道德生死觀下的臨終關懷辨析

Caring for Terminally Ill Patients: The Daoist Perspective

Abstract

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

戀生懼死是人之常情。對於一個瀕臨死亡的人來說，其最大的悲劇莫過於沉浸於對死亡的心理焦慮之中。因此，臨終關懷的重要價值指向應是最大限度地減輕瀕死者的心理痛苦。人生的態度與死亡的觀點息息相闕，瀕死者的悲哀正在於死亡焦慮中的生死困惑。道家文化倡導出生入死、道法自然、無為處世。它以低音悠揚但可震憾現代人心曲的生死吟唱，可以引導臨終者走出死亡焦慮的心理誤區，消解悲苦於無形。

安樂死是臨終關懷的應有之意。道家生死論尚自然，法自然，主張人為要與自然之序相協調，不應違反自然而強做妄為。道家反對用過枉之舉去擾亂人的生死變化，認為在死亡來臨時，順其自然，享其“安樂”，尊嚴而歸是不失為善終的。因此，在道家生死觀下，“被動安樂死”（即放棄治療）實為良策，而各種形式的“主動安樂死”（包括醫助致死）均與道家生死論主旨相悖。

In confronting death there are differences among people regarding their deep concerns. A survey shows that most Chinese Catholics are worried about what will happen to them after death, whereas most other Chinese are concerned about unfinished life plans, unfulfilled familial obligations, and so on. However, most Western and Chinese authors agree that a great number of terminally ill patients suffer from anxiety, sadness, and depression. And no one denies that unease, puzzle, solitude, and even anger are often experienced by many dying patients. Against this background, this essay argues that the mental sufferings of terminally ill patients can appropriately be healed by taking the Daoist perspective over life and death. Moreover, the essay demonstrates that the Daoist position sheds light on the debate around the issue of passive and active euthanasia.

According to the Daoist, the Dao is the way of nature. Nature is a universal process of constant change, binding all things together into a vast and natural harmony. Humans should live freely, naturally, and spontaneously in accord with the Dao. From the Daoist perspective, life and death can be analogized as day and night. They constitute two complementary aspects of nature. Where there is life, there is death. Everything living dies, and death implies new life. In short, just as the ceaseless transformation of four seasons in nature, life and death constitute a balanced knot in the harmonious chain of constant natural changes. Therefore, humans should take death naturally, just as they take life naturally. Humans should not have unnatural worry or anxiety on death in their mind.

As there are the natural rules of the Dao, one should follow these rules rather than create artificial human laws. For the Daoist, one artificial expectation for humans is to gain an eternal life without death (here the classical philosophical Daoism remarkably differs from the subsequent religious Daoism which pursues immortality). The other unnatural concerns include mental inseparability from the benefits, utilities, and complicated human relations offered in the living world. The Daoist believes that life and death should be identified as one process and that humans and nature should be taken as a unity.

Concerning the issue of euthanasia, we believe that the Dao as following nature is consistent with the position of so-called passive euthanasia. Passive euthanasia allows the terminally ill patient naturally to accept death by foregoing aggressive medical procedures when such procedures cannot do more benefit than harm to the patient. Peaceably accepting death when it naturally comes is the human action performed in accord with the Dao. Launching extra human efforts against natural processes is against the Dao.

However, the Daoist cannot advocate any type of active euthanasia or physician assisted suicide. On the one hand, the Daoist admires the man who does not use unnatural instruments to prolong the period of dying in the natural process of death. On the other hand, however, to take active means to kill the patient is to act against the Dao. Indeed, actively to kill the patient is on purpose to destroy the natural mechanism and process of human life. It is to intervene with the spontaneous way of nature in the worst sense. Therefore, the Daoist cannot consider it good to take human life with the help of medical tools.

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