【作者】 胡纾；

【导师】 林庆华；

【作者基本信息】 四川大学 ， 宗教学， 2007， 硕士

【摘要】 当今急救科学飞速发展，在挽救无数生命的同时也将生命与死亡的定义一次又一次地推向了极至。危重病人是否有义务穷尽一切现有医疗手段?抑或我们有权放弃某些治疗?这些都成了急需解决的问题。著名的天主教道德神学家理查德·A·麦哥铭多年来一直关注这一问题，并给人们留下了丰富的学术遗产。麦哥铭追随天主教会的立场，认为人们在濒死时最需要的是爱、关怀与照顾，危重病人没有义务穷尽一切医疗手段延长生命。从这一立场出发，麦哥铭回答了什么样的情况下人们有权力放弃治疗、应该由谁来做出这一决定、患者、患者家属、医护人员和社会各自的权力与义务等等一系列问题，为正在进行的讨论做出了重大的贡献。其中生命质量标准、推测检验和最大利益检验以及家庭自决原则都引起了各界的广泛讨论。本文介绍了首先介绍了麦哥铭之医学伦理的理论基础。重点放在生命作为人类基本善的相对意义、在判断人性行为的道德属性时的整体性原则及与之相应的“充足顾及人性位格”思想、相称主义和自然法理论在生命理论中的运用及二者的关系。本文的第二部分集中讨论危重病人的治疗原则，主要是放弃治疗问题。包括放弃治疗的理论依据(生命价值的相对性)、判断标准(治疗手段标准与生命质量标准)、术语的沿革(常规／非常规手段的演变)以及其背后隐藏的实质(生命神圣性与生命质量之争)。重点集中在生命质量标准的合理性与问题。最后，在这一章中还会将两类无自主能力患者(严重残障婴儿与持续性植物状态病人)的治疗决定做一个单独的说明在弄清了危重病人的治疗原则后，第三部分将阐述决定权的问题。决定权主要分两个部分，即有自主能力患者的自决权(包括对此权力的限制)和无自主能力患者的代理决定(包括代理人——首选患者家属和代理判断的标准——推定检验与最大利益检验)。重点将围绕自决权的限制和代理判断的标准展开讨论。最后本文将讨论与危重病人治疗相关的社会正义问题。作为弱势人群，危重病人特别需要社会的保护和关怀，同时作为社会的一员，他们也要顾及社会医疗资源的有限性，这两者间需要的是一种较为平衡的状态。本文将以介绍为主，同时穿插对其观点的评论，力求描绘出问题的全貌。更多还原

【Abstract】 For more than half a century, the advancement in modern technology has rendered treatment decision for the dying one of the major issues in medical ethics. Among those who take an acute interest in this debate was the famous catholic moral theologian Richard A. McCormick. Over the years, McCormick had constantly addressed these issues and thus left a rich heritage that will guide us through many of the troubled waters. It is therefore the aim of this paper to present McCormick’s insights as well as his deliberations.We will first of all examine the basic values on which he founded his medical ethics, namely the meaning of life and death, the meaning of personhood as well as proportionism and the theory of natural law. After this we’ll enter into the discussion of treatment decision for the dying, including McCormick’s deliberation on the basis of foregoing treatment, the burden/benefit calculus (especially the quality of life judgment), the term ordinary/extrordinary, its history, the criticism it faces and the essence of the debate. At the end of this chapter we’ll also look more closely at two kinds of treatment decisions which are particularly troublesome--that of serious defective newborns and that of PVS patients. The third chapter will focus on the decision-maker. It’ll deal respectively with the principle of self-determination for the competent patients and proxy decision for the incompetent. The key issues are the limitation of self-determination and the guidelines for proxy judgment. After this, the fourth and the last chapter will talk about the social justice issues within the context of terminally ill. It will be divided into two parts: the responsibility of the society and that of the patient. This paper aims mainly at introducing McCormick’s contribution to the said issues, but along the way the author will also offer comments and analyses so as to support his points or explore the possible weaknesses.更多还原