女性照顧者在臺灣醫療體系面臨之困境與社工實務原則

Challenges among female caregivers in Chinese societies and the principles of social work practice: Examples from the medical system in Taiwan

社工實務需要貼近當地文化脈絡，否則會損傷案主的最大利益。西方社會立基在個人主義上，著重獨立與自我實現，而華人社會講求家庭照顧責任以及人際關係，因此單就西方服務觀點與策略無法完整體察女性華人照顧者的需求，進而削弱服務的成效。社工處理案主與醫療團隊衝突的議題上，更需要考量案主所處文化之特性，以確保有效倡導案主權益，且避免增加案主未來使用醫療服務的困難度，或損傷團隊對社工的信賴感與建言的接受度。有關華人社會工作服務文獻極為有限，期望本文能喚起對這些議題的重視，並有助華人服務模式的建立。全文以文獻與案例來強調女性照顧者在台灣可能遇到的困境，首先描述台灣文化與醫療體系、進而討論華人社會衝突解決的策略，最後提出服務原則。

Simply transplanting Western social work practice model into non-Western societies could lead to potentially harmful conflicts with clients' cultural values. Western social work model has rooted in individualism that may not be appropriate for social workers working with female caregivers in Chinese societies where people value family responsibilities and interrelationships with others. Furthermore, to advocate effectively for clients' rights without jeopardizing either clients' ability to access medical care in the future or social workers own professional positions, social workers practicing in Chinese cultures should behave in accordance with the cultures' values. This paper is designed to increase social workers' awareness of social work practice with female caregivers from the collectivists' perspective and to encourage scholars to devote their attention to this topic. A review of the literature and case studies are used to highlight the challenges that female caregivers may face in Taiwan. Taiwanese culture and health care system are first described, along with reflections on culturally appropriate practice. Ways of integrating culturally relevant strategies into a social work practice model are suggested.