從科學知識與政策角度探析臺灣地區慢性傳染病之控制－以漢生病為例

Abstract

早期由於知識界對漢生病的認識不足，使得充滿隱喻、污名，與道德的聯想，千百年來就一直與漢生病鑲嵌在一起，成為病患擺脫不掉的痛苦與夢靨。臺灣地區對於控制像漢生病這樣的慢性傳染病，於不同的時間分界點，有其不同的處理方式與目的。疾病控制的政策推展，似乎應與科學知識同步進行，然而在臺灣地區漢生病的控制上，卻有著政策與科學知識不相連結的狀況，主宰組織決策的專家與菁英，似乎並非以建構科學知識作為風險評估之依據。 控制漢生病傳播的強制隔離政策雖然解除，但現今仍有許多法律或規定，突顯對於病患的歧視與誤解，而醫學知識的爭議內容，也是致使漢生病與這些條文無法脫鉤的關鍵因素。因此清楚將漢生病定位，將之從法定傳染病名單中除名，漸次修改與廢止有關之歧視條款，才是使社會不再對它恐懼與誤解的方式。本文將探究自1895年迄今，漢生病控制政策形成與當代科學知識的關係，並且反省目前漢生病的醫學知識爭議、相關的歧視條款，以及對於病患後續安養的風險評估。 政府應體認過去公共衛生政策上的錯誤，給予曾遭強制隔離的病患除金錢外之安養照護與協助，在制定決策之風險溝通上，能真正跨領域與跨學科，而非僅以經濟建設或交通發展，作為國家是否進步之指標，才是人民與社稷之福。也期盼在風險溝通的公民論壇上，專家與技術官僚能傾聽更多的聲音與需要，對風險之評估作出最平衡與妥適之處理，才能為人民謀取最大之幸福可能。

The imagination which full of metaphor, stigma and moral has been enchasing with Hansen’s disease over a long periods, as a result of lacking the understanding of Hansen’s disease in the early stages, then the imagination bring suffering and nightmare to this disease patients. In Taiwan, depending on different time of demarcation, it has diverse methods and intentions to control the chronic infectious disease just like Hansen’s disease. It which carrying out the policy of controlling disease should expanded with scientific knowledge, but in fact the situation to control Hansen’s disease has no relation between scientific knowledge and policy in Taiwan. The expert and elite who decide the policy, seem not depend on scientific knowledge to assess the risk. Although the policy of compulsory isolation which control Hansen’s disease has abolished, but it still has many legislations and regulations which display prejudice and misunderstanding against Hansen’s disease. The medical knowledge dispute is also the key point connect Hansen’s disease and legislations. We should orientate Hansen’s disease properly, expelled it from the list of statutory infectious disease and abolish the unjust clause in law, it is just the way to let multitude have no dread and misunderstanding anymore. This thesis will discuss the relationship between the policy of controlling Hansen’s disease and the contemporary scientific knowledge since 1895, reflect on medical knowledge dispute of Hansen’s disease, unjust clause in law and risk assessment of taking care of old patients at present. The government should recognize the mistake in the past public health policy, and provide help to the old patients who had ever suffered from the policy of compulsory isolation. And it would be the best when administering the risk communication which decided the policy has no sphere and subject. If the expert and the technical bureaucrat can learn how to listen to more voice and demand when they hold the public forum, then the risk communication will have the proper and equitable effect, and that’s the way to let multitude have happiness.