傳染病照護的選擇性歧視：醫師及牙醫師的愛滋病專業倫理觀與照護意願

Selective Discrimination in the Health Care of Infectious Diseases: Professional Ethics and Willingness to Treat AIDS Patients among Physicians and Dentists

10.6288/TJPH2004-23-01-05

丁志音(Chih-Yin Lew-Ting)；涂醒哲(Shing-Jer Twu)

愛滋病 ； 專業倫理 ； 照護意願 ； 選擇性歧視 ； AIDS ； professional ethics ； willingness to treat ； selective discrimination

台灣公共衛生雜誌

23卷1期（2004 / 02 / 01）

45 - 58

繁體中文

目標：在新興傳染病不斷侵襲的時代，本研究試圖以愛滋病的醫療照護為例，瞭解醫療專業在遭逢危機及挑戰時，其專業成員的反應方式，特別是檢視專業倫理的價值觀及照護愛滋病患及感染者（people with AIDS, PWAs）的意願。方法：研究資料來自於1995及1996年分別針對全國的醫師及牙醫師所做的郵寄問卷調查。在剔除曾有照護PWAs經驗之220名醫師及94名牙醫師以後，本研究的樣本共包括了1482名醫師及1685名牙醫師等從未照護PWAs之專業成員。針對每一個專業群體，以雙變項分析及多變項邏輯斯迴歸分析，來檢視照護焦慮及專業特質對照護倫理觀與照護意願的影響。結果：兩群專業人員對愛滋病所具有的專業知識不足，對此病表達出極其負向的反應，且對照護倫理與意願欠缺利他傾向，顯現出違反專業倫理的選擇性歧視。只有25.2%的醫師及18.1%的牙醫師自述願意照護所有的PWAs，不願照護任何PWAs則分別為9.7%及53.0%；介於兩者間的則為「只願意照護不知情感染者」（27.7% vs. 14.5%），而有37.5%的醫師及11.6%的牙醫師則能更進一步地接受某些類別的高風險PWAs群體（37.5% vs. 11.6%），其中最無法忍受的則為靜脈注射毒癮者。如此的負向反應主要源於對感染AIDS之恐懼及對PWAs的情感性的心理不舒服感。而專業歸屬感、專業知識及執業型態等測量專業性的變項扮演次要的角色。結論：面臨新興不確定性高的新型傳染病，醫療專業人員的憂懼有時會凌駕科學理性與專業價值，而顯現出悖離社會期許的反應。在傳染病侵襲日漸嚴重的時代，醫師養成教育必須強調醫療執業場所中潛伏的執業風險及預防方法，並應重申醫者專業角色的重要性。

Objective: In the era of continuous attack from newly emerging infectious diseases, this paper, by taking AIDS as an example, aims to explore the medical professionals’ responses to the challenges of an epidemic. Particularly emphasized are individuals’ ethical values and willingness to treat people with HIV and AIDS (PWAs) among physicians and dentists. Methods: Structure questionnaires were mailed to practicing physicians and dentists in 1995 and 1996, respectively. The final physician sample consisted of 1482 and dentist sample 1685 respondents after excluding 220 physicians and 94 dentists who reported having experience in treating PWAs. For each professional group, bivariate analysis and logistic regression were used to explore the effects of perceived care-related worry and anxiety and professional attributes on ethical values and willingness to treat. Results: A lack of AIDS clinical knowledge was commonly found among both groups of medical professionals. They showed very negative, un-altruistic reactions to AIDS and PWAs, such as rejecting the value for ethical responsibility and being reluctant to treat PWAs. An obvious tendency of selective discrimination was observed. Only 25.2% physicians and 18.1% dentists were willing to treat all PWAs. The percentages of those unwilling to treat any PWAs were 9.7% and 53.0%, respectively. In between were those who were only willing to treat the uninformed (27.7% vs. 14.5%), and who were still willing to treat some of the high risk individuals (37.5% vs. 11.6%). Among the high risk groups, the most unaccepted category was IV drug users. The extremely negative reactions mainly came from the fear of infection and psychological discomfort towards PWAs. Sense of professional belongingness, AIDS knowledge and type of practice, all characterizing professional attributes, played relatively less significant roles. Conclusion: In the face of uncertainty inherent in the emergence of new infectious diseases, the medical professionals’ worry and anxiety might go beyond scientific reasoning and professional values, and their responses may be against the expectations of the society. With the increasing threat posed by infectious diseases, medical education should urgently pay greater attention to the prevention of occupational risks which are inherent in clinical settings. Likewise, the critical roles physicians are expected to play during the time of epidemic are to be emphasized.

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