走在推廣善終的路上《斷食善終4》新書分享（單堂）

繪本《一片葉子落下來》中出現了一段對話:

「我們都會死嗎？」弗雷迪問。

「是的」丹尼爾說。

「任何東西都會死，不論是大是小、是強是弱。

我們先做完該做的事。

我們體驗太陽和月亮、經歷風和雨。

我們學會跳舞、學會微笑。

然後我們就要死了。」

死亡，是大部分的人不敢去觸碰的議題，因為它會勾動我們內心最深層的恐懼。但是有沒有一個可能，死亡其實是我們生命中最好的一份禮物，以及最棒的老師? 當我們不再把它當作是一個可怕的敵人，不再把它推得遠遠的，我們才能回過頭來好好活著，活出一個真正精采、有意義的人生!

長期推動「斷食善終」的畢柳鶯醫師，透過一本本的著作，想要讓更多人了解什麼是「死亡善終權」。想要善終，是不是一個奢侈的夢想呢? 走在善終的路上，又會遇到什麼阻礙呢? 當家人跟我的想法出現了衝突，我該如何捍衛自己的生命權和善終權呢?

真正的愛，不是緊抓在手上，而是溫柔地放手!

真正的勇氣，不是不害怕，而是帶著恐懼繼續往前走!

有智慧的放手，是生命最後的一份禮物，也是一份莫大的慈悲!

報名截止時間: 美西2025/7/31–20:00止 ；亞洲2025/8/1–11:00止。

【課程大綱】

一、為什麼要寫四本書

• 『斷食善終』

描寫母親斷食往生得善終的故事，一位失能病人想要撤除人工餵食管卻被安寧緩和醫師拒絕，發願要推動「拔管運動」。

• 『有一種愛是放手』

協助了五十位病人斷食往生，分享其過程，分析國外如何避免長期插管臥床的困境。

• 『如何好好告別生命』

前兩本書出版以後，受到安寧緩和界持續的攻擊，並表示不接受自主斷食和撤除維生醫療的病人。因此撰寫自主善終的詳細臨床指引，希望家屬自立自強學習如何照顧斷食往生的病人，讓病人在宅善終。

• 『走在推廣善終的路上』

報紙以頭版抨擊斷食善終有爭議，斷食無法善終。我寫下身為復健科醫師看到全民健保以後，無效醫療氾濫，許多病人急性治療後毫無復健潛能，因此長期對這些插管臥床者及其家屬心生同情。我復健醫師的專業訓練，加上照顧數百位病人斷食往生的經驗，以及上百本書籍的啟發，如何在合情、合法、合理的情況下推廣善終。介紹十五本有關死亡、靈魂、臨終照顧觀念啟發的書籍，翻轉國人的「死亡禁忌」與「飲食迷思」。

二、3年來協助三百位病人斷食往生，其病情分為以下四類

1. 無復原可能的插管臥床者，撤除無治療效果的維生醫療（呼吸器或者人工餵食管）
2. 老衰末期不吃不喝睡睡走，在宅善終，避免將病人送醫被無效醫療延遲死亡。
3. 癌症等重症末期病人，消化吸收不好，不強制病人進食，或者自主斷食，不延長或縮短末期的病苦時間。
4. 嚴重失能病人，全身癱瘓或者進食困難，拒絕人工餵食管或者自主斷食，脫離無品質、無尊嚴的痛苦，在宅善終。

【講師簡介】 

畢柳鶯 / Liu-Ing Bih

台灣大學醫學系畢業，台大醫院復健科住院醫師訓練。曾任台中市立復健醫院院長，中山醫學大學醫學系教授退休，目前任職衛福部復健科資深教學醫師。小學時就感受到男女不公平，人類社會弱肉強食，喜好打抱不平。擔任復健科醫師是我人生最正確的選擇，養成不是只看見疾病而是全人照顧的素養。感謝所有我服務過的病人及家屬，他們的脆弱、受苦、堅強與韌性，給了我許多的啟發與力量。也感謝復健團隊中所有成員無私熱情的協助。

喜歡藝術、旅遊、攝影與閱讀，2009年起透過部落格「阿畢的天空」分享心得，發表500多篇文章。著有「醫步醫腳印」。

【學經歷】

國立臺灣大學醫學系畢業

紐約大學附設醫院及日本國立復健中心進修

台中市立復健醫院院長

中山醫學大學醫學系教授

【現任】

衛生福利部台中醫院復健科資深教學醫師

【Course Outline】

一、Why write four books?

