從西方個人自律原則與儒家關係自律原則論醫病關係中諮詢同意的倫理議題

吳瓊玲(Chiung-Ling Wu)

指導教授 ： 李瑞全

國立中央大學/文學院/哲學研究所碩士在職專班/碩士(2008年)

摘要

近幾年來，民主意識抬頭，隨著各種人權運動的興起，人們更懂得爭取自己的權益，醫病關係已逐漸發生改變。西方個人自律原則，對於個人經過思考、判斷而提出的決定，每個人皆應予以尊重，違反一個人的自律權將僅僅把人視為工具，不免貶抑人的尊嚴和價值，並且是產生最大的反功效。當前醫學倫理中，強調病人獨立自主與地位平等的尊重模式，但是在醫學實踐衝突發生時，病人是否真正能受到尊重？或是依照原則倫理學，要求道德推理所做出的臨床決策即是符合病人的最佳利益？
在我國醫療決策過程主要涉及三方面的人員：醫護人員、病人和家屬。這三群人員形成決策的鐵三角，他們的想法有時是一致，但是有時候卻也是相悖，在想法一致時，對於醫療決策當然沒有任何的紛爭，但是當此三方人員無法產生一致的決定時，困擾、紛爭也就在此時產生出來，誰在最後決定具有主導權？做決定的基礎論據是什麼？是否有我們共同認同的最低道德概念呢？而在此時應該如何化解衝突呢？我們近來接受西方尊重病人自律權的觀點，但是此來自西方的觀點與作法，真能切合我們的民情與習慣嗎？在東、西方文化、宗教背景皆不同的雙方，我們若只是一昧的接受來自西方的觀點，在臨床將面臨重大的挑戰，產生許多未能符合真正處理兩難狀況的問題，這是值得我們去探究與解決。
本文提出以東亞社會深受影響的儒家倫理學來做調合，期以儒家倫理學中關係自律原則來探討醫病關係中的諮詢同意問題，為適合我們東亞社會文化的醫病關係尋求一個新的視野及具體作法。

關鍵字

倫理關係自律 ； 醫病關係 ； 諮詢同意 ； 自律原則 ； 儒家

並列摘要

Accompanying the spreading of democracy and the movement of different human rights, people learn to protect their own benefits. The physician-patient relation has also graduately been transformed. According to the principle of respect of autonomy, we have to respect the personal considered decision of the patient. Disrespect of patient’s autonomy is regarded as treating the patient as means to one’s interest and a degradation of human dignity and value, and also causes the greatest disutility. However, it is doubtful that such emphasis of respect of patient’s independence and equality during a medical dilemma will serve the patient’s best interet. Or, rather, we just require that clinical decision be at the patient’s best interest.
In Taiwan, a medical decision usually involves the medical professionals, the patient and the family. These three groups of people form a triad of dicision making. Sometimes they have consensus, sometimes not. In the former case, it is well and fine. In the latter case, there will be a lot of confusion and controversy. Who has the final say? What is the ground for such decision? Do we have some common minimal moral principles? In case of conflict, how should we resolve it? We tend to accept the western point of view and respect the autonomy of the patient, but would such imported value really fit into our ethos and customs? With much difference in culture and religion matters, our whole-heartedness acceptance of the western conception will doubtless leads to serious challenge and causes many difficult moral dilemmas. This is an issue that merits our investigation and seeking of a solution.
In this thesis, I try to bring into our analysis the most influential ethics of east Asian societies, namely Confucian ethics, to make out a compromised solution. The Confucian idea of ethical relational autonomy is being employed to an explication of the problem of informed consent in our physician- patient relation. It proved to be able to provide a new vision on the relation and a solution which is more suitable to the Asian culture and society.

Key Word: principle of autonomy, Confucianism, ethical relational autonomy, physician-patient relationships, informed consent,

並列關鍵字

principle of autonomy ； Confucianism ； physician-patient relationships ； ethical relational autonomy ； informed consent

參考文獻

李瑞全，《儒家倫理學》，2000，台北：鵝湖出版社，再版。

蔡錚雲、龔卓鈞（譯），李察˙詹納（Richard Zaner）（著），2004，《醫院裡的危機時刻：醫療與倫理對話》（Conversation on the Edge: Narratives of ethics and illness, 2004），台北：心靈工坊文化，初版一刷。

毛愷民、蔡甫昌、陳慶餘，2004，〈在談病情告知〉，刊於《當代醫學》第31卷第2期，台北：橘井文化事業股份有限公司，頁54-7。

邱啟潤、許淑敏、吳淑如，2003，〈居家照護病患之主要照顧者綜合性需求調查〉，刊於《醫護科技學刊》第5卷第1期，台北：臺北護理學院，頁13。

許麗齡，1999，〈護理倫理—病人的自主性〉，刊於《護理雜誌》第46卷第4期，台北：臺灣護理學會，頁57-61。