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第 71  期

專題論文
Special Issue

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新冠肺炎流行期安寧緩和醫療所面臨的挑戰
Challenges of palliative care during the epidemic of COVID-19
作者 釋照量
Author Zhao-Liang Shi
關鍵詞 COVID-19 大流行,安寧緩和治療,禁止探視安寧緩和 患者,居家安寧治療,醫療資源,預立醫療決定
Keywords COVID-19 Pandemic, Palliative care, Prohibition for visiting palliative patients, home palliative care, medical resources, Advance medical decisions
摘要 在 2019 年冠狀病毒病或COVID-19 大流行期間,為了防止醫院感染,安寧治療病房禁止家屬探望病人,但臨終病人除外。為了避免在醫院孤獨度過臨終時,許多有多種症狀需要醫療幫助的臨終病人會選擇接受家庭家治療。然而,居家安寧治療的資源相對不足。如果患者出現不適症狀,在家中很難得到很好的控制,家人也會面臨很大的護理壓力。此外,疫情期間,探視禁令不僅影響家屬陪伴患者的機會,也影響醫療團隊協助家屬的醫療決策討論和家屬預期的悲痛。由於COVID-19 疫情這項禁止在安寧緩和病房探視患者的政策可能會在疫情嚴重時期持續下去,上述影響還將會持續發生。因此,應更迅速、更充分地調整居家安寧療護的資源,以滿足臨終患者的此類需求。本文建議醫療團隊應善用視訊,幫助住院患者及其家屬建立有效的情感聯繫,必要時召開家屬會議。此外,視訊設備還可用於遠程診療,幫助患者居家進行安寧緩和醫療治療,減輕不適症狀。
另外在加護病房重症安寧及COVID-19 重症患者面對無效醫療時,突發性重症患者家屬在做醫療決策兩難的困境,突顯預立醫療決定的重要性。
Abstract During the severe epidemic of Coronavirus Disease 2019 or covid-19 pandemic and in order to prevent hospital infections, palliative care wards prohibit family members to visit patients except for dying patient. To avoid spending end-of-life dying alone in the hospital, many terminal patients with multiple symptoms requiring medical assistance would choose to have home palliative care. However, the resources for palliative care at home are relatively inadequate. If the patient has symptoms of discomfort, it is difficult to get good control at home, and family members will also face great care pressure. In addition, during the pandemic, the ban on visits not only affects the chances of
family members to accompany the patient, but also affects the medical team helping family's medical decision-making discussion and the expected grief of the family. Since this policy of prohibiting visits to patients in palliative care wards may continue indefinitely, and the above-mentioned impact will continue. Therefore, home palliative care resources should be adjusted more quickly and
adequately to meet such needs of patients at the end of life. It is suggested in this paper that the medical team should make good use of video equipment to help hospitalized patients and their families making effective emotional connections, and to hold family conferences when necessary. In addition, video equipment can also be used for remote diagnosis and treatment to help home palliative care of patients to reduce symptoms of discomfort.
In addition, when critically ill patients in the intensive care unit and covid-19 critically ill patients face ineffective medical treatment, the family members of sudden critically ill patients are in a dilemma in making medical decisions, highlighting the importance of advance medical decisions.
二十一世紀新冠肺炎全球流行病之倫理法律社會與政策之意涵 (ELSPI)
/ 李瑞全    Shui-Cheun Lee
1
攸關新冠病毒疫情之治人醫心生命文化反思
/ 蔡篤堅    Duujian Tsai
5
新冠病毒及疫情流行所產生之倫理爭議舉隅
/ 釋昭慧    Chao-Hwei Shih
27
COVID-19 大流行引發之醫療倫理議題
/ 陳祖裕    Cho-Yu Chan
59
新冠肺炎蔓延期間告別的勇氣與意義
/ 蕭玉霜    Yu-Shuang Hsiao
75
大 COVID 時代的疫苗分配與接種政策倫理考量
/ 葉明叡    Ming-Jui Yeh
119
新冠肺炎疫苗研究倫理探討與公眾信任之建立
/ 陳妤嘉    Yu-Chia Chen
137
從儒家「人文關懷」的觀點反思新冠肺炎疫情對世界的衝擊
/ 金美華    Mei-Hua Chin
161
公共衛生倫理學之基本原則與全球流行病之實踐分析:儒家生命倫理學之效用與應用
/ 李瑞全    Shui-Chuen Lee
183

/     Bunrong Kouy
207
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