世界各國人口老化趨勢是全球性的事實。先進工業國家，面對對於處理長期照護問題，根據其國家的歷史背景，分別採取對應照顧模式。臺灣也同樣迫切面臨人口高齡化並且必須面對長期照護問題。臺灣推動「長期照顧十年計劃」福利政策模式，面臨了平等對待老人和婦女問題，以及世代之間的公義倫理問題與家庭倫理問題。 本篇論文以約翰．羅爾斯所提出之公義二原則，並藉由差異原則，以說明公民對醫療照護存在的差異和改善。其次，本文進而論述諾曼．丹尼爾斯健康照護公義理論。丹尼爾斯的理論主張健康直接影響機會公平平等之社會分配，所以提出以健康照護作為公民的權利的理論，並且提出預防、健康修復、補償與支援、慈善等四個層次的健康照護理論，並且認為老人長期照護並非完全是社會的責任，家庭照護責任仍然是主要部份，社會必須同時支持家庭的中成員照顧老人。丹尼爾斯提出世代間公義儲蓄理論，對先進國家以社會福利模式或者社會保險模式的評論，回應聯合國對老人長期照護的世代間公義倫理問題。本文並以相同的理論檢視臺灣老人長期照護的「長期照顧十年計劃」政策。這是一種以執行社會福利方式照顧老人的政策。然而，是以資產調查替代需求的正當性。臺灣的老人長期照護形式，不論是採用公共稅收的福利政策模式，或者推行社會公共保險政策模式，仍舊必須面對未來世代間公義儲蓄問題。本文對臺灣全民健康保險，涉及社會弱勢族群、老人醫療照顧平等問題，提出檢視評論。本文認為老人長期照護必須考慮到世代間公義，以及對婦女和女童平等對待，並且必須維持家庭親情倫理，不可毀棄家庭倫理。本文的觀點認為老人長期照護，應該以儒家之家庭倫理，彌補社會公義理論欠缺親情之不足。 Population aging is a global reality and every industrial country has been facing this problem and made their response according to their cultural backgr- ound. Taiwan is n exception, we have to face the aging problem and make our response to the long-term care needs. Taiwan is promoting a “ten-year long t- erm care plan”which is a welfare policy. It has to solve the problems of how to treat old people and the females fairly, and inter-generation justice asw well as the ethical problems within family. In this dissertation, I begin with John Rawls’ two principles of justice and how he explains the difference principle could be applied to healthcare. It then explores Norman Daniels’s Theory of just healthcare as an extension of Rawls’ principle of fair equality of opportunity. Daniels argues that health affects our just and it is a civil right to have healthcare. He proposes a four layers of hea- lthcare provision as prevention, rehabitation, caring for disables, and finally a b- enevolent service for terminal patients. Daniels thinks that long term care for old people is not only a societal responsibility, it is still mainly the responsibility of the family. However, the public must support those family members who take care of the old people. Daniels also proposes a saving theory in response to inter -generation justice as a way in response to the Uniter Nations concerns on the j- ustice of long term care for old people. We shall employ the same theory in o- ur evaluation of Taiwan’s long term care policy. This is supposed to be a welf are policy and its legitimacy is based upon needs of the old people. I argues th- at we have also to take future justice into question and need to be just for the old as well as for the females and maintain the ethical relation within the family. It s -hould be complemented with Confucian family ethics to make up for the lack of intimacy in social justice theory.