『Fasting for a good death』：A story about a mother who achieved a good death through voluntary fasting: A patient with disabilities wished to have her feeding tube removed, but was refused by a palliative care doctor. She then vowed to promote a “Tube Removal Movement.”

『There is a kind of love that means letting go』：Having assisted fifty patients in achieving a good death through voluntary fasting, she shares the process and analyzes how other countries avoid the predicament of long-term intubation and bedridden states.

『How to Say Goodbye to Life with Grace』：After the first two books were published, the author faced continued criticism from the palliative care community, which stated they do not accept patients who choose voluntary fasting or withdrawal of life-sustaining treatments. So she wrote a detailed clinical guide on self-directed dying, hoping to empower families to learn how to care for patients choosing to fast until death, and to support them in achieving a good death at home.

『Walking the path of promoting a good death』：The newspaper ran a front-page article criticizing the controversy surrounding fasting as a means to a good death, claiming that fasting cannot lead to a good death. As a rehabilitation physician, I wrote about what I have observed since the introduction of National Health Insurance: the widespread use of futile medical treatments. Many patients receive acute care but have no rehabilitation potential afterward, and I have long felt deep compassion for these intubated, bedridden patients and their families. With my professional training as a rehabilitation physician, combined with the experience of caring for hundreds of patients who chose to fast until death, and the insights gained from reading over a hundred books, I explore how to promote a good death in ways that are compassionate, legal, and reasonable. Introducing fifteen books that inspire new perspectives on death, the soul, and end-of-life care, aiming to challenge societal taboos around death and myths about diet.

二、Over the past three years, 300 patients were helped to fast until death. Their conditions are divided into these four types.

Intubated bedridden patients with no chance of recovery, removing life-sustaining treatments (ventilator or feeding tube) that have no therapeutic benefit.

In cases of natural aging at the end stage, patients stop eating and drinking and pass away peacefully at home, avoiding hospital transfers that lead to futile treatments and delayed death.

Patients with terminal illnesses such as cancer often have poor digestion and absorption. They are not forced to eat and may choose voluntary fasting, which neither prolongs nor shortens the suffering during the final stage.

Severely disabled patients, patients who are completely paralyzed or have difficulty eating may refuse feeding tubes or choose voluntary fasting, escaping a life of painful suffering without quality or dignity, and achieve a good death at home.

【Lecturer Profile】

Liu-Ing Bih

Dr. Liu graduated from the National Taiwan University School of Medicine and trained as a resident physician in the Department of Physical Therapy and Rehabilitation at the National Taiwan University Hospital. She used to be the Dean of Taichung Municipal Rehabilitation Hospital and is a retired professor at the Chung Shan Medical University Hospital. She is currently a senior medical professor at the Department of Physical Therapy and Rehabilitation of the TW Ministry of Health and Welfare. Since she was in elementary school, she felt gender inequality. She also felt that the weak are prey for the strong in the human world, and she endeavors to fight against injustice. Being a rehabilitation physician was the greatest choice she made in her life. She learnt to develop an ability to not simply focus on how to combat an illness but to treat and care for a patient as a whole person holistically. She is grateful for all her patients and their families that she has served. Their vulnerability, suffering, grit, and resilience have given her a lot of inspiration and strength. She also wants to express her gratitude to all the members of the rehabilitation team for their selfless and enthusiastic assistance.Dr. Liu likes art, travel, photography and reading. Since 2009, she has shared her experience through her blog “A Bi’s Sky” (http://bee1955.blogspot.com/) and published more than 500 articles. She is also the author of “Medical Steps and Medical Footprints” A literal translation of Book Title)

【Education】

Graduated from National Taiwan University School of Medicine

Advanced Studies at New York University Langone Health (Affiliated Hospital) and JAPAN National Rehabilitation Center

Dean of Taichung Municipal Rehabilitation Hospital

Professor, Department of Physical Therapy and Rehabilitation of the TW Ministry of Health and Welfare

【Current Position】

Senior Medical Professor, Department of Rehabilitation, Taichung Hospital, Ministry of Health and Welfare

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