困難的倫理：論護理人員的道德困擾

The Difficult Ethics: On the Nurses' Ethical Distress

王心運(Shin-yun Wang)；柯薰貴(Hsun-kuei Ko)

道德困擾 ； 困難的倫理 ； 情緒 ； 關懷 ； 臨床倫理 ； Moral distress ； Difficult ethics ； Emotion ； Care ； Clinical ethics

應用倫理評論

61期（2016 / 10 / 01）

59 - 76

繁體中文

護理人員的道德困擾起因於種種無法控制的因素，以致他們無法維護病人的最大利益，進而承受痛苦等情緒壓力。若無法排除阻礙，護理人員將進入道德困擾情緒的反應期，除身心都受影響外，也會影響倫理問題的解決。因而道德困擾的問題愈受到護理教育的重視。本文試圖以困難的倫理討論道德困擾與情緒的問題，認為目前臨床倫理方法並沒有正視引起道德困擾的真正困難。臨床倫理的困難一方面在於行善意向受到種種現實條件變的零碎與複雜化，另一方面在於意義脈絡與互為主體性變的不完整。研究也指出，若護理人員能形成自己的價值觀較能安置道德困擾的情緒問題。

Because of various factors which are beyond control and make it impossible to maintain the best interests of the patient, the healthcare personnel may feel moral distress and suffer from their emotional stress. If such obstacles cannot be removed, they will enter a stage of reactive moral distress, experiencing suffering from the mind and body and therefore cannot solve clinical ethical problems. Thus we should put more attention on the nursing education. This article attempts to discuss the moral distress and emotional stress from the perspective of difficult ethics, because we think the difficulties of clinical ethics which incur moral distress are not really noticed by the existing methods of clinical ethics. On the one hand, it lies in the becoming fragmentedand complicated of a nurse's good -intentions; on the other hand, it results from the becoming incompleteness of the context of significance and inter-subjectivity under the condition of real health care situations. This study also points out that if nurses can form their own moral values, they will deal with their emotional stress in a better way.

1. 王心運(2014)。臨床倫理的現象學考量。應用倫理評論，57，1-15。
   連結：
2. 林慧如、王心運(2015)。白色倒影—敘事醫學倫理故事集。高雄:高雄醫學大學。
   連結：
3. Editor(2002).The nurse-doctor game.Nursing,June,60-65.
4. Editor(2000).Doctors and nurses: A new dance?.British Medical Journal,320(15)
5. Fagin, L.,Garelick, A.(2004).The doctor-nurse relationship.Advances in Psychiatric Treatment,10,277-286.
6. Ferrell, B. R.(2006).Understanding the moral distress of nurses witnessing medically futile care.Oncology Nursing Forum,33(5),922-930.
7. Fry, S. T.(2002).Ethics in Nursing Practice: A Guide to Ethical Decision Making.Oxford, UK:Blackwell Science Ltd..
8. Fry, S. T.,Harvey, R. M.,Hurley, A. C.,Foley, B. J.(2002).Development of a model of moral distress in military nursing.Nursing Ethics,9(4),373-387.
9. Hamric, A. B.(2012).Empirical research on moral distress: Issues, challenges, and opportunities.HEC Forum,24(1),39-49.
10. Jameton, A.(1984).Nursing practice: The ethical issues.Englewood Cliffs, NJ:Prentice-Hall.
11. Jameton, A.(1993).Dilemmas of moral distress: Moral responsibility and nursing practice.AWHONN'S Clinical Issues in Perinatal and Women's Health Nursing,4(4),542-551.
12. Ko, H-K.,Hsu, M-T.,Chin, C-C..Moral Distress Model Reconstructed by Grounded Theory.Journal of Nursing Research
13. Kopala, B.,Burkhart, L.(2005).Ethical dilemma and moral distress: Proposed new NANDA diagnoses.International Journal of Nursing Teminologies and Classifications,16(1),3-13.
14. Levinas, E.(1991).Zwischen uns: versuche uber das denken an den anderen.Munchen:Carl Hanser Verlag.
15. Levinas, E.(1998).On thinking-of-the-Other, entre nous.New York:Columbia University Press.
16. Marcus, P.(2008).Being for the other: Emmanuel Levinas, ethical living and psychoanalysis.Milwaukee Wisconsin:Marquette University Press.
17. McCarthy, J.,Gastmans, C.(2015).Moral distress: A review of the argument-based nursing ethics literature.Nursing Ethics,22(1),131-152.
18. Oberle, K.,Hughes, D.(2001).Doctors' and nurses' perceptions of ethical problems in end-of-life decisions.Journal of Advanced Nursing,33(6),707-715.
19. Pendry, P. S.(2007).Moral distress: Recognizing it to retain nurses.Nursing Economic,25(4),217-221.
20. Watson, J.(1988).Nursing: Human science and human care. A theory of nursing.NY:National League for Nursing.
21. Wilkinson, J. M.(1987).Moral distress in nursing practice: Experience and effect.Nursing Forum,23(1),16-29.
22. 吳秀瑾(2006)。關懷倫理的道德蘊涵：試論女性主義的道德知識生產與實踐。國立政治大學哲學學報，16，107-162。
23. 柯薰貴(2016)。博士論文(博士論文)。高雄，高雄醫學大學護理學系。
24. 柯薰貴、王瑞霞(2011)。知行合一—談護理執業上的道德勇氣。護理雜誌，58(1)，102-107。
25. 柯薰貴、楊玉娥(2010)。護理藝術與美。長庚護理，21(1)，33-40。
26. 柯薰貴、楊美賞(2009)。倫理道德困擾與護理領導。護理雜誌，56(3)，72-77。

1. 李美秀(2018)。台灣臨床倫理困境之解決－由儒家義理做解析。護理雜誌，65(6)，95-103。