台灣醫療界以理性思維為主的醫療生態，醫療以科技掛帥，技術主義優先考量，因此人文在這樣的環境中是被忽略的。醫師經常忘記自己照護的是「人」，而將之視為無數個基因有機體組合而成的生物體。一貫以所謂專業形象處理醫病關係，造成以儀器探討生物體變化，不但忽視病患心理的變化，也忽視醫療人員自己的價值與定位。本文以社會學中日益增多的醫療糾紛作為觸發點，藉以呈顯出醫病關係的惡化。 關懷是人類的特性，所有的人都有關懷的能力。因此提出關懷倫理學中關懷與關係的觀點作為調和醫病關係的基礎，以諾丁的關懷倫理學作為醫學倫理之外另一種思考模式，帶入關懷倫理學的觀點進入以生物科學角度思維的醫學環境，讓關懷暖化機械式運作的一成不變。關懷倫理學是著重實踐，在適當的時刻依被關懷者不同的需求，隨時注意被關懷者的需要而給予不同回應。因此關懷者所給予的關懷是否恰如其分的符合被關懷者，是建立關懷關係重要的關鍵。由關懷倫理學建構的醫病關係將有助於跨越原則主義的理性所建構的醫病之間冷漠的藩籬，是改善醫療品質的重要作為，並為有效的醫病互動關係創造價值。 醫療在詮釋病患生活世界的意象結構是疏離的，如果醫療過程只能處理生理功能的問題，醫病之間意向焦點與生活世界的焦點的差距就越大，是本文提出的產生醫病關係問題之所在。因此本文除了關切醫療人員在關懷能力與關懷理想的培養，仍想關注於臨床上關於醫師與病家之間的溝通的問題。藉由教育醫療專業人員，修正應用生物醫學的盲點，這些正是需要在人際關係中去練習與學習，並將對於關懷的記憶實踐在病患身上，開啟以關懷為理念的人本醫療。最後以專業倫理諮詢的過程協助病家作出重要決定、深入思考個人的信仰與價值觀、了解個人處境會帶來何種問題、認清自己應該如何面對這些問題，協助他們在盤根錯節的醫病關係和醫療問題中，釐清哪些事是需要特別留意與關注的，哪些是病患自己的利益與價值觀並從中挑選出關鍵的決策。讓醫病關係成為一種對人生命的深度關懷、同情共感以及相互依賴的信任關係。 In Taiwan, medical treatments are basically based on rational consideration with technological fix as the basic principle and first priority. Hence, humanity is largely neglected. Physician seems to forget that the patient is a person and not just a conglomeration of genetic organisms. Under such professional attitude, the core of patient-physician relation is degenerated into a kind of technological examination of the biological body. The psychological needs of the patient as well as the true value and role of the medical professionals are neglected. In this dissertation, I take confrontations between the patient and physician as the starting point to show how the way patient-physician relation has been degenerated and need be treated itself. Care is a human characteristic and everybody has certain capability to care. In this thesis, I argue how caring relation in care ethics could bring an alternative perspective to the patient-physician relation. The introduction of care into the bio-technological medical context could soften the mechanical operation and could provide in time the concern and response to the need of the patient. This will help not only to establish a caring relation but also transcend the cold separation of patient-physician relation embedded in the main stream ideology of principlism. I try to argue how a caring relation could improve the quality of medical treatment and interaction between the patient and physician. The cultivation of caring capability and ideal for medical professionals is the key to improvement and in the last part of this paper I propose to inject a dose of care education in medical training so as to make medicine more humanistic. To facilitate the building of caring relation and trust of the patient, a course in the training in bedside consultation in medical program is necessary. For it could help patient and patient family to understand their situation, solve their puzzles and make their decisions. With caring and consultation, we could help to rebuild the patient-physician relation upon a deep caring concern with empathy and mutual trust.
