發生在2003年三至六月的SARS疫情曾經帶給台灣社會前所未有的衝擊,事後關於SARS防治過程之檢討分析的文獻也已累積不少,惟其中以自由權論述影射國家的自主性決策戕害人權為主。但是這無法進一步解釋國家何以在三天內將封院就地治療政策改為封院轉院治療政策。本文以2003年4月25日台北市和平醫院因爆發院內感染遭致政府倉卒封院,部份醫護人員採取「衝出封鎖線」之激烈方式對抗的過程為例,探討事件背後的政策形成與轉變之脈絡,說明醫護人員的激烈行為所隱含之生命權優位觀點,並試圖將此以一行為定義為市民不服從行為,以茲對市民不服從「極端狀態」之概念性原則做一補充。 在和平案例中,醫護人員的「職業安全衛生」法益與社會大眾的「公共衛生」法益產生衝突的原因在於:政府以防止傳染病在社區擴散為優位思考,高度依賴專家但又不完全採納專業意見,並且選擇性的適用法律。此種公衛決策模式造成了第一線工作者的職業安全衛生價值無法被吸納進政府的防疫管控策略,從而使國家管制的成效大打折扣,並造成醫護人員與國家的對立。 在和平醫護的抗爭行為方面,該行為雖然對法律秩序的維持造成破壞,但有被正當化的空間;本文以John Rawls關於市民不服從行為之正當化的三個判定準則進行分析。首先,封院政策涉及對和平醫護人員的生命權的嚴重危害,因此抗爭行為符合第一原則。其次,和平個案乍看似不符合第二原則有關「可用管道已被適當使用」的判準,不過,本文針對Rawls未曾細論的「極端狀態」提出補充原則:當政策或法律要求特定少數公民為了公益在權利事項上退讓時,如果他們面對的是未知的自然力量之危害,並且缺乏基本必要的保護時,他們即使是在適當管道並未用盡之情況下,當情勢危及時所發動的不服從行為也可以取得正當性。最後,關於第三原則,由於「衝破封鎖線」的行為的動機在於突顯就地封院隔離與治療對所有被隔離者造成不正義,而此行為的結果未「造成其他社會成員的不幸」,故應符合第三原則。
On April 24(superscript th) 2003, Taipei Municipal Heping Hospital, where the first Taiwanese SARS (serious acute respiration syndrome) hospital infection occurred, was shut down abruptly to halt the outbreak of SARS infections in Taiwan. Being compelled to work and without necessary protection against SARS, some hospital staff broke the quarantine order by getting through the blockade. Based on the right to life, this research investigates the social construction of the medical professionals' disobedience, with the intention of evaluating the operation of the state's emergency health powers. In the light of critical debates on civil disobedience together with some interview data about those directly involved in the Heping case, we explore the reasons, the right to life mainly, for the healthcare workers' acting in self-defense, with a concern about the lack of an adequate quarantining policy to protect those quarantined insiders. The social right meanings of ”occupational health and safety” and ”public health” are addressed in an attempt to explore the ”conflict” between them in the case under consideration. The discussion also draws upon John Rawls's (1971) argument on the justification for civil disobedience, leading to supplementing Rawls' brief assertion relating to the so-called ”extreme conditions”. We argue that Taiwanese public health policy-making represents a dictatorial regime relying on experts, in that the values of front-line medical workers and hospitalized patients are by and large excluded in the formation of the nation's epidemic prevention and control measures. Thus, the effects of the state's regulation have detracted significantly from the resistance of the medical professionals in the Heping case.
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