“仁術”與“方技”: 中國傳統醫患關係的倫理現實

The Art of Benevolence and the Skill of Medicine: Physician-Patient Relations in Traditional Chinese Medicine

Abstract

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

本文首先對中國傳統醫學生活的結構和運動模式兩個方面進行了探討，借此提出以下觀點：中國傳統的醫患倫理關係並不是一種典型的職業倫理關係，它建立在中國傳統醫學學術和社會生活的基礎之上，其道德效力整合於這種特定的生活境遇之中；醫生與病人都被整合在社會倫理關係的網路之中，醫患關係根據醫病雙方各自具體的社會倫理身份以及具體的醫療活動場景的不同而運動變化。這樣一種倫理關係使中國傳統醫學生活充滿了矛盾：醫家雖然將醫學稱為“奪造化之權，以救人生死”《醫學源流論˙醫非人人可學論》的大“道”，但又必須承認其在現實性上是一種“持方技以事上”的小“術”，苦苦掙扎在崇高的道德責任感和低下的自我倫理認知之間；病家既保有一種有限的選擇和評價醫生、干預診療活動的自主權，又必須遵循社會倫理法則來認識和調整與醫生的關係，在和醫生的相互角力中維護自己的權益。傳統醫學道德過於追求高尚而遠離普通醫生的生活實際，這就大大消弱了它對現實生活的指導力量，無助於建立一種合理的職業倫理規範，更違背了中國傳統倫理學“德得相通”的最高道德原則。

Using examples from ancient texts, this paper contends that the traditional physician-patient relationship should be understood and interpreted within the matrix of the social and ethical network of a society. As such, the physician-patient relationship is not what we call “a professional relationship,” in that there is no fixed or objective standard to qualify it. In the Confucian tradition, for instance, the physician-patient relationship changes according to the social identity of the patient. The moral responsibility of the physician also becomes ambiguous when he or she is required to treat the patient as a “relative” or “friend.” The patient, in contrast, has a very limited “autonomy,” if there is such a thing, to choose his or her own doctors and make medical decisions. The same situation can be seen in Daoist medical practice when the physician has to struggle between the “Dao of medicine” and the “skill of medicine,” or between the moral dimension of medicine and the efficaciousness of medicine. The medical profession in the past was never an independent entity with independent ethical standards, and has always been part of a wider value system.

Because of this, when medical professionals nowadays try to adopt Western ideas underpinned by different principles and theories, they find moral clashes between two traditions due to their conflicting value systems. As a result, concepts such as “patient rights” are at odds with the traditional understanding of the physician-patient relationship, which emphasizes context and situation. This paper also criticizes virtue-based morality in China, contending that principle-based morality would be better for reconstructing a more objective standard of morality for medical professionals in China.

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