護理人員於臨床處理婚姻暴力的倫理困境

Ethical Dilemma for Nurses who Manage Marital Violence in Clinical Setting

婚姻暴力是指親密伴侶間的暴力行為，是嚴重且會重複發生的公共健康議題。臨床上，受暴婦女常因婚姻暴力導致健康問題求助醫療機構，而護理人員是醫療團隊成員中接觸受暴婦女較頻繁的人，當其面對受暴婦女，為使其不繼續遭受傷害，護理人員可在未獲個案同意下，執行通報責任嗎？如此是否違反自主原則？這是護理人員在照護受暴婦女時會面臨的倫理困境。本文旨在應用阿洛斯卡（Aroskar）倫理決策模式對案例進行倫理決策分析，其中包括：在價值系統與時間脈絡下，闡明背景資料、考慮來自決策理論所衍生的問題、以及表達所選擇行動的倫理理論或立場，以澄清倫理困境、進而決定及採取行動。藉此希望能提供護理人員於臨床處理婚姻暴力的倫理困境時，可參考的倫理決策模式。

Marital violence or intimate partner violence is a serious and reccuring public health issue. In the clinical setting, battered women often seek medical advice, because of the health problems that result from marital violence. Thus, nursing staff are the first persons to come into contact with the battered women. Can nurses execute their notify responsibility to prevent continued injury before obtained the woman's agreement? Will this action violate the principle of autonomy or not? Nurses would face an ethical dilemma when they care for battered women. The purpose of this article is to use Aroskar's ethical decision making model to analyze and clarify the ethical dilemmas involved in managing marital violence, including: under the value systems of the person, the profession, and time to illustrate the basic information, decision theory dimensions, and ethical theories or positions. It is hoped that this article provides an ethical decision making model for the ethical dilemmas facing nurses who manage marital violence in the clinical setting.