以安寧緩和醫療維護善終並減少末期病人的醫療糾紛

Promotion of Hospice Palliative Care for Peaceful Dying and Minimizing Medicolegal Disputes

醫生的天職是把病人救活，把疾病治好，將痛苦解除，促進人類的健康。但是當生命已走到盡頭，死亡已是不可避免時，醫療從業人員，應該以最大的愛心及人性的關懷，來提供給每一個病人沒有痛苦，能夠安詳有尊嚴的往生的機會。最後階段的臨終關懷，更應發揮「拔苦予樂」的宗教情操與人文精神。請大家響應衛福部「尊重末期病人的生命及其醫療自主權」的呼籲，努力推動安寧緩和醫療的理念。期待台灣各個醫學會早日對各器官系統衰竭病人訂定安寧緩和醫療的指引，各級醫療人員能善用安寧緩和人性化醫療的理念與愛心，以病人的最大利益為考量，面對病人與家屬，努力宣導安寧理念及政府推動預立DNR意願書的精神。不論在病房、急診或ICU面對需要以CPR急救的病人時，如果已確認是末期病人，請以同理心，告知家屬：「病人現在的狀況，需要以心肺復甦術插管急救，但是因為病人末期疾病的關係，插管急救無法救回生命，只有增加及延長病人的痛苦。是否考慮不要以無效的心肺復甦術折磨病人，協助他安詳的走？」如果病人已經預立DNR意願（有意願書或健保卡註記），更應該說服家屬，協助病人安詳往生。ICU的醫師，面對已經插管急救仍然無法恢復呼吸且持續極重度昏迷的病人（台灣昏迷指數0分），如果研判不可能恢復，應該與家屬耐心溝通，根據病人簽署的不施行維生醫療意願書或家屬代表簽署的不施行維生醫療同意書，儘早依法撤除無效的呼吸器等措施，減少及縮短病人的痛苦，協助病人善終，並減少醫療糾紛。

The purpose of medicine is to prevent illness, cure disease, relieve suffering, and maintain health. The duty of physicians is to rescue life, cure disease, relieve suffering, and promote good health. However, “birth, aging, sickness, and death” are unavoidable paths of human life. When a person has reached the end of life and death is imminent, the duty of medical professionals will be to provide love and humanistic care for the patient, relieve pain and suffering, and provide a peaceful and dignified demise. A physician provides care from birth to death (i.e., from “womb to tomb”). At the conclusion of terminal care, physicians should maintain a religious and holistic spirit for “removal of suffering and provision of happiness” to their patients as much as possible. Provision of hospice palliative care and terminal DNR according to medical ethics and law can ensure peaceful dying of the patients.