論醫療中的家庭決策

On Family Decisions in Medical Practice

Abstract

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

本文首先通過引入“家庭決策”揚棄“家屬決策”之概念而統一了家庭、患者和家屬之意願，消弭了長久以來醫療決策領域存在的患者決策和家屬決策之矛盾與紛爭。其後，文章從中國儒家文化中的“仁愛”、“孝悌”與“家庭觀”之視角立論了家庭決策的妥當性與可行性，並在西方倫理的自由主義和主體性思想中找到了家庭決策之落腳點。

This paper begins with a definition of “family decisions.” I emphasize that family decisions are made jointly by all close family members on a voluntary basis. This decision-making mechanism is designed to embody the spirit of Confucian family ethics and maximize the benefit of family involvement in medical decision making.

Introducing this concept allows us to abandon the outdated concept of “family member decisions” that seems to exclude the patient from the process of decision making. Family decision models should reflect the unity of the family, and should include both the patient and his or her close family members in the proper way in the decision making process. This unity will help to eliminate contradictions or disputes on whether medical decisions should be made by the patient alone or by the patient’s family members only. This paper expounds on the appropriateness and feasibility of the family decision model from the perspectives of benevolence (ren), filial piety (xiao), and family values cherished in the Chinese Confucian culture. First, Confucianism regards benevolence as the highest ethical and moral virtue, with filial piety as the foundation. According to the Confucian concept of filial piety, the rudimentary moral standard for individuals is that they must love their family members. As family decisions involving medical care need to take into account the long-term interests and common development of all family members, those decisions should be more in line with the spirit of reciprocal affection among family members advocated in the concepts of Confucian benevolence and filial piety. At the same time, family members are more likely to reach a compromise among themselves, based on mutual love, that maximizes the interests of the family for every member. Second, in accordance with the Confucian concept of the family, the life and behavior of individuals do not entirely belong to them, but rather to their family. Indeed, individual happiness is greatly dependent on the well-being of the family. Hence, the Confucian concept of the family underpins the family decision model and makes it appropriate in a clinical context. Influenced by the Confucian concept of the family, family decisions are easier to reach in China.

This paper also explores the basis for family decisions in Western ethics, and suggests that the family decision model can also be defended from a liberal ethical perspective. In the process of family decision-making, every family member must limit their own behavior so as not to interfere with the freedom of other family members, thereby allowing every member the maximum freedom that they can enjoy in familial life. This reflects the ethical meaning of liberalism in a more comprehensive and in-depth way. Further, when making family decisions, all family members participate in the consultation as moral agents, and the status of each member as a moral agent is fully respected and exhibited. Finally, a family often serves as a moral community, and there are thus few obstacles to joint decision making arising from differing views on values. At the same time, even if family members hold different moral standards, they can still fully understand the needs of other family members in the process of familial decision making through effective mutual communication, so that a consensus is easier to reach through reciprocal compromise.

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