| Summary: | 博士 === 國立中央大學 === 哲學研究所 === 101 === Abstract
A good medical ethical decision-making model can be widely used on clinical practices to solve increasingly complex ethical issues because the sources of morality, interpersonal relationship, and the moral concepts and principles applied are presupposed to be able to accommodate the conditions and requirements of a medical situation. In this thesis, I employ these three aspects in the analysis of a medical decision model to show its special features. The sources of morality is the foundation of a medical decision model and this foundation explains not only the meaning of morality, but also implies the kind of personal interaction and the moral concepts and principles are derived from this source. In other words, the source of morality is the fundamental principle, and the moral concepts and principles are applied to clinical practice. The three aspects are so interrelated and inseparable and through their analysis we could grasp the advantages and disadvantages of a model. Taking the current western mainstream medical ethical decision-making model created by Albert R. Jonsen as an example, we could see that its source of morality is the “common morality” of principlism. Its main concepts are the four principles, i.e. the principles of beneficence, nonmaleficence, respect of autonomy and justice. These principles of principlism presuppose the liberal individualism of the west. Under this background, Jonsen’s model takes priority the principle of respect of personal autonomy. Personal relation is the typical citizen contractual relationship. Persons involved in medical decision making are limited to doctors and patients while familial participation could be scraped. The self-determination of patients is enhanced. However, under certain conditions, it is risky to leave medical decision making to the patient whose power of judgment is inflicted by the disease. Patient sometimes does not wish to disclose his or her choice and value judgments, and it easily leads to
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tough ethical dilemmas. Confucian conception of family participation and family autonomy could supplement the shortcomings of Jonsen’s model. Furthermore, Jonsen’s citizen contractual physician-patient relationship is too loose and his model does not respond to the loss of trust between doctors and patients. Confucianism provides family participation to relieve the patient's lonely helpless predicament. While Noddings care ethics has detailed how to improve interactions between the caring and the cared, some of the elements could be applied in clinical practice.
For Noddings, care between persons is the source and foundation of morality. In medical situation, caring is the basic physician-patient relationship, and from this we could derive Noddings’ medical decision model. Confucianism takes the mind of empathy as the source of morality and emphasizes human ethical familial relation. Presently, Confucian communities are still deeply affected by this philosophy, and their life style and behaviors still embody these old Confucian thoughts. Therefore, in a society that takes Confucianism as the basis, it always shows certain Confucian elements in its medical decision model.
The paper employs the framework of moral sources, personal relation, and moral concepts and principles in the analysis of the medical ethical decision models of Jonsen, Noddings and Confucianism and after some detailed analysis, it tries to construct a Confucian community medical ethical decision model. It is a medical decision model built upon interpersonal empathy with universal significance. In this new model, we take the Confucian moral empathy as the source of morality which could contain Noddings’ caring and the common morality of Jonsen’s model. The mind of empathy is an inherent and intrinsic feature of every person. It is our inherent conscience and moral capability, and it fits closely with our moral experiences and judgments. As the patient is usually weak and dependent, the capacity for judgment naturally decreased, hence family participation in medical ethical decision is
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legitimate and a kind of protection for the patient. According to Noddings’ care ethics, family members are in the innermost circle of caring and would provide much more care than others. Hence, Noddings may also approve Confucian family autonomy. In this model, we absorb the concepts and principles of Jonsen, Noddings and Confucian theories into a well-founded model. It tries to remove the shortcomings of each single theory and merges the advantages of three theories in order to improve the quality of medical care. Furthermore, it employs the Confucian point of view and reconstruct the situations of human being, the meaning and value of life. It constitutes a different model and could provide a workable model for medical professionals to solve probable moral dilemmas, so as to arrive at the best ethical solution for the medical professionals, the patient and the family.
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