| 摘要: | 二十一世紀人口結構高齡化是全球性的議題，然而在台灣尤其劇烈。自民國82年起，台灣已正式邁入高齡化社會，隨之而來的是政治、經濟、倫理上的困境。有鑑於此，本文在老人長期照護的範圍內，著眼於公義與幸福的議題，探討醫療之公平分配與醫療之良好狀態，並針對我國老人長期照護制度的現行狀況作一反省與建言，尋出一可行的解題之道。
首先在公義上，以丹尼爾斯的健康照護理論為主要的探討，同時參酌羅爾斯的公義論。由於醫療費用的不斷上漲，即使是最先進的國家，對於要投注多少資源在健康照護方面也是見仁見智，各執一詞。然而丹尼爾斯堅持健康照護應該是一種權利，而且是積極的權利，因為它關係著公平平等機會對個人開放的範圍，因此，病人有權利要求最基本的醫療資源服務。另外，除了支持健康照護的基本權利之外，本文以「維持正常生活的基本能力」為準，對幸福的生活品質與良好的生命質素作一客觀評量，特別是在「生命價值與尊嚴」的層面，藉著落實「預立指示」與彰顯《安寧緩和醫療條例》的精神，使老人維持尊嚴與更美好的生活。
對於幸福的議題，由於羅爾斯與丹尼爾斯在這方面的研究與論述非常缺乏，可以說是付之闕如，因此，本文將以儒家之觀點，補丹尼爾斯健康照護理論不足之處。社會上總是存在著一些鰥、寡、孤、獨、廢、疾者等令人遺憾的弱勢族群，雖說他們主要還是需要倚靠國家政府的救助與扶持來改善情況，但就儒家而言，對於世間缺憾之事，個人應當做出相應的補救，參贊天地化育之功，使有憾之人亦能各盡其性分。此一「成己成物」的歷程，「公義」與「幸福」的精神已蘊涵在其中了。
最後，在實務上，本文以丹尼爾斯十個「公平性基準」來檢視台灣長期照護制度之公義性，同時，以儒家的思想進路作一全面的反省，依循其觀點，在自助、他助、互助的過程中，讓每個人生命各階段需求都能得到滿足，生命各個階段都能得到充分發展，以至於生命得以善終。; Aging population has become a global issue in the 21st century, especially in Taiwan. Since 1993, Taiwan has literally been included in an aging society; in the meantime, we have to face the difficult situations in politics, economy and ethics. This study deals with the issues of justice and wellbeing involved in the management of the long-term care for the aged, and the equal issues in distribution and the wellbeing of health care. This study also tries to make some proposal for Taiwan's long-term care system for the elderly towards the end.
This study starts with an examination of the theory of health care of Norman Daniels, which is based upon John Rawls's theory of justice. Due to enormous need of healthcare and ever rising expenditure of health care, even the most advanced countries, there are always controversial opinions on how much be allocated for health care. Daniels insists that healthcare is a right and it is a positive right is, as it relates to the range of fair equality of opportunities that are opening to all, therefore patients have rights to certain basic medical services. Besides advocating basic rights of health care, this study emphasizes what is important for the aged people is “the basic capability to maintain a normal life”, in which the quality of life is estimated in an objective way, especially the level of “value and dignity of life”. We opt for the practice of advance directives as is promoted in the Hospice Palliative Medicine Act for the elderly to maintain dignity and a better life in Taiwan.
Both Rawls and Daniels made little exploration on the problem of wellbeing in their theory of justice healthcare. Therefore, this study tries to make good of this part of healthcare from the perspective of Confucianism. Confucians concern much with the vulnerable sectors of the population including, widowers, widowers, young without parents, old without family, the disabled and the sick and try to have all well taken care of. Although it is the government that is held accountable for taking care of and supporting them for their living with quality, yet from the viewpoint of Confucianism, everyone has the obligation to help others to manifest in full their mandates and natural talents, especially those weak and vulnerable to achieve a live with wellbeing. In this way, both justice and wellbeing are fully covered.
Lastly, the problem of justice of Taiwan's long-term care system is examined in accordance with the benchmarks of fairness in Daniels' theory and Confucian ideas, and we arrive at some practical proposal for the reform of Taiwan's long term healthcare program for the aged. It is some combination of self-help, help-others, mutual help, so that every person's needs at each stage of life can be met, and one's wellbeing of life could be achieved throughout one's whole span of life. |
