舉報兒童虐待之臨床倫理困境

Clinical Ethic Dilemmas and Difficulties in Reporting Child Abuse

臺灣舉報兒童虐待（兒虐）的案件逐年攀升，舉報兒虐為醫護人員應盡的職責和義務，然介入家庭與臺灣社會規範及傳統文化價值觀衝突，專業人員在面臨相關事件時經常困惑並難以下抉擇。本文藉由Jonsen等人（2002）所提出的倫理四主題方法論分析疑似兒虐案例，探討醫護人員在面臨疑似兒虐個案時所遭遇的困境與障礙，並從文化價值觀與專業責任間的矛盾、個人價值觀的影響及法律定義模糊等層面進行論述。分析結果為醫護人員在決策過程中，除考量個案及整個家庭的最大利益，還需面臨文化衝突及個人價值觀與專業責任的矛盾，但基於行善、不傷害及盡責原則並權衡舉報的利弊，醫護人員必須依法舉報疑似兒虐的個案，舉報讓個案持續獲得後續追蹤與關注，並提供家庭求助的管道。本案例分析結果能提供醫護人員處理兒童虐待時可參考的決策方向。

The number of reported cases of child abuse has been rising steadily in Taiwan. Although child abuse reporting is mandatory for healthcare professionals, Taiwan-specific social norms and traditional cultural values make the decision to report such abuse more complex and difficult. We used Jonsen's four topics method to examine a suspected case of child abuse and to analyze its associated dilemmas and ethical difficulties. We then discussed the identified conflicts among the three aspects of cultural values, legal obligations, and personal values. Findings indicate that healthcare professionals experience dilemmas among these three aspects. Reporting suspected child abuse appears the best resolution after considering and balancing the principles of non-malfeasance, beneficence, fidelity and follow-up care. Once reported, resources can be provided to the affected child and his / her family. This case analysis provides a reference for healthcare professionals to deal with child abuse cases.