儒家伦理视域下医疗决策中利益冲突之化解

Resolving Conflicts of Interest in Medical Decision-making from the Perspective of the Confucian Ethics

儒家伦理以仁、义、礼、智、信为主要内容,具有丰富的化解医疗决策中利益冲突的理论资源。其一,在儒家看来,医之仁道的体现是"生",当维系患者的生命权与自主权相冲突时,儒家认为生命权更具重要性和优先性。其二,儒家主张先义后利、舍利取义,这要求医生等医疗群体在遵循义的前提下求利,同时,患者也不应吝惜必要而合理的医疗支出。其三,儒家之礼的精神体现为敬、让、和。在医疗决策中,医生要敬畏生命、态度恭敬,允许患者充分表述病情,容让患者的不专业询问。为了保证全体患者的利益,"和"必须通过礼的规范来实现。其四,儒家伦理中的"信",就诚信而言,医患双方都应如实告知病情;就信任而言,患者不应无根据地怀疑医生,医生也要提高医疗水平以获取患者信任;就信仰而言,信仰医理是化解利益冲突的重要条件。其五,儒家强调"智"的变通性,医生既要具有一定的医学知识和道德观念,又要根据实际情况进行灵活变通,使之能更好地处理医疗决策中的各种问题。

Confucian ethics takes benevolence, righteousness, rites, wisdom and faith as the main contents, and has rich theoretical resources to resolve conflicts of interest in medical decision - making. Firstly, in the view of Confucianism, the embodiment of the medical treatment is ＂life＂. When the right to life of the patient is in con- flict with the right of autonomy, the Confucian believes that the right to life is more important and priority. Second- ly, Confucius advocates profit after righteousness, which requires doctors and other medical groups should pursue interests under the premise of righteousness. At the same time, patients should not begrudge the necessa^y and rea- sonable medical expenses. Thirdly, the spirit of Confucian rites is embodied in respect, comity and hamlony. In medical decision - making, doctors need to respect life, have respectful attitude, allow patients to fully express their illness, and tolerate the patient＇ s unprofessional inquiries. In order to ensure the interests of all patients, ＂hamaony＂ must be realized through the norms of rites. Fourthly, it is the ＂faith＂ in Confucian ethics. In terms of good faith, both doctors and patients should truthfully informed the condition ; in terms of trust, patients should not suspect doctors without any basis and doctors should improve their medical level to obtain patients＇ trust as well ; in terms of beliefs, believing medical knowledge is an important condition to resolve conflicts of interest. Fifthly, Con- fucianism emphasizes the flexibility of ＂wisdom＂. Doctors should not only have certain medical knowledge and mor- al concepts, but also be flexible in accordance with the actual situation so that they can better deal with various problems in medical decision -making.