醫病關係中的癌末真相告知－從權力倫理原則到臨床專精的展現

The Performance of Terminal Cancer Truth Telling in Doctor-Patient Relationship: From Power and Ethical Principles to Clinical Expertise

許樹珍(Shuh-Jen Sheu) ； 林明慧(Ming-Hwai Lin) ； 歐美(Meei Ou) ； 陳祖裕(Cho-Yu Chan) ； 黃淑鶴(Shu-He Huang)

《應用倫理評論》 50期 (2011/04) Pp. 1-25

https://doi.org/10.29904/JAF.201104.0001

摘要

本文主要目的在探索癌末病情真相告知的議題，反思國際間生命倫理和本土文化特質對醫病關係中病情言說之社會和個人意義。研究以多重觀點和多重場域，原針對癌症患者、家屬與醫療小組成員爲對象來收集資料，共進行10次焦點團體和26位個別深度訪談，以及23次以上實際場域觀察。本文焦點在以詮釋現象學研究法，分析醫病關係中對癌末真相告知的相關處境及經驗，結果以三大主題來描述：(1)倫理原則和關係權力的衝突－醫療威權與俗民人性的對峙；(2)風險的醫病關係－壞消息的揭露或隱瞞；(3)醫療專業自主的倫理開展－從醫療權威轉臨床專家。藉此，研究者展現不同倫理原則和關係權力間的倫理困境，進而比較、剖析和發現較理想切實的癌末真相告知的概念和行動所在。

關鍵字

醫病關係 ； 癌症末期 ； 真相告知 ； 倫理 ； 詮釋現象學

並列摘要

The purpose of this study is to explore the truth telling issue of patients with terminal cancer. Through reflecting the social and personal meaning on this issue from bioethics perspectives internationally or Taiwanese cultural characteristics nationally, it may own the possibility to facilitate and generate more effective indigenous knowledge and action in clinical ethics. The original participants in the large study were patients, family members, and health professionals, and the ways of data collection included 10 focus groups, 26 in-depth individual interviews, and above 23 field notes from multi-perspectives and multi-sites.This article is focused on exploring truth telling phenomenon within the doctor-patient relationship, which mainly adopted the approach of hermeneutic phenomenology. Three themes were emerged from the data analysis: (1) conflict between ethical principles and relational powers-the contrast between the medical authority and public humanity, (2) risky doctor-patient relationship-covering or disclosing bad news, (3) opening up the ethical development of professional autonomy-from medical authority to clinical expert. The results represent the encountered ethical dilemma with diverse ethical principles and particular cultural context of health professional-client relationship in Taiwan. Furthermore, this study tries to compare, analyze, and discover more realistic concepts and potential action for illness truth telling in clinics.

並列關鍵字

Doctor-Patient relationship ； Terminal cancer ； Truth telling ； Ethics ； Hermeneutic phenomenology

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