儒家正義論及其對醫療公正問題的啟示

The Confucian Concept of Justice and Its Implications for Justice in Healthcare

Abstract

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

正義是一個歷史範疇，任何具有實踐品格的正義理論都只能是與特定道德共同體特殊的善的規定相聯繫的正義論，從這一意義上說，儒家當然也有自己的正義論。儒家正義論是以天道性命的邏輯關係為起點，通過仁、禮、義三維一體的倫理結構而表現的正義論。這種正義論將社會正義與個人正義統一起來，總體上體現為一種“厚生”的思想意識和行動。由於“生”具有不同的實踐領域和境界層次，從而使儒家正義論具有多維的展現向度。把這種正義論應用於醫療公正領域，儒家主張醫療保健政策必須以維護國民的生命意義和完整實現為前提，主張政府應提供一種基礎性的全民性的醫療保障和保健制度。但儒家不認同單級的平等主義的分配制度，而是強調資源的差等分配，但資源差等分配的前提不在於每個人實際的貧富狀態，而取決於人的修德程度或者說後天努力與貢獻的程度。個體對自我生命的完整實現負有天定的義務，因此儒家主張在醫療保健領域應當賦予個體和家庭以更多的自主權。

In the West, “justice” is a complex ethical principle, with meanings that range from the fair treatment of individuals to the equitable allocation of healthcare resources. Justice in bioethics is perhaps the most contested and controversial principle. This paper argues that the Confucian notion of justice is neither rights-based nor distributive; rather, it is based on the virtues of humanness and benevolence (ren), correct behavior and propriety (li), and uprightness and appropriateness (yi). Those virtues cherished in the Confucian tradition constitute what can be called a Confucian concept of justice, the primary principle of which is to respect human life. This means that in the healthcare system, the Confucian idea of justice is approached from the perspective of equality and fairness. On the one hand, the government should provide basic care for all persons according to the virtue of humanness/benevolence; on the other hand, the government should allow for diversity and differences in medical treatment and healthcare resource allocation according to the virtues of propriety and appropriateness, given that medical resources are limited and China supports a huge population. In other words, the government has the responsibility of providing public health care to those who cannot afford to pay for their own basic healthcare needs. At the same time, the government should allow for alternatives and should permit people to choose between ways of dealing with their medical issues.

Clearly, the language of “rights” is absent from the Confucian tradition. However, this essay argues that because the Western notion of justice, particularly in the legal sense, does not take into account what is good, the Confucian virtue-based justice better fits the cultural milieu of medical practice in China. From the standpoint of Confucianism, healthcare and bio-medical ethics should be more concerned about what is good for society, family, and the individual than about absolute equality or the principle of fair equality, which engender both moral and economic hazards.

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