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研究生:黃志中
研究生(外文):HUANG, JOH-JONG
論文名稱:以後現代女性主義重構婚姻暴力受虐婦女診療驗傷之內涵與意義
論文名稱(外文):Reconstruct the medical care context and meanings of domestic violence battered women via postmodern feminism perspectives
指導教授:謝臥龍謝臥龍引用關係
指導教授(外文):SHIEH, VINCENT
口試委員:周煌智劉淑瓊王珮玲余嬪謝臥龍
口試委員(外文):CHOU, FRANK HUANG-CHIHLIU, JOANNE S.WANG, PEI-LINGYU, PINGSHIEH, VINCENT
口試日期:2016-06-20
學位類別:博士
校院名稱:國立高雄師範大學
系所名稱:性別教育博士學位學程
學門:教育學門
學類:其他教育學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:476
中文關鍵詞:婚姻暴力現代性責任通報危險評估診斷書
外文關鍵詞:domestic violencemodernitymandatory reportdangerous assessmentmedical certificate
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摘 要
本研究者探究台灣婚暴診療著重驗傷及診斷書開立之現象,省思婚暴婦女需要獲得婚暴傷害的診斷書做為司法訴訟佐證,過去卻常被拒絕診療、或被索取高額診斷書費用的歷史脈絡,回應到醫療照護強調證據、診療規範的現代性功能與困境,藉由後現代女性主義的研究觀點與取向,試圖透過診療驗傷現場及婚暴處遇歷程脈絡之間的互動經驗解釋,探索診療驗傷之內涵及意義。
於2015年7月至11月期間,本研究共計訪談67位研究參與者,包括17位婚暴婦女的三場焦點團體、13位護理師的四場焦點團體及1位護理師的個別訪談、6位醫師的個別訪談、17位社工及6位警察的四場焦點團體及3位社工的個別訪談、3位律師及1位法官的個別訪談。訪談資料的逐字稿在編碼後,依照婚暴診療驗傷事件歷程所顯現的主顯節,包括:看見婚姻暴力的醫療需求、婚姻暴力在診療驗傷過程中如何被看見、婚姻暴力傷害之診療驗傷、婚姻暴力傷害的診斷書,將研究參與者所提供的互動經驗加以編織、歸納與分析,再以後現代女性主義的知識生產揭露在診療驗傷互動經驗現象的意義。
研究結果顯示,婚暴婦女在外顯診斷書需求的診療驗傷下,對其婚暴隱私性以及婚姻關係衝擊的影響,會有著複雜而拉扯的思緒與狀態,是不被瞭解又不容易說明的婚暴處境,而醫療人員是在分科分工而缺乏共構的醫療作業中,形構出以外傷診療為主的診療關注,少重視心理創傷,在「修補-關懷模式」中,因過於強調機械損害的檢查、評估,與婚暴事件發生的情境脈絡斷裂,且迴避涉入他人婚姻關係的性別範示,及減弱在診療過程可能引起的情緒勞動,而少有關懷照護的互動關係建立。在醫療現場經過斷裂(de)程序而成為許多的碎片(parts)的斷裂碎片(de-partment)模式醫療工作中,婚暴診斷書的開立就成為「木乃伊化」的現象。婚暴診療所觸及關於婚姻關係的性別範式以及診療所帶來的情緒勞動,對醫療人員造成明顯的診療壓力。於是,透過婚暴被斷裂成傷害的碎片,以明確的現代性醫學技術框架來契合醫療分科的部門模式,將婚暴診療驗傷特殊化,在醫院急診的特定場域進行,婦女可以獲得傷害診療與診斷書,醫療人員也可避免不確定的蔓延而獲得安頓。因而,與婚暴防治資源具連結性的工作,像是責任通報或填寫TIPVDA量表以評估致命危險,在婚暴傷害與其脈絡被切割而缺乏連結的診療驗傷工作中,成為具規範性作業而非婚暴婦女為主的觀照,而容易失去其所具有關懷本質的積極意義,以致淪為被醫療人員視為是繁瑣、麻煩的行政程序。而婚暴婦女所遭受到的傷害,由其所外顯婚暴傷害、診療驗傷、病歷記錄到節本性質的診斷書,每一個過程都是一種限縮與失真的敘說斷裂,最後所呈現的婚暴診斷書是在「多重斷裂」後的產物。
根據上述研究結果,本研究建議婚暴診療除了既有的外傷傷害評估、診療架構外,需同時關注到婚暴婦女的情緒狀態,並能與婦女所處的情境脈絡相連結,以成為對婚暴傷害具有說明的醫療文字,兼顧婚暴傷害的損害評估、診療,以及婚暴狀態的關懷照護。以整合性醫療模式的複診診療以及資源連結,而非單一次急診的診療驗傷,提供婦女完整的照護,而所形成的病歷文本更可取代診斷書,而成為更具證明能力的證明文書,以說明婚暴及其傷害。
Abstract
In Taiwan, the medical care of domestic violence battered women usually focused on the medical certification, instead of medical care needs. However, in the past Taiwanese battered women suffered from medical care by being rejected to obtain medical certification or being charged high. This is quite different from Western countries, where the main issues are screening, identification and medical care without gender bias. At present time, standardized operation procedure with objective evidences for the medical care of battered women is also strongly influenced under modernity and this may restrict the heterogeneous needs of battered women. This study is designed to explore the complex intersection of social identity and modern medical care of battered women in the medical context via Interpretative interactionism approach.
From July to November 2015, there were totally 67 participants included in the study, as 17 battered women, 14 registered nurses, 6 medical doctors, 20 social workers, 6 police officers, 3 attorneys and one judge with 11 focus groups and 14 in depth interviews. The texts of participants’ thick description were analyzed according to the epiphanies of interpretative interactionism approach, and postmodern feminism as epistemology originated to produce knowledge via revealing the meaning of the interactional experiences of domestic violence medical care between battered women and medical staffs.
The results of this study showed that under the “fix-care model”, modern medical care used to doing “de” domestic violence events and put the injuried “parts” apart under the dominant ways of modernity, but with much less caring, which was rather an emotional labor to medical staffs. And this let battered women not being bothered by her miserable state. Medical practice mainly focused on the objective state of the injuries to exact examination and measurement, which was detached from the context. So, the medical certification was just a mummy significant of the medical violence, not to mention of gender paradigm of martial relationship, which regarded a husband as an owner of the marriage, and any male should be kept away from the private territory. Under these circumstances, mandatory report or dangerous assessment of domestic violence became just a kind of bureaucratic professional processes without active caring content. All these lead to the multiple levels fragmentation of the domestic violence management.
This study suggested that the emphasis of both fix and care should be balanced to maintain comprehensive medical care, and also the needs of co-construction of sub-specialties to offer better follow-care. Holistic medical care can provide more understanding of the violent state and the medical charts should be included more delicate documents, which could replace the medical certificate used in the court.
目 錄

