國內對於人工生殖技術需求與日俱增,但人工生殖絕不僅是醫療技術之抉擇而已,人工生殖參與者的身心發展、社會、法律與倫理等議題亦應審慎面對之。在未全面性瞭解施行人工生殖可能產生之影響的情形下,驟下任何醫療決定都可能對人工生殖參與者帶來不可預期的困擾與傷害,且人工生殖療程須投入大量時間、金錢與心力,在內在與外在多重因素夾擊下,人工生殖參與者時常承受莫大壓力,進而影響人工生殖參與者身心狀況甚或是人工生殖醫療品質。 為健全人工生殖醫療環境,英國、澳洲、紐西蘭、美國與德國等國皆設立人工生殖諮詢制度,集合跨領域專業人員協助人工生殖參與者理解、面對與處理人工生殖醫療過程中可能面臨之問題與困境。國內人工生殖諮詢雖已運作多年,但整體制度規劃卻不如外國嚴謹,故本文從制度面出發,檢視我國人工生殖諮詢制度不足之處。 本文於第壹章緒論說明問題意識後,接續於第貳章探究人工生殖諮詢制度之必要性,其後於第參章檢視與反思我國人工生殖諮詢制度,再於第肆章借鏡國內人工流產諮詢/諮商、遺傳諮詢及英國、澳洲、紐西蘭、美國與德國人工生殖諮詢制度經驗,依此於第伍章針對人工生殖諮詢規範模式、人工生殖諮詢內容、人工生殖諮詢運作機制與人工生殖諮詢員四議題進行比較分析,並對國內人工生殖諮詢制度提出建議,最後於第陸章綜合前述,提出總結。 本文對國內人工生殖諮詢制度提出以下建議:一、以訂定專業自律準則為短期目標,立法任意諮詢輔以行政命令與自律準則為長期發展目標,以期建立明確規範模式。二、人工生殖諮詢以資訊提供與探討為首要任務,並適時輔以心理支持服務。三、因應人工生殖機構層級設立彈性諮詢運作機制,並完善相關轉介與支援系統。四、推行諮詢員資格認證制度。希冀藉人工生殖諮詢之輔助,能建構真實「尊重自主」與「知情同意」之人工生殖決策環境,提升醫療品質。
The decision of artificial reproduction is not only a medical treatment, but also involving psychosocial, legal, and ethical issues. All participants should understand the implications of proposed treatment services and have been provided with such relevant information before giving consent. To improve medical and health care quality in artificial reproduction, United Kingdom, Australia, New Zealand, United States, Germany and other countries have established the counseling system conducted by interdisciplinary professionals, helping participants to deal with and to adjust problems and dilemmas caused by medical treatment of assisted reproductive technology. Compared with foreign regulatory framework and experiences, the counseling system practiced for years in Taiwan still has some deficiencies. Therefore, the purpose of this study is to review and construct the counseling system in Taiwan with the help of a comparative analysis of Taiwan’s abortion counseling, Taiwan’s genetic counseling, as well as counseling on artificial reproduction from the United Kingdom, Australia, New Zealand, the United States, Germany and Taiwan. Based on the study findings, the author suggests that our counseling system should include the following elements: establishing a specific regulatory framework, providing and discussing relevant information which is a primary task as well as providing psychosocial supports if needed, developing flexible operating mechanisms and referral support systems, and establishing a counselor accreditation as well.