| Summary: | 碩士 === 國立臺灣師範大學 === 社會工作學研究所 === 105 === High-standard end-of-life patient care should be in line with the patient and family-centered decision-making mode, including a good communication mechanism, continuous care, comfortable treatment, avoidance of pain, emotional comfort, substantial care and spirit support. In this study, we conducted in-depth interviews with four senior social workers with over 14 years of experience in the medical social work field about ethical dilemmas they faced when the medical team removed life-sustaining treatment, their role in this process, their interaction with the medical team and family members and how they dealt with the issues.
First, we divided the life-sustaining treatment withdrawal process into four phases: initiation phase, decision-making phase, removal or termination preparation phase and the final phase. With respect to the functions of a medical social worker provided in the team, the social worker needs to clarify the position of family members by communication and coordination, stabilize the emotion of patient/family and team members, assist in assessing the legality of the implementation process and educate the members of the life-sustaining treatment withdrawal team. In terms of the work with family members, the social worker’s main job is to serve as a communication bridge between the medical team and the patient/family, accompany the patient and family during the adaptation process and be attentive to the family’s sorrow. The dilemmas faced by the medical social workers were their reluctance to see the patients suffering and the family struggle on making medical decisions and worry about their financial ability. Finally, in order to provide appropriate service, and establish and enhance knowledge and ability, the medical social workers usually studied medicine-related knowledge on their own and actively participated in self-growth learning in addition to the training provided by the hospital or the department. Peer supervision and self-learning provided great support.
Based on the experience in the withdrawal of life-sustaining treatment, these senior medical social workers agreed that it requires a certain degree of work experience to work more smoothly in the team and experiences are accumulated through active learning. The findings of this study can be the recommendations for medical and other related team members.
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