第一章 緒論 …………………………………………………………………1
第一節 研究緣起……………………………………………………………1
第二節 研究背景……………………………………………………………7
一、台灣婚姻暴力醫療服務之現況………………………………7
二、從照顧服務到診療驗傷的現況困境…………………………9
第三節 後現代女性主義研究觀點與取向 ………………………………13
第四節 研究目的 …………………………………………………………17

第二章 文獻回顧 …………………………………………………………18
第一節 婚姻暴力的性別意涵及其歷史演變 ……………………………18
一、 婚姻暴力的性別意涵 ………………………………………18
二、 西方婚姻暴力定義的歷史演變 ……………………………19
三、台灣婚姻暴力定義的歷史演變 ……………………………21
小結:婚姻暴力意涵的時代脈絡性 ……………………………23

第二節 當代婚姻暴力防治發展 …………………………………………23
一、全球性別暴力治理下的婚姻暴力防治 ……………………23
二、全球性別暴力治理下婚姻暴力防治之台灣在地回應 ……25
三、婚姻暴力防治的現代性困境 ………………………………29
四、婚姻暴力防治的後現代情境 ………………………………30
五、交織性下的婚姻暴力現象 …………………………………33
六、婚暴關係中的性別流動與操演性 …………………………34
小結:婚暴力治理的後現代取向 ………………………………36

