预防医学的哲学与伦理基础课件

預防醫學的哲學與倫理基礎季瑋珠預防醫學研究所1公共衛生與預防醫學的基本思考範疇Public:Individual:Thepublicisprimarilycomprisedoftheactionsandmotivesofdiscreteindividual.Collective:Thepublicisprimarilyconceivedaspopulationswithinsocial,economic,andpoliticalsystems.2公共衛生與預防醫學的基本思考範疇Health:Mechanicviewthatemphasizesthetraditionalmedicaldistinctionbetweendiseaseandnon-diseaseintheindividual.Thedegreetowhichanindividualreachesanequilibriumstatewithsomatic,psychological,andsocialinfluences.3公共衛生的決策牽涉的考量Ontology（本體論）：thenatureoressenceofreality,ofbeingandexistence,thenatureofcausation.Ethics（倫理）：thenatureofrightnessandthestudyofwhatactionsarerightactions.Epistemology（認識論）：thestudyofhowknowledgeisgainedandthegeneralvalidityofclaimstoknowledge(howknowledgeisgainedaboutcausation).4公共衛生倫理的定位倫理學分類基本倫理學：終極發問、道德前提、道德本質的論證應用倫理學：個人—醫學倫理屬此類社會—公共衛生與環境倫理屬此類德行倫理學：倫理教育與發展做對的決定5醫學倫理的原則自主性（autonomy）：尊重個人自決與保護喪失自主性的個人。仁愛或善意（beneficence）：以個人的福祉為最優先考量與最大程度來增亦個人的健康。非惡意（non-maleficence）：避免傷害個人，或至少減低傷害。公正（justice）：以公平、公正態度對待每個人，儘可能公平的分配保健的福利與負擔。6當代重要的政治哲學思想康德(Kantianism)vs.功利主義（utilitarianism）自由主義（Libertarianism）馬克斯主義（Marxism）or社會主義（socialism）自由平等主義（liberalequality）社區主義（Communitarianism）女性主義（Feminism）多文化主義（Multiculturalism）7康德主義(Kantianism)

道德責任論deontology有絕對的是非對錯不因結果而改變人本精神人是目的不是手段8功利主義（utilitarianism）Themorallyrightactorpolicyisthatwhichproducesthegreatesthappinessforthemembersofsociety.(Bentham)遠離神權、不問道德、結果主義（consequentialism）追求效用極大化（maximizetheutility）welfarehedonism,pleasure-orientedvs.non-hedonisticmentalstateutilitykeyword:utility問題：個人效用的衝突9自由主義（Libertarianism）自由市場經濟的擁護者，完全相信市場機能可以達成最適當的分配，又稱保守主義（conservatism）Right-wing,capitalism,pursueoverallsatisfactionMaintainmarketfreedom,limittheuseofstateforsocialpolicy“Minimalstate”:protectionagainstforce,theft,fraud,orenforcementofcontracts,…10自由主義（Libertarianism）Nozick’sentitlementtheory:Principleoftransfer:whateverisjustlyacquiredcanbefreelytransferredPrincipleofjustinitialacquisition:howpeopleownthingsshouldbejustPrincipleofrectificationofinjustice:howtodealwithholdingsiftheyareunjustlyacquiredortransferred11自由主義（Libertarianism）Entitled:havinganabsoluterighttofreelydispose,solongasitdoesnotinvolveforceorfraudLiberty>equalityKeyword:liberty問題：分配是否真能達到公正（just）？12馬克斯主義（Marxism）社會主義（socialism）Left-wing,perfectionismCommunismbeyondjustice/communistjustice:ObjectionagainstajuridicalcommunityAtrulygoodcommunityhasnotneedforjustdistribution!13馬克斯主義（Marxism）社會主義（socialism）Likeanidealizedfamily:anidentifyofinterests,respondingspontaneouslytotheneedofothersoutofloveratherthanrespondingonthebasisofrightfuldutiesorcalculationsofpersonaladvantages（各盡所能，各取所需）Keyword:equality問題：這種理想的社會似乎不存在/社會實驗的失敗14自由平等主義（liberalequality）Rawls:ATheoryofJustice,1971.Principles:Equalrightprinciple:eachpersonistohaveanequalrighttothemostextensivetotalsystemofequalbasiclibertiescompatiblewithasimilarsystemoflibertyforall.Differenceprinciple:socialandeconomicinequalitiesaretobearrangedsothattheyarebothtothegreatestbenefitoftheleastadvantaged,andattachedtoofficesandpositionsopentoallunderconditionsoffairequalityofopportunity.15自由平等主義（liberalequality）Priorityrules:1stpriorityrule(thepriorityofliberty):theprincipleofjusticearetoberankedinlexicalorderandlibertycanberestrictedonlyforthesakeofliberty.2ndpriorityrules(thepriorityruleofjusticeoverefficiencyandwelfare):theprincipleofjusticelexicallypriortotheprincipleofefficiencyandtothatofmaximizingthesumofadvantages,fairopportunityispriortothedifferenceprinciple.16自由平等主義（liberalequality）Forcommongoodslikebasicliberties:Equalliberty>equalopportunity>equalresources社會契約（socialcontract）的產生Keyword:fairness17社區主義（Communitarianism）LiberalindividualsandstateneutralitySelf-determinationvs.statepaternalismKeyword:commongoodphilosophical/political/vernacular/liberal,...早期的社區發展、社區工作，近期的社區總體營造18女性主義（Feminism）性別平等與歧視（discrimination）問題、性別刻板印象（stereotype）世界上大部分的國家是男性主導致定政策男性的觀點與法則不等於女性Keyword:androgynyorgender-freeGenderissue,genderstudy19多文化主義（Multiculturalism）尊重文化差異性跳脫主流文化觀點Keyword:culturaldiversity醫療人類學20最被接受的公共衛生決策哲學Ontology（本體論）：群體比個人重要，全面健康比身體健康重要Ethics（倫理）：醫學倫理的四個原則Epistemo