協商與決策：雙老家庭照顧責任之代間轉移

Negotiation and Decision-making: The Shift of Care Responsibility for Family Members with Mental Disability between Generations

徐儀潔(I-Chieh Hsu)

指導教授 ： 張英陣

國立暨南國際大學/人文學院/社會政策與社會工作學系/碩士(2020年)

https://doi.org/10.6837/ncnu202000048

摘要

出於對雙老家庭中老化的心智障礙者未來照顧以及照顧女性化的憂心與關懷，本研究旨在了解雙老家庭進行照顧責任代間轉移的協商與決策歷程，深入探討家庭倫理變遷與性別角色對家庭協商與決策產生的影響，並從微視的「小家」角度來討論雙老家庭手足照顧與照顧女性化的困境，從鉅視的「大家」角度以關懷倫理討論國家的角色與照顧關懷實踐。本研究採質性研究深度訪談，選取五個心智障礙雙老家庭，共六位研究參與者，將參與者之經驗進行歸納、分析與討論，結果如下：
一、照顧協商開始起因分為「父母無力照顧」、「家人發現不對勁」。照顧協商過程分為「消極餘留型」、「曖昧擔當型」、「協作負擔型」、「積極承諾型」。照顧協商之決策結果分為「直接照顧」、「部分照顧」、「間接照顧」。
二、雙老家庭照顧責任協商與決策受性別角色與家庭倫理變遷影響，有著男性出錢、女性出力的照顧期待，以及男性傳承的應然責任與財產分配的掛勾，家庭倫理變遷亦使得夫妻、手足、親子的互動與照顧協商，更講求獨立、對等、平權、互惠、溝通、尊重、關懷！
三、從關懷倫理的角度，手足照顧過程即是關懷實踐過程，而關懷作為公共道德價值，更應是團體、政府乃至於社會、國家的集體責任，國家應有責任對手足照顧與照顧女性化之困境提供關懷，現金給付或可成為的解方。
目前心智障礙雙老家庭面臨手足照顧與照顧女性化的困境，漸漸有以「現金替代照顧」的趨勢，政府應提供更多元、彈性化的照顧選擇，秉持關懷價值，持續推動性別平等，注意福利服務輸送提高資源可及性、可近性，以建構關懷社會。

關鍵字

雙老家庭 ； 手足照顧 ； 照顧協商 ； 關懷倫理

並列摘要

This study aimed to explore the shift of care responsibility for family members with mental disability between generations in Taiwan, especially focus on family ethics and gender role that influence the process of family negotiation and decision-making. This study examines the dilemma of sibling-care, feminization of care work, and the role of the governments from the perspective of ethics of care. Designed as a qualitative research, in-depth interview is used as main method for collecting dada and purposeful sampling is used to select the participants. In total 6 participants from 5 families are interviewed. The main findings are as followed:
1.When people found "parents unable to care" or found "something wrong", they start to negotiating for care, and the negotiation process is divided into "negative residual type", "ambiguous responsibility type", "collaborative burden type", and "positive commitment type". The decision-making results of care consultation are divided into "direct care", "partial care" and "indirect care".
2.The negotiation and decision-making of caregiving responsibilities are affected by gender roles and family ethics
3.From the perspective of ethics of care, the process of sibling care is also a praxis of care ethics. Caring as a public moral value, therefore family, civil society and government should shoulder the responsibility of care together. The government should be responsible for the needy and care-givers. "Cash for care" could be a possible solution.
At present, "pay for care" is trend for helping family care-givers to solve the burden of care. Female family members take the major responsibilities for caring, the government should provide more diversified and flexible service to promote gender equality in caring work. Welfare service delivery should improve the accessibility for constructing a more equal and caring society.

並列關鍵字

mental disability ； sibling ； caregivers ； family decision-making ； ethics of care

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一、中文部分