精神障碍领域医疗决策的儒家家庭主义差序格局构造及伦理分析  

Confucian Familism and Ethical Analysis of the Constructed Differential Order Pattern in Medical Decision-Making in the Field of Mental Disorders

作　　者：张琨[1] 丛亚丽[1] ZHANG Kun(School of Health Humanities,Peking University,Beijing,100191,China)

机构地区：[1]北京大学医学人文学院,北京100191

出　　处：《医学与社会》2023年第9期130-137,144,共9页Medicine and Society

基　　金：2021年教育部哲学社会科学研究重大课题攻关项目,编号为21JZD032;国家社会科学基金资助项目,编号为20BZX128。

摘　　要：“儒家家庭主义”的孕生具有深厚的形而上学基础和价值论上的信念体系支撑。但是,小家庭的“儒家家庭主义”过分强调家庭的整体性,建立在具有普遍抽象且平等的家庭成员之上,未对家庭本身的内部结构作充分论证。相较于大天下的“儒家家庭主义”,它关注的视角局限在个体利益的范畴,缺乏对公共利益的关照。此外,其适用场景无法有效涵盖精神障碍领域,忽视了精神障碍患者自身与家庭成员关系的复杂性,而导致的家庭内部具有层级性的差序格局构造。基于反思平衡、监护和代理制度、精神病学等方法论、理论和医学基础,提出精神障碍领域下基于差序格局的儒家家庭主义医学伦理分析框架。通过该框架对精神障碍领域发生的“税会梅诉白云康复站”案作出适用,发现该分析框架尽管存在不足,但具有有效性,是一次医学伦理分析框架建构上的有益尝试。The birth of Confucian familism is supported by a profound metaphysical foundation and value system.However,the small family-oriented"Confucian Familis"overemphasizes the integrity of the family,based on family members who are universally abstract and equal,without sufficient argumentation about the internal structure of the family itself.Compared with the large-scale"Confucian Familism",it focuses on the scope of individual interests,lacking attention to public interests.In addition,its applicable scenarios cannot effectively cover the field of mental disorders,neglecting the differential order pattern constructed within the family due to the complexity of the relationship between the individual with mental disorder and family members.Based on the methodology of reflective equilibrium,guardianship and agency systems,psychiatry and other theoretical and medical foundations,this study proposes a Confucian Familism medical ethical analysis framework based on the differential order pattern in the field of mental disorders.This framework is applied to the"Shui Huimei v.Baiyun Rehabilitation Station"case in the field of mental disorders,which finds that although this analytical framework has shortcomings,it is effective and a useful attempt in constructing a medical ethical analysis framework.

关 键 词：医学伦理 医疗决策 精神障碍 儒家家庭主义 差序格局 

分 类 号：R19-019[医药卫生—卫生事业管理]