疫情期間安寧病房住院病人確診新冠肺炎後之照護與倫理困境

The ethical dilemma and care issue in terminal patients admitted to hospice ward during COVID 19 pandemic

自 2019 年 12 月新冠疫情自中國開始，全球新冠疫情傳播已邁入第三年，為確保醫療量能不潰堤同時也限制住院病人家屬、長照機構住民家屬探視之權力，致使醫療體系內加護病房病人、住院天數較長的慢性病人、甚至安寧病房住院之末期病人影響甚大，安寧病房的醫護團隊成員也面臨相關挑戰與困難，在親情與疫情之間難以取捨。
尤其安寧病房病人一旦確診新冠肺炎後，須依疾病管制署規範轉至專責隔離病房，在安寧照護上會面臨到一些問題與挑戰，接受緩和療護之末期病人是否須使用抗病毒藥物，除考量醫療適應性、病患意向以及生活品質之外，情境特徵在疫情下亦是一個必須考量的要素，因此即便安寧病房確診新冠肺炎之末期病人，在醫師評估合適後，皆可給予藥物治療，但須注意避免讓有限的抗病毒藥物淪為無效醫療。
醫療照護團隊應在隔離病房中及時掌握病人病情的變化，協助引導病人及家屬在隔離狀態下完成四道人生，達成安寧療護中生死兩相安之目標。

The COVID-19 pandemic has been raged for 3 years since December 2019. The hospital and long-term care facilities implemented visit restrictions to prevent health care system collapse. These visit restrictions affect patients admitted to intensive care unit, chronic illness patients with long hospitalization course, and especially terminal patients admitted to hospice ward. The hospice ward staff must strike a balance between pandemic restriction and humanitarian consideration.
The hospice ward patients must be transferred to quarantine ward if diagnosed with COVID-19 by regulation and which may impose some challenge and problems in hospice care. There may be ethical dilemma in treatment these terminal patients receiving hospice care with COVID-19 specific drugs. Besides medical indication, patient preferences, and quality of life, contextual features should be considered carefully in making the decision. Generally, the COVID-19 treatment drugs could be administered in these terminal patients without the possibility of medical futility.
The goal of hospice care is to provide peace in both the deceased and their family. Therefore, the health care team in quarantine ward should observe the clinical changes of terminal patients and provide the chance for patients and their family to express gratitude, forgiveness, love and saying goodbye in time.