将病人利益置于首位原则的现实挑战与理性对待

The Practical Challenges and Rational Approach of the Principle of Putting Patient's Interests First

将病人利益置于首位原则在实践中遭遇现实挑战。如何重新认识和理性对待将病人利益置于首位原则,是医学伦理学再启程必须回应的现实诘难和学术命题。回顾了将病人利益置于首位的历史演绎,即从德性范式到原则范式,包含了从个体德性到公共规范、从病人健康到病人利益、从感性经验到理性原则三个维度的提升。然后讨论了将病人利益置于首位原则面临的现实挑战,主要来自市场化背景下医方利益、家属决策和病人利益判断的复杂性等。理性客观看待将病人利益置于首位原则,需要认识病人利益的正当性、实现利益的程序合理性以及病人利益与他人/社会利益的权衡。

The principle of putting patient's interests first faces significant challenges in practice.How to re-examine and rationally approach this principle has become a pressing issue for medical ethics in its new stage of development.This paper first reviews the historical evolution of the principle of putting patient's interests first,tracing its development from a virtuebased paradigm to a principle-based paradigm,which involves three dimensions of enhancement:From individual virtues to public norms,from patient health to patient welfare,and from emotional experience to rational principles.It then discusses the current challenges faced by the principle,primarily stemming from the complexities of healthcare providers,family decisionmaking,and the assessment of patient's interest in a market-driven context.Finally,it proposes a rational and objective perspective of the principle,including the legitimacy of interest/welfare,the rationality of tools used to achieve welfare,and the balance between patient's interest and the welfare of others/society.