Tsai D F-C
Department of Social Medicine, College of Medicine, National Taiwan University Hospital, No 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan.
J Med Ethics. 2005 Mar;31(3):159-63. doi: 10.1136/jme.2002.002113.
This paper examines whether the modern bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice proposed by Beauchamp and Childress are existent in, compatible with, or acceptable to the leading Chinese moral philosophy-the ethics of Confucius. The author concludes that the moral values which the four prima facie principles uphold are expressly identifiable in Confucius' teachings. However, Confucius' emphasis on the filial piety, family values, the "love of gradation", altruism of people, and the "role specified relation oriented ethics" will inevitably influence the "specification" and application of these bioethical principles and hence tend to grant "beneficence" a favourable position that diminishes the respect for individual rights and autonomy. In contrast, the centrality of respect for autonomy and its stance of "first among equals" are more and more stressed in Western liberal viewpoints. Nevertheless, if the Confucian "doctrine of Mean" (chung-yung) and a balanced "two dimensional personhood" approach are properly employed, this will require both theorists and clinicians, who are facing medical ethical dilemmas, of searching to attain due mean out of competing moral principles thus preventing "giving beneficence a priority" or "asserting autonomy must triumph".
本文探讨了博尚和奇尔德雷斯提出的尊重自主性、行善、不伤害和公正等现代生物伦理原则是否存在于中国主要道德哲学——孔子伦理学之中，是否与之兼容或为其接受。作者得出结论，这四条初步原则所秉持的道德价值观在孔子的教义中清晰可辨。然而，孔子对孝道、家庭价值观、“差等之爱”、人们的利他主义以及“角色特定关系导向伦理”的强调，将不可避免地影响这些生物伦理原则的“具体规定”和应用，从而倾向于给予“行善”一个有利地位，而这会削弱对个人权利和自主性的尊重。相比之下，西方自由主义观点越来越强调尊重自主性的核心地位及其“平等之中的首要地位”立场。然而，如果恰当地运用儒家的“中庸”学说和平衡的“二维人格”方法，这将要求面临医学伦理困境的理论家和临床医生在相互冲突的道德原则中寻求恰当的中庸之道，从而避免“优先考虑行善”或“断言自主性必须胜出”。
