scholarly journals 醫乃仁術: 儒家視野下的醫患關係

2009 ◽  
Vol 7 (1) ◽  
pp. 13-41
Author(s):  
Jue WANG
Keyword(s):  
Medical Ethics ◽  
Moral Authority ◽  
The Other ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Potential Conflict ◽  
Moral Principles ◽  
Ethical Implications ◽  
Western Model ◽  
Physician Patient

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文首先廓清了“醫乃仁術”在傳統儒家思想脈絡裏的含義，並指出從來源上說，它迥異於西方生命倫理學主流，而採取了一種獨特的“不離人倫，親親為本”的視角。然而這種視角使得“醫乃仁術”總是被一種歧義所困擾：它既是一種行善原則，也是一種未顧及自主性原則的行善原則，家長主義的陰影無處不在。“醫乃仁術”的歧義成為中國生命倫理學建設的最大瓶頸。面對這種困境，本文試圖在現代西方生命倫理學話語實踐之外，另闢蹊徑，借助關懷倫理學和美德倫理學的最近研究成果，闡發“醫乃仁術”的合理內涵。This essay addresses the ethical implications of the physician-patient relationship from the Confucian perspective, which holds that the physician must regard the patient as a family member to treat the patient properly. It is well known that there are two primary approaches to moral authority in contemporary Western medical ethics. One is internal, and assumes that the good inherent to medicine is the source of moral authority in medical activities. The other is external, and denies that the ends and ethics of medicine can be determined by typical medical activities. It holds that medical ethics should be based on general moral principles, such as autonomy and justice. However, the Confucian model seems to be at odds with both of these approaches. On the one hand, Confucians do not think that medicine constitutes a self-contained domain of activity with its own ethics; rather, medicine is seen as a continuum of familial relationships and ethics. On the other hand, Confucians also hold that the physician-patient relationship should follow the example of the flexible relationships among family members rather than the rigid general principles of autonomy and justice.The Western model is aimed at action, whereas the Confucian view focuses on personal affective relations. The greatest problem with the Confucian model is its notorious paternalism; that is, it appears to fail to pay sufficient attention to the potential conflict between patient and physician about the good, ignoring the issue of patient autonomy. In the modern Western tradition, the model of the physician-patient relationship is based on two self-sufficient agents (patient and physician) who are united in pursuing a certain good, where each is the final source of what is good for him- or herself. However, the real physician-patient encounter demands a deeper commitment between the two than this model suggests. When entering a physician-patient relationship, what the patient seeks is care from the physician, not autonomy. That is to say, the patient first of all trusts the physician. To earn that trust, it is not enough that the physician treat the patient based only on the principle of autonomy or what the patient requires. Rather, a deep attachment – analogous to a familial relationship – must be developed that can serve as the basis of the encounter between the patient and physician. The Confucian physician-patient model, which is rooted in such a relationship, does not contrast but rather complements its Western counterpart.DOWNLOAD HISTORY | This article has been downloaded 564 times in Digital Commons before migrating into this platform.

Medical Ethics

2016 ◽  
pp. 331-336
Author(s):  
Keith M. Swetz ◽  
C. Christopher Hook
Keyword(s):  
Medical Ethics ◽  
Best Interests ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Moral Problems ◽  
Physician Patient

Medicine is first and foremost a relationship—a coming together of a patient, who is ill or has specific needs, and a physician, whose goal is to help the patient. The physician-patient relationship is a fiduciary relationship; physicians have knowledge, skills, and privileges that patients do not have. In turn, patients trust that physicians act in their patients’ best interests. Medical ethics consists of a set of principles and systematic methods that guide physicians on how they ought to act in their relationships with patients and others and how to resolve moral problems that arise in the care of patients.

scholarly journals Per una medicina centrata sul paziente: riflessioni sulla fondazione etica del rapporto medico-paziente

2005 ◽  
Vol 54 (3) ◽  
Author(s):  
Ignacio Carrasco De Paula ◽  
Nunziata Comoretto
Keyword(s):  
Medical Profession ◽  
The Other ◽  
Simple Relationship ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Medical Activity ◽  
Real Community ◽  
Community Concept ◽  
Physician Patient ◽  
Practical Level

