【作者】 孙雯波；

【导师】 胡凯；

【作者基本信息】 中南大学 ， 伦理学， 2010， 博士

【摘要】 随着社会文明和医学科学技术的发展,现代传染病已不仅仅是一种可导致个体躯体损伤和疼痛的单纯的生物学意义上的流行病,或是可给病人添加躯体和精神痛楚的复合的心身事件,而是世界性、复杂的社会疾患,同时还是一种复杂的文化、社会现象,小到影响家族的繁衍,大至改变人类文明的进程。人类社会发展和医学实践中,政治、道德文化因素在传染病防治和社会控制、约束人们行为养成健康的生活方式等方面发挥着积极作用,在现实中,传染病已经超越了生理层面的具象意义,其道德隐喻使得病人在身体病痛之外还须承受那些加诸疾病之上象征意义的重压；疾病因果报应观和天谴观将疾病与病人的善恶品性相联系,赋予疾病以复杂的道德色彩；“医人”到“医国”隐喻的建立使疾病治疗与社会变革有机联系起来,流行性传染病的防控与社会政治控制一脉相承,传染病的起源与政治迫害相关,细菌战、生化武器使得传染病毒走向了政治暴力,疾病被政治化、道德化,社会对某些传染病患的道德评判,与特定历史时期的政治生态和社会道德统治的需要相结合,道德偏见转变为行动上的社会歧视、排斥甚至政治迫害。这直接践踏了公民尊严的底线,侵害了病人的正当权利,伤及社会公正的终极价值,也影响了社会和谐。人类的历史是科学战胜疾病的历史,也是人权平等与歧视偏见抗争的历史。通过伦理分析、政治批判和文化祛魅,倡导观念启蒙和科学普及,改变寻找意义的隐喻性思维方式,确立道德的边界,将疾病去政治化和道德化,明确界定传染病的科学内涵和伦理意义是做好传染病防控工作的前提条件。在传染病防控中,个体权利和公共健康之间何者优先呢?传染病关怀道义与功利的价值博弈,保护病人隐私与保证公众知情的艰难选择,传染病防控公权的边界不确定等常常使传染病防控工作和对传染病患的关怀陷入矛盾与冲突中,围绕传染病防治诸环节中的道德现象和道德关系以广阔的伦理文化视野从理论上溯源、厘清；于冲突中比较、选择；在现实中实践与论证,克服和突破传统生命伦理学的局限,致力于建立和发展一个以个体病人弱势群体为中心的医学人文伦理学,构筑一种兼顾个体人道关怀和社会整体功利的公共健康伦理学。广泛借鉴和拓展各种社会伦理资源,充分调动政府、民间、社区家庭及病患自身的积极力量,贯彻权利、人道、义务、和谐的理念和原则,体现社会主义核心价值观,强调病人的自我尊严和社会权利,倡导和强化保护弱者的公共道德意识,呼吁社会公正,反对社会歧视和排斥,不伤害。同时也提出病人的社会理性约束和道德义务,倡导全社会范围内传染病关怀的社会伦理运动,推动社会精神文明和生态文明,促进民族健康水平,这是当代伦理学的责任所在,也是本文主旨所在。本文着力于传染病及其防控的伦理分析,运用现象学和跨学科等研究方法从医学、伦理、政治、社会等方面架构传染病伦理,力求理论研究与公共卫生政策和社会伦理实践紧密结合。更多还原

【Abstract】 With the development of social civilization & medicine technology, the infectious disease is not only one simple kind of epidemic disease which result in physical injury & pain in biological meaning, or a multiple spirit & body event which add pain of the body & spirit of patients, but also a cosmopolitan & complicate social affection, at the same time which is a complicate social phenomena,little to influence family multiply, large to change the process of human civilization. In the development of human society and the practice of medicine, the political & ethical factors have play active role on the prevent & control of infectious disease、restrained people’s behavior and cultivated people’s healthy life style. In fact the exist of infectious disease has already surpassed the significane of physiology deck, the ethic metaphor of some infectious disease made the patients beared not only body ailment but also the deal rolling of the symbol meaning. The viewpoint such as the automatic repayment in later life of whatever one does, the wrath of heaven of disease connect the disease with the moral character of patients, enduing with disease the complicate morality color & meaning, the establishment the metaphor of "cure people" to "cure country" conneting the disease treatment with the social reform, the prevent & control of the epidemical infectious disease & the social politics have same origin, the orgin of infectious disease compiltely related with witch-hunting, bacterological warfare have been questioned insistently, biochemistry weapons have made infectious disease turn to politics violence summit. The disease has been politicalize & moralitilize, the society has formed the ethics judge of some infectious disease, connecting with the demand of political ecosystem & social ethics control in definite history period the ethic prejudice changed to the social discrimination、rejection and even political oppression,which has directly tread on the bottom line of the citizen human rights dignity, encroached on the proper right of patients, hurt the ultimate value of social fair, affected social harmony. Human history is the history of science winning a victory to disease, or fight for discrimination & prejudice. Through the ethic analysising, the politic criticizing、the culture disenchanting, advocating the concept enlighting & science becoming popular, changing the metaphor thinking style of looking for content, establishing the ethic boundary, removing politics & morality of disease, definitely deciding the science connotation & ethics meaning of infectious disease.Which have the priority between the individual right & public health in the preventing & controling of infectious disease? It is a contradictory & conflict that playing chess between the concern morality & utilitarian value of infectious disease, the difficult selection between protecting patient’s secrets & ensuring public acknowledging the fact, the boundary deciding of public right of preventing & controling of infectious disease. Enclosure the all links of preventing & controling of infectious disease to trace something to its source from the theory, comparting & selecting individual rights & public rights、duty and such ethics phenomenon in conflict. Through practicing & demonstrating in reality to overcome & break through the limit of the tradition life ethics.The moral relationship & the wide ethics culture field of vision overcome & breakthrough the limit of traditional life ethics, go in for establishing & developing medicial human ethics enclosuring the individual patients & disadvantaged groups, constructing a kind of public healthy ethics, which pay close attention to individual humanity concern & social whole benefits.It manifest the social core value view based on decks such as government、civilian society、community family & individual, generally mirror & expand various social ethics resource, shift the active strength of government civilian、community family & patients personal, carry out right、humanity、duty、homonious idea & principle, emphasize the self dignity & social rights of patients, advocate & strengthen protecting the public morals consciousness of disadvantaged groups, appeal for social justice, object social discrimination & repel,spare by means of the humanity & justice principle, At the same time, it raise the social rationality restrain of patients & the moral duty of patients, advocat social ethics movement of concerning & controlling of infectious disease, push about social culture & ideology & ecosystem civilization, promote nation health level. This is the responsibility of the present ethics,and the aim of this paper.This essay has emphasized on the ethics analysis of the prevention & control of the infectious disease. To structure the ethic study of infectious disease through applying phenomenology & interdiscipline method from such aspects as medicine、ethics、politics、society and so on, trying to connect the theory study with the public health policy、socail ethics practice tightly.更多还原