以差異原則分析長期照護之健康照護需求與實踐

Analysis of Long-term Care of Health Care Needs based on the Difference of Principle

失能老人與其照護者都是弱勢的倚賴者，除了要面對機能老化從衣、食、住、行等無法自我照顧的狀況，還有負擔慢性病及長期的照顧人力、財力、醫療、社會與家庭環境設備等照護資源的支出。本文考察了丹尼爾斯，納斯邦和姬泰的論述，認同從「依賴者」與「衍生依賴者」提出個體的健康照護需求，與提供每個人在醫療照護上平等機會是公義社會所必備之條件。但本文認為要更進一步以差異原則為基礎，才能確立失能老人和照顧者的權利和合理的照護資源。因為，差異原則關懷最不利者；失能老人屬於最不利者；所以差異原則最能照護失能老人和照顧者，以及他們的需求。本研究確認差異原則可以保障失能老人的健康照護需求，所以可做為長期照護倫理基礎。建議政府在研擬長期照護保險法時，應透過公開對話的審議民主程序，廣納專家、學者、醫療院所從業人員、及相關民間協會與學會組織的意見，來擬定長期照顧政策。

Disabled elderlies and their caregivers are vulnerable and dependent persons. They have to face the situations where they cannot take food, get clothed, live by themselves, and the heavy burden of the cost of caring for chronic diseases, medical expenses, social and domestic provisions, etc. In this essay, I have examined the discussions between Norman Daniels, Martha C. Nussbaum and Eva F. Kittay, and then adopted Kittay’s idea of “dependence” and “derivative dependence” of the elderlies and their care-takers, advocating to offer them the necessary resources according to their fair equality of opportunities. But I argue that, it should be based on the difference principle, in order to establish and secure the rights of the disabled elderlies and caregivers and the reasonable sharing of care resources. For the difference principle emphasizes the caring of the most disadvantaged and disabled elderlies and they are among the most disadvantaged. Hence the difference principle could protect them and their needs most appropriately. The present research confirms that the principle of difference can be the foundation of long-term care ethics, that it could also be used to improve feeding method to meet the health-care needs of the disabled elderly. Furthermore, I propose that if the government plans to legalize long-term care insurance, it should take the democratic procedure in dialogues with experts, scholars, pharmacy industry, relevant organizations and associations, in order to draft a proper and just long-term care program.