荷爾蒙補充療法的風險論述

Risk Discourse in Hormone Replacement Therapy

醫界使用荷爾蒙補充療法藥物在更年期婦女身上已經超過70年，然其爭議始終不斷；2002年7月美國NIH公佈對接受荷爾蒙補充療法藥物婦女可能導致風險的研究結果，使婦女對於用藥與否有更多困惑與質疑，台灣醫界紛紛指出研究用藥不同、束西方婦女體質不同，企圖降低該研究帶來的衝擊，荷爾蒙補充療法為最廣泛被使用，也最具爭議的醫療科技之一。風險是討論科技爭議時最常引用的概念，Lupton （1999）指出有關風險現象的討論主要分為科技和社會文化視野，科技視野以認知科學為基礎，企圖以精確之科學知識預測並控制不利之風險；社會文化視野則弦調風險應放在社會及文化的脈絡下被理解，風險成為社會現範之一環，甚至風險科技將特定的社會團體或人口識別出來為「高危險群」進行監控與管理，風險論述成為道德科技。本文強調醫護人員應檢視荷爾蒙補充療法藥物使用者對於風險意涵之詮釋，避免將婦女的生活與生物、文化和歷史脈絡分離，建議醫護人員反省「高危險群」在特定識別條件與過程中之意義，轉換監控與管理策略為營造夥伴關係及賦權之護理措施。

The medical world has used Hormone Replacement Therapy (HRT) on menopausal women for over 70 years, but controversy surrounding the treatment remains. Findings reported by the NIH, U.S.A. in July 2002 indicated that HRT might cause cardiovascular and cancer risks, and resulted in serious concern among menopausal women using HRT in Taiwan. One after the other, members of the medical profession in Taiwan have argued that the medicine used in the research was different (from that used in Taiwan) and that the constitutions of western women are different from those of Taiwanese women, attempting to limit the negative impact of this research. HRT is one of the most widely used, but also one of the most controversial of medical technologies. The technico-scientific and sociocul-tural perspectives are two major approaches to the conceptualization of risk in relation to technology. Based on cognitive science, the technico-scientific discourse of risk emphasizes human forecasting of harmful events and scientific measures for preventing risk. The sociocul-tural perspective emphasizes that the risk is socially constructed and applies to control deviance, in addition, surveillance and regulated measures are applied to high-risk populations, as normalizing technology with moral implications. This paper suggests that health care professionals examine how HRT users interpret the meanings of risk. Reflection on the process and criteria for identifying high-risk populations is also suggested. Partnership with and empowerment of HRT users is advocated in preference to the use of regulating and normalizing measures