台灣的道德先鋒：焦慮、產檢選擇與責任的矛盾

Taiwanese Moral Pioneers: The Paradox of Choice, Anxiety and Responsibility

台灣於1995年全民健保實施後，估計約有97.2％的懷孕女性接受產前檢查。然而台灣的女性是如何經驗產前篩檢與檢測（產檢）？以及這些經驗對女性的影響是什麼？美國女性主義學者Rayna Rapp指出，在產檢科技與醫療運作下，當代的女性被迫成為社會的「道德 先鋒」（moral pioneers），決定什麼樣的小孩可以進入我們的社會，對自己未岀世的孩童作價值判斷。在不同的社會脈落下，台灣的懷孕女性是如何經歷「台灣道德先鋒」的角色，此為本文的關懷。本研究於2008年、2009年與2012年間進行田野調查，在三家婦產醫療院所進行參與式觀察和訪談，並從訪談中收集到33張關於「什麼是產檢」的手繪圖。本文分析在產檢的醫療化與常規化下，女性如何被建構為篩檢胎兒健康的決定權主體：承擔著面對產檢對胎兒健康的篩檢結果、以及整體社會的優生意識凝視。透過受訪者所作的選擇以及背後的道德詮釋，提供我們去認識台灣女性在懷孕生物醫療化歷程的焦慮，及其背後的道德與責任的矛盾。本文延伸Charis Thompson的「本體編舞」（ontological choreography）概念，檢視產檢中的不同物質符號行動者的參與以及產檢運作本身如何因應不同行動者的加入或退出而有不同的編舞，以瞭解台灣女性在產檢中所經歷的道德責任的矛盾。

This paper aims to explore women’s experience of prenatal screening and testing (PST), and also how these experiences affect women’s pregnancy and decision-making. According to an official survey, 97.21% of Taiwanese pregnant women underwent PST in 2008 (Department of Health, Executive Yuan, 2009: 49). From conducting ethnographic observations, interviews with pregnant women and couples, and collecting participants’ drawings about what PST is, I found that my participants experienced much anxiety during their pregnancy. I explain this in the context of routine medical practices that construct women as responsible decision‐making subjects, which thus stirs their anxiety by invoking the spectre of a disabled child or of aborting a desired child. As American feminist Rayna Rapp suggests, this positions women as ‘moral pioneers’ who stand at the moral frontier of our society to decide what kind of children can enter society. Following Rapp’s ‘moral pioneer,’ I use the term ‘Taiwanese moral pioneer’ to suggest that in Taiwan women’s decision-makingare entangled with health care policy, the concept of you sheng (superior birth), medical practices, medical professionals, and these women’s families. I see these as material-semiotic actors participating in an “ontological choreography”, which is a term coined by Charis Thompson and describes the heterogeneous practices within medical practices. To examine these choreographic enactments, this paper provides accounts of how PST is practiced, and also of its ontological enacting. In the end, the paper contributes to our understanding of the complexity of PST and also its paradox, which is enfolded within Taiwanese women’s anxiety, responsibility and decision-making together.