对危重病人的治疗
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
当今急救科学飞速发展,在挽救无数生命的同时也将生命与死亡的定义一次又一次地推向了极至。危重病人是否有义务穷尽一切现有医疗手段?抑或我们有权放弃某些治疗?这些都成了急需解决的问题。
     著名的天主教道德神学家理查德·A·麦哥铭多年来一直关注这一问题,并给人们留下了丰富的学术遗产。麦哥铭追随天主教会的立场,认为人们在濒死时最需要的是爱、关怀与照顾,危重病人没有义务穷尽一切医疗手段延长生命。从这一立场出发,麦哥铭回答了什么样的情况下人们有权力放弃治疗、应该由谁来做出这一决定、患者、患者家属、医护人员和社会各自的权力与义务等等一系列问题,为正在进行的讨论做出了重大的贡献。其中生命质量标准、推测检验和最大利益检验以及家庭自决原则都引起了各界的广泛讨论。
     本文介绍了首先介绍了麦哥铭之医学伦理的理论基础。重点放在生命作为人类基本善的相对意义、在判断人性行为的道德属性时的整体性原则及与之相应的“充足顾及人性位格”思想、相称主义和自然法理论在生命理论中的运用及二者的关系。
     本文的第二部分集中讨论危重病人的治疗原则,主要是放弃治疗问题。包括放弃治疗的理论依据(生命价值的相对性)、判断标准(治疗手段标准与生命质量标准)、术语的沿革(常规/非常规手段的演变)以及其背后隐藏的实质(生命神圣性与生命质量之争)。重点集中在生命质量标准的合理性与问题。最后,在这一章中还会将两类无自主能力患者(严重残障婴儿与持续性植物状态病人)的治疗决定做一个单独的说明
     在弄清了危重病人的治疗原则后,第三部分将阐述决定权的问题。决定权主要分两个部分,即有自主能力患者的自决权(包括对此权力的限制)和无自主能力患者的代理决定(包括代理人——首选患者家属和代理判断的标准——推定检验与最大利益检验)。重点将围绕自决权的限制和代理判断的标准展开讨论。
     最后本文将讨论与危重病人治疗相关的社会正义问题。作为弱势人群,危重病人特别需要社会的保护和关怀,同时作为社会的一员,他们也要顾及社会医疗资源的有限性,这两者间需要的是一种较为平衡的状态。
     本文将以介绍为主,同时穿插对其观点的评论,力求描绘出问题的全貌。
For more than half a century, the advancement in modern technology has rendered treatment decision for the dying one of the major issues in medical ethics. Among those who take an acute interest in this debate was the famous catholic moral theologian Richard A. McCormick. Over the years, McCormick had constantly addressed these issues and thus left a rich heritage that will guide us through many of the troubled waters. It is therefore the aim of this paper to present McCormick's insights as well as his deliberations.
     We will first of all examine the basic values on which he founded his medical ethics, namely the meaning of life and death, the meaning of personhood as well as proportionism and the theory of natural law. After this we'll enter into the discussion of treatment decision for the dying, including McCormick's deliberation on the basis of foregoing treatment, the burden/benefit calculus (especially the quality of life judgment), the term ordinary/extrordinary, its history, the criticism it faces and the essence of the debate. At the end of this chapter we'll also look more closely at two kinds of treatment decisions which are particularly troublesome--that of serious defective newborns and that of PVS patients. The third chapter will focus on the decision-maker. It'll deal respectively with the principle of self-determination for the competent patients and proxy decision for the incompetent. The key issues are the limitation of self-determination and the guidelines for proxy judgment. After this, the fourth and the last chapter will talk about the social justice issues within the context of terminally ill. It will be divided into two parts: the responsibility of the society and that of the patient.
     This paper aims mainly at introducing McCormick's contribution to the said issues, but along the way the author will also offer comments and analyses so as to support his points or explore the possible weaknesses.
