- 學位論文
青少年的醫療決策倫理：實證研究法
Medical Decision in Adolescence：An Empirical Ethical Research
摘要
隨著醫療科技的進步，相關的倫理議題的討論也應運而生，對於 成人，已經有相當多的討論以及研究，也有相關法令的規範以及倫理 宣言。在傳統社會中，孩童的一切多由父母做決定，然而基於尊重自 主，當青少年具備醫療決策能力時，不應扼殺青少年的決策參與。 而台灣至今沒有對青少年醫療決策權的共識。本研究目的為理解 倫理專家對青少年醫療決策中的難點，以及其解決此問題之思辯過 程，建議最適宜本土青少年醫療決策的模式。 我們以假想的青少年醫療決策倫理困境為例，利用放聲法（think aloud methods）以及劇本一致度測驗（SCT）兩種方法，收集分析醫 療倫理專家的看法，理解其對該議題的思辯過程，得知處理此一議題 的決策思考方法。共有三位專家參與放聲法訪談，SCT 部分有13 位 專家參與。 我們發現，台灣的醫療倫理專家在面臨此一議題時，不認為年齡 是唯一標準。並且，當面臨父母或是病童本身意見與病人最大利益相 左時，會努力說服其接受病人最大利益。當父母堅持己見時，專家們 還是表現出無奈地尊重態度。台灣的醫療倫理專家已經注意到面臨青 少年醫療決策問題時，需聆聽青少年本身的意見。 在面臨未成年人醫療決策的問題，應同時與父母以及未成年人溝 II 通，並且仔細評估孩子的決策能力。以維護未成年人的利益。
並列摘要
Along with the advances of medical technologies, the related ethical issues are becoming challenging. Ethical theories, regulations and laws have been developed to solve ethical problems in medicine. In Taiwan, adult patients have full right to make medical decision and to receive full disclosure, while little is known for adolescents. It is believed, in the traditional society, Taiwanese parents made medical decisions for their children. There is little consensus on the ethical issues of medical decision making when involving children. The purpose of this research is to understand how experts deal with the issues of adolescents' medical decision making, and to suggest strategies for ethical problem solving. This is a qualitative study. To extract experts' thoughts, we used a hypothesized case that involved an amputation operation for a 12-year-old adolescent. Think aloud interviews and Script Concordance Test (SCT) were used to collect verbal and text data. Three experts were invited for think aloud interviews, and 13 were asked for the written SCT. Results: The experts believed 「age」 is not an only factor that determines medical decision capacity of a child. They stressed the importance to listen to the minors, and evaluate their capacities. When parents' decisions violating the best evidence in medicine, the experts would put more efforts for communication, and yield to parents' decisions if failed. Currently in Taiwan, experts found difficult to accuse parents on behalf of children. IV Conclusion: Communication, involving both minors and parents, and careful evaluation for children's capacity on medical decisions are important to defend for children's best interests.