結核病防治措施對病患基本人權影響之研究

「結核病防治」是全世界重要公共衛生議題，「結核病」不但危害民眾健康及生命，甚致耗損社會生產力，更嚴重影響國家競爭力及國際形象。因具傳染特性，社會上對「結核病」的不當解讀及污名隱喻，導致病患常以逃避態度面對治療，擔心因此喪失工作權益。因此結核病患隱私應予以保障，提供其安心服藥治療，免於畏懼他人異樣眼光，是病患應享有之基本人權。因此本研究對結核病之防治措施是否影響病患基本人權進行探討，希冀有助於提高結核病防治效能及衛生單位強制執行公權力之同時，更能兼顧人民權利的維護與保障。本研究採質性研究以深度訪談法進行，共訪談八人，對象包括疾病管制署、衛生局、衛生所結核病防疫相關工作者及肺結核病患。訪談問題主要包括結核病防疫措施及個人內在因素及社會外在因素，對病患人權之影響議題，如對生命權、工作權、隱私權、藥物自主管理權、人身自由權、居住自由權之影響分析。研究結果分述如下： (一)個人內在因素：支持系統及病患服藥遵從性與藥物副作用反應，是影響病患生命權重要因素。 (二)社會外在因素：污名隱喻導致社會排擠、職場同仁歧視眼光、親友迴避遠離，影響病患工作權。 (三)防治措施部分：抗結核藥物是財產，由衛生所回收管理，影響財產支配、自主管理權利。「強制隔離治療」「限制飛航管制措施」影響人身自由權。「都治服藥策略」、「強制就醫」有影響居住自由權益。防治措施之執行雖然對病患基本權利有所影響，但基於公共利益目的，仍需依照憲法規範落實人民權利保障意旨。根據研究結果提出以下建議： (一)對都藥策略影響病患人權保障之建議。「都藥策略」為全世界最重要且最有效之防治措施，確是病患最反彈排斥之防治項目。建議應立法規範，或提供具體證明文件，協助基層說服病患配合相關防治規定。 (二)對隱私及工作權保障之建議。衛生教育是結核病防治重要基石，因而需落實全面推動結核病防治衛教宣導。包括校園、社區與機關團體，以改變民眾對結核病負向烙印，保障病患基本人權意旨。 (三)對結核病防治業務推動建議。包括（1）衛生所業務繁雜人力有限，需培訓結核病個管師或派專員進駐。協助防疫業務推動，讓防疫工作無軌接縫得以延續，結核病方有可能達十年減半目標；（2）針對特殊族群及社區提供篩檢，以早期發現早期治療，降低日後發病機率；（3）衛生局應定期舉辦結核病教育訓練。尋求治療醫院之醫師及個管師協助，對初通報病患提供都藥策略醫療資訊，降低後續管理困難度。關鍵字：肺結核、防治措施、隔離治療、基本人權、都治觀察治療法。

關鍵字

肺結核；防治措施；隔離治療；基本人權；都治觀察治療

並列摘要

"Tuberculosis Control" is an important public health issue worldwide. "Tuberculosis" not only endangers the health and lives of people but causes loss of social productivity, which has more serious impacts on the national competitiveness and the international image. Due to the contagious characteristics, the communities impose on "Tuberculosis patients" improper interpretation and stigma metaphor. It made TB patients fearing to lost their work rights and interests which resulting in patients often have evasive attitude toward treatments. Therefore, the privacy of tuberculosis patients should be protected in order to provide their medication at ease, free from fear others strange vision. TB patients should be entitled to the basic human rights. In this study, the impacts of tuberculosis control on patients' basic human rights were discussed. Hoping that while improve the effectiveness of tuberculosis control and also protect patients' rights at the same time. This study conducts with a qualitative research method of in-depth interview. Interviewees includes eight cases, who are representatives of Centers for Disease Control, Health Bureau, health-related TB epidemic prevention workers and tuberculosis patients. The interview questions are about tuberculosis prevention, personal internal factors, social external factors on the human rights of patients. Human rights issues include the right to life, the right to work, the right of privacy, drug management rights, personal liberty, the right to freedom of residence. Analysis of interviews as follows: (I) Intrapersonal factors: support systems, patient compliance and side effects of medication, are important factors affecting the right to life of patients. (II) Social external factors: the stigma metaphor cause social exclusion, discrimination in the workplace, away from family and friends which affecting the right to work of the patient. (III) Prevention strategy: anti-TB drugs are the property of health station who take back those drugs, it will affect the patients' right of property allocation, and the right of self-management. "Forced isolation treatment" "restricted flight control" affect the right of personal liberty. "DOTS medication strategy," "mandatory medical treatment" affect the freedom of residence. Although the implementation of prevention and control have impacts on the fundamental rights of patients, but based on public interest purposes, it is necessary in accordance with constitutional norms to protect people's rights. According to the research findings, the following recommendations are proposed: (A) Protection human rights of patients is recommended for all drug policies. "DOTS strategy" is the most important and the most effective prevention measures in the world, but it is also indeed the most exclusive treatment by the patients within all the control projects. I suggest that it should pass related legislation, or provide specific documents to help convincing patients to comply with primary medical treatments. (B) Recommendations for the protection of privacy and the right to work of the patients Health education is an important cornerstone of TB control. Therefore, it will require the implementation of a comprehensive health education to promote the prevention and treatment of TB, which including schools, communities, government agencies, and organizations in order to change the public's negative stigma of TB, and to protect the basic human rights of patients. (C) Recommendations for TB control services 1. Due to limited manpower of health station, well-trained TB cases manager or specialist recruitment is needed. Through promoting disease prevention services, it will reach the target of reducing tuberculosis cases by half within a decade. 2. Provide screening for communities and specific groups for early detection and early treatment to reduce the incidents of later morbidity. 3. Health Bureau should organize TB education and training regularly, request the assistance of physicians and case managers, and provide the information of DOTS treatment strategy to the patients as soon as possible, in order to reduce the difficulty of subsequent treatment management. Keywords: Tuberculosis, Prevention measures, Isolation treatment, Human rights, Directly Observed Treatments（DOTS）