生態思潮與醫療理念的交會──本土生態醫學思維初探

The Interaction between Ecological Perspectives and Medical Philosophies: A Pilot Exploration of Ecological Medicine in Taiwan

陳俊霖(Chen Chun-lin)

指導教授 ： 高美英

臺北醫學大學/醫學院/醫學科學研究所/碩士(2006年)

摘要

醫學於人類文明中發軔甚早，而人類與自然生態的互動亦是文明中不可或缺的層面。及至生態學知識成形，對於生態保育和環境保護概念的注重，則是在十九到二十世紀間逐步演變而來，並進而發展成一套生態思維，融入當代人類的文明發展中。在環境問題日益嚴峻的今日，醫學也開始面臨如何融合生態理念的挑戰，故而在西方醞釀出生態哲學與醫療理念交會而成的「生態醫學」思想。 本研究旨在以質性研究法探討本土關於醫學與生態交會而形成的理念之初步輪廓，係採用深度訪談法，共計訪問六位實際參與過生態保育團體環境保護行動的醫師、牙醫師，徵詢他們在多年的醫療實務經驗與環境保護行動中，孕育出哪些結合生態思想與醫療理念的觀點，以探索出本土生態醫學初現的可能樣貌。 經以紮根理論的精神來分析受訪者的逐字稿與相關文本後，發現在這些受訪者間，開始出現的生態醫學理念主要有： 一、對生命與健康的觀點：主張整體性的健康觀，思考身心靈全人的整體健康，以及個體與環境的共同健康，面對生命時謙卑、質樸、而熱情。 二、對於疾病的觀點：注重疾病背後的脈絡，省思文明演進對疾病型態的影響，謙卑地面對疾病以安守醫者的工作。 三、對於療癒的理念：尊重個體內在的自我療癒力量，醫者應學習適度的等待，以免落於過度醫療。對各種治療模式採取較寬容多元的精神。關注醫療廢棄物之處理，以免造成後續的危害。醫者並可善用自然生態來支持自己的身心。 四、對於醫學倫理與醫病關係的觀點：主張建立正向、和諧的醫病關係，醫病間保持平等、相互溝通的關係。尊重患者的自主決定，但同時秉持義工的熱情，善用解說技巧來完成溝通。另並對績效導向的醫療制度提出省思。 此一兼顧個體、群體、與生態健康的生態醫學理念仍待持續建構。而同時，因為生態主義中「去人類中心化」的思考，卻也使「人文主義」更具深度。因此，值得將生態醫學教育引為醫學人文教育之一環。

關鍵字

生態醫學 ； 生態主義 ； 環境主義 ； 醫學哲學 ； 醫學人文

並列摘要

Medicine rose very early in the history of civilization, and another indispensable aspect of civilization is the interaction between mankind and the ecology of nature. But it was not until the 19th and 20th century when the scientific knowledge of ecology gradually took shape, has the concept of conservation and environmental protection become a concern to mankind. These concerns progressed further into a systemic way of thinking and become an integral part in the development of modern civilization. Today, in the time when the environmental issues are in critical stages, medicine, also, faces the challenge of how to incorporate these new ecological perspectives into practice. As a result, the concepts of “ecological medicine” which were rooted both in ecological and medical philosophies started to spring out leaves in western society. This thesis used qualitative research to explore and depict the contour of local ideations of the interaction between medicine and ecology. Six doctors and dentists who have participated in environmental protection actions in environmental non-government organizations were engaged in depth interviews. To explore the initiatory contour of the local ecological medicine, the subjects were inquired of the ideas which were conceived as a result of joining ecological concepts and medical philosophies during their long-term personal experiences in medical practices and environmental actions. After analyzing the verbatim and related texts with the spirit of grounded theory, some ideas of ecological medicine were found to start developing among these doctors, mainly: 1. The ideas on life and health: advocating a holistic view of health, that is to regard the health of body, mind, and spirit, and the collective well-being of individuals and the environment as a whole, and leading the life with humility, simplicity, and passion. 2. The ideas on disease: emphasizing the background context of the disease, taking the progress of civilization as an influencing factor on the disease pattern of human beings into consideration, and facing illness humbly in abiding the virtue of being a doctor. 3. The ideas on healing: respecting the power of self-healing in an organism, learning to wait adequately in order to avoid over-treating, being tolerant of different therapeutic models, caring about the disposition of medical wastes in order to ensure no further harm done, utilizing nature as a self-supporting and self-soothing resource for doctors themselves. 4. The ideas on medical ethics and doctor-patient relationship: advocating the establishment of a positive, harmonic doctor-patient relationship, maintaining an equal and mutual communication relationship with patients, respecting patients’ autonomy and decision making, meanwhile being passionate and utilizing the techniques adopted by interpreters in communication, and reflecting the problems underlying in the efficiency-oriented medical system. The ecological medicine respecting simultaneously the health of individuals, populations, and ecosystems is to be constructed further. While the anti-anthropocentric discourse in ecologism deepens humanism, incorporating ecological medicine into medical humanism education can be very beneficial to all.

並列關鍵字

ecological medicine ； ecologism ； environmentalism ； medical philosophy ； medical humanity

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