City University of Hong Kong, Kowloon, Hong Kong.
Theor Med Bioeth. 2011 Oct;32(5):301-13. doi: 10.1007/s11017-011-9191-z.
The family is the exemplar community of Chinese society. This essay explores how Chinese communitarian norms, expressed in thick commitments to the authority and autonomy of the family, are central to contemporary Chinese bioethics. In particular, it focuses on the issue of surrogate decision making to illustrate the Confucian family-grounded communitarian bioethics. The essay first describes the way in which the family, in Chinese bioethics, functions as a whole to provide consent for significant medical and surgical interventions when a patient has lost decision-making capacity. It is argued that the practice of not having an established order for surrogate decision makers (e.g., spouse, children, and then parents), as it is done in the United States, reflects the acknowledgment that the family as a social reality cannot be reduced to a stereotype of the appropriate order of default decision makers. This description of the family as being in authority to make surrogate decisions for an incompetent family member is enriched by an elaboration of the differences among the concepts of patient autonomy, family autonomy, and moral autonomy. The Chinese model, as well as the Confucian communitarian life of families, engages a family autonomy that is supported by a Confucian understanding of moral autonomy, rather than individual autonomy. Finally, the issue of possible conflicts between patient and family interests in relation to a patient's past wishes in the Chinese model is addressed in light of the role of the physician.
家庭是中国社会的典范社区。本文探讨了中国社群主义规范如何将对家庭权威和自主性的深厚承诺表达出来，成为当代中国生命伦理学的核心。特别是，它侧重于代理决策的问题，以说明基于儒家家庭的社群主义生命伦理学。本文首先描述了在中国生命伦理学中，家庭如何作为一个整体，在患者失去决策能力时，为重大的医疗和手术干预提供同意。有人认为，在美国，没有为代理决策者（例如配偶、子女，然后是父母）建立既定顺序的做法，反映了这样一种认识，即家庭作为一种社会现实，不能简化为适当的默认决策者顺序的刻板印象。对家庭作为为无行为能力的家庭成员做出代理决策的权威的这种描述，通过阐述患者自主性、家庭自主性和道德自主性之间的区别而得到丰富。中国模式以及家庭的儒家社群主义生活方式所采用的家庭自主性，得到了对道德自主性的儒家理解的支持，而不是个人自主性。最后，根据医生的角色，针对中国模式中患者过去意愿与患者和家庭利益之间可能发生冲突的问题进行了讨论。
