精神病患者的醫療倫理決策——個人與家庭

Medical Decisions for the Mentally Ill: A Confucian Response

Abstract

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

本文從一位生命倫理學家關於一個精神病患者的醫療倫理決策的法律案例評論出發，探討中國的儒家家庭主義倫理同美國的現代個人主義倫理之間所存在的重大差別，提出不應該照抄照搬美國生命倫理原則及其分析來做出中國的生命倫理決策。本文基於中國倫理觀點，特別是儒家倫理觀點，論證適合於中國醫療的社會現狀，並在道德上可以得到辯護的不同於美國個人主義的中國生命倫理學及其精神病患者的醫療倫理決策模式。

This essay provides a Confucian moral response to American bioethicist Arthur Caplan’s comments on an American case. The case involves the issue of abortion and sterilization regarding a 32-year-old pregnant woman from Massachusetts, known as Mary Moe, who suffers from severe schizophrenia and bipolar mood disorder. Caplan argues that the appellate court was right to decide that neither sterilization nor abortion should be imposed. However, he thinks the court gave the wrong reason – that if Moe were competent she would not want an abortion. As Caplan sees it, this is a hopeless quest because Moe is too sick to tell us anything. In addition, Moe’s parents are already raising one of her children, so their stake in this situation disqualifies them from deciding what ought to happen. Caplan agrees that Moe needs to be on permanent birth control. As to abortion, he insists on a negative answer. He concludes that “If Moe’s medicines put the fetus at risk, then try to lower the dose. If Moe herself becomes even more impaired, stop. If Moe cannot possibly raise the baby and her parents cannot either, then adoption is the best road to follow.”

From a Confucian perspective, Caplan’s view on this case has several problems. First, absolute individual self-determination is ethically improper. Caplan is right that Moe is incapable of making medical decisions, but his comments imply that if she were competent, she would have an exclusive right to make such decisions. The author has experienced several cases in China that indicate that this is an improper individualistic view. Second, Caplan seems to make an inappropriate balance between Moe’s interests and the interests of the fetus. As he sees it, allowing Moe to become pregnant again is not in her best interests, while ending the life of her fetus is not in the best interest of the fetus. Accordingly, his balanced solution is not to allow abortion but to lower (and even stop) her medications to prevent impairment to the fetus. However, this would impair Moe’s mental health, and we cannot see how this can be in Moe’s best interests. Finally, Caplan’s view on the relation between Moe and her parents is ethically misleading. He thinks the parents are disqualified from the decision making in this case because there is a conflict of interests as they are already raising one of Moe’s children. This is unfair to Moe’s parents. That Moe’s parents suggest abortion at this point isclearly in the best interests of Moe. If Moe does not have an abortion, the parents’ interests are not conflicted because they have no obligation to raise another child of Moe’s. In short, this essay concludes that Caplan’s view is too individualistic and family-unfriendly, which should not be copied by Chinese bioethicists in dealing with Chinese cases.

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