第三節 女性主義婚姻暴力理論的發展 …………………………………36
一、女性主義對於婚姻暴力防治的影響 ………………………36
二、自由主義女性主義的婚姻暴力理論主張 …………………38
三、基進主義女性主義的婚姻暴力理論主張 …………………40
小結:鬆動父權的多面向跨越 …………………………………41

第四節 婚姻暴力醫療服務現況與困境 …………………………………42
一、婚姻暴力受虐婦女的醫療照護需求 ………………………42
二、婚姻暴力醫療服務的內涵 …………………………………44
三、以婚暴篩檢的施作省思婚姻暴力之醫療服務 ……………47
四、醫療專業人員對於婚暴醫療服務的經驗 …………………48
五、婚暴婦女對於婚暴醫療照護經驗的反應 …………………50
六、非醫療領域專業對於婚暴醫療照護的回應 ………………52
小結:醫療現代性的社會性困頓 ………………………………54

第五節 後現代女性主義觀點的婚暴醫療 ………………………………55
一、婚暴醫療的政策規範 ………………………………………55
二、關於婚姻暴力的醫療知識 …………………………………58
三、醫療專業人員對於婚暴的個人認知態度 …………………60
小結:關係情境互動影響下的婚暴診療驗傷 …………………62

第三章 研究設計與執行 …………………………………………………63
第一節 解釋性互動取向 …………………………………………………63
一、婚暴診療驗傷的後現代情境探究需要 ……………………63
二、解釋性互動取向之觀點與內涵 ……………………………65
第二節 研究資料收集方法 ………………………………………………67
一、焦點團體法 …………………………………………………68
二、個別深度訪談法 ……………………………………………70
第三節 研究執行步驟 ……………………………………………………71
一、研究者的準備 ………………………………………………71
二、研究參與者及其背景 ………………………………………73
三、訪談大綱之構成 ……………………………………………75
四、前導性研究之執行 …………………………………………76
五、研究參與者之邀請與同意 …………………………………77
六、訪談之進行與資料收集 ……………………………………78
七、研究資料整理與轉譯 ………………………………………79
八、研究資料之厚實描述 ………………………………………80
九、研究資料之解釋與分析 ……………………………………81
十、對於研究者在執行研究過程中的檢核機制 ………………83
第四節 研究倫理 …………………………………………………………84
一、研究者之倫理研習與訓練 …………………………………84
二、研究計畫之倫理審查 ………………………………………85
三、研究參與者之權益保障 ……………………………………85
四、研究資料之保存、處理與銷毀 ……………………………86
五、研究結果之發表 ……………………………………………86

第四章 結果分析與討論 …………………………………………………87
第一節 看見婚姻暴力的醫療需求 ………………………………………89
一、 受虐婦女看見婚姻暴力的醫療需求 ………………………89
二、 醫療看見婚姻暴力受虐婦女的醫療需求 …………………117
三、 非醫療人員看見婚姻暴力受虐婦女的醫療需求 …………149
第二節 婚姻暴力在診療驗傷過程中如何被看見 ………………………169
一、 婚暴診療驗傷基本原則與技能 ……………………………169
二、 護理師所看見的婚暴診療驗傷 ……………………………192
三、 對婚暴婦女的危險評估與通報 ……………………………201
四、 不同醫療現場的婚暴診療驗傷 ……………………………221
第三節 婚姻暴力傷害之診療驗傷 ………………………………………243
一、 婚暴外傷傷害的診療驗傷 …………………………………243
二、 關於婚暴心理創傷的診療驗傷 ……………………………273
第四節 婚姻暴力傷害的診斷書 …………………………………………310
一、 婚暴婦女的診斷書經驗 ……………………………………311
二、 婚暴傷害診斷書的製作經驗 ………………………………321
三、 影響婚暴傷害診斷書製作之司法因素 ……………………339

