輩們，學習如何跟他們溝通的方式，建立與失智患者的對話能力，進而做出「對」的決定。結論失智症的病情告知是一連串的溝通、關懷行動，融合成一種磋商、諮商、交流、討論等形式，過程中體現對於人的真誠關懷與照護內涵。

Truth-telling is crucial in patient diagnosis and treatment. Deciding whether to be truthful with patients regarding their dementia diagnoses requires balancing the patient's autonomy against health care professionals’ obligation to avoid harm. Dementia is a chronic progressive cognitive degeneration syndrome, which causes mood instability as well as the deterioration of language and social skills. Currently, dementia cannot be effectively treated, contributing to the dilemma as to whether to be truthful with patients regarding their dilemma diagnoses. Medical professionals can take ethical considerations into account when deciding whether to truthfully report dementia diagnoses to patients. In addition, the judgment of health care professionals regarding truth-telling should be fl exible and oriented toward the patients’ families as well as patient-role-centered, familyrole- centered and ethical-role-centered, through the process of emotional titration. We must realize that dementia patients are trapped time, and learn to communication with them before making an appropriate truth-telling decision. In conclusion, truth-telling involves communication and caring for patients and should be considered carefully by health care professionals.