長期呼吸器依賴病患撤除維生治療之倫理法律議題

The Ethical-legal Issues in Withdrawing Life Support from Prolonged Mechanical Ventilation-dependent Patients

10.6320/FJM.2012.16(2).10

蔡甫昌(Daniel Fu-Chang Tsai)；方震中(Cheng-Chung Fang)；陳麗光(Li-Kwang Chen)；王榮德(Jung-Der Wang)

末期照護倫理 ； 不施行或撤除維生治療 ； 不施行心肺復甦術 ； 無效醫療 ； end of life care ethics ； withholding and with drawing life support ； do not resuscitate ； DNR ； medicalfutility

台灣醫學

16卷2期（2012 / 03 / 25）

156 - 173

繁體中文

本文探討長期呼吸器依賴病人撤除維生治療之各種倫理法律議題，分析常見的倫理爭議觀念，並參照美、英、加專業醫學會相關末期照護倫理指引，列舉數例西方經典法院判例，並根據病患是否具決定能力及是否屬於末期疾病狀態，來說明有關撤除維生治療之倫理處置原則，最後介紹呼吸器撤除之步驟與作業指引。本文指出，使用過度與無效的維生治療來延長病患的死亡歷程，是不符合醫療適應症的醫療行為，醫師應基於專業判斷來避免與終止，並以尊重病患自主意願與維護其最大利益為原則，來達成終末照護倫理難題之解決。

This paper explores the ethical and legal issues of withdrawing life supports from prolonged mechanical ventilation-dependent patients. Common controversial ethical conceptions are analyzed. Certain American, Canadian and British Professional ethical guidelines concerning end-of-life care ethics are introduced and some classical cases are discussed. The authors then propose basic ethical principles of patient management based on whether patients have decision capacity and whether they are in terminal disease status. Finally the procedures and guidelines for ventilator withdrawal are presented. It is argued that using excessive and futile life supports to prolong the dying processes of patients are not of medical indication, and therefore physicians should avoid and terminate such practices based on professional judgment. The resolution of end-of-life care ethical dilemmas should base on the principles of respecting patient autonomy and promoting the best interest of the patients.

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