困難的倫理：論護理人員的道德困擾

The Difficult Ethics: On the Nurses’ Ethical Distress

護理人員的道德困擾起因於種種無法控制的因素，以致他們無法維護病人的最大利益，進而承受痛苦等情緒壓力。若無法排除阻礙，護理人員將進入道德困擾情緒的反應期，除身心都受影響外，也會影響倫理問題的解決。因而道德困擾的問題愈受到護理教育的重視。本文試圖以困難的倫理討論道德困擾與情緒的問題，認為目前臨床倫理方法並沒有正視引起道德困擾的真正困難。臨床倫理的困難一方面在於行善意向受到種種現實條件變的零碎與複雜化，另一方面在於意義脈絡與互為主體性變的不完整。研究也指出，若護理人員能形成自己的價值觀較能安置道德困擾的情緒問題。

Because of various factors which are beyond control and make it impossible to maintain the best interests of the patient, the healthcare personnel may feel moral distress and suffer from their emotional stress. If such obstacles cannot be removed, they will enter a stage of reactive moral distress, experiencing suffering from the mind and body and therefore cannot solve clinical ethical problems. Thus we should put more attention on the nursing education. This article attempts to discuss the moral distress and emotional stress from the perspective of difficult ethics, because we think the difficulties of clinical ethics which incur moral distress are not really noticed by the existing methods of clinical ethics. On the one hand, it lies in the becoming fragmentedand complicated of a nurse’s good -intentions; on the other hand, it results from the becoming incompleteness of the context of significance and inter-subjectivity under the condition of real health care situations. This study also points out that if nurses can form their own moral values, they will deal with their emotional stress in a better way.