「我不能拖累子女！」照顧悲劇之老年配偶照顧者的分析

“I Canʼt Be a Burden to My Children”: An Analysis of Elderly Spousal Caregivers in Caregiving Tragedies

研究目的：照顧者因照顧負荷殺害照顧接受者，已成為長期照顧領域重視的新興議題，本研究探討老年配偶照顧者的照顧脈絡與其壓力，瞭解案件發生的相關因素。研究方法：透過內容分析法分析十件照顧者存活且進入司法審理的案件，並運用深度訪談法呈現案件當事人與重要關鍵人的觀點。研究結果：（一）參照高負荷照顧者指標，應重視照顧者的身心狀況與照顧情境改變；（二）與過往「養兒防老」觀念不同，老年配偶照顧者堅持自行擔負照顧責任是為「防老伴拖子女」；（三）照顧者的身心與睡眠狀況是關鍵警訊；（四）對長期照顧服務體系的抗拒使用與缺乏認識；（五）司法應將婚姻的「未曾離棄」與照顧分開談論。研究結論：照顧壓力累積易導致照顧者殺人─自殺行為的產生，建議政策檢視我國長期照顧服務與傳統文化的互動關係，鼓勵家庭開始討論照顧安排。

Purpose: Caregivers killing their charges due to their caregiving burden has become an issue of concern in the long-term care field. We explored the caregiving context and stress of elderly spousal caregivers to understand the factors related to the occurrence of such cases, including both caregiver-perpetrated homicide and homicide-suicide events. Methods: We conducted a content analysis of 10 official court judgments in Taiwan involving cases in which the care recipients were murdered by their caregivers, and the caregivers survived and were prosecuted through the criminal justice system. Among them, five of the defendants had attempted suicide. We also conducted in-depth interviews with the parties involved and key stakeholders in order to present a range of perspectives. Findings: Our analysis resulted in 5 key findings: (1) The physical and mental health status of caregivers and of their charges and their caregiving circumstances may serve as early indicators of highburden care situations; (2) In contrast to the traditional concept of raising children as a safeguard in old age, six of the ten elderly spousal caregivers expressed a strong desire to bear caregiving responsibilities alone in order to avoid burdening their children; (3) Depressive symptoms and severe sleep disturbances among caregivers may be a critical warning sign, often preceding acts of violence. (4) The caregivers themselves exhibited both a reluctance to engage with and an insufficient understanding of the long-term care service system available in Taiwan. (5) The judiciary should separate the moral commitment of marriage from the practical responsibilities of caregiving to better recognize the caregiver’s burden. Conclusion: The accumulation of caregiving stress can lead to caregiver homicidesuicide. We suggest that future research is needed to examine the interactive relationship between Taiwan's long-term care services and traditional culture so as to design policies that encourage families to begin discussing care arrangements before tragedy happens.