從信任的角度重建現代醫病關係

A Reconstruction of Physician-Patient Relationship From the Perspective of Trust

褚盈鑛(Ying-kuang Chu)

指導教授 ： 李瑞全

國立中央大學/文學院/哲學研究所/碩士(2011年)

摘要

人的一生皆無法避開醫療照護，因此醫病關係對於個人的重要性是毋庸置疑的。醫病關係的好壞直接影響到醫療成效與醫療品質，但隨著社會結構以及醫療體制的改變，醫病之間的關係越來越疏離。此外，現今社會的醫療醜聞與醫療疏失事件層出不窮，致使醫病關係呈現出緊張狀態，醫病之間的信任也面臨考驗。當代生命倫理學在探討醫病關係此一議題時，不斷地強調病人自律與病人權利，然而這樣的強調是否能增進醫病關係的信任，抑或是帶來醫病之間信任的侵蝕？此自是值得探究，也因而本文將環繞在自律與信任之間的關聯來討論醫病關係此一論題。
　　本文首先回顧西方傳統到近代醫學倫理守則的核心內容的演變，而醫學倫理著重在對病人責任或對病人權利維護所帶出的醫病關係模式皆有不足之處，因而再次回歸到強調醫生德性的醫病關係模式，然而這些醫病關係模式未能提供良好的信任基礎。
　　本文闡述當代生命倫理學各理論系統對自律概念的詮釋及其各自應用在醫療實踐上所展現出的樣貌，包括有中層原則主義之尊重自律原則、歐妮爾之有原則的自律、女性主義生命倫理學之關係式自律與儒家生命倫理學之倫理關係自律等四種理論，進而從中探討醫病關係中的信任基礎。本文研究的結果指出，儒家生命倫理學的倫理關係自律概念可補足其他自律理論之不足，最後藉儒家式信任理論為基礎，建立內部信任為主，兼以外部信任為輔的信任機制來展開新的醫病關係，以期醫病之間能夠進入到更親密的信任關係，達到病人的最大幸福。

關鍵字

醫病關係 ； 內在與外在信任 ； 有原則的自律 ； 儒家倫理關係自律

並列摘要

Since nobody could avoid necessary healthcare needs, it is no doubt that physician-patient relationship is important to everyone. The quality of the physician-patient relationship is an important factor affecting the quality and success of medical of treatment. On the one hand, with the changes of the structure in society and development of the medical system, on the other hand, in modern society, medical disputes and scandals happening one after another, the relation between physician and patient grows into a very tense situation, and therefore the trust between them faces greater and greater challenges.
　Contemporary discussions of the physician-patient relationship have been focused on patient’s autonomy and patient’s right, but there has been a steadily increasing emphasis on patient’s autonomy and patient’s right. But, it is doubtful whether it helps to restore trust or derails it further？ This essay is an analysis of the physician-patient relationship in terms of autonomy and trust.
　In this essay, I begins with a review of the changes of the codes of medical ethics and models of the physician-patient relationship from the traditional paternalism to patient’s right and to the virtue theory. I argues that they are not sufficient for a good foundation to rebuild a good physician-patient relation.
　Then I critically examine the different conceptions of autonomy, including the individualistic autonomy of principlism, Onora O’Neill’ s principled autonomy, the feminist relational autonomy and finally the Confucian ethical relational autonomy and their relationship to the problem of trust
　I come to the conclusion that Confucian conception of ethical relational autonomy could enhance the shortage of the western conception and together could give a good foundation for physician-patient relationship. More precisely, the Confucian conception builds up a kind of intimate trust between the two parties as close relatives and lays the foundation for the internal trust of the relation. The accountability and responsibility of the physician could provide a mechanism to check the external trust of the two sides. With internal and external trust, we could hope to reconstruct the intimate trust of the two and promote to the best treatment and result for the patient.

並列關鍵字

Confucian ethical relational autonomy ； physician-patient relationship ； internal and external trust ； principled autonomy

參考文獻

江弘基、李蘭，2003，＜管理式醫療照護下的醫病信任議題＞，刊於《醫學教育》，第七卷第2期，臺北：台灣醫學教育學會，頁95-105。

林火旺，1997，＜西方社會困境與儒家家庭倫理＞，原刊於《宗教哲學》，頁1-10。

林遠澤，2007，＜從醫學技術主義回歸人道關懷如何可能？試論醫護人文教育的關懷倫理學〉，刊於《哲學與文化》，第三十四卷第9期，臺北：哲學與文化月刊雜誌社，頁61-86。

陳振崑，2004，＜從儒家倫理看醫病關係＞，《哲學與文化》，台北：哲學與文化月刊社，頁45-61。

李瑞全，1999，《儒家生命倫理學》，台北：鵝湖出版社。