在安寧緩和照護中，最重要的工作就是減輕病人的痛苦並且提供較好的生活品質。所以是否拔除呼吸器，這對病人、病人家屬或醫療人員來說一直是一個痛苦的決定。政府在2002年6月之後，核准癌末病人可拔除呼吸器，而在條例通過前後，我們安寧病房有不同呼吸器拔除的方式。在2002年6月之前有兩位癌末病人由其他醫院轉入我們安寧病房，他們意識清醒且能利用簡單書寫溝通。同年6月之後，亦有兩位癌末病人轉入安寧病房，但是他們已陷入昏迷狀態。這四位病人的家屬均要求拔除呼吸器。我們首先與家屬進行多次會談，再來與胸腔科醫師聯絡準備拔除呼吸器事宜。最後，在確定拔除呼吸器時，亦有社工師及宗教人員的參與和幫忙。 2002年6月前轉入安寧病房的兩位癌末病人，其中一位癌末病人在睡眠中意外的自己拔除了呼吸器，於一個月後平靜死亡；另一位癌末病人則在拔除呼吸器5天後於家中死亡。同年6月轉入之兩位癌末病人，則均於呼吸器拔除次日死亡。雖然，移除生命維持器條例在2002年6月已通過，但是拔除癌末病人的呼吸器仍是一項艱困的工作，因為在有限的時間之內，有很多的問題仍須被考慮。
Introduction: Discontinuation of mechanical ventilation (DMV) in the terminal cancer patients is not legally approved by the government until June 2002 in Taiwan. Until that time, DMV in the terminal cancer patients remained a painful practice whether to the patient, the patient's family or to the medical staff. However, relieving suffering and providing best quality of life to the patients is of paramount concern in hospice-palliative care. Different ways of DMV were performed in our hospice ward before and after they were legally approved by the government of Taiwan. Methods: Two terminal cancer patients with mechanical ventilation were transferred from another hospital to our hospice ward before June 2002, in both patients' consciousness was clear and they could communicate through a word board or simple writing, the patients and their family asked for DMV. Two terminal cancer patients with mechanical ventilation were transferred to our hospice ward after June 2002, both patients' consciousness were in a drowsy state. Their family also asked for DMV. We first performed frequent family conferences with the family or people who were concerned about the patients. In the meantime pulmonary therapists were asked to help in the preparation for removing the endotracheal tube. The patients' pastor and social worker were asked to help when the extubation was performed. Results: Before June 2002 one patient received DMV by pulmonary therapist and died peacefully in his own home five days later. The other patient removed his endotracheal tube by himself accidentally during his sleep, and died peacefully one month later after last reunion with his son who came back from Hong Kong. After June 2002, one patient aspirated one mouthful of a peach after extubation and died in the next day; the other patient died peacefully surrounded by his family the day following extubation. Conclusions: After legislation about withdrawal of life-sustaining apparatus was made in June 2002, DMV from the terminal cancer patients still remains a sophisticated task in Taiwan, because many issues must be considered totally in a limited time.
