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| Title: | 衰弱與死亡地帶的法意識：居家護理師的裁量與關係責任
Legal Consciousness between Frailty and Death: Discretion and Relational Responsibility among Home Care Nurses |
| Authors: | 蔡蕙珊
Tsai, Hui-Shan |
| Contributors: | 王曉丹
Wang, Hsiao-Tan
蔡蕙珊
Tsai, Hui-Shan |
| Keywords: | 法意識
官僚法意識
關係責任
情感衡平
居家護理
專業裁量
Legal consciousness
Bureauractic legal consciousness
Relational responsibility
Emotional balance
Home care nursing
Professional discretion |
| Date: | 2025 |
| Issue Date: | 2025-09-01 16:24:03 (UTC+8) |
| Abstract: | 法律賦予醫護人員一定程度的專業裁量權，然而在醫療照護的實務中，裁量常游移於官僚規範與護病關係之間的灰色地帶，展現了操作上的彈性空間，也揭示了法律在面對衰弱與死亡時的倫理張力以及實踐樣貌。本研究旨在探討：當制度規範與護病關係中的倫理困境衝突時，居家護理師如何在風險責任與倫理能動之間思維與行動。現有的官僚法意識研究多指出，街頭官僚的專業助人者傾向訴諸法律權威，以正當化對民眾訴求的拒絕，卻較少觸及突破此法律霸權的可能。
本研究從法意識的關係性視角切入，分析居家護理師如何在照護實務中，反覆定位自身角色，歷經矛盾、協商與調整，最終實踐裁量的動態過程。透過訪談十位居家護理師，蒐集其照護經驗與法律相關敘事，聚焦兩個面向：第一，護理師在照護現場如何詮釋自身的專業角色與倫理情境；第二，如何理解法律風險與糾紛經驗，並發展出因應策略。
研究發現，雖然制度規範深植於護理官僚的法意識之中，但在居家照護場域中，多重關係的影響改變了原本由法律霸權主導的行動邏輯。透過「情感衡平」的判準，護理師與案家逐步由情、權威、公共性三個層次建立起「關係責任」，促發了護理師作為倫理主體的能動性，進而挑戰既有的法律霸權。藉此，本研究期望能為街頭官僚的法意識研究提供不同的視角，並開啟更多關於制度規範與人本關懷間的省思。
Legal frameworks grant healthcare professionals a degree of discretion, yet in practice, this discretion often operates in a gray zone between bureaucratic regulation and caregiver–patient relationships. Such ambiguity reveals the ethical tensions that emerge when law confronts frailty and end-of-life care.
This study explores how home care nurses navigate conflicts between institutional norms and ethical obligations in their caregiving roles. Drawing on a relational perspective of legal consciousness, the research examines how nurses interpret their professional identities and respond to legal risks. In-depth interviews were conducted with ten home care nurses, focusing on two dimensions: (1) how they make ethical decisions in practice, and (2) how they understand and manage legal disputes.
Findings reveal that while bureaucratic norms shape nurses’ legal consciousness, caregiving interactions grounded in the cultural model of emotional equilibrium give rise to a sense of “relational responsibility.” This responsibility enables nurses to exercise moral agency, sometimes challenging formal legal authority in favor of human dignity and context-sensitive care.
This study contributes to legal consciousness literature by illustrating how professional caregivers engage with law not only through compliance, but also through ethically motivated discretion. It calls for institutional frameworks that better accommodate the ethical complexity of care work and support professionals in balancing legal and relational responsibilities. |
| Reference: | 壹、中文文獻
一、專書
1. 醫療改革基金會（2021）。醫療爭議處理參考手冊 （第四版）。
二、期刊論文
1. 王曉丹（2018）。法意識探索：關係自我的情感衡平。政治與社會哲學評論，67，103–159。
2. 陳昭如（2009）。在棄權與爭產之間：超越被害者與行動者二元對立的女兒繼承權實踐。臺大法學論叢，38(4)，133-228。
三、雜誌文章
1. 葉宏明、林秀碧、吳重慶、黃秀雲、顏裕庭（2000）。台灣居家照護的軌跡初探。秀傳醫學雜誌，2（3），111-115。
2. 黃芷芊（2005）。SARS 時期護理專業人員的倫理困境。應用倫理研究通訊，34，15-25。
3. 楊婉萍、陳玉鳳（2021）。護理業務與法律風險管理－以注意義務為中心。護理雜誌，68（4），6-13。
四、學位論文
1. 吳冠昇 （2022）。專業證照制度之研究：以專技人員執業資格之考試權與工作權保障為核心（未出版碩士論文）。 國立臺灣大學法律學研究所。臺灣博碩士論文知識加值系統。https://hdl.handle.net/11296/bue5dh。
2. 張慶言（2022）。從醫病關係看安樂死與協助自殺（未出版碩士論文。國立台灣大學科際整合法律學研究所。 臺灣博碩士論文知識加值系統 https://hdl.handle.net/11296/f8cztj
3. 鄭淑芬（2010）。居家護理人員介入居家照顧經驗之研究－以獨立型態及區域醫院居家護理師為例（未出版碩士論文）。南華大學生死學研究所。臺灣博碩士 論文知識加值系統https://hdl.handle.net/11296/tkur97
