Abstract 摘要

Medical and healthcare reform in China over the past three decades has faced various challenges, one of which has been the lack of an ethical spirit in public life. The old moral foundation has collapsed and a new ethical system has not been established. It follows that neither the validity of reform nor public policies derived from that reform have a solid moral and ethical foundation. As the government seeks an effective way of reshaping the national healthcare system in terms of quality and accessibility to keep pace with rapid socio-political and economic transformation, it has to deal with various moral challenges. This essay provides a critical review of healthcare reform in past 30 years, with the shift away from a state-controlled, comprehensive healthcare system. While “fairness” is considered an ethical principle in a socialist systemlike China, it has always been a problem in reality given the huge disparity between wealthy cities and poverty-stricken countryside brought about by differences in economic situations and medical human resources. The reform has been welcomed by many, but it has also led to a decline in the scope and quality of healthcare services in certain regions. Hence, recent healthcare changes have focused primarily on grassroots medical networks, which aim to penetrate lower-tier and remote regions. However, the moral basis for these changes is ambiguous. The essay argues that it is crucial for Chinese scholars, healthcare professionals, and government administrators to think about the moral foundation upon which legal regulations and public policies can be implemented to meet specific needs in China.

在中國醫療衛生體制改革近30 年的風雨歷程中,由於前改革時期沒有條件形成公共生活的倫理精神,在醫療衛生體制改革的第一階段,即過渡期的10幾年中,同樣沒有能夠為改革確立合理的價值目標和形成強有力的道德基礎。在此後改革的推進期,政策制定和制度安排過程倫理基礎的缺失,是改革不成功的重要原因之一。中國社會在對改革的質疑和經驗教訓的反思中啟動的新一輪醫改,無論是政策制定還是框架設計,以及幾年來所取得的成就,都表明此一輪改革具備了較為自覺的生命倫理意識和公共生活倫理精神。中國醫療衛生體制改革的生命倫理基礎生成過程表明,生命倫理學研究在方法上應該堅持中國化的立場。