從醫病關係發展探究其?信任?（trust）的危機 — 以關懷關係重構 ; From the physician-patient relationship development to explore the risk of trust-- reconstruction with the caring relationship.

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题名:	從醫病關係發展探究其?信任?（trust）的危機 — 以關懷關係重構;From the physician-patient relationship development to explore the risk of trust-- reconstruction with the caring relationship.
作者:	林佳縈;Chia-ying Lin
贡献者:	哲學研究所
关键词:	歐妮爾;諾丁　;信任;關懷關係;醫病關係;caring relationship;trust;physician-patient relationship;Onora O'Neill;Nel Noddings
日期:	2011-01-18
上传时间:	2011-06-04 15:16:32 (UTC+8)
出版者:	國立中央大學
摘要:	建立良好的醫病關係是相當重要，因能助於病人達到最佳的治療效果、減少不必要的醫療糾紛等等，進而增進醫療的品質。然而，近年來醫療糾紛的案例層出不窮，顯示出當前醫病關係的惡化，造成許多問題，如:雙方之間容易產生誤解、緊張的局面，影響病人其健康恢復的情形。而良好的醫病關係首重於相互信任的基礎上，由於當病人能相信於醫生，即是認為醫生會以恢復他的健康作為自身職責，並給予最佳的治療方式。同時，醫生若能感受病人的信任，在治療的過程中則會更加積極促進病人的福祉。然而，醫病之間，病人因疾病的事實產生脆弱性，而必須藉由醫生的幫助回復其自身的健康及消除心中的不安，因而醫病關係不可避免地則是建立在不對等的基礎之上，當中病人便處於較為弱勢的地位，相對地，其受傷害的可能性也更為增加，一旦如此，長期下來醫病之間則會愈為疏遠、冷淡，逐漸形成不信任的醫病關係，導致雙方走向相互猜忌、懷疑，而無法建立良好的醫病互動。因此，本文主要探討的問題即是當醫病關係必然地存在不對等的基礎之上，該如何避免雙方關係的惡化，並增進相互之間的信任。而在關懷關係的觀點中，由於其中便包含對於不對等關係的說明，以關懷者與被關懷者的角色來作為互動，強調關懷者必須主動接受被關懷者，同時，也需要被關懷者的回應，重視其自由的展現。則藉由此觀點，改善醫病關係因不對等的基礎性所產生的問題，並且透過關懷情感的特性，拉近醫病之間的距離，使雙方更為親近，進而達到互信的關係。 It is important to build a good physician-patient relationship which can benefit patients to achieve optimal treatment, reduce medical disputes, etc, and then enhance the quality of medical care. However, in recent years, medical dispute cases grow rapidly. It reveals that physician-patient relationship is currently deteriorating, hence lead to many problems, such as the misunderstanding between the physician and the patient, a tense relationship, and the patient's recovery process is thus affected. A good physician-patient relationship is based on mutual trust. When the patient trusts his physician that means he thinks the physician will take his health as a duty and provide optimal treatment. Likewise, if the physician feels that the patient trusts him, he will be more enthusiastic to enhance patient's well-being. However, the patient becomes vulnerable due to his illness; he needs the physician’s help to recover and eliminate anxiety about his own illness. Unavoidably, the physician-patient relationship is unequal, so the patient is more vulnerable to being harmed. When harmed is done, it will result in an aloof and mutually mistrustful physician -patient relationship. In this thesis, I show how to prevent the physician-patient relationship from becoming worse, as well as how to achieve mutual trust under the unequal condition. According to caring relationship of care ethics, the one-caring must actively accept the caring-for. It also requires the response from caring-for as a free agent. By this interactive relation, we could improve the problems that derived from the unequal relationship, and close the gap between the physician and the patient so as to achieve the mutual trust relationship eventually.
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