引文
① Pastoral Constitution on the Church in the Modern World, www.vatican.va/archive/hist_councils/ii_vatican_council/documents/vat-ii_cons_19651207_gaudium-et-spes_en.html
    ② Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 42
    ① Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 345
    ② Charles E. Curran ed. Moral Theology: Challenges for the Future. New York/Mahwah: Paulist Press, (1990): 270
    ① 卡尔·白舍客:《基督宗教伦理学》,静也,常宏等译,上海三联书店,2002年,第298-299页
    文言Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, 1981:405-406
    ① Richard A. McCormick, S.J., "Ethics and Genetic Research" in Method and Catholic Moral Theology: The Ongoing Reconstruction, ed. Todd A. Salzman, Omaha, Nebraska, Creighton University Press (1999): 269
    文言Richard A. McCormick, S.J., "Theology and Biomedical Ethics," Logos 3 (1982): 27
    ② Richard A. McCormick, S.J., Health and Medicine in the Catholic Tradition. New York: Crossroad, (1987): 17
    文言Richard A. McCormick, S.J., Corrective Vision: Exploration in Moral Theology. Kansas City: Sheed&Ward, (1994): 59-62
    ① Richard A. McCormick, S.J., "Theology and Biomedical Ethics," Logos 3 (1982): 38
    ② Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, 1981: 14, 347
    ③ Richard A. McCormick, "Genetic Technology and Our Common Future," America 152, no.6 (April 27, 1985), 341
    ① Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, 1981:346
    ② Richard A. McCormick, S.J., "Experimentation in Children: Sharing in Sociality," Hasting Center Report 6, no.6 (December 1976): 42.
    文言Richard A. McCormick, S.J., Notes on Moral Theology 1981 through 1984. University Press of America. (1984): 50
    ② 有人对这种区分提出置疑,认为这只是为辩论的缘故而采取的混淆视听的策略。对此麦哥铭举了在合法的自卫中杀人的例子。我们将这称为什么呢?道德的善吗?当然不是。然而它又是正当的。传统上会将它称作物理的恶,然而“物理”太容易让人联想到与身体有关的外在行为,因此麦哥铭建议使用前道德的恶或者本体恶。见Richard A.McCormick, S.J., Notes on Moral Theology 1981 through 1984. University Press of America, (1984): 5
    ① Richard A. McCormick, S.J., Notes on Moral Theology 1981 through 1984. University Press of America, (1984): 69-71
    ① Charles E. Curran, Notes on Richard A. McCormick, in Theological Studies 61(2000), 540
    ② Richard A. McCormick, S.J., Notes on Moral Theology 1981 through 1984. University Press of America, (1984): 17
    ① Richard A. McCormick, S.J., How Brave a New World?." Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 11
    ① Richard A. McCormick, S.J., Corrective Vision: Exploration in Moral Theology. Kansas City: Sheed&Ward, (1994): 170
    ② Richard A. McCormick, S.J., The Critical Calling. Washington: Georgetown Univ., (1989): 366
    ③ Richard A. McCormick, S.J., Corrective Vision. Exploration in Moral Theology. Kansas City: Sheed&Ward, (1994): 172
    文言Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, 1981:368
    ① Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 347
    文言John Connery, "Quality of Life", Linacre Quarterly 53 (1986): 26-33
    ② Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 350
    ① Richard A. McCormick, S.J., The Critical Calling. Washington: Georgetown Univ., (1989): 383
    ② Charles E. Curran, ed. Moral Theology: Challenges for the Future. New York/Mahwah: Paulist Press, (1990): 275
    ① Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 359
    ① Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 410
    ① Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 349
    ② Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 408-409
    ① Weber, Leonard J., Who Shall Live? (New York: Paulist Press, 1976): 82
    ② Weber, Leonard J., Who Shall Live? (New York: Paulist Press, 1976): 85
    ① Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 10-11
    ② Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 407
    文言 Charles E. Curran,, ed. Moral Theology." Challenges for the Future. New York/Mahwah: Paulist Press, (1990): 278
    文言Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 349
    ① Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 350
    ② 张丽静,“关于持续性植物状态患者的伦理学思考”,中国医学伦理学,2005,18(6):18
    文言 Charles E. Curran ed. Moral Theology: Challenges for the Future. New York/Mahwah: Paulist Press, (1990): 276
    ① Richard A. McCormick, S.J., The Critical Calling. Washington: Georgetown Univ., (1989): 381
    ① Richard A. McCormick, S.J., Corrective Vision." Exploration in Moral Theology. Kansas City: Sheed&Ward, (1994): 216
