全民健保之醫學倫理觀

Medical Ethics and Humanities: Effect of the Implementation of National Health Insurance on Medical Ethics

余依婷(Yu Yi-Ting)

指導教授 ： 邱文達

臺北醫學大學/醫學院/醫學科學研究所/碩士(1998年)

摘要

全民健保自一九九五年開辦以來，國人對此醫療社會化之德政雖深表滿意，然而 朝野各界卻對健保財務規劃、醫療資源分配、社會正義公平等議題甚表關切；其於影 響醫界生態、影響病患就醫權益之醫學倫理爭議，更受政府、醫界、民眾之高度重視。 為了解全民健保之醫學倫理觀，本論文以社群主義之醫學倫理理論為經、醫學倫 理的歷史演變為緯，藉以檢視現階段醫療體系內自全民健保實施後的重要倫理爭議： 市場機制的介入、醫療保健政策的公共化、醫療資源的分配與評估。在研究結論上， 建議醫界加強對醫學倫理原則的認識，如保障病患權利、不可傷害病患原則、使病患 受益原則；並於臨床上達成醫學倫理規範之實踐，如尊重病患自主權、避免錯誤的陳 述、積極為病患爭取最大福址、公平合理化分配醫療資源。醫學倫理的妥善應用必能 有效減少醫療體系的利益衝突，並作為全民健保日後發展之指引。

關鍵字

醫學倫理 ； 生命倫理 ； 臨床醫療倫理 ； 健康照護倫理 ； 全民健保

並列摘要

Medicine has encountered dramatic social changes in the past few decades. Major issues such as the transformation of medical practice from individuals to institutions, the expeditious progress of technology, the formation of global multicultural society and the rise of self-awareness of the right to know have resulted in serious ethical dilemmas. These multidimensional ethical conflicts reflect the fact that we adopted different approaches while we dealt with them. Nevertheless, the fundamental of medicine remains the same and the core nature of ethics is untouched. Therefore, we need to take a new look at how these changing issues affect our perspective of medical ethics. The implementation of National Health Insurance (NHI) at Taiwan in 1995 represents a good example. Despite of the survey result that satisfactory rate to NHI among the general public has steadily increased, crucial issues regarding the finance, social obligation of the government, resources allocation etc. have surfaced and generated ethical dilemmas among the medical personnel, educational and clinical institutions, patients and the government. The interpretation of current ethical dilemmas was analyzed through Communitarianism theory and the history of medical ethics. Critical issues such as market mechanism intervention to the health care delivery, public policy and health care industry, and the allocation of scare medical resources are thoroughly discussed and presented in this thesis. The objectives of this thesis are to apply these ethical principles to resolve the conflict of interests in the clinical institutes as well as to establish a set of suitable guidelines for today''s medical practice.

並列關鍵字

Medical Ethics ； Bioethics ； Clinical Ethics ； Health Care Ethics ； National Health Insurance