新冠瘟疫蔓延時的「知情同意」原則

The Principle of "Informed Consent" during the COVID-19 Pandemic

Abstract

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

本文就此次爆發的心冠病毒疸疫，探討中國在對抗疫情過程中所帶出的幾個倫理議題，尤其是如何把握傳染病突發處理中「知情同意」的倫理原則。根據世界衛生組織的規定，「知情同意」意指有行為能力的個體根據充分的相關信息採取行動的主動權，這個行動不能受到強制或謗導。然而在疫情突發時期，知情同意所涵蓋的諸如知情、能力、自願等原則在公共衛生受到挑戰之時也會受到一定的限制。如何在個人自主、個人權利與公共衛生、公共利益之間找到平衡？如何在最低限度的道德言語中找到共同的道德原則，這是疫情中值得探討的倫理議題。本文從世衛《傳染爆發倫理問題指南》出發，對其具 體的倫理原則進行分析，並將其原則放在此次爆發的疫情情境中加以説明，刨析這些原則在具體操作上的困境。作者最後試圖從儒家倫理學的角度闡述如何在東方的「家長主義式干預」和西方的「個體自主式不干預」中找到平衡點，如何在保護公民權利與保證公共衛生中找到平衡點。

This paper addresses the question of informed consent during the COVID-19 pandemic. Informed consent is “the process in which a competent individual authorizes a course of action based on sufficient relevant information, without coercion or undue inducement” (WHO, 2016). However, informed consent based on disclosure, capacity, and voluntariness has been seriously challenged during the public health crisis we are facing today. How should we resolve the ethical conflict between individual autonomy and individual rights and public health and public good? How should we attain social consensus through “the minimum grammar” of common morality? In this paper, I first introduce the WHO’s “Guidance for Managing Ethical Issues in Infectious Disease Outbreaks” (2016) and its seven basic principles: justice, beneficence, utility, respect for persons, liberty, reciprocity, and solidarity. I then explain how those principles could face challenges in implementation during the pandemic, as there will always be tensions between individual rights, state interference, and health paternalism. Finally, I explore from a Confucian perspective the possibility of seeking the “middle point” between paternalism and individual autonomy, and between civil liberties and public health.

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