多元性別融入醫病溝通與醫療決策

The Physician-Patient Communications and Medical Decisions on the Gender Diversity

本文係探討多元性別議題興起後，對於醫病關係的影響。二元性別的架構，無法面對多元性別的醫療行為，多元性別也不易定義，故本文首先嘗試定義多元性別。所謂多元性別，係指任何人的生理性別、性別特質、性傾向以及性別認同等差異情形。多元性別所涉及的法律關係，主要係在同性伴侶的醫病法律關係，未來可能會具有關係人、家屬或是配偶等身分。身分的不同，對於醫病溝通、病情告知與醫療決策也有所不同。在醫病溝通部分，除需要考量生理與社會性別差異所導致的溝通模式與醫療照護不同外，也需考慮跨性別或同性伴侶就診者對於門診稱謂以及問診方式。在病情告知部分，是臨床工作比較棘手的部分，醫師如基於保護同性伴侶（第三人），而洩漏病人隱私，必須符合緊急性與必要性的要件。在醫療決策部分，對於手術或侵入性醫療行為，當病人昏迷時，同性伴侶能以關係人的地位簽署同意書，也能透過同性伴侶證確認其身分；然而，對於不施行、終止或是撤除心肺復甦術或是維生醫療，以及器官捐贈等，則必須病人事前預立醫療委任代理人或書面同意始得為之。最終的目標，係將多元性別融入醫病溝通與醫療決策。 This article aims to discuss the impact on the physician-patient relationship and gender diversity. The gender diversity is difficult to define. We will try to define gender diversity based on the differences between sex, gender quality, sexual orientations, and gender identity. The legal relationships between the same-sex couple can be stakeholders, family members or spouses. We should understand each gender has a distinct communication pattern. Also, we should notice how to name and interview the transgender or same-sex couple patients. When the medical condition is emergent and necessary, based on same-sex partner (the third party) protection, doctors should be allowed to tell the condition of one same-sex partner to the other same-sex partner, even though it violates the patient’s privacy or wills. One same-sex partner is allowed to sign surgery consent or related medical practice consent on the ground of the other same-sex partner’s stakeholder when he or she is comatose. One same-sex partner is not allowed to sign the DNR related consent and the organ donation and organ transplantation consent from corpse unless he or she has been designated as a medical surrogate agent in advance or the patient has made prior written consent.