協助末期病人撤除維生醫療經驗分享－一個案報告

Assistance in Withdrawal of Life-Sustaining Treatment for A Terminal Ill Patient: A Case Report

10.6537/TJHPC.2014.19(3).6

沈政廷(Cheng-Ting Shen)；戴志融(Chi-Jung Tai)；黃裕雯(Yu-Wen Huang)；錢靜馨(Ching-Hsin Chien)；黃洽鑽(Chia-Tsuan Huang)；吳建誼(Chien-Yi Wu)

末期病人 ； 撤除維生醫療 ； 家庭會議 ； 安寧療護 ； terminal ill patient ； withdrawal of life-sustaining treatment ； family meeting ； palliative care

安寧療護雜誌

19卷3期（2014 / 11 / 01）

296 - 308

繁體中文

近年來，越來越多末期病人選擇接受緩和照護，撤除維生醫療。家庭會議在撤除維生醫療扮演很重要的角色。撤除前和家屬舉行家庭會議、和家屬溝通並讓家屬了解撤除的流程以及如何照護病人，以期給予病人最好的照護。病人為83歲男性，因原發不明腹膜轉移癌併急性腸阻塞、敗血症、急性腎衰竭於加護病房進行血液透析與維生醫療。病人意識保持清醒，但狀況持續未改善，一直無法脫離呼吸器；因此會診安寧團隊介入，與家屬召開家庭會議進行撤除維生醫療討論。家屬尊重病人意願；在家屬的協助和團隊的見證下，病人簽署施行安寧緩和醫療及不施行維生醫療意願書。撤除維生醫療後，病人轉至安寧病房接受緩和照護，在家人的陪伴下，走完人生的最後一段旅程。

In these years, more and more patients in the terminal stage asked to withdraw life-sustaining treatment and chose to receive palliative care. The family meeting plays an important role before withdrawal of life-sustaining treatment. Holding the meeting and communication with the family let them realize the process of withdrawal and palliative care for these patients. The case was a 83-year-old male who was diagnosed as the terminal stage of unknown-origin cancer with metastatic carcinomatosis, with acute ileus, sepsis, and acute kidney injury. He was treated in the intensive care unit with hemodialysis and life-sustaining treatment. His consciousness was clear, but his condition could not get improved at all, and thus it was difficult for him to wean from mechanical ventilation. Hospice care team was consulted and we held the family meeting for discussion about withdrawal of life-sustaining treatment. His family respected the patient’s decision, and then he signed the document of do-not-resuscitate (DNR) and withdrawal of life sustaining treatment. After withdrawal of life-sustaining treatment, the patient was transferred to hospice ward for end-of-life care with his family.