影響女性婚姻移民的醫病權力關係－民族誌的評估

The Doctor-Patient Power Relationship Involved Female Marriage Migrants-An Assessment of Ethnography

顏芳姿

《人文社會與醫療學刊》 6期 (2019/05) Pp. 47-91

https://doi.org/10.6279/JHSSM.201905_(6).0003

摘要

本文探討新移民女性遭遇的醫病溝通問題及不平等的醫病關係，根據民族誌的評估，了解使用者的看法，進行影響女性移民醫病權力關係之結構分析，並深入了解夫家期待移民及早生育、國家控制生育和社會要求同化之下，新移民作為生育健康的主體，對醫院產檢和生育的表述。本研究分別在社區和醫院進行參與觀察和深度訪談，分析種族、階級和性別組成的性別體系如何影響女性婚姻移民就醫的醫病權力關係。研究發現，影響台籍醫生與新移民女性的醫病權力關係來自國家對新移民的生育控制，醫學論述生產有問題的新移民身體和夫家的父權宰制。內診的性別觀念衝突和產檢的過度醫療化，導致新移民就醫產生疏離感和焦慮不安，部分新移民因處於性別體系的底層、醫療體系沒有通譯改善醫病溝通問題，身體自主權和生育權受損。本研究有助於了解當代台灣新移民所遭遇的跨文化醫病關係，俾使醫療體系做出改革，提供移民文化適切的健康照顧。

關鍵字

新移民 ； 種族 ； 階級 ； 性別 ； 醫病權力關係

並列摘要

This paper explores the communication problems and unequal power relations female marriage migrants encountered. Based on an ethnographic assessment, this study explores how the social structure of race, class and gender influences their doctor-patient power relationship. It also includes the viewpoints of female immigrants on prenatal examinations and hospital delivery. My fieldwork was conducted in a community and a hospital. 15 and 21 mothers were interviewed respectively. Though being an agency of reproduction, female migrants have to confront their husbands' expectation of early childbirth, state controls over reproduction and social request of assimilation. As the target of state's birth control, they are required to accept prenatal examinations after pregnancy. However, due to the conflict of gender notion during internal diagnosis, and excessive medicalization of prenatal examinations, they appear alien and anxious when attending hospital. For those migrants who cannot express their symptoms or query the doctor, they obey passively for doctors communicate mainly with their husband's families without the assistance of medical interpreters. If not aware that their husbands' families often filter information so as to control wives' actions and bodies, doctors may violate medical ethics. Under the influence of the gender system, medical practices may damage the medical autonomy and reproductive right of these female immigrants. The findings of this study provide insights on the patient-doctor relationship involved cross-cultural encounters in contemporary Taiwan and changes of medical system on culturally appropriate healthcare.

並列關鍵字

immigrant ； race ； class ； gender ； doctor-patient power relationship