中國“病人自主權”的歷史演變——20 世紀80 年代之前

Patient Autonomy in China before the 1980s: A Historical Perspective

Abstract

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

本文簡要梳理了從帝制時代到上世紀80 年代之前中國病人自主狀況和相關社會理念的演變過程，並對其出現的特定歷史條件進行了初步分析。中國傳統的病人自主權是整合在社會禮法秩序中的病人家長制。雖然從中國近代到新中國成立初期，病人自主狀況和自主權的概念都發生了一定的變化，但因為它們幾乎都屈從於這兩個階段的社會政治運動，所以無法實現基礎倫理結構和價值觀的轉變。目前中國從西方引入的現代個人主義式的病人自主權概念，不僅與傳統的理解存在巨大差異，也與當前的醫學生活與社會制度不完全匹配。在中國解決病人權利保護的難題，不是任何一種單一化的理念引進、制度改造或者政治運動就可以實現的，我們必須把自己的思考投入到那個歷史與當下、理論與現實、中國與西方糾纏在一起的真實的世界，才有可能發現問題的癥結並找到正確的方向。

This essay offers a historical outline of the evolution of patient autonomy and related social and medical concepts in China from the imperial era to the 1980s. The author contends that the idea of patient autonomy was totally absent from traditional Chinese culture, as every area of society, from family to medicine, was structured according to a distinctively paternalistic model and regulated by ritual guidelines (lifa). Although the Western medical practices that arrived in China in the 1840s somewhat altered the Chinese approach to medicine, and the physician-patient relationship was viewed in a more egalitarian manner after the establishment of “new China” in 1949, the effects of these changes were minimal due to the political ideology of the time. The author argues that taking a historical perspective on the issues of patient autonomy and the rights of patients in China will aid understanding of the current challenges facing medicine in China and suggest ways of resolving ethical dilemmas and ambiguities at both a theoretical and a practical level.

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