Tsai D F
Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
J Med Ethics. 2001 Feb;27(1):44-50. doi: 10.1136/jme.27.1.44.
The modern doctor-patient relationship displays a patient-centred, mutual-participation characteristic rather than the former active-passive or guidance-cooperation models in terms of medical decision making. Respecting the wishes of patients, amounting to more than mere concern for their welfare, has become the feature central to certain modern bioethics theories. A group of ethical principles such as respect for autonomy, beneficence, non-maleficence, and justice has been proposed by bioethicists and widely adopted by many medical societies as an ethical guide to how doctors, in their daily practice, should treat their patients. However, seeing patients as persons who are rational, self-conscious beings capable of valuing their own lives, and who are consequently entitled to the liberty and rights to choose for themselves, is in general the backbone of Western bioethical principles. Since Confucian philosophy has long been a representative of the East-Asia cultural tradition and Confucian bioethics has recently been developed as a theory of applied ethics, examining Confucius's idea of "persons" may shed some light on the current bioethical debates. Confucius's concept of persons, which is best interpreted via his theories of "chun-tze", (the morally ideal person) encapsulating a two-dimensional approach, (the "autonomous person" and the "relational person"), provides a more comprehensive model regarding what a person is and how he/she should be treated. This two-dimensional approach sees a person not only as a rational, autonomous agent but also as a relational, altruistic identity whose self actualisation involves incessant participating in and promoting of the welfare of his fellow persons. Hence this may balance the current bioethical trend whereby "respect for autonomy" often triumphs.
在医疗决策方面，现代医患关系呈现出以患者为中心、相互参与的特征，而非以往的主动-被动或指导-合作模式。尊重患者意愿，这不仅仅是对其福祉的关心，已成为某些现代生物伦理学理论的核心特征。生物伦理学家提出了诸如尊重自主权、行善、不伤害和公正等一系列伦理原则，并被许多医学协会广泛采纳，作为医生在日常实践中应如何对待患者的伦理指南。然而，将患者视为有理性、有自我意识、能够珍视自己生命、因而有权为自己做出选择的自由和权利的个体，总体上是西方生物伦理原则的核心。由于儒家哲学长期以来一直是东亚文化传统的代表，且儒家生物伦理学最近已发展成为一种应用伦理学理论，审视孔子的“人”的观念可能会为当前的生物伦理辩论提供一些启示。孔子的“人”的概念，最好通过他的“君子”理论来解释，该理论包含一种二维方法（“自主的人”和“关系中的人”），提供了一个关于人是什么以及应如何对待他/她的更全面的模式。这种二维方法认为，一个人不仅是一个理性、自主的主体，而且是一个关系性、利他性的身份，其自我实现涉及不断参与和促进他人的福祉。因此，这可能会平衡当前“尊重自主权”往往占上风的生物伦理趋势。