第五章 結論與建議 ………………………………………………………372
第一節 結論 ………………………………………………………………372
一、 看見婚姻暴力的醫療需求 …………………………………372
二、 醫療看見婚姻暴力受虐婦女的醫療需求 …………………376
三、 婚姻暴力傷害之診療驗傷 …………………………………380
四、 婚姻暴力傷害的診斷書 ……………………………………389
第二節 建議 ………………………………………………………………395
一、 婚暴診療驗傷方式及內容的改變 …………………………395
二、 提升醫學教育關於婚暴之學養 ……………………………398
三、 改變醫療體制的結構性 ……………………………………400
四、 提升婚暴防治專業人員對於婚暴診療驗傷的跨領域認識及應用 ……………………………………………………………401
五、 未來研究之建議 ……………………………………………403
第三節 研究省思 …………………………………………………………405
一、 以醫療、婚暴為主體思維的轉變 …………………………405
二、 以婚暴實務厚實經驗作為婚暴防治研究創新的基礎 ……406

表次
表格一、工具性與價值性診療驗傷的比較………………………………………126
表格二、現代性與後現代女性主義取向診療驗傷的比較………………………265

參考書目
中文文獻 …………………………………………………………………………408
英文文獻 …………………………………………………………………………413

附錄
附件一、政府部門處理婚姻暴力的流程圖 ………………………………………433
附件二、研究者關於婚暴診療驗傷之相關著作發表 ……………………………434
附件三、研究者關於婚暴醫療之其他相關著作發表 ……………………………436
附件四、台灣親密關係暴力危險評估表(TIPVDA)……………………………440
附件五、台北市政府衛生局103年度醫院督導考核紀錄表:醫療機構受理家庭暴力及性侵害事件就醫保護作業考評(行政項目) ………………………………441
附件六、台北市政府衛生局103年度醫院督導考核紀錄表:醫療機構受理家庭暴力及性侵害事件就醫保護作業考評(專業項目) ………………………………443
附件七、新北市衛生局102年度醫院督導考核家庭暴力暨性侵害防治作業考核表
………………………………………………………………………………………446
附件八、彰化縣衛生局102年度性侵害責任醫院及家庭暴力防治督導考核表
………………………………………………………………………………………450
附件九、研究參與者基本資料資料 ………………………………………………454
附件十、診療驗傷訪談大綱 對象:接受婚暴診療驗傷者 ……………………457
附件十一、診療驗傷訪談大綱 對象:對象:診療驗傷執行者(醫師及護理師等醫療人員)…………………………………………………………………………458
附件十二、診療驗傷訪談大綱 對象:對象:診療驗傷後續工作者(社工人員、警政人員、司法人員)………………………………………………………………459
附件十三、研究者自2012至2015年參加之研究倫理訓練程 …………………460
附件十四、人體試驗/研究同意證明書(中版)…………………………………462
附件十五、人體試驗/研究同意證明書(英版)…………………………………463
附件十六、家庭暴力事件通表 ……………………………………………………464
附件十七、婚姻暴力被害人之安全計畫衛教(TIPVDA =0~5分) ………………467
附件十八、婚姻暴力被害人之安全計畫衛教(TIPVDA =6~7分) ………………468
附件十九、婚姻暴力被害人之安全計畫衛教(TIPVDA =8~15分) ……………469
附件二十、某私立醫院甲種診斷書 ………………………………………………470
附件二十一、某公立醫院甲種診斷書 ……………………………………………471
附件二十二、某精神科專科醫院甲種診斷書 ……………………………………472
附件二十三、某私立醫院乙種診斷書 ……………………………………………473
附件二十四、某公立醫院乙種診斷書 ……………………………………………474
附件二十五、某精神科專科醫院乙種診斷書 ……………………………………475
附件二十六、家庭暴力事件驗傷診斷書 …………………………………………476

參考文獻
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內政部(2013)。2013年內政部家庭暴力及性侵害防治委員會第6屆第4次委員會議資料。台北:內政部。
王佩玲(2010)。警察、檢察官、法官對社工認知之探討:以家庭暴力及性侵害案件處理為例。臺大社工學刊,21:1-54。
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