Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
J Formos Med Assoc. 2013 Oct;112(10):589-99. doi: 10.1016/j.jfma.2013.04.009. Epub 2013 Jun 13.
Withdrawal from dialysis is ethically appropriate for some patients with multiple comorbidities and a shortened life expectancy. Taiwan has the highest prevalence of dialysis patients in the world, and the National Health Insurance (NHI) program offers renal replacement therapy free of charge. In this review, we discuss its current status and many background issues related to withdrawing dialysis from patients with advanced renal failure in Taiwan. Compared with dialysis therapy, the medical resources for hospice care are relatively sparse. Since the announcement of the Statute for Palliative Care in 2000, there has been a gradual improvement in the laws and health polices supporting dialysis withdrawal. Culture and social customs also have a significant impact on the practice of hospice care. Based on current evidence and in accordance with the local environment, we propose recommendations for the clinical practice of dialysis withdrawal and hospice care. There remains a need to expand upon the community-based hospice care and home care systems to better serve patients. In conclusion, there are cross-cultural differences relating to dialysis withdrawal between Taiwan and Western countries. Our experience and clinical recommendations may be helpful for the countries with NHI systems or for the Eastern countries.
对于一些合并多种疾病且预期寿命较短的患者，停止透析治疗在伦理上是合理的。台湾地区是全球透析患者患病率最高的地区，全民健康保险（NHI）计划免费提供肾脏替代疗法。在这篇综述中，我们讨论了台湾地区终末期肾衰竭患者停止透析治疗的现状及其与许多背景问题。与透析治疗相比，临终关怀的医疗资源相对较少。自 2000 年《安宁缓和医疗条例》公布以来，支持停止透析治疗的法律和卫生政策逐渐得到改善。文化和社会习俗对临终关怀的实践也有重大影响。根据现有证据并结合当地环境，我们提出了停止透析治疗和临终关怀的临床建议。仍需要扩大以社区为基础的临终关怀和家庭护理系统，以更好地为患者服务。总之，台湾地区与西方国家在停止透析治疗方面存在跨文化差异。我们的经验和临床建议可能有助于那些实施 NHI 制度的国家或东方国家。
