倫理照護的美學實踐

The Aesthetic Practice of Care Ethics

處於醫師與患者之間的護理人員，是構建醫病關係不可或缺的重要角色，其所面對的不只是照料病患的疲累，還包括倫理層面上被萊維納斯（Lévinas）稱為「為他人」的責任承擔。在醫病關係的討論中，不乏視病患為「他者」的觀點，並嘗試以此立論突破傳統醫者為大的觀念。在固有的醫病關係結構中，醫師為診斷的主體，而患者則為客體；從被決定的觀點而言，患者常感到無力與挫敗，因而需要照護者和護理人員的安撫。在此意涵上，直接面對病患的護理人員，也常常是「看見」病患「面容」的人。在此照面關係中，一旦病患得不到情感的肯定，其無力感和挫敗感也往往直接反應在護理人員身上。在此情況下，照護工作所承擔的將不只是單純的操作活動，而已然包含了情感的付出與承受。一方面在承受患者情感與情緒的狀態下執行專業的工作，一方面又必須保持視病如親的專業呈現，遮掩內心的感受與情緒。此夾在「醫師與患者」間的護理人員究竟該如何自處？當護理人員被要求以視病如親的方式面對病患，他們又將如何面對內心的情感與情緒？本文嘗試從萊維納斯（Lévinas）與皮耶克索夫斯基（Klossowski）的尼采（Nietzsche）詮釋為基礎，反思倫理照護的美學實踐之可能。

Situated between the doctor and the patient, nurses play a central role in the doctor-patient relationship. Nurses attend to patients' exhaustion and take responsibility for the ”Other,” in Lévinas' sense of the word. In discussions of the doctor-patient relationship, the patient is often regarded as the ”Other”. This perspective seeks to challenge the traditional contention that the doctor plays the dominant role. In the structure of this relationship, the doctor, responsible for providing diagnoses, is the subject and the patient is the object. The latter constantly feels frustrated and helpless and requires the comfort of the nurse. In this sense, the nurse, having the direct contact with the patient, constantly sees the faces of the patients. In the care relationship, the patient's frustration and helplessness will sometimes be expressed to the nurse if the patient cannot be affectively affirmed. In this type of situation, the nurse bears not simply his / her routine work, but also affective devotion and endurance. On the one hand, the nurse must practice professional medical care in the face of patients' affective feelings and emotions and, on the other hand, he / she must treat the patient as a relative and suppress inner feelings and emotions. How does a nurse situate herself into the doctor-patient relationship? As the nurse is asked to treat the patient as a relative, how does he / she face inner emotions? This paper reflects on the possibility of the aesthetic practice of care ethics.