癌末病童之靈性照顧－以安寧病房為例

Spiritual Care of Ill Children with Cancer at the Terminal Stage: A Case Study of Hospice Ward

10.6537/TJHPC.2013.18(1).6

釋普安(Pu-Ann Bhikkhuni)；蔡昌雄(Chang-Hsiung Tsai)；程裕藍(Yu-Lan Chen)；游碧真(Bih-Jen You)

癌末 ； 兒童 ； 靈性照顧 ； 安寧療護 ； Cancer at the Terminal Stage ； Children ； Spiritual Care ； Hospice

安寧療護雜誌

18卷1期（2013 / 03 / 01）

62 - 75

繁體中文

安寧療護提供整體性的照顧方式給生命末期的兒童及青少年，以提升病童生活品質並維護自主權及生命尊嚴。一般認為，兒童認知有限，無法理解疾病狀態及死亡，或因家屬刻意隱瞞病情，常造成家庭衝突及壓力；在積極治療無效時，家屬常為決定病童是否接受緩和治療而掙扎。本文為病例報告，以兩位癌末病童接受安寧療護靈性照顧為主題，照顧過程發現病童對靈性照顧有以下四點需求︰1.病情告知、2.關係和解、3.死亡焦慮緩解、4.宗教諮商。第一位病童的照顧程序是：1.與家屬進行病情理解溝通，透過「腳底按摩」與病童建立關係，使能談論病情和宣洩情緒；2.使用「舊照片」及「敘舊」引導進行「生命回顧」，讓關係再連結及和解；3.肯定病童生命意義，藉此實踐「四道人生」。第二位病童的照顧程序是：1.引導病童「懺悔、道歉」，以疏解病童對過去殺生經驗的內疚；2.臨終時刻尊重病童的自主權；3.以「念佛」的宗教經驗啟發內在力量，緩解其死亡焦慮情緒。兒童安寧照顧若能關注本文所提靈性照顧方式，對病童的善終將能有所助益。死亡雖是生命的斷裂，但病童的善終卻能讓逝者無憾，生者能「善別」、「善生」，悲傷緩解，生死兩相安。

Since hospice provides a holistic mode of care for ill children and youth with terminal condition, it could enhance the quality of life and maintain their autonomy with dignity. It is commonly believed that children has limited cognition and can't understand disease and death. Or tension and conflict within the family were often caused due to family members' intention of concealing the medical situation. As the active treatment becomes futile, the family members often struggle with receiving palliative treatment. This study is a report on two clinical cases, emphasizing on the spiritual care received by two terminally ill cancer children in hospice. Based on the care process, it was found that the spiritual care for the ill children involved the following four aspects: 1. informing the status of disease, 2. reconciliation of relationship, 3. reducing death anxiety, 4. Religious counseling. For the first case, the process went as follows: 1. discussing the status of disease and letting out emotion by building up the relationship. 2. a life review being conducted for reconnecting and reconciliating the relationship. 3. affirming the life meaning to facilitate the expression of love, sorry, thanks and farewell. For the second one, 1.helping express regrets and apologies to reduce guilty feeling toward the early ant-killing experience. 2. respecting the autonomy during the final stage. 3. activating the inner strength and reducing the death anxiety by reciting the Buddha's name. Attending to the ways of spiritual care for children in hospice as in this report could help facilitate ”good death” of ill children. Death is a chasm of life, but the good death of ill children could leave no regret for the dead and comfort the bereaved family members.