• 作者： 張苙雲
• 作者服務機構： 中央研究院社會學研究所籌備處
• 中文摘要： 這篇論文的寫作源自於現實議題的困惑：一個完全和臺灣社會有著明顯不同宇宙觀和自然律，來自西方的生物醫學範型，如何在一百多年的發展中，成為今日大眾生活中的理所當然。它合法地成為提供醫療服務的場所，而且是主流的醫療服務場所。這篇論文指出臺灣醫療照顧產業不是發韌於知識層次的研讀，也不是從上層社會和知識分子著手，而是借由西方傳教士配合他們的傳教藍圖有計劃的散播，始於實證及庶民層次的經驗體會，是中國人以直觀與體會的思維方式的典型。這時民眾對西醫照顧的效果的折服與接納，是附著於西藥、手術、和傳教士西醫個人的信任。此個附著於西藥、手術、和西醫個人的信任，在殖民政府的介入建構後，逐漸擴散漫延，轉而成對醫療組織制度的信任。日本殖民政府據臺後的種種積極的作為，奠定了西醫的絕對優勢，同時促使民間漢醫的沒落。本文指出在臺醫療制度的落地生根，從無到有，到成為合法提供醫療服務的場所，這個歷程是個價值營造、建構信任的過程：初期有透過教會傳教士，進行庶民層次的傳播；繼而由國家力量奠基。無論是日本殖民政府，或是其後的國民政府，政府介入的方式是為訂定醫院規格形式以及相關的遊戲規則。這個過程彰顯的是科學·理性、與紀律，集體性品質保證，可以稱之為「集體能力」。生物醫學範型的醫療照護以這樣的特質，贏取民眾的信任。
• 英文摘要： This study examines the institutionalization of the biomedical model of health care in Taiwan. Despiteits profound incompatibility with Chinese folk wisdom and medical culture, Western medicine has become thedominant model of medical care and its legitimacy is firmly established in the society. The basic finding is thatthe dominance of the biomedical model was the result of three distinct processes. First, the transfer wasmainly a by-product of western medical missionary in the late 19th Century - over 130 years ago. The transferdid not originate from an indigenous attempt to learn and acquire western knowledge, nor did it diffuse as atop-down process that began with the upper class and the well educated Taiwanese. Second, the native peopleaccepted the biomedical model only after witnessing startling success of western medicine. The acceptancecame only after much personal experience with western medicine in daily life. Many were convinced by themounting experiential evidence that western medicine indeed works. Third, public trust in biomedicine wasreinforced and generalized by the efforts of the Japanese Colonial Government and the National Government.Originally, patient-physician trust was personal and based on the characteristics of individual physicians.Because of severe agency problems in a patient-physician relationship, the demand for personal trust haslimited the spread of this relationship. When the Japanese colonial government in Taiwan started to regulatethe practice of medicine, the basis of trust in western medicine began to shift. By imposing quality standardsand promoting an image of collective competence in delivering scientific, rational, and disciplined medical care,the state has transformed the medical care industry: the demand for personal trust in individual physicians hasbeen greatly reduced; public trust in western medicine is increasingly driven by trust in the institutions ofmedical care; and the dominance over Chinese medicine is virtually complete.
• 中文關鍵字： 制度信任; 臺灣醫療制度; 醫療專業; 醫療傳道; 日本殖民政府
• 英文關鍵字： institutional trust; Taiwanese medical system; health professions; medical missionary; Japanese colonial government