知情同意的權利主體: 儒家倫理視角下的考察

Who has the Right of Informed Consent? A Study in the View of Confucian Ethics

Abstract

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

“ 知情同意”這個在西方文化背景中產生的倫理和法律術語在中國仍然是一個比較新的概念。尤其是對於知情同意的權利主體這一基本問題，在立法實踐和臨床實務中仍存在認識模糊和不一致之處。本文基於儒家家庭倫理的基本精神——尊重個人意願與家庭關懷的統一，提出了關於知情同意權利主體的立法建議。在儒家倫理中，主張“和而不同”、“互以對方為重”，體現了尊重個人意願的思想。在儒家倫理中還主張“父慈子孝”、“兄友弟恭”、“夫婦和順”，體現了家庭關懷。可見，在儒家倫理視野下，知情同意權利並非由家屬包辦，也非僅僅屬於患者而和家庭無關，而是在患者做主前提下的家庭參與，是患者做主與家庭關懷的統一。所以，對於有同意能力的患者而言，其本人所作的同意表示才具有法律效力；只有在某些特殊的情形下患者家屬才可以代為簽署知情同意書或者代行知情同意權利。

Informed consent has been a core principle endorsed by modern Western medical ethics. It involves patient-physician relationship as well as family relationship. It has been a focus of debates since it was introduced to the Chinese world whether informed consent is agreeable to the cultural ethos of China, and if not, whether it can be applied transculturally. This paper first discusses three principles in the policy of informed consent: 1. the principle of individual autonomy; 2. the principle of non-maleficence; and 3. the principle of effectiveness. Then the paper explores the issue informed consent within the framework of the Confucian concept of family and family values, indicating that in Confucian ethics, the idea of“ harmony in diversity” acknowledges the importance of individuality whereas the notion of reciprocal relationship emphasizes the interconnectedness of everyone in family and society at large. We should always look for a balanced point between the right of the patient and the duty of the physician, and between the interest of an individual person and the interest of the family as a unit.

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