五、政府機關資料
1. 中央健康保險署（2023）。全民健康保險居家醫療照護整合計劃（112年3月 22日公告）。
2. 司法官學院犯罪防治研究中心（2023 年）。 家庭照顧者為何殺人？判決書類文本分析之探討。中華民國法務部司法官學院。
貳、 英文文獻：
一、專書
1. Ewick, P., & Silbey, S. S. (1998). The Common Place of Law: Stories from Everyday Life. University of Chicago Press.
2. Foucault, M. (1975). Discipline and punish: The birth of the prison (A. Sheridan, Trans.). New York, NY: Pantheon Books. (Original work published 1975)
3. Goffman, E. (1990). Stigma: Notes on the management of spoiled identity. Penguin Books. (Original work published 1963)
4. Hertogh, M. (2018). Nobody’s Law: Legal Consciousness and Legal Alienation in Everyday Life. Palgrave Macmillan.
5. Lipsky, M. (2010). Street-level bureaucracy: Dilemmas of the individual in public services (30th anniversary expanded ed.). Russell Sage Foundation. (Original work published 1980)
6. McNamee, S., & Gergen, K. J. (2015). Relational responsibility: Resources for sustainable dialogue (Rev. ed.). SAGE Publications. (Original work published 1998)
7. Merry, S. E. (1990). Getting justice and getting even: Legal consciousness among working-class Americans. The
University of Chicago Press.University of Chicago Press.
8. Watson, J. (2008). Nursing: The philosophy and science of caring. University Press of Colorado. (Original work published 1979)
二、期刊論文
1. Abrego, L. J. (2019). Relational legal consciousness of U.S. citizenship: Privilege, responsibility, guilt, and love in Latino mixed-status families. Law & Society Review, 53(3), 641–670.
2. Chua, L. J., & Engel, D. M. (2019). Legal consciousness reconsidered. Annual Review of Law and Social Science, 15, 335-353
3. Cooper, D. (1995). Local government legal consciousness in the shadow of juridification. Journal of Law and Society, 22(4), 506–526.
4. Halliday, S., Kitzinger, C., & Kitzinger, J. (2014). Law in everyday life and death: a socio-legal study of chronic disorders of consciousness. Legal Studies, 35(1), 55–74.
5. Halliday, S. ,& Morgan, B. (2013). I fought the law and the law won? Legal consciousness and the critical imagination. Current Legal Problems, 66(1), 1–32.
6. Headworth, S. (2020). The power of second-order legal consciousness: Authorities’ perceptions of “street policy” and welfare fraud enforcement. Law & Society Review, 54(2), 320–353.
7. Richards, S. (2015). Unearthing bureaucratic legal consciousness: Government officials’ legal identification and moral ideals. Social & Legal Studies, 24(3), 289–308.
8. Silbey, S. S. (2005). After legal consciousness. Annual Review of Law and Social Science, 1(1): 323–368.
9. Silva, F. de Sa e (2022). Relational legal consciousness and anticorruption: Lava Jato, social media interactions, and the co-production of law’s detraction in Brazil (2017–2019). Law & Society Review, 56(3), 344–368.
10. Wang, Hsiao-Tan (2019). Justice, emotion, and belonging: Legal consciousness in a Taiwanese family conflict. Law & Society Review, 53(3), 764–790.
11. Young, K. (2014). Everyone knows the game: Legal consciousness in the Hawaiian cockfight. Law & Society Review, 48(3), 499–530.
三、學位論文
1. Jansson, K. (2020). Legal consciousness in street-level bureaucracies: An interpretive approach to social workers’ legal reasoning in activation policy implementation [Unpublished Master’s thesis]. Lund University. https://lup.lub.lu.se/student-papers/search/publication/9013451
四、政府機關資料
Institute of Medicine. (1999). To err is human: Building a safer health system. National Academy Press. |
| Description: | 碩士
國立政治大學
法學院碩士在職專班
111961008 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0111961008 |
| Data Type: | thesis |
| Appears in Collections: | [法學院碩士在職專班] 學位論文
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