癌末病情告知的倫理兩難

獲悉癌末病情往往對病患與家庭帶來突然且巨大的衝擊，倘若家屬擔心病患承受不了打擊而要求隱瞞病情，那麼「是否告知癌末病患實情」將是醫師最先遭遇到的兩難問題。本研究首先就個人、家庭及法律三方面的觀點探討癌末病情告知的倫理與法律議題，並指出其中的爭議所在與可能面臨的道德衝突。對於道德兩難所產生的問題，倫理分析提供道德理據支持或反對一個判斷或行動，以達成解決問題的目的而又可減輕負面效果。本文引用Beauchamp與Childress（2009）兩位學者依據多年的實踐經驗所提出的一套決策方法，藉以有效地處理爭議所產生的困難。另一方面，儒家的「經權原則」也可提供醫師一個思考與判斷的方向，指引面臨道德兩難者做出符合道德本義要求的抉擇，而對病患的「真誠關懷」及「同理心」是能否真正貫徹經權原則的關鍵所在。

關鍵字

癌症末期；病情告知；倫理分析；經權原則

並列摘要

Terminal cancers usually have a great impact on the patients and their family members. We should concern for the biological, psychological, social and spiritual needs in the care for terminal cancer patients. Truth telling will be the first encountered ethical dilemma. This article investigates the ethical and legal issues in disclosing bad news from individual, familial and legal perspectives. The moral conflict between ＂principle of respect for autonomy＂ and ＂principle of non-malefi cence＂ is also pointed out at the same time. An ethical analysis provides us a basis to solve moral conflicts and lower negative effects. This article introduces a framework which was proposed by Beauchamp and Childress (2009) to balance ethical principles and manage ethical dilemmas. In addition, ＂principle of flexibility＂ of Confucianism also provides us a method for judgment, and empathy is the key point to practice the principle of fl exibility. Developing the guidelines of disclosing bad news in clinics may be helpful for improving the quality of terminal care in Taiwan.