| 摘要: | 本文旨在根據儒家的公義理論，建立一套儒家的健康公義理論，以處理健康照護資源分配的公義問題。健康照護是人類賴以維持及恢復健康生活的重要的社會財，但由於人類對健康照護的需求不斷增加，已造成世界各國沉重的負擔，使健康照護資源分配的公義問題成為學界關注的焦點。在各種著手處理此一問題的哲學進路當中，其中一個最具代表性的進路莫過於丹尼爾斯依據羅爾斯公義即公平的理論所建立的健康公義理論。其理論中的其中兩個最主要的部分，即是他對健康照護的目的及重要性所作的解釋，以及他所構想的健康照護改革公平性基準。對他而言，健康照護的目的，在於維持或恢復每個人的正常物種功能，從而保障了每個人的正常機會範圍。由於羅爾斯的公義即公平要求保障機會，因此該理論賦予滿足健康照護的需求以特殊的重要性。雖然如同本文所論證的，丹尼爾斯的理論相比於其他進路而言，已較具完整性及說服力，但他的進路仍受到契約論和個人主義的觀點所限制。 本文希望透過對儒家經典文獻的分析，以確立儒家的公義理論所要求的終極目的即在於一切人一切物實現性分上的平等。這表示就人而言，儒家的公義所要求的，是保障所有人自律自主的消極權利和積極權利、盡可能幫助所有人其道德能力和其他才能之充分實現、自然生命的健康發展和家庭生活的幸福美滿。儒家認為，這些基於公義而有的要求同時是健康照護的終極關懷，因此健康照護不應只限於維持或恢復每個人的正常物種功能，而應擴展到通過可能的醫療方法提昇人的道德和其他能力上。因此，本文依據儒家對健康照護的終極關懷之觀點，以及儒家在家庭對其成員和社會對最弱勢的階層在滿足其健康照護需求方面所應盡的義務之看法，建構出儒家的公義健康照護之基本原則。此外，本文依據上述這些原則對丹尼爾斯的公義理論提出批判的省察，同時對他的公平性基準加以修正，構想出儒家本身的公平性基準，以完整儒家公義理論的基本架構。 The aim of this study is to construct a theory of just health according to Confucian theory of justice. Health care is an important social goods for human beings to maintain and restore their healthy lives. As all countries around the world face the heavy burden of increasing health care needs, the problem of justice in distributing health care resources becomes one of the main concerns in academic circles. Among various philosophical approaches in addressing this problem, one of the most prominent approach would be the work of Norman Daniels in constructing his just health theory based on Rawlsian theory of justice as fairness. Two of the main elements in Daniels’ theory are his explanation on the objective and importance of health care and his formulation of a group of benchmarks for health care reform. For him, the objective of health care is to maintain or to restore our normal human species functioning in order to protect our normal range of opportunity. Since Rawls’ justice as fairness requires protecting opportunity, it gives special importance to meeting health care needs. Though Daniels’ theory may be more comprehensive and persuasive than other approaches in dealing with distributive justice in health care, as I argue in this work, his own approach is limited by contractarian and individualist perspectives. In this study, I clarify first the ultimate end of justice in Confucianism through an analysis on its classics and argue that for Confucian justice requires equality in fulfilling all kinds of beings, whether human or non-human, their own hsing feng, that is, requirements derived from their own essence. For human, it means that justice requires to protect all human beings their positive and negative rights to autonomy, to let and help them to realize their moral capacities and natural talents, to be healthy and to enjoy a happy familial life as far as possible. Confucian thinks that these requirements of justice are also the ultimate concern of health care, so that it should not be limited to maintain or restore normal human species functioning and should be extended to enhance human moral and other capacities through possible medical methods. Hence, I construct the basic principles of just health care in Confucianism according to its perspective on the ultimate concern of health care, as well as its views on the duty of a family to its members and a society to its worst off group regarding to their health care needs. Moreover, I offer a critical examination on Daniels’ theory of just health according to these principles and revise his benchmarks of fairness to formulate Confucian own version of benchmarks, in order to complete the construction on the basic structure of Confucian theory of just health. |
