公共衛生倫理學之基本原則與全球流行病之實踐分析：儒家生命倫理學之效用與應用

The Basic Principles of a Public Health Ethics with an Analysis of some of the Moral Issues in COVID-19 Pandemic: The Ramifications of Confucian Bioethics

新冠肺炎病毒流行全球，造成大量的感染，而且不斷產生新的變異，對於全球的公共衛生安全造成巨大的挑戰。西方生命倫理學或公共衛生倫理學已不能有效地回應當前的多道德爭議的議題。主因是西方主流的生命倫理學是依於自由個人主義為基礎的建構。此一建構在公共衛生倫理的討論上最容易見出其困境與不相應之處。因公共衛生的主體是社群的全體人口，以共同生活中的公共衛生的公共政策為對象，涉及共同的衛生健康問題的解決，如新冠肺炎流行病是共同所面對的疫情。本文指出公共衛生倫理的課題不同於專注於個人之醫藥治療的生命倫理學。因此本文的分析指出兩者實各有不同的醫藥治療的課題，並沒有不相容的道德兩難的取捨。本文進一步提出「警慎原則」是公共衛生倫理學中最重要的基本原則，但此原則是在合法的限制之下的權宜原則，須要符合法律規範，也因此與自主自律自由的基本權利不相衝突。本文主張跨文化的公共衛生倫理學的人性基礎在人與人之間的同情共感中所具有的相互的義務要求。最後根據同情共感所涵的不忍他人受傷害的道德原理，可用以說明諸如疫苗的分配的「救最多生命」的原則，強制接種疫苗與若干在疫情中的追踪監控、隔離等政策的合理性和有限性。最後由此而得出各國先自行滿足自己國民的需求的合理性，與全球醫療資源的公平分配的必要性，提出全球性的公共衛生倫理學是解決諸如目前的新冠肺炎全球流行病所必須建立的共識。病毒的侵入也可以是促成我們確認天下一家，是密不可分的在地球村上的一家人，因此，也必須有相應的公共衛生倫理學。

"As COVID-19 pandemic creates an enormous number of infections and new virulent species keep evolving with stronger infectious power, it becomes a hard challenge to our global public health ethics. The western bioethics is incapable to deal with the moral issues that emerge in this new pandemic, because it is built upon the political idea of liberal individualism. It is most obvious in the case of public health problems. For, here we have the whole population as our subject, and the issues are public policy of public health in respect of the lives and way of living together as acommunity of one body. For instance, issues like the COVID-19 pandemic that we have to face together. In this paper, I point out first that the moral issues in public health is quite different from those that we have with personal medicine. Hence, the two moral perspectives are not on the same level and have no unsolvable moral dilemmas. The paper advances further to argues that the precautionary principle is one of the most important principles in public health and this principle in an out-of-the-hand kind of operational principle that under the auspices of the public laws and has to comply with what the laws prescribed. It is thus had no contradiction with autonomy and liberty of the individuals. I argue that a cross-culture public health ethics must be based on the duty that that derives from our mutual empathy with the sufferings of others. It could provide the rationale for the way of distributing the vaccines according to the principle of''save most lives''when vaccines are not enough for everyone. It also gives justifications to many of the mandatory of vaccinations, as well as tracing one's locations, surveillance, isolations with reasonable restriction by law under the prevalence of pandemics. It also approves that a country may satisfy the need of its own citizens before dispatch extra vaccines to other countries that need the vaccines deadly. But we also have to arrive at some consensus to put the distribution in a more equitable way so as to counter and curd the invasion of the COVID-19 virus. Though the virus is harmful to human being, it reminds us that we are all in a family living closely in a global village and thus must have a relevant and appropriate public health ethics to face the issues that we must face together."