以後現代女性主義重構婚姻暴力受虐婦女診療驗傷之內涵與意義

Reconstruct the medical care context and meanings of domestic violence battered women via postmodern feminism perspectives

黃志中(JOH-JONG HUANG)

指導教授 ： 謝臥龍

國立高雄師範大學/教育學院/性別教育研究所/博士(2013年)

https://doi.org/10.6817/NKNU.2013.00030

摘要

摘 要
本研究者探究台灣婚暴診療著重驗傷及診斷書開立之現象，省思婚暴婦女需要獲得婚暴傷害的診斷書做為司法訴訟佐證，過去卻常被拒絕診療、或被索取高額診斷書費用的歷史脈絡，回應到醫療照護強調證據、診療規範的現代性功能與困境，藉由後現代女性主義的研究觀點與取向，試圖透過診療驗傷現場及婚暴處遇歷程脈絡之間的互動經驗解釋，探索診療驗傷之內涵及意義。
於2015年7月至11月期間，本研究共計訪談67位研究參與者，包括17位婚暴婦女的三場焦點團體、13位護理師的四場焦點團體及1位護理師的個別訪談、6位醫師的個別訪談、17位社工及6位警察的四場焦點團體及3位社工的個別訪談、3位律師及1位法官的個別訪談。訪談資料的逐字稿在編碼後，依照婚暴診療驗傷事件歷程所顯現的主顯節，包括：看見婚姻暴力的醫療需求、婚姻暴力在診療驗傷過程中如何被看見、婚姻暴力傷害之診療驗傷、婚姻暴力傷害的診斷書，將研究參與者所提供的互動經驗加以編織、歸納與分析，再以後現代女性主義的知識生產揭露在診療驗傷互動經驗現象的意義。
研究結果顯示，婚暴婦女在外顯診斷書需求的診療驗傷下，對其婚暴隱私性以及婚姻關係衝擊的影響，會有著複雜而拉扯的思緒與狀態，是不被瞭解又不容易說明的婚暴處境，而醫療人員是在分科分工而缺乏共構的醫療作業中，形構出以外傷診療為主的診療關注，少重視心理創傷，在「修補-關懷模式」中，因過於強調機械損害的檢查、評估，與婚暴事件發生的情境脈絡斷裂，且迴避涉入他人婚姻關係的性別範示，及減弱在診療過程可能引起的情緒勞動，而少有關懷照護的互動關係建立。在醫療現場經過斷裂(de)程序而成為許多的碎片(parts)的斷裂碎片(de-partment)模式醫療工作中，婚暴診斷書的開立就成為「木乃伊化」的現象。婚暴診療所觸及關於婚姻關係的性別範式以及診療所帶來的情緒勞動，對醫療人員造成明顯的診療壓力。於是，透過婚暴被斷裂成傷害的碎片，以明確的現代性醫學技術框架來契合醫療分科的部門模式，將婚暴診療驗傷特殊化，在醫院急診的特定場域進行，婦女可以獲得傷害診療與診斷書，醫療人員也可避免不確定的蔓延而獲得安頓。因而，與婚暴防治資源具連結性的工作，像是責任通報或填寫TIPVDA量表以評估致命危險，在婚暴傷害與其脈絡被切割而缺乏連結的診療驗傷工作中，成為具規範性作業而非婚暴婦女為主的觀照，而容易失去其所具有關懷本質的積極意義，以致淪為被醫療人員視為是繁瑣、麻煩的行政程序。而婚暴婦女所遭受到的傷害，由其所外顯婚暴傷害、診療驗傷、病歷記錄到節本性質的診斷書，每一個過程都是一種限縮與失真的敘說斷裂，最後所呈現的婚暴診斷書是在「多重斷裂」後的產物。
根據上述研究結果，本研究建議婚暴診療除了既有的外傷傷害評估、診療架構外，需同時關注到婚暴婦女的情緒狀態，並能與婦女所處的情境脈絡相連結，以成為對婚暴傷害具有說明的醫療文字，兼顧婚暴傷害的損害評估、診療，以及婚暴狀態的關懷照護。以整合性醫療模式的複診診療以及資源連結，而非單一次急診的診療驗傷，提供婦女完整的照護，而所形成的病歷文本更可取代診斷書，而成為更具證明能力的證明文書，以說明婚暴及其傷害。

關鍵字

婚姻暴力 ； 現代性 ； 責任通報 ； 危險評估 ； 診斷書

並列摘要

Abstract
In Taiwan, the medical care of domestic violence battered women usually focused on the medical certification, instead of medical care needs. However, in the past Taiwanese battered women suffered from medical care by being rejected to obtain medical certification or being charged high. This is quite different from Western countries, where the main issues are screening, identification and medical care without gender bias. At present time, standardized operation procedure with objective evidences for the medical care of battered women is also strongly influenced under modernity and this may restrict the heterogeneous needs of battered women. This study is designed to explore the complex intersection of social identity and modern medical care of battered women in the medical context via Interpretative interactionism approach.
From July to November 2015, there were totally 67 participants included in the study, as 17 battered women, 14 registered nurses, 6 medical doctors, 20 social workers, 6 police officers, 3 attorneys and one judge with 11 focus groups and 14 in depth interviews. The texts of participants’ thick description were analyzed according to the epiphanies of interpretative interactionism approach, and postmodern feminism as epistemology originated to produce knowledge via revealing the meaning of the interactional experiences of domestic violence medical care between battered women and medical staffs.
The results of this study showed that under the “fix-care model”, modern medical care used to doing “de” domestic violence events and put the injuried “parts” apart under the dominant ways of modernity, but with much less caring, which was rather an emotional labor to medical staffs. And this let battered women not being bothered by her miserable state. Medical practice mainly focused on the objective state of the injuries to exact examination and measurement, which was detached from the context. So, the medical certification was just a mummy significant of the medical violence, not to mention of gender paradigm of martial relationship, which regarded a husband as an owner of the marriage, and any male should be kept away from the private territory. Under these circumstances, mandatory report or dangerous assessment of domestic violence became just a kind of bureaucratic professional processes without active caring content. All these lead to the multiple levels fragmentation of the domestic violence management.
This study suggested that the emphasis of both fix and care should be balanced to maintain comprehensive medical care, and also the needs of co-construction of sub-specialties to offer better follow-care. Holistic medical care can provide more understanding of the violent state and the medical charts should be included more delicate documents, which could replace the medical certificate used in the court.

並列關鍵字

domestic violence ； modernity ； mandatory report ； dangerous assessment ； medical certificate

參考文獻

Cramer, E. P., & Plummer, S. B. (2009). People of color with disabilities:

Paulin Baraldi, A. C., de Almeida, A. M., Perdon?, G., Vieira, E. M., & Dos Santos, M. A. (2013). Perception and attitudes of physicians and nurses about violence against women. Nursing Research and Practice, vol. 2013, Article ID 785025, 7 pages, 2013. doi:10.1155/2013/785025

財團法人醫院評鑑暨醫療品質策進會（2016）。105年教學醫院評鑑基準及評量項目。台北：財團法人醫院評鑑暨醫療品質策進會。

蔡墩銘（1997）。鑑定之鑑定能力與證明力。台大法學論叢，26(4)：161-171。

張麗卿（1995）。鑑定證據之研究：以精神鑑定為主。台大法學論叢，23(2)：305-329。