| 摘要: | 醫學科技日新月異的現代，卻看到臺灣的醫療現場因為醫療體制改變、醫療弊案頻傳及強調病患權利保護等因素，像是一層層的紗隔在醫病關係之間，彼此難以真誠相對，甚至形成諜對諜的自我保護防衛。本文將分述近代以來，在尊重自律原則強調病人權利保障下，事實上隱含著存在極少信任的醫病互動畫面；歐妮爾（Onora O’Neill）提出「有原則的自律」，欲形成以義務為立基，有更多正向及彈性空間的醫病互動畫面，使醫病關係間的信任可適切地與病人自律自主相結合；然而，歐妮爾的理論尚有不足之處。因此，在中華文化浸濡的臺灣，本文欲以儒家觀點「醫乃仁術」的要求，探討儒家之「仁」在《中庸》以「誠」為推展、實現；從儒家倫理思想對自律的新解，借引孫思邈之「視病猶親」談醫德及醫病間如親人般的內在感通，最後以「誠」為儒家「倫理關係自律」的立論實在基礎，並回應前述歐妮爾面對之困難。最後本文申論在〈病人自主權利法〉通過後的現代，如何形成由「誠」而來之「信」以充實祥和溫暖的醫病互動，使彼此關係更加緊密和諧，以消除醫病的隔閡。;Medical science and technology are ever-changing in modern days. However, changes in the medical system, medical scandals and emphasis of the protection of patient rights in Taiwan′s medical arena, build up layers of concretes separating the physician-patient relation, making both physician and patient unable to be sincere to each other. They sometimes become spy upon each other in self-protection. In this essay, I begin with discussing about emphasizing patient’s rights by the principle of respect for autonomy in modern times, which, in fact, shows little trust in their interaction. Onora O’Neill proposed “principled autonomy” with obligation as its base, in order to make the physician-patient have better interaction with positive and flexible space, so that the trust in physician-patient relationship can be appropriately combined with patient’s autonomy. However, O′Neill′s theory is not adequate. Since Taiwan is deeply immersed in Chinese culture, and the claim of Confucian concept that medicine is the art of humanity, it is appropriate that in this essay, I explore how the core idea of Confucianism, that is, humanity (ren), promoted as sincerity (cheng) in Zhongyong. With this Confucian conception of cheng, we offer a new interpretation of autonomy, and according to Sun Simiao′s (孫思邈) sayings about treat patients like your close relatives, physician can cultivate his or her moral virtues and establish family-like intra-personal feelings between physician-patient. Finally, I come to the conclusion that seeing sincerity (cheng) as the base of Confucian “ethical relational autonomy” we could have a way overcoming the distrust between patient and physician, and give a response to O′Neill′s inadequacy in the treatment of the trust problem. I try to show how this conception of cheng could be of help after the adoption of “Law of Patient’s Rights of Autonomy”, in bridging the gap of physician-patient relation so that the physician-patient relationship could be peaceful, warm, intimate and harmonious. |
