中國第一起嗎啡勝訴案的背後——臨終關懷病人使用嗎啡的儒家倫理問題

Behind the First Legal Case of Morphine in China—A Confucian Ethic: Reflections on the Use of Morphine to Treat Terminal Patients

Abstract

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

緩解癌痛是終末期癌症患者安寧療護的重要目標之一。世界衛生組織提出，嗎啡等鴉片類藥物被列為癌症止痛和安寧療護的首選或必備藥物。而談起嗎啡時，人們常常聯想到毒品。尤其在中國這樣一個深受兩次鴉片戰爭影響的國家，人們畏懼嗎啡，並更加謹慎地使用嗎啡。在臨床上，嗎啡的確能夠有效地緩解患者臨終前因癌症引起的疼痛，但不合理地使用也會引起患者的呼吸抑制，導致其死亡。那麼，臨床上到底應該如何正確地使用嗎啡？嗎啡的使用有哪些制度上的支援？嗎啡被當作主動安樂死的一種手段又是否能夠得到儒家倫理學上的辯護？筆者認為，無論在臨床中，還是在制定嗎啡的相關法律法規中，都應將嗎啡的兩種作用：合理劑量的鎮痛作用和加大劑量的主動安樂死作用嚴格的區分開來。用嗎啡安樂死的行為違背了儒家的孝道、弘毅美德以及儒家生命觀和仁愛的思想。本文將通過探究嗎啡的歷史、臨床使用、政策和儒家倫理四個方面，對嗎啡的使用進行具體的研究和分析。

Pain control is one of the most important goals of end-of-life care for cancer patients in the terminal phase. The World Health Organization recommends that morphine be considered optimal and even indispensable as a means of relieving pain and providing palliative care. However, people often associate this opioid with illicit drugs, particularly in the context of Chinese culture, due to its close association with the two Anglo–Chinese Opium Wars of the mid-19th century. In clinical settings, morphine is usually the preferred treatment for moderate or severe cancer-related pain. However, excessive morphine use may result in respiratory depression and death. Exploring morphine’s history and clinical usage, relevant policies, and Confucian ethics, this essay shows that a clear distinction must be made between relieving pain and performing active euthanasia in cases of morphine use in current Chinese palliative care and bioethics. The essay offers an approach based on Confucian ethics to analyze how euthanasia via morphine use violates the principles of filial piety (xiao) and humaneness (ren), two virtues emphasized in Confucian tradition.

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