一位35歲已婚女性因上臂有著多處不規則、形似手指抓痕的嚴重瘀青而來到急診室。在她的丈夫步出房門後，護理師以非批判的語氣詢問這些傷勢。個案突然崩潰大哭並坦承：「是我丈夫昨晚打我的。護理師，我求求妳，絕對『不要』報警或通報。如果他被抓去關，我的孩子們會餓死，而且等他出來後他一定會把我給殺了。這件事我自己會處理！」在倫理與法律上，護理師最恰當的行動為何？
A 35-year-old married female presents to the emergency department with irregular, finger-shaped severe bruising on her upper arms. After her husband steps out of the room, the nurse asks about the injuries nonjudgmentally. The client bursts into tears and confesses, "My husband beat me last night. Please, I beg you, do NOT call the police or report this. If he goes to jail, my children will starve, and he will literally kill me when he gets out. I will handle this myself!" Ethically and legally, what is the most appropriate action for the nurse?
- ACall the local police department immediately because any form of confessed domestic physical violence is legally subject to mandatory reporting.立即撥打當地警察局電話，因為任何承認的家暴案件依法均須強制通報。
- BCall the husband back into the room and confront him directly about the abuse to show the client she has an advocate.叫丈夫回到房間，直接當面對質其虐待行為，以向病人展示護理師是她的支持者。
- CInform the client firmly that her refusal cannot be accepted because she is endangering her children by staying in an abusive household.堅定地告知病人，由於她留在受虐家庭中危及子女安全，其拒絕介入的意願無法被接受。
- DDocument the client's confession, honor her legal right to refuse intervention, but provide a list of local safe shelters and domestic abuse hotlines.✓ 正解記錄病人的自白，尊重其依法拒絕介入的權利，但提供當地安全庇護所和家庭暴力熱線的清單。
本題探討親密伴侶暴力 (Intimate Partner Violence, IPV) 在法律與倫理上的通報界線。在多數法律規範中，護理人員針對兒童虐待 (Child abuse) 及老人/無能力者虐待 (Elder abuse) 扮演『強制通報者 (Mandatory reporter)』的角色。然而，當受虐者是一位具備行為能力的「成年人」時，她擁有絕對的自主決定權。若是這位婦女明確拒絕醫療團隊介入或報警，護理師「不可（Cannot）」違反其意願強行報案（除非她持有致命武器或將立即危及大眾）。強行報警不僅侵犯其自主權，更被證實會激怒施暴者，導致受害者回家後遭到更致命的報復殺害。選項A與C違反成年自主權。選項B直接與施暴者對質是極端危險的，可能在醫院內引發致命暴力。正確且唯一安全的做法是尊重她的選擇，仔細將傷勢拍照建檔，並提供社會資源、安全避難所及熱線資訊（選項D正確），讓她隨時知道有逃生的後盾。
Competent adults have the legal right to refuse intervention for intimate partner violence, so the nurse must respect this autonomy while ensuring safety. The nurse should document the findings accurately and provide resources such as shelter information and hotline numbers without confronting the abuser or forcing police involvement.
台美在「強暴與家暴」案件中對於強制通報的法規極為不同。台灣《家庭暴力防治法》規定醫事人員在24小時內若得知家暴「必須強制通報主管機關」，但不代表強制報警抓人；而美國法規中，只要是心智正常成年人家暴，多半州別是「尊重被害者意願至上、沒有強制通報」。