從儒家視角檢視突發疫情期間以年齡作為醫療資源配置的道德基礎與疑慮

Examining the Moral Basis and Doubts of Using Age as the Allocation of Medical Resources during the COVID-19 epidemic from the Perspective of Confucianism

周琬琳(Wan-ling Chou)

《應用倫理評論》 70期 (2021/04) Pp. 243-264

摘要

新冠肺炎來勢洶洶，截至2021年2月底，全球確診人數已經超過120,000,000人；死亡人數超過2,600,000人，人數持續上升中。特效藥尚未問世，疫苗雖然問世但尚未穩定，巨大耗費的醫療衛生資源考驗世界各國的健康醫療資源儲備與分配。在醫療資源嚴重缺乏且迫切的情況下，義大利與西班牙相繼傳出限制65歲以上老人進入ICU與使用呼吸機的報導，美國也出現宣導人們應該透過預立醫囑的方式，在疫情期間做好簽屬DNR準備工作的論文，本文認為以年齡作為限制使用高強度醫療資源存在道德風險。本文先檢視以年齡作為分配標準的道德基礎觀點，再從儒家視角提出道德疑慮，最後指出以年齡作為分配標準雖然也有道德理據支持，但是不同文化基礎所傾向的道德理據之間可能就存在價值觀的衝突，在制定政策時，一刀切與全盤移植的方式都需要更為審慎考慮。

關鍵字

年齡歧視 ； 成本效益分析 ； 戰時分診原則 ； 代際正義 ； 儒家公義觀

並列摘要

COVID-19 is coming on fiercely. By the end of February 2021, the number of confirmed cases worldwide has exceeded 120 million; the death toll has exceeded 2.6 million, and the number continues to rise. Special medicines and vaccines have not yet come out, and the huge consumption of medical and health resources tests the reserves and distribution of health and medical resources in countries around the world. In the case of serious lack of medical resources and urgent circumstances, Italy and Spain have successively reported restrictions on the entry of people over 65 years old into ICU and use of ventilators. There have also been papers in the United States advocating that people should prepare for DNR signing during the epidemic through advance medical advice. This article believes that there is a moral hazard in restricting the use of high-intensity medical resources by age. This article first examines theories using age as the moral basis of the distribution standard, and then raises moral doubts from the perspective of Chinese culture. Finally, it is pointed out that although age as a distribution criterion is supported by moral reasons, there are different choice of different values and moral reasons between different cultures. When formulating policies, the ＂one size fits all＂ approach and global adaptation require careful re-consideration.

並列關鍵字

age discrimination ； cost-effectiveness analyses ； wartime triage principle ； intergenerational justice ； Confucian justice

參考文獻

牟宗三，2020，《康德的道德哲學》（再版六刷）（臺北：學生書局），頁 15-32。

李瑞全，1999，《儒家生命倫理學》（臺北：鵝湖出版社）。

孟梁，2009，《新的軍事醫學環境下的特殊倫理問題研究》（陝西西安：第四軍醫大學）。

黃光國，2009，《儒家關係主義：哲學反思、理論建構與實徵研究》（臺北：心理出版社）。

羅奈爾得‧德沃金（著），馮克利（譯），2008，《至上的美德：平等的理論與實踐》（江蘇南京：江蘇人民出版社）。