    ① Richard A. McCormick, S.J., The Critical Calling. Washington: Georgetown Univ., (1989): 383
    ② Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 384-386
    ① Virginia M. Ryan, Euthanasia: A Social Justice Perspective. Boston College, (1998): 74
    ① Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 196
    ② Richard A. McCormick, S.J., Corrective Vision: Exploration in Moral Theology. Kansas City: Sheed&Ward, (1994): 223
    文言Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 369
    ① Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 368
    ② Richard A. McCormick, S.J., Health and Medicine in the Catholic Tradition. New York: Crossroad, (1987): 107
    文言Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 27
    ② Richard A. McCormick, S.J., The Critical Calling. Washington: Georgetown Univ., (1989): 365
    文言 Barbara B. MacKinnon, Ethics: Theory and Contemporary Issues, Wadsworth (2001): 134
    ① Richard A. McCormick, S.J., "Theology and Biomedical Ethics," Logos 3 (1982): 27-28
    ① Richard A. McCormick, S.J., How Brave a New WorM? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 407-410
    ② Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 194-195
    ① Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 369-371
    ① Richard A. McCormick, S.J., How Brave a New WorM?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 413
    ① Richard A. McCormic k, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D.C.: Georgetown University,(1981): 415
    ① Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 423
    ① Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 426
    ① Richard A. McCormick, S.J., The Critical Calling. Washington: Georgetown Univ., (1989): 335
    ① 见Richard A. McCormick, S.J., "The Rights of the Voiceless" in How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 99-113
    ① RichardA, McCormick, S.J., Health and Medicine in the Catholic Tradition. New York:Crossroad,(1987): 75
    ② 张丽静,“关于持续性植物状态患者的伦理学思考”,中国医学伦理学,2005,18(6):18
    ① Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 35
    ① Richard A. McCormick, S.J., Corrective Vision." Exploration in Moral Theology. Kansas City: Sheed&Ward, (1994): 169
    ② Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981 ): 36
    o--
    ① Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 20
    ① Richard A. McCormick, "Experimentation in Children: Sharing in Sociality," Hasting Center Report 6, no.6 (December 1976): 42.
    ② 卡尔·白舍客:《基督宗教伦理学》,静也,常宏等译,上海三联书店,2002,第290-291页
    ① Richard A. McCormick, S.J., The Critical Calling. Washington: Georgetown Univ., (1989): 361
    ② Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 101
    ③ Richard A. McCormick, S.J., How Brave a New World?Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 62-63
    ① Richard A. McCormick, S.J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, (1981): 44
    Richard A. McCormick, S. J., The Critical Calling. Washington: Georgetown Univ., 1989.
    Richard A. McCormick, S.J., Corrective Vision: Exploration in Moral Theology. Kansas City: Sheed&Ward, 1994.
    Richard A. McCormick, S.J., Health and Medicine in the Catholic Tradition. New York: Crossroad, 1987.
    Richard A. McCormick, S. J., How Brave a New World? Dilemmas in Bioethics. Washington, D. C.: Georgetown University, 1981.
    Richard A. McCormick, S. J., Notes on Moral Theology 1965 through 1980. University Press of America, 1981.
    Richard A. McCormick, S. J., Notes on Moral Theology 1981 through 1984. University Press of America, 1984
    Richard A. McCormick, S,J., "Theology and Biomedical Ethics," Logos 3 (1982), 25-43
    Richard A. McCormick, "Technology, the Consistent Ethic, and Assisted Suicide", Origins25 (1995)
    Richard A. McCormick, "Experimentation in Children: Sharing in Sociality," HastingCenter Report 6, no.6 (December 1976)
    Richard A. McCormick, S.J., "Ethics and Genetic Research" in Method and Catholic Moral
    Theology: The Ongoing Reconstruction, ed. Todd A. Salzman, Omaha, Nebraska, Creighton University Press, 1999
    Richard A. McCormick, "Genetic Technology and Our Common Future," America 152,no.6 (April 27, 1985)
    Charles E. Curran, ed. Moral Theology: Challenges for the Future. New York/Mahwah: Paulist Press, I990.
