邁向安寧緩和醫療的新一頁

The Next Era of Palliative Care in Taiwan: A Look at Where We Have Been and Where We May Go

10.3966/207466012014120602004

熊誼芳(Yvonne Hsiung)；賴允亮(Yuen-Liang Lai)；蘇韋如(Wei-Ju Su)

安寧緩和醫療 ； 無效醫療 ； 預立醫毒自主計畫 ； Hospice ； Medical Futility ； Advance Care Planning

生命教育研究

6卷2期（2014 / 12 / 01）

99 - 118

繁體中文

現代安寧緩和醫療肇始於1967年，而臺灣安寧療護的理念則萌芽於1983年，至今亦有逾二十年歷史。在臺灣安寧療護的催生與茁壯過程當中，善終善生的「四全照護」一直是發展的核心。最近三讀通過的第三次《安寧緩和醫療條例》相關修法、社會上積極推動的「預立醫療自主計畫」、以及拒絕急救相關之生命教育與臨終倫理決策，都是近年來安寧照護法規制度上力求完備的確據，也是未來此領域的重要議題。當今安寧緩和醫療的時代使命，是凝聚尖端科技，以科學驗證（evidence base）的研究成果來拒絕臨床上的無效醫療（medical futility），立基在科技、知識及技巧來整合流行病學、症狀學及育成新藥，目的在緩解生命中的苦難，增進末期病人的福祉。隨著時代的潮流法令不斷再修正，民眾接受安寧相關教育的普及化，身為安寧療護從業人員所面對的挑戰也更多元，臺灣的安寧緩和醫療正邁向新的一頁。

Originated from the linguistic root ＂hospitality,＂ the term ''hospice'' in medieval time referred to an oasis for the weary on a long enervating journey. Created by Dr. Dame Cicely Saunders in 1948, hospice today is far more beyond a facility for terminally ill patientsit now stands for a mission, applying evidence-based knowledge and employing the stateof- the-art technology, a specialized care to ease patient suffering, provide comfort, and help find peace and dignity at the end of life. The goal is to meet not only physical , but also psycho-social, spiritual and cultural needs of both dying patients and their families. Pioneered in 1967, palliative care in Taiwan has evolved and modified through time to include modern societal meanings, yet the mission to center on ultimate humanity remains. Medical futility, however, as a well-established basis for withdrawing and withholding lifesustaining treatment, continues to be an ongoing clinical controversy that complicates the time point Taiwanese initiating hospice/palliative care. In addition, in the past decade the dying population who received palliative care has enlarged to comprise not only cancer Uueaupatients but also that of other diseases. Palli ative care in the new era quickly progresses and the innovative service of psycho-oncology emerges as well. In accordance with the recent third reading of Hospice Palliative Care Regulation Amendment, the govemmentpromoted ＂Advance Care Planning＂ helps clarify patients' medical preference, reduce futile possibilities, and further ensure their dignity and quality of death. While there are expected challenges and certain cultural barriers on the way for each Taiwan citizen to achieve ＂a good death,＂ palliative care providers shall persist with their efforts to complete this mission.

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