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Student Number 941304005
Author Chiung-Ling Wu(吳瓊玲)
Author's Email Address No Public.
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Department Executive Master of Philosophy
Year 2007
Semester 2
Degree Master
Type of Document Master's Thesis
Language zh-TW.Big5 Chinese
Title 從西方個人自律原則與儒家關係自律原則論醫病關係中諮詢同意的倫理議題
Date of Defense 2008-06-18
Page Count 132
Keyword
  • Confucianism
  • ethical relational autonomy
  • informed consent
  • physician-patient relationships
  • principle of autonomy
  • Abstract Accompanying the spreading of democracy and the movement of different human rights, people learn to protect their own benefits. The physician-patient relation has also graduately been transformed. According to the principle of respect of autonomy, we have to respect the personal considered decision of the patient. Disrespect of patient’s autonomy is regarded as treating the patient as means to one’s interest and a degradation of human dignity and value, and also causes the greatest disutility. However, it is doubtful that such emphasis of respect of patient’s independence and equality during a medical dilemma will serve the patient’s best interet. Or, rather, we just require that clinical decision be at the patient’s best interest.
    In Taiwan, a medical decision usually involves the medical professionals, the patient and the family. These three groups of people form a triad of dicision making. Sometimes they have consensus, sometimes not. In the former case, it is well and fine. In the latter case, there will be a lot of confusion and controversy. Who has the final say? What is the ground for such decision? Do we have some common minimal moral principles? In case of conflict, how should we resolve it? We tend to accept the western point of view and respect the autonomy of the patient, but would such imported value really fit into our ethos and customs? With much difference in culture and religion matters, our whole-heartedness acceptance of the western conception will doubtless leads to serious challenge and causes many difficult moral dilemmas. This is an issue that merits our investigation and seeking of a solution.
    In this thesis, I try to bring into our analysis the most influential ethics of east Asian societies, namely Confucian ethics, to make out a compromised solution. The Confucian idea of ethical relational autonomy is being employed to an explication of the problem of informed consent in our physician- patient relation. It proved to be able to provide a new vision on the relation and a solution which is more suitable to the Asian culture and society.
    Key Word: principle of autonomy, Confucianism, ethical relational autonomy, physician-patient relationships, informed consent,
    Table of Content 論文摘要 --------------------------------------------------------------------------------------------i
    序言   --------------------------------------------------------------------------------------------iii
    目錄   --------------------------------------------------------------------------------------------iv
    第一章導論----------------------------------------------------------------------------------------1
    第一節 研究動機與目的---------------------------------------------------------------------------1
    一、醫病關係中諮詢同意的問題----------------------------------------------------------4
    二、本論題所蘊含哲學意義---------------------------------------------------------------10
    第二節 文獻探討-----------------------------------------------------------------------------------12
    第三節 研究方法與章節安排--------------------------------------------------------------------20
    一、收集資料及文獻研究------------------------------------------------------------------20
    二、論理分析---------------------------------------------------------------------------------20
    三、比較研究---------------------------------------------------------------------------------20
    四、章節安排---------------------------------------------------------------------------------20
    第二章醫病關係的變遷與模式---------------------------------------------------------- 24
    第一節 醫病關係的歷史變遷--------------------------------------------------------------------24
    一、經驗-巫醫時期------------------------------------------------------------------------25
    二、古代科學時期---------------------------------------------------------------------------25
    三、中世紀科學時期------------------------------------------------------------------------27
    四、現代科學時期---------------------------------------------------------------------------28
    五、世俗化的現代時期---------------------------------------------------------------------29
    第二節 醫病關係的縱向剖析模式----------------------------------------------------------------32
    一、保護主義模式的醫病關係-------------------------------------------------------------32
    二、自律模式的醫病關係-------------------------------------------------------------------37
    三、中間商的醫病關係----------------------------------------------------------------------39
    第三節 醫病關係的橫向溝通模式---------------------------------------------------------------41
    一、契約模式的醫病關係-------------------------------------------------------------------41
    二、協定模式的醫病關係-------------------------------------------------------------------43
    三、協商模式的醫病關係-------------------------------------------------------------------44
    第三章病患自律權之倫理依據------------------------------------------------------------48
    第一節 自律權的性質------------------------------------------------------------------------------48
    第二節 尊重自律原則的證成---------------------------------------------------------------------54
    一、尊重自律原則的陳述-------------------------------------------------------------------56
    二、同意或拒絕-------------------------------------------------------------------------------58
    第三節 自律選擇的能力---------------------------------------------------------------------------60
    一、醫生對能力之判斷----------------------------------------------------------------------62
    二、行為能力的概念-------------------------------------------------------------------------62
    三、能力的標準-------------------------------------------------------------------------------63
    第四節 浮動基準判定------------------------------------------------------------------------------66
    第五節 反對自律原則的理由---------------------------------------------------------------------68
    第四章醫病關係中的諮詢同意------------------------------------------------------------72
    第一節 諮詢同意的意義與要素------------------------------------------------------------------73
    一、諮詢同意的意義-------------------------------------------------------------------------73
    二、諮詢同意的要素-------------------------------------------------------------------------75
    第二節 資訊公開的標準---------------------------------------------------------------------------77
    一、理性醫師模式----------------------------------------------------------------------------77
    二、理性人模式-------------------------------------------------------------------------------78
    三、病人模式----------------------------------------------------------------------------------79
    四、諮詢同意的例外-------------------------------------------------------------------------81
    五、治療安慰劑的使用----------------------------------------------------------------------82
    第三節 理解與資訊的處理------------------------------------------------------------------------84
    一、理解的本質與資訊處理----------------------------------------------------------------84
    二、不願接受問題和錯誤信念-------------------------------------------------------------85
    第四節 自願同意與放棄---------------------------------------------------------------------------87
    第五節 代理人決策的標準架構------------------------------------------------------------------91
    一、代理判斷標準----------------------------------------------------------------------------92
    二、純粹自律標準----------------------------------------------------------------------------94
    三、最佳利益標準----------------------------------------------------------------------------95
    第五章儒家關係自律原則論諮詢同意------------------------------------------------100
    第一節 儒家倫理學論自律-----------------------------------------------------------------------100
    第二節 儒家關係自律原則論諮詢同意--------------------------------------------------------103
    第三節 結論-----------------------------------------------------------------------------------------111
    一、建立良好的醫病關係------------------------------------------------------------------112
    二、了解病人的意願與狀況---------------------------------------------------------------113
    三、確立病人的行為能力和權利---------------------------------------------------------115
    四、與病人和家屬進行諮詢同意---------------------------------------------------------115
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    蘇令銀,2002,〈生命自主:生命伦理学的终极价值追求〉,中國應用倫理學網,URL = http://www.aecna.com/dispArticle.Asp?ID=822 (2008/3/20瀏覽下載)。
    〈化學醫藥與社會〉,URL = http://chemwww.pu.edu.tw/chemistry/blue/overuse.htm (2007/5/15瀏覽下載)。
    Advisor
  • Shui-Chuen Lee(李瑞全)
  • Files
  • 941304005.pdf
  • approve immediately
    Date of Submission 2008-06-24

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