“扁鵲見蔡桓公”——對一則古代案例的倫理學回顧

"When Bian Que Meets the Duke Huan of Cai": Ethical Reflections on a Legend

Abstract

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

扁鵲是中國先秦時期著名的醫生，同時也是中國傳統醫學和醫學倫理的奠基者和實踐者之一。他在與蔡桓公的幾次會面中作出的對話，有著豐富的道德內涵，展示了傳統醫患之間的一種具有特色的醫學倫理。中國傳統的醫學倫理和職業精神並不把醫生僅僅看成是一個純粹的技術性職業，而是賦與其中豐富的人生道德內涵和家國天下的思想，所以在西方醫患關係中被認為是十分重要的知情同意問題，在中國傳統的醫患關係中雖然也存在，但並沒有成為中國傳統醫患關係的主體。與之相反，中國傳統的醫患關係因為是建立在“上醫醫國”的文化土壤中的，醫患之間的關係也是在綱常倫理的維度中加以調適的，所以這種關係不僅僅是今天意義上的權利和義務、知情和同意等法律屬性的關係。

Bian Que is the earliest known Chinese physician of the Pre-Qin era (ca. 700 B.C.E), whose name is often associated with physicians of the highest medical caliber. One legend tells of how when Bian Que was in the feudal state of Cai, he visited the Lord Huan and told him that he had a serious disease. The Lord Huan thought Bian Que was trying to profit from the fears of his patients and declined the offer for treatment. Eventually, Lord Huan’s condition got worse. The last time Bian Que went to see Lord Huan, he knew that the lord would soon die and escaped from the state. This essay considers the ethical implications of the legend, such as the moral duty of the physician and the nature of the physician-patient relationship. Did Bian Que violate informed consent when he failed to tell the lord he would die of the disease if not treated immediately? The author concludes that the role of physician in ancient China was quite different from what one sees today. Thus, modern ideas and concepts such as informed consent and the language of rights cannot be applied to the case of Bian Que.

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