Sempre più frequentemente è richiesto al medico di giustificare le proprie decisioni in funzione dei fini e dei valori rilevanti nella medicina. In una medicina realmente centrata sull’uomo, il fine dell’attività medica è nella realizzazione del bene del paziente, mediante un agire adeguato non solo alla salute, ma all’intero essere del paziente, che lo consideri per il valore, infinito, che gli è proprio. Tale concezione antropologica implica, a livello pratico, che non è mai consentita di una persona la discriminazione - trattarla secondo criteri differenti da quelli che derivano dalla sua natura -, la strumentalizzazione - usarla per altri fini, diversi dal bene proprio della stessa - e l’oppressione - agire nei confronti di essa mortificando o tenendo in scarso conto la sua irrinunciabile autonomia e libertà. In una medicina centrata sul paziente il rapporto medico-paziente non è uno strumento dell’attività medica, ma il luogo in cui si realizza l’attività medica. La medicina è il rapporto medico paziente, un rapporto interpersonale, asimmetrico, non definito dalla sola identificazione dei ruoli, ma dall’individuazione di un obiettivo comune. Rapporto medico-paziente non significa dunque semplice “relazione”, ma implica una vera e propria “comunità”, concetto che richiama un’interazione tra le parti, o meglio, una condivisione. Alla base di un buon rapporto medico-paziente, identifichiamo almeno tre fattori: il riconoscimento dell’altro come persona, la costruzione di una vera e appropriata alleanza terapeutica, l’accettazione dei rispettivi ruoli. In conclusione, l’esercizio della professione medica non può prescindere dalla riflessione su quali siano i suoi scopi e, soprattutto, da una concezione antropologica di cosa sia l’uomo perché non ci rapportiamo con il paziente se non in relazione a questo. ---------- More and more frequently physician is required to justify his own decisions in accordance whit the goals and the important values of medicine. In a medicine really centred on patient, the goal of medical activity is the realization of the good of the patient, by acting not only according to health, but whit the whole being of patient, considering him for the value, endless, that is to him really. Such an anthropological conception implicates, to a practical level, that it is never allowed discrimination of the person - to treat him or her according to different criterions than those deriving from his or her nature -, the exploitation - to use him or her for other ends than proper good - and the oppression - to act towards him or her mortifying his or her autonomy and liberty. In a medicine centred on patient, the physician-patient relationship is not a tool of medical activity but the place in which medical activity comes true. The medicine is the physician-patient relationship, a relationship between two persons, asymmetrical, defined not only by the identification of the roles, but by singling out a common objective. Physician-patient relationship doesn’t mean simple relationship, but it implicates a real community, concept that recalls an interaction between the parts, or better, a sharing. At the base of a good physician-patient relationship we identify at least three factors: the recognition of the other as a person, the construction of a true and appropriate therapeutic alliance, the acceptance of the respective roles. In conclusion, the exercise of the medical profession cannot leave the reflection on what its purposes are out of consideration and, above all, an anthropological conception of what the man is because we behave to the patient in conformity with it.

scholarly journals “扁鵲見蔡桓公”——對一則古代案例的倫理學回顧

2012 ◽  
Vol 10 (2) ◽  
pp. 73-91
Author(s):  
Jianguang WANG
Keyword(s):  
Informed Consent ◽  
Patient Relationship ◽  
Ancient China ◽  
Physician Patient Relationship ◽  
Ethical Implications ◽  
Digital Commons ◽  
Serious Disease ◽  
Physician Patient ◽  
Chinese Physician

