精神醫療專業人員對兒少精神疾患醫療最佳利益模式考量之初探性研究

An Initial Investigation of Mental Health Professionals' Perspectives on the Best Interests of Child and Youth's Medical Decision Making

目的：本文試圖從精神醫療專業人員（身心科醫師、護理師、精神社工、心理師、職能治療師）觀點來研析精神醫療場域裡兒少精神疾患醫療最佳利益模式之考量。方法：採用質性研究，取樣方式為立意取樣，直到資料飽和即停止收案，共有32位精神醫療專業人員為研究對象進行面對面訪談。結果：研究資料結果顯示，精神醫療場域裡的兒少精神疾患醫療最佳利益考量可分為「家長式主義模式」、「家長式主義與兒童最佳利益平衡模式」、「引導兒童參與、思考、表達模式」以及「醫療團隊、家長以及兒少三方共識模式」等四種模式。結論：兒少精神疾患醫療最佳利益考量在精神醫療領域裡應被理解為兒少、家長以及醫療團隊三方透過討論之後所產生的共識組合，這種模式最有可能創造一個尊重孩子發展自主的友善環境與兒少最佳利益維護的形式。

Objective: The aim of this paper is to explore perspectives of mental health professionals (psychiatrists, mental health nurses, mental health social workers, psychologists and occupational therapists) on children's participation, expression and medical decision making in psychiatric care. Methods: Data collection was carried out through qualitative interviews. A total of 32 mental health professionals were interviewed based on purposive sampling until information saturation. Results: The results of this study showed that decision making in children's psychiatric care can be divided into four models: The “paternalist model”, the “balance between paternalism and children's best interests model”, the “guiding children's participation, thinking and expression model” and the “consensus among medical team members, parents and children model”. Conclusion: Decision-making in children's psychiatric care should be understood as a consensus among medical team members, parents, and child via communal discussion. This model is most likely to create a friendly environment in which children's right to self-determination are respected.