醫學生面對倫理兩難案例時的典型思考模式

Medical Students' Typical Thinking Patterns in Dealing with Ethical Dilemmas

醫學生實習時所面對的倫理問題，對其生涯適應與專業發展有相當大的影響。過去研究指出了學生面對專業疏失時的行動與考量，但未能呈現學生經歷同儕討論、臨床教師引導後，浮現的典型思考模式。本研究接續李錦虹、鄒國英，與邱浩彰（2012）的分析，著重探討醫學生面對案例兩難、知覺內在衝突後，考量了案例的哪些面向，又抱持何種價值觀，才做出最後的決策。受試者為醫學系六年級學生，共計51 名（男生35 名，女生16 名），資料分析因故納入35 人。參與學生在醫學倫理課進行約50 分鐘的小組討論，各組皆有一位資深的臨床醫師帶領。討論過程經學生同意後全程錄影並騰為逐字稿。再由2 位研究助理依紮根理論進行分析。研究結果指出，參與學生的思考模式可依兩大向度，分為八類。X 軸為「醫學生的核心信念」，也就是面對兩難情境時的最高指導原則，向度為：病人至上–法律至上–生命至上。Y 軸為「醫療行動的負責人」，也就是由誰承擔此次決策的責任，以及行動後可能的傷害與衝突，向度為：醫療人員–法律–家屬–病人。有23%的學生屬於「生命至上/法律」型，為最多人符合的思考模式。除了面臨兩難而無法明確表態的「兩難/法律」與「兩難/替代方案」，最少學生符合的分類為「病人至上/醫療」，佔6%。針對研究結果，作者提出可能的解釋並提出教學實務及未來研究的建議。

Previous research showed that ethics dilemmas encountered by medical students during internship had great impact on their career adaptability and professional development. However, there are few studies discussing how medical students think of these ethics dilemmas. This study aimed to investigate medical students' thinking patterns when discussing a case of ethics dilemma in small groups. Thirty five sixth-year medical students were recruited in this study and divided into five small groups. Facilitated by a clinical physician, each group discussed a case of ethics dilemma for around fifty minutes. The process of discussion was videotaped with the students' consensus. Linguistic and paralinguistic contents in the video clip of each group were transcribed and analyzed by two research assistants following grounded theory. The results showed that medical students' thinking patterns could be divided into two dimensions and eight categories. Based on the findings, the authors proposed suggestions and future direction for teaching practice and research.