    Charles E. Curran, Notes on Richard A. McCormick, in Theological Studies 61(2000)
    Virginia M. Ryan,. Euthanasia: A Social Justice Perspective. Boston College, 1998.
    Timothy Flaherty, Using the Expression "Human Dignity" in Public Documents Discussing
    Genetics: A Theological Contribution to the Discussion of its Meaning in Light of the Work of Richard A. McCormick. University of Ottawa.
    Germain Grisez, Euthanasia and Suicide. University Publications of America, Inc., 1977.
    Frederick S. Carney, "On McCormick and Teleological Morality", Journal of Religious Ethics, 6/1(1978).
    J. Gordon Melton ed., The Churches Speak On: Euthanasia, Gale Research Inc. 1991
    Mary Jo. Iozzio, "To Treat or Not to Treat: the Ethical Methodology of Richard A. McCormick, S. J., as Applied to Treatment Decisions for Handicapped Newborns." Theology Studies 66(2005)
    William E. May, Catholic Bioethics and the Gift of Human Life, Huntington Indiana (2000)
    William E. May, Caring for Persons in the Persistent Vegetative State, www. catholicculture.org/docs/doc_view.cfm?recnum=3481
    Barbara B. MacKinnon, Ethics: Theory and Contemporary Issues, Wadsworth, 2001
    Pastoral Constitution on the Church in the Modern World, www.vatican.va/archive/hist_councils/ii_vatican_council/documents/vat-ii_cons_19651207_gaudium-et-spes_en.html
    Evangelium vitae, www.vatican.va/holy_father/john_paul_ⅱ/encyclicals/documents/hf_jp-ⅱ_enc_25031995_evangelium-vitae_en.html
    John Paul Ⅱ, Life-sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas, www.vatican.va/holy_father/john_paul_ii/speeches/2004/march/documents/hf_jp-ii_spe_20040320_congress-fiamc_en.html
    Donal P. O'Mathuna, "Responding to Patients in the Persistent Vegetative State", Philosophia Christi 19.2 (Fall 1996)
    《天主教教理》,河北天主教信德室,2000
    傅乐安主编:《当代天主教》,东方出版社,1996
    唐凯麟主编:《西方伦理学名著提要》,江西人民出版社,2000
    卡尔·白舍客:《基督宗教伦理学》,静也,常宏等译,上海三联书店,2002
    托马斯·A·香农:《生命伦理学导论》,肖巍译,黑龙江人民出版社,2005
    卓新平:《当代西方天主教神学》,上海三联书店,1998
    黄丁全:《医疗法律与生命伦理》,法律出版社,2004
    韩跃红:《护卫生命的尊严——现代生物技术中的伦理问题研究》,人民出版社,2005
    翟晓梅、邱仁宗:《生命伦理学导论》,清华大学出版社。2005
    王平、李海燕:《死亡与医学伦理》,武汉大学出版社,2005
    王海明:《伦理学原理》,北京大学出版社,2001
    张丽静:“关于持续性植物状态患者的伦理学思考”,中国医学伦理学,2005,18(6)
    王志杰:“放弃治疗与安乐死的伦理争论,”中国医学伦理,2005,18(4)
    彭红,李永国:“从滑坡现象和风险社会理论看安乐死,”中国医学伦理,2006,19(3)
    杨立新,张莉:“论植物人的法律人格及补正,”法学论坛,2006(8)
    姜良树:“科学地认识昏迷、植物人、脑死亡,”生物学教学,2006,31(12)
    邓河:“论生命权的本质与安乐死的选择,”法学研究,2005(3)
    陆纪春:“临终关怀的社会学思考,”广西医学院学报,1993增刊
    肖雪飞:“浅谈临终关怀与护理,”中国民康医学,2007,19(1)

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700