癌症生命末期病人維生治療的撤除與不給予之議題

The Withdrawing and Withholding of Life-sustaining Treatment Issues in Life-ending Cancer Patients

10.3966/168395442017101703002

林佑樺(Yu-Hua Lin)

癌症 ； 生命末期 ； 維生治療 ； 撤除與不給予 ； cancer ； end-of-life ； life-sustaining treatment ； withdrawing and withholding

腫瘤護理雜誌

17卷增訂刊（2017 / 10 / 01）

17 - 26

繁體中文

當照顧疾病進展至無法再以醫療技術挽回的生命末期病人，面對維生治療的使用與否對於醫護人員、病人和家屬均將面臨許多的倫理挑戰。國內針對此議題也已多次修訂安寧緩和醫療條例及其施行細則提供臨床醫護人員、病人和家屬實務上的參考，然而臨床個案的情境各有差異，因此在實際施行病人維生治療的撤除與不給予時，仍有許多與倫理相關的議題值得商榷。本文以常見議題進行相關之文獻整理，並配合臨床案例提出可能的倫理議題及執行措施之討論。

At end-of-life, the disease has progressed to its end-stage and the patient can no longer recover with current medical technology. Treatment encounters present many ethical challenges for healthcare workers, patients and their families. There are several revisions of the hospice palliative care regulation amendment and its enforcement rules to provide practical reference for the clinical staff, patients and their families in Taiwan. However, the circumstances of clinical cases vary. Surrounding the actual implementation of withdrawing and withholding life-sustaining patient care, there still remain several ethical issues for discussion. Through literature review, we approached our own cases to explore possible ethical issues and proposed steps for related implementation.

1. American Thoracic Society(1991).Withholding and withdrawing life-sustaining therapy.Annals of Internal Medicine,115(6),478-485.
2. British Medical Association (2007).Withholding and Withdrawing Life-prolonging Medical Treatment: Guidance for decision-making. Third edition, Blackwell Publishing. Re- trieved from http://onlinelibrary.wiley.com/ doi/10.1002/9780470757994.fmatter/pdf
3. Burns, J. P.,Mitchell, C.,Griffith, J. L.,Truog, R. D.(2001).End-of-life care in the pediatric intensive care unit: Attitudes and practices of critical carephysicians and nurses.Critical Care Medicine,29,658-664.
4. Caralis, P. V.,Hammond, J. S.(1992).Attitudes of medicalstudents, house staff, and faculty physicianstoward euthanasia and termination oflife-sustaining treatment.Critical Care Medicine,20,683-690.
5. Center for Bioethics University of Minnesota. (2005). End of Life Care: An Ethical Overview. Retrieved from http://www.ahc.umn.edu/img/ assets/26104/End_of_Life.pdf
6. Chiu, T. Y.,Hu, W. Y.,Chuang, R. B.,Cheng, Y. R.,Chen, C. Y.,Wakai, S.(2004).Terminal cancer patients wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan.Journal of Pain Symptom Management,27(3),206-214.
7. Cohen, M. Z.,Torres-Vigil, I.(2012).The mean- ing of parenteral hydration to family caregivers and patients with advanced cancer receiving hospice care.Journal of Pain Symptom Management,43(5),855-865.
8. Ganzini, L.(2006).Artificial nutrition and hydration at the end of life: Ethics and evidence.Palliative & Support Care,4(2),135-143.
9. Geppert, C. M.,Andrews, M. R.,Druyan, M. E.(2010).Ethical issues in artificial nutrition and hydration: A review.Journal Parenteral Enteral Nutrition,34(1),79-88.
10. Hinshaw, D. B.(2008).Ethical issues in end-of-life care.Journal Medical Libanais,56(2),122-128.
11. Jonsen, A.,Siegler, M.,Winslde, W.(2010).Clin- ical Ethics-A practical approach to ethical decision in clinical medicine.USA:The McGraw-Hill Companies, Inc..
12. Lanuke, K,Fainsinger, R. L,DeMoissac, D.(2004).Hydration management at the end of life.Journal of Palliative Medine,7(2),257-263.
13. Launes, C.,Cambra, F. J.,Jord· n, I.,Palomeque, A.(2011).Withholding or withdrawing life-sustaining treatments: An 8-yr retrospective review in a Spanish pediatric intensive care unit.Pediatrics Critical Care Medicine,12(6),e383-e385.
14. Morita, T.,Hyodo, I.,Yoshimi, T.,Ikenaga, M.,Ta- mura, Y.,Yoshizawa, A.,Shimada, A.,Akechi, T.,Miyashita, M.,Adachi, I.(2005).Association between hydration volume and symptoms in terminally ill cancer patients with abdominal malignancies.Annals Oncology,16(4),640-647.
15. Reynolds, S.,Cooper, A. B.,Mckneally, M.(2007).Withdrawing life-sustaining treatment ethical-considerations.The Surgical Clinics of North America,87(4),919-936.
16. Skjaker, S. A.,Hoel, H.,Dahl, V.,Stavem, K.(2017).Factors associated with life-sustaining treatment restriction in a general intensive care unit.PLOS ONE,12(7),e0181312.
17. Somers, E.,Grey, C.,Satkoske, V.(2016).With-holding versus withdrawing treatment: Artificial nutrition and hydration as a model.Current Opinion Supportive Palliative Care,10(3),208-213.
18. Thorns, A.(2010).Ethical and legal issues in end of life care.Clinical Medicine,10(3),282-285.
19. Welie, J. V. M.,ten Have, Henk AMJ(2014).The ethics of forgoing life-sustaining treatment: Theoretical considerations and clinical decision-making.Multidiscipline Respiratory Medicine,9(1),14.
20. 林春香, C. S.(1995)。護理人員對末期病患自動出院過程之護理、倫理以及民俗考量。護理雜誌，42(3)，78-83。
21. 高以信, Y. H.,張國寬, K. K.(2011)。癌末病人補充人工營養及水分適宜嗎?。安寧療護，16(1)，62-73。
22. 楊庭碩, T. S.(2017)。未期病患之營養與水份的迷思。亞東院訊
23. 廖俊惠(2014),重病末期病人工營養與水份的倫理議題 · Luke Christian Medical Mission HIÉ http://www.lcmmusa.org/ethical-issues [Liao, J. H. (2014). Ethical issues of artificial nu- trition and hydration at the terminally ill patients. Luke Christian Medical Mission. Retrieved from http://www.lcmmusa.org/ethical-issues]
24. 蔡甫昌, F. C(2006)。重症加護病患照護之倫理議題。台灣醫學，10(1)，105-114。
25. 蔡甫昌, F. C.(2014)。衛生福利部102年度補助科技研究計畫衛生福利部102年度補助科技研究計畫,未出版
26. 蔡甫昌, F. C.(2008)。末期病人該不該撤除維生治療。健康世界，395，70-73。
27. 蔡甫昌, F. C.,方震中, C. C.,陳麗光, L. K.,王榮德, J. D.(2012)。長期呼吸器依賴病患撤除維生治療之倫理法律議題。臺灣醫學，16(2)，156-173。
28. 蔡甫昌, F. C.,劉珈麟, J. L.,朱怡康, Y. K(2006)。醫師協助自殺與安樂死的倫理法律議題。台灣醫學，10(5)，601-611。

1. 釋宏琳,賴維淑,詹璧華,梁惠茹(2021)。癌末病人撤除氣管內管之照護經驗。安寧療護雜誌，25(3)，284-297。