LANGUAGE NOTE | Document text in Chinese; abstract also in English.扁鵲是中國先秦時期著名的醫生，同時也是中國傳統醫學和醫學倫理的奠基者和實踐者之一。他在與蔡桓公的幾次會面中作出的對話，有著豐富的道德內涵，展示了傳統醫患之間的一種具有特色的醫學倫理。中國傳統的醫學倫理和職業精神並不把醫生僅僅看成是一個純粹的技術性職業，而是賦與其中豐富的人生道德內涵和家國天下的思想，所以在西方醫患關係中被認為是十分重要的知情同意問題，在中國傳統的醫患關係中雖然也存在，但並沒有成為中國傳統醫患關係的主體。與之相反，中國傳統的醫患關係因為是建立在“上醫醫國”的文化土壤中的，醫患之間的關係也是在綱常倫理的維度中加以調適的，所以這種關係不僅僅是今天意義上的權利和義務、知情和同意等法律屬性的關係。Bian Que is the earliest known Chinese physician of the Pre-Qin era (ca. 700 B.C.E), whose name is often associated with physicians of the highest medical caliber. One legend tells of how when Bian Que was in the feudal state of Cai, he visited the Lord Huan and told him that he had a serious disease. The Lord Huan thought Bian Que was trying to profit from the fears of his patients and declined the offer for treatment. Eventually, Lord Huan’s condition got worse. The last time Bian Que went to see Lord Huan, he knew that the lord would soon die and escaped from the state. This essay considers the ethical implications of the legend, such as the moral duty of the physician and the nature of the physician-patient relationship. Did Bian Que violate informed consent when he failed to tell the lord he would die of the disease if not treated immediately? The author concludes that the role of physician in ancient China was quite different from what one sees today. Thus, modern ideas and concepts such as informed consent and the language of rights cannot be applied to the case of Bian Que.DOWNLOAD HISTORY | This article has been downloaded 182 times in Digital Commons before migrating into this platform.

Eutanasia: una questione di relazione

2007 ◽  
Vol 56 (6) ◽  
Author(s):  
Marianna Gensabella Furnari
Keyword(s):  
Point Of View ◽  
The Other ◽  
Patient Relationship ◽  
Physical Pain ◽  
Physician Patient Relationship ◽  
The Right ◽  
First Moment ◽  
Physician Patient ◽  
The Relationship

L’impostazione classica della questione bioetica dell’eutanasia attraverso il paradigma dei principi conduce a risolvere la questione con un sì, se si privilegia il principio di autonomia, o con un no se si dà il primato al principio dell’indisponibilità della vita. Il saggio muove dalla proposta che sia possibile un altro approccio, basato sull’interazione, suggerita come linea metodica da Warren T. Reich, del paradigma dei principi con gli altri paradigmi della bioetica: l’esperienza, la cura, la virtù. Il primo momento è ripensare l’eutanasia come l’oggetto di una domanda che viene dalla sofferenza e che, come tale, va accolta ed interpretata in un contesto di relazione. A differenza del suicidio, non vi è qui un darsi la morte, ma un domandare la morte all’altro. L’attenzione etica va spostata dal far centro esclusivamente sull’autonomia al focalizzarsi anche e soprattutto sulla relazione, in particolare sulla complessità e le contraddizioni che segnano oggi la relazione tra il paziente e il medico. Anche se chiede una “cura” limite, paradossale che non può essere data, pena la contraddizione e il ribaltamento degli stessi fini della medicina, la domanda di eutanasia non può restare inevasa, ma deve essere accolta, ri-aperta con l’attenzione che il paradigma di cura impone, con l’humanitas che il paradigma di virtù ci consegna. L’attenzione etica all’esperienza di chi domanda la morte diviene il primo momento per trovare una conciliazione tra momenti apparentemente antitetici, come la sacralità e la qualità della vita, per cogliere la complementarità tra diritti apparentemente antitetici come il diritto ad essere lasciati soli e il diritto a non essere lasciati soli, per sostenere insieme la liberazione dal dolore fisico e la liberazione del dolore dell’anima. Spostando il punto di vista dalla libertà alla relazione, il saggio vuole indicare l’impossibilità etica di dire di sì all’eutanasia proprio sul versante della relazione, ponendo al tempo stesso l’accento non solo sulla responsabilità che il dire di sì comporta, ma anche sulle altre responsabilità di cui la domanda di eutanasia ci fa carico: le responsabilità che riguardano la situazione da cui trae origine, e le altre che riguardano ciò che rimane da fare per rispondere alla richiesta di aiuto e di cura che la domanda sottende. Con il movimento proprio dell’etica della cura, il saggio vuole proporre di non risolvere il dilemma in cui la questione bioetica dell’eutanasia sembra costringerci, rinunciando alla vita o alla libertà, ma di provare a ridefinire il contesto da cui il dilemma ha origine, in modo tale che sia possibile tenere insieme vita e libertà. ---------- Classical approach to the problem of the euthanasia, through the paradigm of the principles conducts to solve the matter with a yes, if the principle of autonomy is privileged, or with a no if the primacy is given to the principle of the unavailability of the life. This paper moves from the proposal that another approach is possible, based on the interaction, suggested as methodic line by Warren T. Reich, of the paradigm of the principles with the other paradigms of the bioethics: the experience, the care, the virtue. The first moment is to consider the euthanasia as the object of a question that comes from the suffering and that, as such, it must be welcomed and interpreted in a context of relationship. Unlike the suicide there is not here a killing oneself, but an asking other for death. The ethical attention must be moved from the exclusive center of autonomy to the relationship, particularly on the complexity and the contradictions that mark the physician-patient relationship between today. Even if it asks a limit “care”, paradoxical that cannot be given, or the aims of the medicine itself would be contradicted and overturned, the question of euthanasia cannot stay outstanding, but must be welcomed, opened again with the attention that the paradigm of care imposes, with the humanitas that the paradigm of virtue delivers us. The ethical attention to the experience of whom asks the death it becomes the first moment to find a conciliation among apparently antithetical moments, as the sacredness and the quality of the life, to gather the complementarity among apparently antithetical rights as the right to be left alone and the right not to be left alone, to sustain together the liberation from the physical pain and the liberation from the pain of the soul. Moving the point of view from freedom to relationship the paper wants to point out the ethical impossibility to say yes to the euthanasia just on the side of the relationship, at the same time setting the accent not only on the responsibility that saying yes means, but also on the other responsibilities of which the question of euthanasia ask us: the responsibilities derived by the situation and the others concerning what to answer to the help request and care that the question subtends. In the way proper of the ethics of the care, the paper proposes not to solve the dilemma of the euthanasia abdicating to the life or to the liberty, but trying to redefine the context from which the dilemma has origin, in such way that it is possible to hold together life and liberty.

