儒家伦理视域下医疗决策中利益冲突之化解
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摘要
儒家伦理以仁、义、礼、智、信为主要内容,具有丰富的化解医疗决策中利益冲突的理论资源。其一,在儒家看来,医之仁道的体现是"生",当维系患者的生命权与自主权相冲突时,儒家认为生命权更具重要性和优先性。其二,儒家主张先义后利、舍利取义,这要求医生等医疗群体在遵循义的前提下求利,同时,患者也不应吝惜必要而合理的医疗支出。其三,儒家之礼的精神体现为敬、让、和。在医疗决策中,医生要敬畏生命、态度恭敬,允许患者充分表述病情,容让患者的不专业询问。为了保证全体患者的利益,"和"必须通过礼的规范来实现。其四,儒家伦理中的"信",就诚信而言,医患双方都应如实告知病情;就信任而言,患者不应无根据地怀疑医生,医生也要提高医疗水平以获取患者信任;就信仰而言,信仰医理是化解利益冲突的重要条件。其五,儒家强调"智"的变通性,医生既要具有一定的医学知识和道德观念,又要根据实际情况进行灵活变通,使之能更好地处理医疗决策中的各种问题。
Confucian ethics takes benevolence,righteousness,rites,wisdom and faith as the main contents,and has rich theoretical resources to resolve conflicts of interest in medical decision-making. Firstly,in the view of Confucianism,the embodiment of the medical treatment is "life". When the right to life of the patient is in conflict with the right of autonomy,the Confucian believes that the right to life is more important and priority. Secondly,Confucius advocates profit after righteousness,which requires doctors and other medical groups should pursue interests under the premise of righteousness. At the same time,patients should not begrudge the necessary and reasonable medical expenses. Thirdly,the spirit of Confucian rites is embodied in respect,comity and harmony. In medical decision-making,doctors need to respect life,have respectful attitude,allow patients to fully express their illness,and tolerate the patient's unprofessional inquiries. In order to ensure the interests of all patients,"harmony"must be realized through the norms of rites. Fourthly,it is the"faith"in Confucian ethics. In terms of good faith,both doctors and patients should truthfully informed the condition; in terms of trust,patients should not suspect doctors without any basis and doctors should improve their medical level to obtain patients' trust as well; in terms of beliefs,believing medical knowledge is an important condition to resolve conflicts of interest. Fifthly,Confucianism emphasizes the flexibility of"wisdom". Doctors should not only have certain medical knowledge and moral concepts,but also be flexible in accordance with the actual situation so that they can better deal with various problems in medical decision-making.
Confucian ethics takes benevolence,righteousness,rites,wisdom and faith as the main contents,and has rich theoretical resources to resolve conflicts of interest in medical decision-making. Firstly,in the view of Confucianism,the embodiment of the medical treatment is "life". When the right to life of the patient is in conflict with the right of autonomy,the Confucian believes that the right to life is more important and priority. Secondly,Confucius advocates profit after righteousness,which requires doctors and other medical groups should pursue interests under the premise of righteousness. At the same time,patients should not begrudge the necessary and reasonable medical expenses. Thirdly,the spirit of Confucian rites is embodied in respect,comity and harmony. In medical decision-making,doctors need to respect life,have respectful attitude,allow patients to fully express their illness,and tolerate the patient's unprofessional inquiries. In order to ensure the interests of all patients,"harmony"must be realized through the norms of rites. Fourthly,it is the"faith"in Confucian ethics. In terms of good faith,both doctors and patients should truthfully informed the condition; in terms of trust,patients should not suspect doctors without any basis and doctors should improve their medical level to obtain patients' trust as well; in terms of beliefs,believing medical knowledge is an important condition to resolve conflicts of interest. Fifthly,Confucianism emphasizes the flexibility of"wisdom". Doctors should not only have certain medical knowledge and moral concepts,but also be flexible in accordance with the actual situation so that they can better deal with various problems in medical decision-making.
引文
[1]邱仁宗.利益冲突[J].医学与哲学,2001(12):21-24.
[2]曹志平.中国医学伦理思想史[M].北京:人民卫生出版社,2012:28.
[3]马其昶.韩昌黎文集校注[M].上海:上海古籍出版社,1986:20.
[4]张岱年.中国伦理思想研究[M].南京:江苏教育出版社,2005:82,118.
[5]喻昌.医门法律[M].北京:中医古籍出版社,2002:8.
[6]寇平.全幼心鉴[M].北京:中国中医药出版社,2015:8.
[7]龚廷贤.万病回春[M].北京:人民卫生出版社,1984:29.
[8]张景岳.类经图翼[M].北京:人民卫生出版社,1965:5.
