Kējì Fǎxué Pínglùn (Dec 2009)
論「性別差異」對醫療行為及病人同意的影響 On Gender Differences Patients’ Consent and Medical Disputes
Abstract
「告知後同意」與「性別意識」，係近年來新興的議題，對醫療實務的重要性自不言可喻，也與醫療糾的發生息息相關。故本文擬藉由國內外曾醫療糾紛發生的實例 ―「縮胸手術留疤案」以及「處女膜撕裂傷害案」，從醫學倫理與法律的觀點，以及性別平等的角度，探討醫療上「性別差異」對醫療行為及病人同意可能產生的影響。 「縮胸手術留疤案」的醫療糾紛，主要係醫師對於「肢體形象(疤痕)」的性別敏感度與病人有明顯的落差，此等落差可能基於生理性別的差異所產生，也可能基於社會性別的差異所產生，惟是否會造成病人同意的無效，應由病人係醫療目的或美容目的檢視其同意的內容作為判斷。 「處女膜撕裂傷害案」，主要也是醫師忽略「處女膜」對病人的意義，說明不足所導致的醫療糾紛。雖然對於處女膜的重視係由於「社會性別的偏差」所產生，應該是要破除這方面的偏差，但是這不應該由醫師單方面決定，就醫學倫理的觀點，仍應站在以「病人為中心」的思考模式，培養性別意識，才不致發生醫療糾紛。 因此，從醫療的角度觀察，醫師應站在以病人為中心的角度，尊重病人的自我決定權，培養性別意識，瞭解及尊重性別差異，同理病人的感受，才能避免醫療糾紛的發生。 This article discusses the issues arising from the interaction between gender differences and medical practice & patient’s consent by the true cases of medical disputes. The first case is Korman v. Mallin, 858 P.2d 1145 (Alaska 1993), a case of breast reduction surgery. It indicates that physical image is very important and every physician should keep in mind. If a plastic surgeon neglects it and give inadequate explanations or descriptions, it will result in medical dispute. The Patient’s consent may be invalid if she seeks the operation based on cosmetic demand and the physician may face criminal and civil liability. The second case of “vaginal examination and hymen tear” results from gender bias that people pay too much attention to hymen integrity. This gender bias should not be secured by criminal liability. On the other hand, if the patient values it, the physician should still afford the damages so produced on the basis of civil liability. The most important thing is that the physician should cultivate gender sensitivity so as to avoid and decrease medical disputes in this respect.
