| 摘要: | 醫學倫理不只是對某些醫學議題的深入探討，例如複製人、墮胎、或胚胎幹細胞等，更是一種倫理的推論於醫學決策上的應用，因此，如何應用倫理原則作出醫學倫理的決策，是醫護人員必須具備的能力。湯姆畢樸（Tom L. Beauchamp）與詹姆契德斯（James F. Childress）提出了整合式的倫理決策模式，模式中的醫學倫理四原則（中層原則）：尊重自主性原則、不傷害原則、行善原則、以及公平原則，早已廣為人知。本論文主要是探討整合式的倫理決策模式在醫學倫理議題上的適用性。 本論文將闡述畢樸與契德斯二氏的學說內容，包括思慮後的判斷，分殊化、平衡、反思平衡、四原則、共通道德理論、以及融貫理論，並簡介決疑論。本論文也談到醫病關係、道德品格和四原則的對應關係、以及其他倫理學者對整合理論的批評及畢契二氏的回應，最後將整合式的倫理決策模式帶入一個實際的醫學案例中，以檢視這種倫理決策模式是否適用於醫學案例的決策上。 本論文除了著重在倫理決策過程的正當性及實用性外，另外也不可避免的論及原則、規則、及理論之間的複雜關係，以及道德理論的定位問題，這是另一個值得關切的議題。 本論文最後提出的論點是：（1）湯詹的整合式的倫理決策適合一般醫師作為醫學倫理決策之用。（2）整合式的倫理決策模式無法避免個人價值觀的不同所造成的影響，但只要是（正確的）思慮後的判斷，則不影響最後判斷的對錯。最後的決論是：整合式倫理決策模式不只是學說，並且也適用於一般醫師的臨床應用上。
Medical ethics does not just deeply explore such issues as human cloning, abortion, and embryonic stem cell, but it also puts into application reasoning of ethics in medical decision making. Hence, making a medical decision using ethical principles is an ability that nursing members have to possess. Beauchamp and James F. Childress have proposed an integrated model of ethical decision making, which includes four well-known principles of medical ethics: Respect for Autonomy, Nonmaleficence, Beneficence and Justice. The main subject of this thesis is to explore the application of integrated model of ethical decision making in medical-ethic issues. This thesis expresses Beauchamp and Childress’ theory, including Considered Judgment, Specifying, Balance, Reflective Equilibrium, Four Principles, Common Morality Theory, Coherence Theory, and a brief introduction of Casuistry. This thesis also touches upon professional-patient relationship, the relationship between the four principles and moral character, and the criticism by other ethicists on the integrated model and the responses by Beauchamp and Childress. The integrated model of ethical decision making will then be practiced in a real medical case in order to examine whether the model can be applied in the decision making in medical cases. Aside from the justification and pragmatism in the process of ethical decision making, this thesis investigates the complicated relationship among principles, rules and theories. Another issue that deserves attention is the position of moral theory. This thesis proposes two points in the end: 1) Beauchamp and Childress’ integrated model can be applied when medical practitioners are making medical decisions; and 2) Integrated ethical decision-making model can not avoid the impact resulted in by different personal values. However, it will not affect the right or wrong of the last decision if only the decision is made after (correct) considered judgments. The conclusion is: integrated model of ethical decision making is not just a theory, but it can also be applied in the clinical practice by general medical practitioners. |
