從儒家到生命倫理學四原則

From Confucianism to the Four Principles of Bioethics

Abstract

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

要解決諸如個人或國家因醫療引發的經濟上的“雙崩潰”，伴隨醫生個人權威的沒落和患者個人權利的提升造成醫療領域的“禮崩樂壞”和醫患之間道德異鄉人等的問題，首要是需要選擇一種文化為指引以便思想和行動。本文從多方面思考，認為儒家是最佳的和最具比較優勢的可選擇的文化。儒家生命倫理學的核心基礎是雙重人性觀和均衡發展論。儒家生命倫理學本質特徵是利他主義，它提供了一系列指令性、指導性和約束性的道德規範或道德標準，而這些標準在內容上更具備多樣性和包容性的價值和行為譜系，例如“仁”、“孝”。根據“孝”的道德規範，安樂死可以選擇，而自殺則不能被選擇；根據“禮”要求，儒家要建立一種基於禮樂文明的醫療衞生保健制度以進行衞生保健資源配置，這種制度完全不同於西方文化的現代財產制的分配制度。根據中庸的法則，生命倫理學的四原則可以被簡化為一個簡單的原則：微創原則。

This paper discusses the possible application of the four principles of medical ethics advocated by Beauchamp and Childress to the current healthcare reform and transition in China from the perspective of someone who has many years of experience as a physician. It aims to show that many of the medical problems and solutions identified in the West also make sense in the Chinese context, although different moral language may be used. I believe that traditional resources such as the Confucian moral/ritual system can be reconstructed to handle ethical questions both in theory and in practice in China. It is argued that hospitals and physicians administer medicine through the art of benevolence. Using Confucian morality as a guide for healthcare reforms may help to make the transition period easier, and the four principles may help to standardize the regulations needed for hospitals.

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