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The Confucian bioethics of surrogate decision making: Its communitarian roots

机译：儒家替代决策的生命伦理学：其社群根源

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摘要

The family is the exemplar community of Chinese society. This essay explores how Chinese communitarian norms, expressed in thick commitments to the authority and autonomy of the family, are central to contemporary Chinese bioethics. In particular, it focuses on the issue of surrogate decision making to illustrate the Confucian family-grounded communitarian bioethics. The essay first describes the way in which the family, in Chinese bioethics, functions as a whole to provide consent for significant medical and surgical interventions when a patient has lost decision-making capacity. It is argued that the practice of not having an established order for surrogate decision makers (e.g., spouse, children, and then parents), as it is done in the United States, reflects the acknowledgment that the family as a social reality cannot be reduced to a stereotype of the appropriate order of default decision makers. This description of the family as being in authority to make surrogate decisions for an incompetent family member is enriched by an elaboration of the differences among the concepts of patient autonomy, family autonomy, and moral autonomy. The Chinese model, as well as the Confucian communitarian life of families, engages a family autonomy that is supported by a Confucian understanding of moral autonomy, rather than individual autonomy. Finally, the issue of possible conflicts between patient and family interests in relation to a patient’s past wishes in the Chinese model is addressed in light of the role of the physician.
机译：家庭是中国社会的典范社区。本文探讨了以对家庭权威和自治的坚定承诺表达的中国共产主义规范如何成为当代中国生物伦理学的核心。特别是，它着重于替代性决策的问题，以说明儒家以家庭为基础的社群生物伦理。本文首先描述了中国生物伦理学中的家庭如何整体运作，以在患者失去决策能力时同意重要的医学和外科手术干预。有人认为，像在美国那样，没有为代孕决策者（例如配偶，子女，然后是父母）建立既定命令的做法，反映了人们承认，家庭作为一种社会现实不能减少。对默认决策者适当顺序的刻板印象。通过详细阐述患者自主权，家庭自主权和道德自主权之间的差异，丰富了对家庭有权为无能的家庭成员做出替代决定的描述。中国模式以及儒家的家庭生活，是由儒家对道德自主而非个人自主的理解所支持的家庭自治。最后，根据医师的角色，解决了患者和家庭利益之间可能因中国人过去的意愿而发生冲突的问题。

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