有限医疗家长主义及其辩护
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摘要
医疗家长主义来源于古希腊的希波克拉底传统。传统的家长式医疗中,医生对待病人像家长对待孩子,从病人的利益出发代替病人做出各种医疗决定,却忽视病人自己的意愿。医疗家长主义的思想带有利他性和强迫性,它充分体现了医学伦理中有利无害原则。家长式医疗在传统医疗中一直占据主导地位,并延续了几千年。随着近代人权运动和自由主义的发展,病人权利运动蓬勃兴起。传统医疗家长主义受到猛烈地批判,病人的自主权得到空前地提高。病人自主权所反映的是尊重自主的原则。尊重自主原则要求在医疗过程中首先要考虑的是病人自主自愿的选择,它十分重视病人的知情同意。随着病人自主权利在医疗过程中的确立,医疗家长主义逐渐式微。
近年来不断出现的医疗纠纷让我们不得不重新反思这种片面强调尊重自主原则的正确性。尊重自主原则也有其局限,完全式的病人自主在医疗实践中根本无法真正地实现。有时即使强调尊重自主原则,最终受损的也可能仍是病人的利益。为了超越尊重自主原则的局限性,有些学者开始转向诉诸医疗家长主义的合理之处,但他们的方案仍然未能很好地解决尊重自主原则与医疗家长主义的矛盾。本文尝试提出一种能在道德上获得辩护的有限医疗家长主义的观点。这种有限医疗家长主义主张,在某些具体的医疗情境下,病人的利益重于病人的权利,有利无害原则优先于尊重自主原则。有限医疗家长主义平衡了尊重自主原则与医疗家长主义,是对传统医疗家长主义的扬弃。
Medical paternalism comes from the Hippocratic tradition of ancient Greece. The way by which doctors treat patients in traditional medical process likes the way by which parents treat their children. For the sake of interests of the patient, doctors make all kinds of medical decisions instead of patients and ignore patients wishes. The thought of medical paternalism has altruism and compulsory. It embodies the principle of beneficence and nonmaleficence. Paternalistic medical care has been dominant for several thousand years in the traditional medical care. With the development of modern human rights campaign and the liberalism, patient's right campaign is raising vigorously. The traditional medical paternalism is fiercely critized. The patient's autonomy gets unprecedentedly improved. What the patient's autonomy reflects is the principle of respect of autonomy. The principle of respect of autonomy requires that the patient's independent and voluntary choice in the medical process should be considered primarily. And it attaches great importance to the informed consent. With the establishment of patient's autonomy in the medical process, the paternalistic treatment declined gradually.
In recent years, the medical disputes appeared continuously in the medical process, we have to reflect the correctness of stressing the principle of respect of autonomy in a one-side way. The principle of autonomy also has own limitation that absolute autonomy can not be realized in the medical process at all. And sometimes even if we emphasize the principle of respect of autonomy, the interests of the patient are still harmed. Some scholars begin to recourse to the rationality of medical paternalism in order to beyond the limitation of the principle of respect of autonomy. But their projects still can't resolve the contradictions between the principle of respect of autonomy and medical paternalism. This paper tries to put forward an idea of limited medical paternalism which can be morally justified. This limited medical paternalism affirms that the interests of patients is more important than the rights of patients, the principle of beneficence and nonmaleficence have precedence over the principle of respect of autonomy in some specific medical situations. The limited medical paternalism balances the principle of beneficence and nonmaleficence and the principle of respect of autonomy. It abandons the defects of the traditional medical paternalism.
近年来不断出现的医疗纠纷让我们不得不重新反思这种片面强调尊重自主原则的正确性。尊重自主原则也有其局限,完全式的病人自主在医疗实践中根本无法真正地实现。有时即使强调尊重自主原则,最终受损的也可能仍是病人的利益。为了超越尊重自主原则的局限性,有些学者开始转向诉诸医疗家长主义的合理之处,但他们的方案仍然未能很好地解决尊重自主原则与医疗家长主义的矛盾。本文尝试提出一种能在道德上获得辩护的有限医疗家长主义的观点。这种有限医疗家长主义主张,在某些具体的医疗情境下,病人的利益重于病人的权利,有利无害原则优先于尊重自主原则。有限医疗家长主义平衡了尊重自主原则与医疗家长主义,是对传统医疗家长主义的扬弃。
Medical paternalism comes from the Hippocratic tradition of ancient Greece. The way by which doctors treat patients in traditional medical process likes the way by which parents treat their children. For the sake of interests of the patient, doctors make all kinds of medical decisions instead of patients and ignore patients wishes. The thought of medical paternalism has altruism and compulsory. It embodies the principle of beneficence and nonmaleficence. Paternalistic medical care has been dominant for several thousand years in the traditional medical care. With the development of modern human rights campaign and the liberalism, patient's right campaign is raising vigorously. The traditional medical paternalism is fiercely critized. The patient's autonomy gets unprecedentedly improved. What the patient's autonomy reflects is the principle of respect of autonomy. The principle of respect of autonomy requires that the patient's independent and voluntary choice in the medical process should be considered primarily. And it attaches great importance to the informed consent. With the establishment of patient's autonomy in the medical process, the paternalistic treatment declined gradually.
In recent years, the medical disputes appeared continuously in the medical process, we have to reflect the correctness of stressing the principle of respect of autonomy in a one-side way. The principle of autonomy also has own limitation that absolute autonomy can not be realized in the medical process at all. And sometimes even if we emphasize the principle of respect of autonomy, the interests of the patient are still harmed. Some scholars begin to recourse to the rationality of medical paternalism in order to beyond the limitation of the principle of respect of autonomy. But their projects still can't resolve the contradictions between the principle of respect of autonomy and medical paternalism. This paper tries to put forward an idea of limited medical paternalism which can be morally justified. This limited medical paternalism affirms that the interests of patients is more important than the rights of patients, the principle of beneficence and nonmaleficence have precedence over the principle of respect of autonomy in some specific medical situations. The limited medical paternalism balances the principle of beneficence and nonmaleficence and the principle of respect of autonomy. It abandons the defects of the traditional medical paternalism.
引文
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[1]见附录1
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