是保護還是傷害？老人長期照顧機構住民約束的倫理抉擇探究

Ethical Choices for the Physical Restraint of Residents in Long-Term Care Facilities

相較急性醫療環境，國內針對老人長期照顧機構之約束議題研究、討論仍屬少數，且無針對倫理兩難困境做出處理之建議。鑑於老人長期照顧機構中落實無約束環境的倫理議題，必須透過由不同專業人員及家屬運用團隊決策的方式，評估使用約束的措施，社會工作者無法自身於此重要議題之外。本文乃參閱過去從醫護的角度探討約束之議題，瞭解長期照顧機構住民約束現況（定義、盛行率、理由與正負向後果），同時參考社會工作專業談到約束所涉及的法律、倫理議題與兩難，最後討論發生倫理兩難抉擇之建議與注意事項，給予長期照顧之團隊處理約束倫理兩難之參考。

 

Few studies have been conducted on the use of physical restraint in long-term care facilities. Furthermore, none have provided any suggestions for handling ethical dilemmas. Given that the implementation of a “restraint-free care environment” requires an assessment of the measures of physical restraint that involves both the professionals and the kin to arrive at a decision, social workers play a role in this critical issue. Referring to the literature on restraint use from the perspective of medical care, this paper examines definitions and current restraint practices (and their prevalence), for residents of long-term care facilities. Furthermore, taking legal and ethical dilemmas related to restraint use into consideration from the viewpoint of social workers, this study provides suggestions for those facing such dilemmas in long-term care institutions.