從敘事學談醫學倫理教育之人性化改革

Humanities Reform of Medical Ethic Education from the Perspective of Narratology

2012 年美國早期投入醫學人文教育的文學教授Anne Hudson Jones 於瑞士柏恩發表演說，論醫學人文在美國三十餘年發展所遺留問題，以做為各國醫學教育之借鏡。Jones 教授以最根本問題為：在（科學與文學）兩種文化的隔閡與角力下，醫學人文不斷被邊緣與弱勢化：無論是專業素養或生命倫理學，這些原本與人文高度相關的領域多半被生物醫學與社會科學背景的學者壟斷，明顯違反Flexner Report 最初推動醫學院校進行醫學人文教育改革的精神。晚近興起的敘事醫學強調藉由敘事能力的培養，重新建構臨床經驗中的人文感受。本文從敘事學理論出發，檢視現有醫學倫理教育問題，闡明醫學倫理教育之要旨並不止於培養倫理判斷知能，完整的人文教育應同時涵蓋知識論進路、美學進路與倫理學進路。

Literature professor Anne Hudson Jones, who was one of the American scholars engaging in the teaching of medical humanities in early stage, gave a speech in Bern, Switzerland in 2012 to discuss the problems that have persisted in the past 30 years concerning the development of medical humanities in the United States. Her speech served as a reference for administering medical education programs in various countries. Jones asserted that the primary problem of this field is that medical humanities has been marginalized and overlooked because of the difference and contradiction between science and literature. No matter professional literacy or bioethics, the disciplines that were originally highly related to humanities have mostly been monopolized by scholars with the background of biomedicine or social science. This noticeably violates the essence of educational reform in medical humanities advocated in the Flexner Report. Narrative medicine emphasizes that through the cultivation of narrative capability, the humanistic perception in clinical experience can be reconstructed. Therefore, this study adopted narratology theories to examine the existing problems in medical ethic education, clarifying that the educational goal of medical ethics involves not only cultivating capability of ethical reasoning, but also incorporating epistemological, aesthetical, and ethical approaches to provide a comprehensive humanities education.