患者利益至上——傳統情懷與現實挑戰

Patient First: The Traditional Moral Ideal and its Contemporary Challenge

Abstract

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

以患者利益為重被視為醫學的傳統美德，也是醫生的職責。它的基本宗旨是將患者的利益放在首位。當醫生的利益不受其他因素干擾時，他們較能承擔“患者利益至上”這一責任。而當出現利益衝突時，醫生則會面臨特殊的挑戰，有時還有可能需要做出一定的自我犧牲。西方醫學倫理在強調醫師職業道德的同時也通過制度建設盡量避免利益衝突的發生，以更好維護患者和醫生雙方的利益。

中國傳統醫學倫理中，“患者利益至上”雖然沒有作為具體道德原則予以規定，但在醫療實踐中卻常常可以體現出醫生“患者利益至上”的情懷。之所以如此，與儒家文化的影響密不可分。儒家“仁”的思想強調愛人，提出對待病人要“皆如至親之想”。儒家將愛親的情感擴展到病人身上，同時也將“博施於民而能濟眾”視為自己高尚的道德追求。在義利關係問題上，儒家提出了獲取利益的正當性問題，即“不以其道得之，不處也”。醫生受其影響，反對“恃己所長，專心經略財物”，強調維護病人健康利益的重要性。另一方面，儒家修身的實踐精神有助於“仁”、“義”等從一種自然情感上升為真正意義上的道德德性，而古代重視家庭親情的傳統對於醫生的品德修養也起到了重要作用。醫生在修德的同時注重自身專業技能的訓練和提高，良好品德和精湛的技藝為維護患者的利益提供了重要條件。目前，患者利益至上的職業精神正面臨著經濟、政治、科技等多方面的挑戰，中國傳統文化缺失帶來的個體道德情感的弱化使這一問題更為突出。

The doctor-patient relationship in China is currently experiencing a crisis of trust brought on by the absence of traditional morals and values in healthcare. The Confucian doctrine of ren (benevolence) is based on the possibility of moral perfection in humanity, which in turn guides one how to treat others in family and non-family social relationships. Ren as a relational virtue is particularly important for the doctor-patient relationship. That is why the Confucian idea of “treating a patient like a family member” was popular in traditional medical practice. However, current medical practice is designed around the people who deliver the care, who happen to pay more attention to their own interests and benefits than those of their patients.

The essay contends that although Confucian teaching does not exclude the pursuit of self-interest or self-benefit, it does emphasize virtue and personal character, especially for doctors. No doctor is expected to make a profit that is not within the scope of moral principles, even in a resource-constrained setting. It is thus time to realign the values of the Chinese healthcare system based on Confucian virtues so that the patient is again the center of attention. The essay puts forward suggestions for medical professionals to discipline themselves by ensuring good professional and interpersonal skills.

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