Basics of Ethical Issues in Obstetrics

2020 ◽  
Vol 3 (1) ◽  
pp. 01-02
Author(s):  
Gopa Chowdhury
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Medical Ethics ◽  
Medical Practice ◽  
Ethical Issues ◽  
Positive Outcome ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Health Organizations ◽  
Physician Patient

Obstetrics is a high-risk specialty with the challenge of wellbeing of mother and baby. Medical ethics, a disciplined study of morality concern obligations of physicians and health organizations to patients as well as the obligations of the patients, is an integral part of medical practice which builds and sustains physician patient relationship and involves a systemic approach to decision making and actions while being secular. Primary strands of thoughts: Utilitarian, considers most positive outcome and Deontological, judges if action right or wrong, consequences of actions not considered.

scholarly journals IMPORTANCE OF TEACHING BIOETIHICS IN MEDICAL INSTITUTIONS

1969 ◽  
Vol 2 (2) ◽  
pp. 142
Author(s):  
LIAQAT ALI
Keyword(s):  
Medical Ethics ◽  
Patient Autonomy ◽  
The Other ◽  
Ethical Responsibility ◽  
Patient Relationship ◽  
Moral Principles ◽  
Medical Institutions ◽  
History Of ◽  
Classical Philosophy ◽  
Moral Nature

Medical ethics is merely one branch of general ethics,and it is precisely defined by professor Dunston as“ Obligations of moral nature which govern the practiceof medicine” 1 the morals are based either on religion,philosophy or socio culture traditions. The three basicmoral obligations in a doctor- patient relationship arebeneficence, patient autonomy and justice the practiceof medicine, in a board philosophical sense, is a searchfor the truth and all the ethical and moral principles areinbuilt and inseparable with in this search. Morepragmatically, Medicine is both and art and science.The aspect of science in medical is very easilyunderstood like making a measurable observation thatleads to hypothesis. The truth of hypothesis issubsequently validated by relevant observations andtests for significance. On the other hand the art in themedicine is an immeasurable quantum, whichaccording to Bertrand Russel is the art of rationalconjecture. It is very fascinating that the medicalprofessionals have been some of the best philosophersthough the history of mankind and they have explainedthe abstract theories of classical philosophy intopractical actions at bedside. The practice of medicinerequired education, knowledge and wisdom bom ofexperience. It has to be taught to the medical studentsand its ethical responsibility of a society to make surethat it’s actually done.

Sign in / Sign up

Export Citation Format

Share Document