協商風險：羊膜穿刺檢查在台灣的早期發展 （1970s-1990s）

Abstract

本研究描繪1970年代到1990年代羊膜穿刺檢查在台灣的早期發展，分析引進與推行羊膜穿刺檢查的行動者讓技術擴展的過程。本研究以「風險」作為核心概念，探討羊膜穿刺檢查在發展過程中，制度上如何建構染色體異常胎兒的風險，並將羊膜穿刺檢查作為處理風險的工具、醫界行動者如何處理技術風險，讓羊膜穿刺檢查在台灣落地，並從圍繞羊膜穿刺檢查的論述、實作和制度如何調整的面向，探討何以使用率低迷的羊膜穿刺檢查能在1990年代中期後迅速擴大。本研究主要以「檔案文獻」方法進行資料收集，分析圍繞羊膜穿刺檢查的論述、實作與制度。主要的檔案資料來自政府機關檔案、醫學期刊、醫學會會刊、醫界人士的傳記與回憶錄、以及報章媒體與雜誌。 本研究發現，羊膜穿刺檢查從1970年代引進台灣，1980年代技術落地，到1990年代中期的迅速擴展，為一個建構風險、編排風險及重組風險的社會過程。1970年代到1980年代，染色體異常胎兒在制度上逐步被建構為主要的有礙優生群體，並在《優生保健法》立法過程中，由人工流產合法化、優生保健諮詢中心，以及羊膜穿刺補助政策的條件配合下，讓羊膜穿刺檢查成為解決此風險的工具。1980年代到1990年代，醫界行動者編排技術風險，讓羊膜穿刺檢查在台灣落地，但甫向大眾推行檢查，便遭遇檢查失敗所導致的醫療糾紛事件，絨毛膜取樣術的興起也讓侵入式檢查的風險意識升高，使羊膜穿刺檢查遲遲無法提高。1990年代起，醫界行動者轉變風險論述，建構一個新的風險現象：重塑風險目標為「唐氏兒」、劃定新的風險團體「年輕孕婦」，以及裝配新的技術「母血篩檢」，並在隨後推行母血篩檢唐氏兒政策，讓更大規模人口的孕婦，爲了避免生下唐氏兒，決定先行篩檢後做羊膜穿刺檢查。透過醫界行動者重組風險的過程，羊膜穿刺檢查使用率得以在1990年代中期開始飆升。

This paper traces the early development of amniocentesis in Taiwan from the 1970s through the 1990s. It examines how the actors enabled this technology to expand. This paper uses ‘risk’ as the main concept to explore how the risk of chromosomal abnormal fetuses shaped and how amniocentesis was framed as the tool to solve this risk at the institutional level; how medical professionals arranged technical risks and introduced amniocentesis; and how the utilization of amniocentesis has rapidly grown since the mid-1990s. I use documentary analysis as the main research method. Data include government archives, medical journals, medical association journals, biographies and memoirs of medical professionals, newspapers, and magazines. Through documentary analysis, this paper shows that the early development of amniocentesis in Taiwan from the 1970s through the 1990s is a social process of constructing risk, arranging risk, and reconfiguring risk. From the 1970s to the 1980s, chromosomal abnormality fetuses were gradually constructed in institutional terms as a major category of ‘eugenically undesirable’ populations. During the legislative process leading to the Genetic Health Act, the legalization of abortion, the establishment of eugenic health counseling centers, and the subsidy policy of amniocentesis together enabled this technology to be framed as the tool to solve the risk of chromosomal abnormality fetuses. From the 1980s to the 1990s, medical professionals arranged the technical risks and started to implement amniocentesis. However, technical risk, including procedural failure and complications, significantly constrained the early introduction of the procedure. The introduction of CVS also impacted awareness of the risks of intrusive tests, resulting in the low utilization of amniocentesis before the 1990s. From the 1990s, medical professionals reconfigured risk discourse by framing Down syndrome as a serious social problem and broadening the population eligible for testing, which enabled the rapid expansion of amniocentesis use from the mid-1990s. This paper demonstrates that the implementation of amniocentesis depends not only on technical knowledge but on the ongoing negotiation of multiple risks, with medical professionals playing a dominant role in shaping clinical uptake in Taiwan.