兒童虐待議題之研究倫理探討

Abstract

台灣自 1973 年頒佈「兒童福利法」起邁出了兒少保護的第一步。2011 年頒 布的「兒童及少年福利與權益保障法」，整合了兒童與少年的保護與照顧規範， 也呼應聯合國兒童權利公約的精神。隨著實務工作的推展，聚焦在兒童虐待(以下 簡稱兒虐)相關議題的學術研究也越顯得重要，研究者更需要審慎地面對其中牽涉的研究倫理問題。但相對於歐美國家，我國較少聚焦在兒虐議題的學術研究，也 較少此類研究的倫理論述。 本研究參考關於兒虐議題研究之專論並歸納出幾個主題:知情同意、傷害與 行善的權衡、保密與通報、報酬。再綜合研究者規劃兒虐議題研究之親身體會， 增列主題「研究合作與個案招募」，並將「報酬」併入「傷害與行善的權衡」主 題中，最後以 1)研究合作與個案招募，2)知情同意，3)傷害與行善的權衡，4)保 密與通報，作為研究之四大主題。 本研究旨在瞭解國內兒少保護相關專業人士對於兒虐議題研究倫理的見解， 並希望提出符合我國國情的兒虐議題研究之建言。本研究採半結構式深度訪談學 者專家、國內法條整理、系統性文獻回顧的方式，探討兒虐議題相關的研究倫理 挑戰。共訪問來自兒童醫學、社政、倫理、法律、精神醫學、心理衛生等領域之 專家共 15 人，整理法律條文 19 條，回顧文獻 82 篇。 研究討論的倫理挑戰議題中，專家在部分議題的意見分歧，如:社工參與研究招募之爭議、被安置之兒少個案的知情同意爭議、研究者不接觸兒少個案的知情同意爭議;在部分議題上，專家學者提出與文獻不同的觀點，如:研究造成個案的心理創傷;亦有倫理議題雖在國外備受討論，在國內並不具爭議性，如:研究報酬。本文參照專家意見、法律條文與文獻，對於在國內進行兒虐議題研究將面對的倫理議題提出建議:應該允許社工參與兒虐相關研究的招募工作;當家長本身是施虐者時，家長在兒虐議題研究上便很難以兒童最佳利益作考量，因此兒少個案參與研究的法定代理人應為社工;當研究者以不接觸個案的方式收集研究資料，應視資料之辨識度決定其是否需要取得個案本身的知情同意;研究者應在風險評估時區分「不適感」與「心理創傷」的差異，並且為個案規劃輔導諮商的資源;研究者面對兒虐或生命安全事件時，有義務打破保密協定並通報，研究者應在收案時告知個案此一可能性。

The promulgation of Children Welfare Act in 1973 was considered the first step toward child protection in Taiwan. Based on The Convention on the Rights of Children, the Children Welfare Act was revised and rename as the Protection of Children and Youths Welfare and Rights Act in 2011. This Act is an integration of the regulations about child welfare and protection. As the domain and intensity of related practices increases, the need for research about child abuse becomes more urgent than ever. The ethical considerations about doing good research of child abuse have also become important. But compared to Western countries, the number of studies about child abuse in Taiwan is small and literature about research ethics in this field is even scarce. According to the review articles about child abuse research ethics, topics such as informed consent, balance between maleficence and benefit, confidentiality and report, payment and incentive were identified as important ethical challenges. This finding was integrated with the researcher’s personal experience of organizing a child abuse research. The topic of “collaboration and recruitment” was added, while “payment and incentive” was merged into the topic of “balance between maleficence and beneficence”. The 4 major topics in this study were 1) collaboration and recruitment, 2) informed consent, 3) balance between maleficence and beneficence, 4) confidentiality and report. The aims of this study are to explore the different views of different professionals about how to conduct child abuse research ethically in Taiwan and to make suggestions about doing research in this field. The research methods included in-depth semi- structured interview with professionals, reviewing Taiwan’s related laws and regulations, and systemic literature review about research ethics in child abuse. In total, 15 professionals from fields of pediatrics, social work, ethics, law, psychiatry, and mental health were interviewed. 19 provisions of laws and regulations, and 82 related academic articles were retrieved and analyzed. Through interview, it was shown that interviewees had diverse views on topics such as social workers’ involvement in recruitment, informed consent in children under foster care, and informed consent in researches which do not collect information directly from children. In the topic of trauma caused by research, professionals held views different from the majority of literature. In the topic of payment and incentive, professionals did not consider it an ethical challenge as serious as in other countries. Combining the results of in-depth interview, statutory review and literature review, suggestions were made about the research ethics in doing child abuse research in Taiwan. Social workers should be allowed to participate in the process of recruitment. If a child was abused by his/her parents, it’s reasonable not to trust the parents to make substitute decisions about joining a child abuse research based on the child’s best interest. A social worker is more appropriate as a legal representative instead. If a researcher collects data not directly from a person, the identifiability of the data is the major consideration of whether a researcher should obtain informed consent from him/her. While evaluating the potential risk of a research, a researcher should differentiate “distress” from “psychological trauma”, and prepare the resource of counseling for the participants. A researcher is obligated to breach confidentiality and to report when information about maltreatment or life-threatening events is disclosed. And this possibility should be informed to the participants during recruitment.