| 摘要: | 失能老人除了要面對機能老化導致失能，從衣、食、住、行等無法自我照顧的狀況，還有負擔慢性病及長期的照顧人力、財力、醫療、社會與家庭環境設備等照護資源的支出。當家庭之人力、環境、設施已不敷失能老人的健康照護需求時，失能老人和其照護者都受到沈重的壓力，甚至被扭曲而釀成人間悲劇，以及不當的護照方式。失能老人與其照護者都是弱勢的倚賴者，因此，本文以羅爾斯之差異原則作為照護的基本原則，由此以建立老人和照護者應有的在資源分配上的權利和政府之責任。由此確認滿足失能老人的健康照護的方法，以實質上維護其自由與尊嚴。
本文考察了，丹尼爾斯，納斯邦和姬泰的論述，認同從「依賴者」與「衍生依賴者」提出個體的健康照護需求，與提供每個人在醫療照護上平等機會是公義社會所必備之條件。但本文認為要更進一步從差異原則為基礎，才能確立失能老人和照顧者的權利和合理的照護資源。因為，差異原則關懷最不利者；失能老人屬於最不利者；所以差異原則最能照護失能老人和照顧者，以及他們的需求。
本文並分析丹尼爾斯用以分析健康照護公平性的九個基準，以及參考儒家的觀點，以充實本文以差異原則為基礎的失能老人的健康照護論述。最後，作為一參照的例子，本文從台灣咀嚼吞嚥障礙者的鼻胃管灌食，探討其營養供給模式，對咀嚼吞嚥失能的老人的生命造成的不公義和喪失尊嚴生活的窘境，並從日本護理師模式實施改善措施，確認可以成功移除鼻胃管，恢復經口進食而有的自由與尊嚴。由此建立照護失能老人應有的資源，使老人和照護者得到合理的支援，並享有尊嚴和自由的生活。
本研究除了確認差異原則可以做為長期照護倫理基礎，並可作為推展進食尊嚴的參考模式，以維護失能老人的健康照護需求。本文建議政府在研擬長期照護保險法時，應透過公開對話的審議民主程序，廣納專家、學者、醫療院所從業人員、及相關民間協會與學會組織的意見，來擬定長期照顧政策。
;The disabled elderlies, in addition to the encountering organs degeneration, have to face the situation where they cannot take food, clothing, living by themselves, and facing the problem of the heavy burden of the cost of caring for chronic diseases, medical expenses, social and domestic provisions etc. When family could not provide the necessary financial or human resources to take care the needs, disabled elderlies and their caregivers are under heavy pressure, and may even lead to distortions as human tragedy and improper ways of caring. Disabled elderlies and their caregivers are vulnerable dependent persons. Therefore I take Rawls′s difference principle as the basic principle of long-term health care, in order to establish the rights of the elderlies and their caregivers the proper allocation of resources and the responsibility of the government. Thereby setting up the basic health care program meeting their needs and maintain their freedom and dignity.
In this thesis, I have examined the discussions between Norman Daniels, Martha C. Nussbaum and Eva F. Kittay, and adopted Kittay’s idea of "dependence " and "derivative dependence ′ of the elderlies and their care-takers , and offering them according to their fair equality of opportunities in their medical resources sharing. But I argue that, it need be based on the difference principle, in order to establish and secure the rights of the disability elderlies and caregivers and the sharing of reasonable care resources. For, the difference principle emphasis the caring of the most disadvantaged and disabled elderlies and their careers are among the most disadvantaged. Hence the difference principle could protect them and their needs most appropriately.
I go further for an analysis of the nine benchmarks of just health proposed by Daniels, as well as Confucian ideals of health care, in order to enrich and fortify the difference principle in our treatment of disabled elderlies health care. Finally, as an example, I present the Taiwan case of feeding the disabled through nasogastric tube, who cannot chew and swallow food, and try to show that how the adoption of the principle could make a great improvement in the lives of the elderlies. Moreover, I introduce how the Japanese model by improving the feeding method and removal of the nasogastric tube, could help the elderlies returning to a free and dignity personality by taking food through mouth. Thereby establishing proper care resources, by taking seriously the dependence of the elderly and caregivers, could improve the life with dignity and freedom of the elderlies.
The present research discovers, in addition to the confirmation that the principle of difference can be made the foundation of long-term care ethics, it could also be used to improve feeding method to meet the health-care needs of the disabled elderly. Furthermore, I propose that when the government plans to legalize long-term care insurance, it should take the democratic procedure with dialogues with experts, scholars, pharmacy industry, opinions of societies, communities and associations, in order to form a proper and just long-term care program. |
