医疗家长主义的伦理辩护及道德边界

The Ethical Justification and Moral Boundary of Medical Paternalism

尊重自主是现代医疗实践的基本规范。在现代医疗实践中,医疗家长主义是否具有存在合理性存有争论。否定其合理性的主张基于自主的内在价值和医疗家长主义的可能后果,如伤害脆弱的医患信任、可能不理想的结果招致病人的怨恨;合理性辩护在于特殊医疗语境下“善对于权利”的优先性。我国社会形态处于现代性进行中,个体的主体理性和公共理性尚未完成,加之临床语境下医师的德性和病人的依赖性都决定了医疗家长主义的合理性。但是,其道德边界为“自主的生命”,即自主由纯粹的健康选择拓展至自主与福祉、善的三维关系,表达为超越于健康的生命自主。医疗家长主义的实践需要社会学的自我认识。

Respecting autonomy is the basic norm of modern medical practice.There has been a dispute about the rationality of medical paternalism during modern medical practice.The opinion of denying its rationality is based on the intrinsic value of autonomy and the possible consequences of medical paternalism,such as hurting the fragile trust of doctors and patients,and possibly causing resentment of patients with unsatisfactory results,while the justification of it lies in"the priority of good to right"in the special medical context.The social form of our country is in the process of modernity,in which the subjective rationality and public rationality of individuals have not been completed,and the virtue of doctors and the dependence of patients in the clinical context all determine the rationality of medical paternalism.However,its moral boundary is"life with autonomy".Autonomy is expanded from pure healthy choice to the three-dimensional relationship among autonomy,well-being and goodness,and being expressed as life autonomy beyond health.The practice of medical paternalism needs self-understanding of sociology.