醫療專業表現及其倫理實踐之認知與作為的探討

A Preliminary Study of Cognitions and Conducts of Medical Performance and the Practice of Ethics

陳敏郎

《人文社會與醫療學刊》 2期 (2015/05) Pp. 1-23

https://doi.org/10.6279/JHSSM.2015.2(1).01

摘要

醫療專業表現及其倫理實踐，是含括倫理認知及技術操作的一種「整體實踐過程」的展示。在現代醫療社會的持續發展與變遷情境中，對於醫療專業表現的詮釋與估量，有了與過去極為不同的參數與基準。不論就其理念意涵及臨床應用之間連繫的討論，或是醫界內外人士的眾多相關文獻來看，醫療倫理的「重要性」幾乎無庸置疑。然而，同樣清楚的是，醫師如何看待與操作醫療倫理的重要性，並非如文字所強調般地自然與無疑。對於醫療專業表現及其倫理實踐相關爭議的理解，乃至其如何可能有利於醫病雙方權益的增進，從而有助於現代社會醫療服務與需求水準的進一步提升，仍有其重要的理論與經驗意義。本文的主要目的，一方面，在於理解關於醫療與健康照護專業表現形式及其內容的眾多爭辯與討論，如何認知及看待醫療專業表現及其倫理實踐在臨床操作中的可能形態與關聯；二方面，則是希望進一步思考相關認知與臨床表現之間關聯的若干結果，對於醫師專業表現乃至醫病互動關係與發展的可能影響。本文認為，關於醫療倫理實踐的先驗演繹型認知，相當程度上反映了醫療倫理實踐的若干內在困境；而建構性實作倫理認知，固然強調醫療倫理實踐所關注之內容、方向與作為的行動差異，但也突顯定位與建構臨床典範的若干挑戰。此外，在增進醫病雙方權益的思考脈絡下，醫師如何面對體現在現代醫病互動關係中之權威性與主導性的相對減弱，以及適當回應難以逆轉的社會期待與要求，仍是值得關於醫療專業表現及其倫理實踐相關討論持續關注的實務問題。

關鍵字

醫療專業表現 ； 倫理實踐 ； 典範角色 ； 演繹性倫理 ； 建構性倫理

並列摘要

For this article, medical performance and the practice of ethics means ethical cognitions and technical operations as a whole in the clinic processes. Besides, there are significantly different criteria to assess the performances of medicine in modern medical society. It seems that the ＂importance＂ of medical ethics is absolutely no doubt whatever in the discussions of its ideal meanings or practical applications. But, it’s not so much how the physicians to cognitive and operate the ＂importance＂ of medical ethics. Therefore, it is still reveals important theoretical and practical meanings to comprehend the controversies of medical performance and the practice of ethics. The purposes of this article were to understand the various discussions about the possible forms, contents, behaviors and their relations of medical performance on one hand; on the other hand, making further thinking and evaluating the possible effects and influences of those relative consequences. This article considers the deductive-ethics cognitions reflected some of the inherent difficulties of the practice of medical ethics firstly. Secondly, the constructive-ethics cognitions revealed several challenges to the identified and construction of clinic role models. Thirdly, in the conceptual contexts of improving the rights and obligations both of physicians and patients, there are practical issues worthy of concerned permanently how the physicians to cognitive as well as deal with the irreversible changes of physician-patient relationships in modern medical society.

並列關鍵字

Professional Performance of Medicine ； Ethic Practice ； Role Model ； Deductive-Ethics ； Constructive-Ethics