效益主義的幽靈：大COVID時代的公共衛生倫理反思

The Specter of Utilitarianism: Reflections on Public Health Ethics in the COVID-19 Era

效益主義是公共衛生政策中彷彿不證自明的倫理基礎，在各項防疫政策中尤其明顯。效益主義與民主政治有特殊連結，因效益主義式公衛政策須建立在民主政治程序所決定的效益界定和排序之上，而效益主義式公衛政策與民主共同體的目的，都包括維繫共同體的存續。我們因此對公衛政策效益主義基礎提出兩層次的批判性反思：質疑國家以效益主義之名限制個人權利的界線（第一種層次），以及論證除了單純自利的個人觀點，民主公民也要有能力將群體觀點納入倫理考量中（第二種層次）。本文以台灣實施的COVID-19 隔離檢疫措施為例，主張建立政策倫理評估機制，以鍛造民主公民的群體效益思考觀點，長遠而言有利推行公衛工作，確保民主共同體的健康。

Utilitarianism seems to be a self-evident ethical basis for public health policies, particularly regarding epidemic prevention. Utilitarianism shares common features with democratic politics because utilitarian health policies must be based on the definition of utilities and a hierarchy of priorities determined through democratic political procedures. A common purpose of both utilitarian health policies and a democratic community aims to sustain the community. In this article, we thus propose a two-level critical reflection on the foundations of utilitarianism in public health policy: first, questioning the boundaries of the state’s restrictions on individual rights in the name of utilitarianism, and secondly, arguing that democratic citizens should build the ability to incorporate a solidaristic perspective into ethical considerations, in addition to individual self-interests. Take the COVID-19 quarantine measures implemented in Taiwan as an example. We call for a policy ethics assessment mechanism to forge democratic citizens’ awareness of collective interests, which shall facilitate the promotion of public health work and ensure the well-being of the democratic community in the long run.