儒家倫理視閾下家庭醫療儲蓄帳戶之“家庭”的界定

How Should We Define the Family for Health Savings Accounts? A Confucian View

Abstract

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

家庭醫療儲蓄帳戶的概念自提出以來，引起了國內外同仁的廣泛關注，學者們也都紛紛就自己的理解發表獨特看法。這一新概念引起中國生命倫理學術界的共鳴，根源性是因為它與中國的家庭倫理思想和家本位的價值觀念相契合。家庭醫療儲蓄帳戶的意義和積極作用是毋容置疑的，而有一點卻讓研究者駐足深思：家庭醫療儲蓄帳戶的家庭範圍該如何去界定？這個問題不僅僅是理論界定那麼簡單，它更涉及到家庭醫療儲蓄帳戶的可行性和可操作性。筆者在2011 年12 月份舉辦的“醫療儲蓄帳戶、深化醫改及儒家生命倫理”國際學術會議時曾試圖從社會學的角度進行分析，但是沒有文化背景與倫理理論的支持，終覺失去了根基。而傳統倫理學是我們應用倫理學去釐定問題的觀念背景， 也是我們分析問題的主要工具和解決問題的核心價值依據。鑒於此本文轉向中國傳統的主流倫理學去尋找答案。

儒家倫理學作為一種傳統倫理學，也必然在一定程度上為我們醫療儲蓄帳戶的建構提供一種觀念背景、分析工具和價值選擇。筆者首先論述了家庭的重要性，同時探討了家庭範圍界定的複雜性，然後轉而向儒家倫理學思想尋求觀念、價值和倫理的依據。本文以家庭的血緣關係和婚姻關係為主線，以儒家家庭倫理為依據，將家庭醫療儲蓄帳戶中家庭的範圍界定從倫理的角度操作化。這將有利於挖掘儒家生命倫理的潛在價值，為解決當代醫療改革問題提供依據，使傳統的主流倫理價值融入現代的生活中，去解決現實中存在的問題，同時這也是儒家生命倫理當代建構的一個方面。

The notion of family health savings accounts has attracted wide attention from academic circles, both domestic and international. Many Chinese scholars understand the importance of this notion and support the establishment of family health savings accounts in Chinese society, because it fits very well with Confucian family ethics and the family-oriented values that are vibrant in Chinese society. However, to pursue fully the significance and function of the family in operating appropriate health savings accounts, we must explore the question of how the family should be defined.

The problem is not only in offering a theoretical definition, but also related to the feasibility and operability of family health savings accounts. However, we cannot begin our inquiry from nowhere. We must rely on the traditional ethical resources that are still operating in Chinese society to develop a conceptual background and value basis for analyzing the problems we face in attempting to define a suitable notion of the family in Chinese society. Accordingly, this paper turns to Chinese traditional mainstream ethics, namely Confucian ethics, to identify the intellectual and moral resources to provide a conceptual background, analysis tools and value choice. The authors first discuss the importance of the family in the Confucian tradition and explore the complexity in defining the scope of the family. The paper then draws on particular Confucian ethical ideas and values to seek proper solutions. Specifically, based on the Confucian central commitments, we draw on both blood relationships and marriage relationships to consider the nature and scope of the family in the Confucian tradition. We thus form the main line of our argument to establish Confucian family ethics as the basis for defining the suitable scope of the family for adequate family health savings accounts in contemporary Chinese society. Basically, we conclude that nuclear families should be basic family institutions for health care in general and health savings accounts in particular, while adult children must be allowed, indeed encouraged, to supplement their elderly parents’ health savings accounts. This will be conducive to using the potential value of Confucian family-based and family-oriented ethics to provide the motivation to solve the difficult problem of health care reform in contemporary Chinese society.

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