[9]南京中医学院校释.诸病源候论校释[M].北京:人民卫生出版社,1980:207.
[10]丁珠林.北京市卫生局有关李丽云死亡事件的通报[J].中国卫生,2008(1):26-27.
[11]比彻姆,邱卓思.生命医学伦理原则[M].李伦,等译.北京:北京大学出版社,2014:69.
[12]李承焕.儒家基于美德的道德中存在权利观念吗?[J].现代哲学,2013(3):88.
[13]梁子君,吴超,郭洪宇,等.我国暴力伤医事件成因的政策分析及应对[J].中国医院管理,2014,34(11):60.
[14]费伯雄.医方论[M].北京:中医古籍出版社,1987:1.
[15]裘沛然.中国医学大成:第26册[M].上海:上海科学技术出版社,1990:39.
[16]徐大椿,等.洄溪医案寓意草诊余集[M].北京:学苑出版社,2008:28.
[17]李华年.新序全译[M].贵阳:贵州人民出版社,1994:58.
[18]杨宽.古史新探[M].北京:中华书局,1965:308.
[19]陈飞龙.孔孟荀礼学之研究[M].台北:文史哲出版社,1982:48.
[20]孙红,王晓燕.医学人文案例精粹[M].北京:人民卫生出版社,2011:178-180.
[21]张彦军.关于医院“红包”问题的思考与对策[J].基层医学论坛,2015(18):2535.
[22]苏礼.中医临床必读丛书合订本·医案医话医论:卷一[M].北京:人民卫生出版社,2011:51.
[23]傅沛藩.万密斋医学全书[M].北京:中国中医药出版社,1999:474.
[24]李景荣,等.备急千金要方校释[M].北京:人民卫生出版社,1998:166.
[25]袁华忠,等.论衡全译[M].贵阳:贵州人民出版社,1993:772.
[26]彭铎.潜夫论笺校正[M].北京:中华书局,1985:125.
[27]黄宗羲.宋元学案[M].北京:中华书局,1982:326.
[2]曹志平.中国医学伦理思想史[M].北京:人民卫生出版社,2012:28.
[3]马其昶.韩昌黎文集校注[M].上海:上海古籍出版社,1986:20.
[4]张岱年.中国伦理思想研究[M].南京:江苏教育出版社,2005:82,118.
[5]喻昌.医门法律[M].北京:中医古籍出版社,2002:8.
[6]寇平.全幼心鉴[M].北京:中国中医药出版社,2015:8.
[7]龚廷贤.万病回春[M].北京:人民卫生出版社,1984:29.
[8]张景岳.类经图翼[M].北京:人民卫生出版社,1965:5.
[9]南京中医学院校释.诸病源候论校释[M].北京:人民卫生出版社,1980:207.
[10]丁珠林.北京市卫生局有关李丽云死亡事件的通报[J].中国卫生,2008(1):26-27.
[11]比彻姆,邱卓思.生命医学伦理原则[M].李伦,等译.北京:北京大学出版社,2014:69.
[12]李承焕.儒家基于美德的道德中存在权利观念吗?[J].现代哲学,2013(3):88.
[13]梁子君,吴超,郭洪宇,等.我国暴力伤医事件成因的政策分析及应对[J].中国医院管理,2014,34(11):60.
[14]费伯雄.医方论[M].北京:中医古籍出版社,1987:1.
[15]裘沛然.中国医学大成:第26册[M].上海:上海科学技术出版社,1990:39.
[16]徐大椿,等.洄溪医案寓意草诊余集[M].北京:学苑出版社,2008:28.
[17]李华年.新序全译[M].贵阳:贵州人民出版社,1994:58.
[18]杨宽.古史新探[M].北京:中华书局,1965:308.
[19]陈飞龙.孔孟荀礼学之研究[M].台北:文史哲出版社,1982:48.
[20]孙红,王晓燕.医学人文案例精粹[M].北京:人民卫生出版社,2011:178-180.
[21]张彦军.关于医院“红包”问题的思考与对策[J].基层医学论坛,2015(18):2535.
[22]苏礼.中医临床必读丛书合订本·医案医话医论:卷一[M].北京:人民卫生出版社,2011:51.
[23]傅沛藩.万密斋医学全书[M].北京:中国中医药出版社,1999:474.
[24]李景荣,等.备急千金要方校释[M].北京:人民卫生出版社,1998:166.
[25]袁华忠,等.论衡全译[M].贵阳:贵州人民出版社,1993:772.
[26]彭铎.潜夫论笺校正[M].北京:中华书局,1985:125.
[27]黄宗羲.宋元学案[M].北京:中华书局,1982:326.