以生命歷程觀點探討遊民照顧議題：以嘉義醫院為例

為了實踐社會福利政策綱領以及社會救助法之相關規定，並加強對遊民照顧服務與建立網絡間的處理工作共識，衛生福利部特訂定遊民安置輔導自治條例範例。然而經了解，各縣市提供遊民服務，有著極大落差；實務上，醫務社工依法定通報職責辦理，卻常遭遇地方政府怠於職務，常見的情形有遊民住院期間費用不予補助、地方政府不協調家屬出面處理並分擔費用、涉有遺棄行為地方政府不依法處理、不協助出院安置等事項。更有甚者，若涉及生活上緊急危難之評估，地方政府常以個案自由權為依據，不積極介入處理，使醫務社工在處理遊民照顧議題上，陷入了倫理兩難當中。醫務社工在處理遊民病患，最嚴重者莫過於遊民個案涉及生活上緊急危難是否需緊急安置，醫務社工與案主及地方政府對此一事件評估上的差異。實務上目前地方政府常以案主自由權為由，拒絕安置個案，其涉及遊民相關福利哲理與法律規定及實務議題。本文將由宏觀社會福利哲學討論遊民照顧議題，強調對遊民照顧深層的社會福利哲理及相關福利服務制度之間關係的討論，就遊民照顧倫理所衍生出來的照顧、依賴與家庭關係的議題上，再輔以生命歷程觀點來瞭解遊民所延伸的議題，作深入的分析與探討。

關鍵字

遊民；親屬照顧；生命歷程；醫務社會工作

並列摘要

In order to implement the Social Welfare Policy Program, with the relevant provisions of the Social Assistance Act, and to improve the care services and to establish the supporting system for disabled vagrants. The Ministry of Health and Welfare has constructed the self-governing regulations and give advices for vagrants to stabilize their life. However, the services provided by various counties and the cities have a big gap; in fact, medical social workers perform their duties in accordance by law, but the local government does not. After receiving the announcement, the local government does not tell the family of disable vagrants come to hospital to take care of them and pay the hospital's fee. Further, the local government does not support discharge procedures and does not stabilize the lives of disabled vagrants after discharging. Moreover, when the local governments evaluate the emergency situations in life, they often base on the right of ＂freedom＂ of vagrants and do not actively intervene. That makes the social medical workers face to the ethical dilemma in handling the issue of disabled vagrants. Medical social workers in hospitals are facing many difficulties when dealing with patients who are vagrants. The most serious case derives from that of the vagrants involving emergency resettlement in life and that of the difference in assessing this incident between medical social workers and local government. In practice, local governments often refuse to have these cases settled on the grounds of not only the liberty but also the welfare philosophy, legal provisions and even practical issues of the vagrants. In this paper, we will discuss the issues of the care for disabled vagrants about physical and mental from the perspective of social welfare philosophy, emphasizing on the discussion of the relationship between social welfare philanthropy for disabled vagrants and the related welfare service system. It is based on the perspective of the care, the dependence and the concern of family members, as well as the life-cycle perspective to carry out the analysis and depth discussion on care issues for disabled vagrants.