公共健康倫理中的自主性問題：COVID-19疫情背景下的討論

Issues of Autonomy in Public Health Ethics: A Discussion in the Context of the Covid-19 Pandemic

Abstract

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

COVID-19疫情的爆發，突顯出公共健康倫理中自主性與公共健康之間的緊張關係。以“publichealth”、“ethics”、“autonomy”為主題詞在WebofScience核心合集數據庫中進行文獻收集，借助CiteSpace6.1軟件進行信息可視化分析，發現2020年1月1日至2022年5月14日期間，生命倫理/公共健康倫理領域對於“自主性”概念的討論大體上集中在“知情同意”、“健康保健政策"、“健康質量”、“信息技術”和“老年歧視/老年群體”範圍。本文在此基礎上提煉分析COVID-19疫情中的四個“自主性‘‘難題    如何避免以公共健康/公共利益為名過度限制自主性、在數字技術應用中如何保障自主性、如何保障老年群體的自主性和生命權，如何通過促進自主性來推動公共健康目標的實現。COVID-19疫情是一個重塑公共健康倫理自主性概念的歷史契機。冷酷的病毒已經作為一種媒介把人類的命運緊密地聯繫起來，而基於關懷倫理和共同體倫理重塑的自主性概念則有望給疫情下的世界帶來團結、温暖和希望。

In the field of public health ethics, the COVID-19 pandemic has highlighted the tension between autonomy and public health. Using CiteSpace 6.1 software and information visualization analysis, we performed a search of literature in the Web of Science core collection database using thematic words such as “public health”, “ethics” and “autonomy”, we found that from January 1, 2020 to May 14, 2022, discussions on the concept of “autonomy” within the field of bioethics/public health ethics were generally focused on the following topics: “informed consent”, “health care policy”, “health quality”, “information technology”, “ageism” and “elderly group”. In this paper, we distill and analyze four controversial issues: how can we avoid excessive restrictions on autonomy in the name of public health/public interest? How can we protect autonomy when using digital technology? How can we protect the autonomy and rights of the elderly? How can we advance the goals of public health by promoting autonomy? The COVID-19 pandemic is a unique historical opportunity to reshape the concept of autonomy within the field of public health ethics. Although the virus has bound the fate of humanity together, a reinvented concept of autonomy based on care and community ethics holds the promise of bringing solidarity, comfort, and hope to the world in the midst of the pandemic.