從醫療人員觀點來看兒童醫療決策參與權利

Participation, Medical Decision-Making and Children’s Rights: Perspectives of Medical Professionals

目的：本研究試圖從醫療人員(醫師、護理師、社工師/員、心理師、職能治療師以及語言治療師)視角來呈現醫療場域裡兒童醫療決策參與權利能力展演的現況。方法：藉由立意取樣以及滾雪球方式，招募與兒童病患一起工作的醫療人員，共99人參與質性訪談。結果：超過四分之三的受訪者(n=75)聽過「兒童權利」一詞，約六成受訪者(n=63)聽過《聯合國兒童權利公約》。受訪者雖然認同兒童醫療決策是一種權利概念，但兒童是否具備決定接受或拒絕治療的能動性，則是秉持保留的態度。其中年齡、認知能力以及有無危及生命是兒童醫療決策參與多寡的影響要素。結論：基於兒童就其自身相關事務有自由表達意見權利的考量，兒童在醫療決策參與的權利能力應受到承認。在醫病互動關係裡，醫療人員對兒童醫療決策參與的權利能力展演是重要的輔佐角色，藉由不同互動機會以及程序機制，提供兒童意見表述的機會，甚至是決策的可能性，如此一來，方能落實兒童是疾病情境中的權利主體。

Objectives. The aim of this study was to explore how medical professionals conceptualize and implement children's rights to participation, freedom of expression, and decision-making in health care settings.
Methods. Data were collected through in-depth qualitative interviews with 99 health professionals including clinicians, nurses, clinical psychologists, occupational therapists, medical social workers, mental health social workers and language therapists.
Results. More than three-quarters of respondents (n=75) had heard of the term ''children's rights'' and about 63 respondents had heard of the ''United Nations Convention on the Rights of the Child''. Although children's medical decision-making was perceived as a concept of rights, interviewees were uncertain as to what extent children should be involved in decision-making about their medical treatments. Age, cognitive ability, and endangerment of lives affected children's participation in medical decision-making.
Conclusion. Based on the consideration of children's right to freely express their opinion about what happens to them, children's participation rights in medical decision-making should be recognized and promoted by medical professionals. Moreover, the perspectives, views, and experiences of children should be taken into consideration. In doing so, children as persons with rights can be realized in clinical practice.