醫療行善: 中國醫學道德傳統的詮釋

Medical Beneficence: Understanding the Chinese Medical Ethical Tradition

Abstract

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

中國古代醫學道德具有悠久的傳統。中國醫學史上“醫乃仁術”的命題，充分體現了中國醫學傳統十分重現醫療實踐的倫理價值。該文基於中國傳統文化的背景從四個方面討論了醫療行善的思想基礎和實踐意義。首先，文章追溯了中國古代儒、道、佛思想對醫療行善觀念的重要影響，指出中國傳統醫學的醫療行善觀念是以儒家仁愛思想為核心，融合了道家和佛家的仁慈、慈悲觀念而形成的一種多元價值取向的框架體系。其次，該文闡述了中國傳統醫學非常重視醫療實踐的道德價值，其中主要包括強調醫療活動以病人而不是疾病為中心；將病人視為一個整體的人而不是損傷的機器；主張關懷病人、尊重病人；重視醫患之間的合作關係；重義輕利、捨利取義的理想人格成為醫生的追求目標；反對義醫射利。再次，文章評述了在以儒家文化背景下醫療行善的社會道德價值，表現在：知識分子因各種原因不能治國安邦時，將行醫治病作為實現個人價值的重要途徑；將行醫治病作為增進家族或家庭和睦的有效手段；將行醫治病作為傳播宗教思想的重要途徑；將行醫治病作為政府舒緩民怨的良方。最後，該文簡要地比較了中西方醫療實踐中醫療行善觀念的異同，指出醫療行善作為醫療實踐的一項最基本原則在中西方得到普遍的認同，但是，在具體的實踐過程中，中西方對於醫療行善的理解和解釋依然存在着一定的差異。西方醫學倫理學認為醫療行善應服從於尊重病人自主權，醫療行為的善體現在以病人利益為目的，而中國醫學倫理學則是強調醫生救死扶傷的義務，主張醫療行為在注重病人利益的同時也應兼顧家庭的利益。

China has a long standing of a dominant medical ethical tradition. This tradition can be characterized a medial beneficence. The physician, within this tradition, is morally required to pursue the best interest of the patient rather than the best interest of himself. The practice of this tradition is characteristic of the Chinese culture of family determination on medical issues and is also closely related to the basic virtues approved in the Chinese community.

This tradition is rooted in three primary Chinese religions. First, Confucianism sets the basis of Chinese medical beneficence. Confucianism emphasizes humanity (ren) as the fundamental principle of human life. Humanity represents a specific human heart-mind that has been invested to every human by Heaven, the ultimate reality. The human heart-mind includes the potential of loving, respecting others, and distinguishing right and wrong. Accordingly, humanity, in its very basic sense, requires loving humans. Medicine provides a good means in practicing humanity. Thus in Chinese culture medicine is termed "the art of humanity." In addition, the Confucian virtue of filial piety has often been the impetus to push the Chinese physician to study and practice medicine effectively.

Daoism cherishes human life and seeks to gain longevity in terms of Daoist techniques, such as doing physical exercise and making chemical drugs. It includes a strong idea of retribution. Heaven, earth, and man co-exist in a vast field of qi (flowing energy), where qi of each part influences others through the influence of the qi field. Good moral behavior, according to Daoism, becomes a necessary condition for one to be able to gain longevity or even immortality. Thus, Daoism joins Confucianism in stressing that the physician ought to do his best to help the patient improve health, both bodily and mentally.

Chinese Buddhism is similar in this regard. A crucial idea involved here is the Buddhist concept of karma. Karma is literally "action," "doing," or "deed." It says that one reaps what one sowed. Until one is entirely enlightened, everyone goes through an infinite process of rebirth and the result of one's rebirth depend s upon one's accumulated karma. Hence one must do as much good as possible in order to obtain a better next life. Practicing medicine is an effective tool to achieve this goal. Besides, the Buddhist precepts such as "no killing" also plays an important role in Chinese medical practice.

In short, Confucian, Daoist, and Buddhist teachings have shaped the Chinese tradition of medical beneficence. This tradition requires the physician to place the patient's benefit first and the physician's interest second. For Confucianism, this is the requirement of human appropriate ness, fairness, or justice. This tradition also shows a closely-knit team work between the physician and the family to seek the best interest for the patient. The consideration of truth- telling to the patient and the patient's right to medical decision has never been emphasized.

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