台灣社會醫學實踐三部曲：戰後市民社會發展的在地行動與全球視野

Three Junctures of Enacting Social Medicine in Taiwan : Local Action and Global Vision for Developing Post1945 Civil Society

蔡篤堅(Duu-Jian TSAI)

《文化實踐與社會變遷》 2期 (2017/06) Pp. 13-36

摘要

本文針對台灣高等教育發展提出批評，運用敘事認同比較歷史的口述歷史方法延伸，反思在台灣社會醫學所彰顯的在地知識生產和市民社會發展的三個階段，提出面對目前困境以及迎向未來的方法。本文發現戰後台灣首先形成以瘧疾根除和家庭計劃為基礎的衛生公共領域，專業的社會動員突破威權政府統治下發展的困境，帶動第一波市民社會的成長。而第二階段是由台灣時報所引領透過專業思潮引領社會制衡政府的台灣市民社會茁壯時期，也由於台灣醫界聯盟的成立而促成了台灣成功的政治改革和民主轉型。晚近在全民健保發展的挫折中，台灣醫界藉由癌症治療的發展迎向國際生命倫理學推廣的普世價值，彰顯以病人為中心的地位，可是也面臨國家體制和資本主義共同利益結合侵犯醫療專業自主的重大威脅。本文彰顯台灣過往到目前的成就與威脅之後，呼籲醫療專業應積極參與以在地行動打開全球視野的行列，為亞洲文藝復興奠基石，迎向保障人權和維護國際正義的世界趨勢。

關鍵字

比較歷史 ； 知識生產 ； 公共領域 ； 生命倫理 ； 醫療專業

並列摘要

This paper adopts a narrative identity comparative history approach, derived from oral history methodology, and beginning from the current controversy on history curriculum in higher education, to reflect on the three periods of social medicine in Taiwan in which professionals engaged in local knowledge production and civil society development. It aims to address the contemporary impasse and propose horizons for the future. This study finds that the beginning of post-war civil society development in Taiwan was grounded in the health public sphere with the malaria eradication program as well as the family planning program. Professional social mobilization was the key to overcome difficulties under the authoritarian regime. The maturation of Taiwan civil society was led by the newspaper Taiwan Times, embodying professional discourses balancing political power. The consequence was the 1992 establishment of the Taiwan Professional Medical Alliance which successfully advanced political reform and democratic change. In the most recent difficulties in the evolving national health insurance system, bioethical endeavors in cancer treatment development are moving toward global universal values. The emphasis on patient-centered care has been developed to overcome the threat to medical professional autonomy that is coming from the common interests of international capitalism as well as the state apparatus. After highlighting the achievements and threats encountered now and past, this paper urges Taiwan medical professionals to engage in local actions to nurture their global vision. Such efforts are crucial in paving the way for Asian renaissance in human right protection as well as ensuring international justice.

並列關鍵字

Comparative history ； knowledge production ； public sphere ； bioethics ； medical professionalism