臨床倫理議題與衝突調解──以非預期懷孕的衝突為例

Clinical ethical issues and therapeutic mediation in managing conflicts of unexpected pregnancy

醫學倫理就是醫療從業人員的行為準則及道德規範。尤其是醫師，更被高度的期待在執行醫療作業時，能時時刻刻用這一把尺衡量，並緊守界線來保障病人的最大利益。醫學倫理的宣導、教學，醫界的反省及自我規範正逐漸的在落實中。但是在醫學倫理議題中，有衝突事件產生，需要多方人士共同解決問題的狀況，是較少被提及的。在出現衝突、爭執場面時，醫療人員除了守住醫學倫理的規範，更要能有效地處理衝突場面，才能處理倫理議題。了解衝突，學習解調技巧，加上良好的醫病溝通能力，可以使用治療式調解，適當地應付平時的臨床倫理爭議，平和地化解衝突，順利地進行下一階段的臨床處置。在處理青少年或精神病患的非預期懷孕問題時，必須考慮當事人的自主能力及法律上的行為能力，同時也要兼顧其法定監護人或代理人的想法。如果雙方意見相左，進入衝突狀態時，醫療人員必須把治療情境（醫病關係）轉換為調解情境，改為調解雙方衝突。須秉持著「不傷害原則」，讓雙方達成共識，尋求最適解決方案。運用治療式調解程序，包括界定問題、聽聽兩邊的說法、規劃環境架構（把診間座位調整或改至較寬敞的會談室），進行三方會談，平衡地達成協議，再進行協調後的決定，完成醫療倫理爭議的處理過程。醫療人員在調解時，必須做到：一、是恰當的溝通，用正面及建設性言語進行重整爭議；二、是運用有效的聆聽，注意自身及當事人雙方的身體語言，保持中立立場；三是溝通整合解除兩方的憤怒或交相指責，和諧地達成共識。醫療人員若經過調解訓練，可以運用調解技巧處理倫理衝突議題。

Medical ethics are rules or standards for medical staff when practicing. Especially for Doctors, they are highly expected to have well-performed medical practices follow the rules of clinical ethics to protect patient’s greatest benefits. Medical ethics educational programs are scheduling to all medical practitioners. In the bioethics issues, conflict management and events need multiple parts involving to resolve problems has been less mentioned. Facing conflicts events, medical staff not only should follow the rules of bioethics, but also manage conflicts of both sides effectively. Understanding conflicts, learning mediating techniques and having good communication ability, Doctors can use therapeutic mediation to cope with daily clinical ethical issues. When managing unexpected pregnancy of adolescence or mentalill patients, their competence and autonomy needs to be careful assessed. If their considerations are opposite to their caregivers, conflicts emerged. Managing conflicts in clinical ethical issue, Doctors must change from therapeutic model to mediation model and use mediating techniques to help patients and their families to find best solutions. Applying mediating process, include clarify the problem, hear both side’s words, arrange mediating environments, active mediating with balance power, converge to consensus, and finally resolve this medical ethical issues peacefully.