基於高齡化社會趨勢對長期照護的迫切需求，本文旨在對老人長期照護提出一個儒家公義的論點。因如何公平分配照護資源自是社會公義的重要議題，而儒家「依仁定義」與「各盡其性分」的公義理論實可有合理的回應。 本文通過批判地論述當代西方極具代表性的諾門．丹尼爾斯（Norman Daniels）之公義的健康照護理論，對照東西方在公義與長期照護的不同的道德觀點；一者，藉以檢視台灣「老人長期照護政策與實踐」的公義問題，並指出丹尼爾斯理論優點為提出公平性的參考判準以進行倫理分析，但無法說明道德根源，而且存在對家庭照顧者給予公平考量不足之問題。從而對照出儒家「各盡其性分」的道德原則與「依仁定義」的道德架構有進於丹尼爾斯的道德論述。另一方面，本文彙整丹尼爾斯之公義長期照護理論，並以他的公平性基準進一步發展儒家於長期照護之公義觀點的內容與架構。 本文論說各盡其性分原則對所有相關照護的各方之公平地對待是一個必要的指引原則，尤其是對被照護者與照護者的公平關注。而儒家從倫常關係之公義的照護觀點也能達到丹尼爾斯所追求的公平、效率與可問責性；同時，儒家王道政治的思路也要求國家社會對人民負有照護之責任，以達「養生喪死無憾」之道德要求。本文即由此勾劃出儒家之公義的長期照護之論述。 In order to give an adequate treatment of the urgent need of healthcare of an aging society, this thesis works out a Confucian account of just long term care. Since the fair distribution of healthcare resources is an important issue of social justice and this thesis argues that the Confucian theory of justice in terms of benevolence and the principle of the utmost extension of everyone’s natural endowment could give a fairly reasonable argument for social justice in long term care. It gives first a critical assessment of Norman Daniels’ theory of just healthcare to illuminate the contrast between the difference in justice and moral perspectives between the east and the west in healthcare. Using Taiwan’s recently released policy and the practice of the geriatric long-term care as an example, this thesis shows on the one hand the merits of Daniels’ criteria of justice as the tool for ethical analysis, though his theory of just healthcare is criticized as lacking the explanation of the source of morality and the neglect of a fair consideration of the home care-giver. It shows how Confucianism could improve the discourse employing the notion of benevolence and natural endowment in these two respects. On the other hand, this thesis is also re-constructing a Confucian theory of just long term care with the help of Daniels benchmarks of justice. It argues that the utmost extension of each one’s natural endowment, especially that of the patient as well as the care-giver, is a necessary guiding principle for a fair treatment and sharing of all parties involved. It could achieve the Confucian political ideal of letting everyone live with “no regret in nurturing those alive and in mourning the dead.” Such a theory is the one that fully achieves Daniels request for fairness, efficiency and accountability in healthcare.
