情愛妄想症之臨床倫理病例報告

A Clinical Ethics Case Report of Erotomania

本文報告一則涉及情愛妄想症（erotomania）之臨床倫理個案。一名神經外科醫師於追蹤一位未破裂腦動脈瘤女性病人期間，發現病人逐漸形成其主治醫師愛上自己的妄想信念，並表現出持續性、帶有個人情感投射之聯繫與詮釋。雖該妄想內容具明顯臨床意義，但病人當時並未出現精神疾病性之惡化、功能明顯受損，或對自己與他人之立即危險，故尚未達必須立即精神科介入之門檻。醫院倫理委員會遂就是否應終止醫病關係進行審議。初步意見傾向轉介，以避免專業界線風險與潛在醫療法律問題；然而，經深入討論後，委員會認為終止照護未必能消除妄想，反而可能加劇其症狀，甚至誘發跟蹤、毀謗或拒絕就醫等不良後果。綜合考量病人之整體風險偏低、醫師能維持專業距離、機構可提供支持，以及可建立同儕審查、家屬參與、完整紀錄與升級處置機制等防護措施後，委員會認為在嚴格條件下持續照護，具有倫理上之可辯護性。本文主張，情愛妄想症之處置，不宜僅以反射性轉介為唯一模式，而應採取兼顧病人福祉、專業界線、風險管理與制度支持之脈絡化倫理判斷。

This article presents a clinical ethics case involving erotomania. During the follow-up care of a female patient with an unruptured cerebral aneurysm, a neurosurgeon came to recognize that the patient had gradually developed the delusional conviction that her treating physician was in love with her, accompanied by persistent communications and interpretations marked by personal emotional projection. Although the delusional content was clearly of clinical significance, the patient had not, at that stage, shown psychotic deterioration, substantial functional impairment, or any immediate risk to herself or others. The threshold for urgent psychiatric intervention had therefore not yet been met. The hospital ethics committee was convened to deliberate whether the therapeutic relationship ought to be terminated. Initial opinion favored a transfer of care to minimize risks to professional boundaries and potential medico-legal concerns. Upon deeper deliberation, however, the committee concluded that termination of care would not necessarily extinguish the delusion and might instead intensify it, potentially precipitating undesirable consequences such as stalking, defamation, or disengagement from medical follow-up. Taking into account the patient’s overall low-risk profile, the physician’s ability to maintain professional distance, the availability of institutional support, and the feasibility of safeguards such as peer review, family involvement, comprehensive documentation, and escalation protocols, the committee judged that continuation of care under stringent conditions was ethically defensible. This case argues that the management of erotomania should not be reduced to reflexive transfer of care, but should instead rest on a context-sensitive ethical judgment that integrates patient welfare, professional boundaries, risk management, and institutional support.