专业名称：科学技术哲学
导师姓名： 刘大椿 教授
提交日期： 2007年 6 月
关键词：医药；高科技产业；价值；伦理建设
摘 要
本文从伦理层面分析我国当前医药高科技产业问题的症结，寻求解决问题的思路和方案。
现代医药高科技富有成效地承担着人们的保健责任。藉以医药科技的成功，人发现生命、认识生命，探究疾病、健康以及保护健康的方法，不断发展出新的技术，征服人类许多严重的疾病，缓解人类的病痛。人类，比过去任何时候都生活得健康和长寿。1996年，美国医学史家罗伊·波特指出，“在过去50年里医学突破性的进展，已挽救了比以往任何时候都要多得多的生命。”不仅如此，作为面对人的生命、健康和疾病的医药高科技，它还具有完全不同于其他科技的特质，这就是，由于特殊的目的和价值，医药科技比其他科学和技术更具备并需要具备严肃的科学态度、艰苦卓绝的科学精神、严谨的科学方法以及高尚的伦理品格。事实上，医药科学的历史就是坚持真理、坚守科学信念、塑造人类精神品格和伦理理想的历史。这种医药科学的内在特质和思想价值，使得作为医药实践活动典型标志的道德精神和伦理品格确立起来。医药的特质和价值在当代得以张扬，越是接近当代，医药事业就越是发展成为各个国家的社会公益性事业，成为各个国家维护国民身体健康、深刻关怀人的生存的社会建制。
中国医药高科技的发展具有一个特别不同的历程。几千年的传统中医药学是中华民族的骄傲，是中国传统社会中人们维护健康的技术和方法。而现代医药科学，由于它的实证理性和精确性而具有特别的说服力，因此如同其他现代科学技术一样，当它在19世纪末20世纪初被引进当时迫切需要发展的中国社会时，便迅速地被传播开来，生根发芽。到20世纪的上半叶，一个现代医药科学与传统中医药学并举的新的医药科学体系建立起来，继而，它伴随着中国社会发展的艰辛步伐一步步地向前迈进，到今天，医药事业出现了实质上的重大进展，成长为一个以现代高科技为基础的医药产业建制，其基本建设、规模、技术水平以及医药服务供给能力迅速提高，在维护当代社会人们的健康、提高人们的健康生活水平方面获得了巨大的成功。
然而，就在取得巨大成功的同时，医药产业领域却出现了大量的异常现象。例如，当我们越是欣喜于医药科技的进步或医药经济的增长，人们却似乎也越看不起病。人们对医学的抱怨增多，越来越不相信医生，医生的行为也常常有负于他们救死扶伤的神圣职业，作为医药事业之标志的伦理道德和精神品格变得稀缺，“医乃仁术”似乎仅仅成为了教科书上的理论或过去了的历史，随处可见的是人们利用医药科技对经济利益的肆意追逐。整个医药市场更是变得混乱无序，竞争不择手段，贿赂随处可见，人们似贪得无厌。与此同时，作为依赖于高科技的医药产业，它的科学性例如规范、标准、方法以及思想精神也不断地在远离它的真义。科学和技术越来越进步，医药的进展越来越依赖于它，然而科技越进步，药品安全问题越是严重和突出。原本为一个高尚事业的医药高科技产业似要陷入一种不堪的境地，种种不利的局面长期以来都难以扭转，人们对这个领域充满了怀疑。事实上，我国当代医药产业面临的问题也是世界性问题。2007年3月10日的西班牙《起义报》发表署名文章评论道，制药业的贪婪将疾病变成了一笔生意，利润比药物的副作用重要，医药市场是世界上垄断最严重的市场，竞争无序，贿赂盛行，医药跨国公司对金钱和利润的无休止追求毁灭了一切。不过综观现实，无论如何，我国医药高科技产业的问题显得特别地严重。那么，我国医药高科技产业的问题究竟在哪里？种种现象都似是伴随着医药高科技的成功而出现，伴随着人利用进步的医药技术治疗疾病时而出现。那么，医药科技进步的代价非得是这样吗？医药高科技产业应当何去何从？常常，人们显得迷茫，陷入种种矛盾之中。
我国医药高科技产业存在着诸多方面的问题，例如体制、各种制度、技术创新、医疗公正、医德等等，十分复杂。综观各个方面，事实上，归根结底，医药高科技产业根本的要害问题在于其伦理问题，尤其伦理价值这个核心层面的问题。伦理价值决定医药实践的方向和性质。由于医药伦理价值的模糊、失却、陷入困境，医药高科技产业的发展偏离了正确的方向。物的目的与医药科学技术的原有价值之间产生了尖锐的对立。伦理价值问题是医药高科技产业的根本和基本的问题。因此，本文选择从伦理价值层面对我国医药高科技产业的伦理问题进行分析。从理论上和现实上看，这都是一个迫切需要研究的问题。本文试图将医药产业置于当代社会和科技大发展的背景之下来理解其变化和新的特征，从现实出发对医药高科技产业进行伦理价值的考量，探寻问题的症结，分析当代医药高科技产业的伦理理念、价值原则以及价值重构，寻求解决当前医药高科技产业伦理问题的思路和方案。
本文第一章：提出问题。当代社会情境中，医药高科技的迅猛发展已经导致医药实践活动本身的特征发生变化，导致医药共同体及其与整个社会的关系都出现了许多相关联的变化，例如医药建制关系复杂化、医药目的多样化、价值多元化等。随之而来的，是医药产业的一系列问题诸如药品安全标准、医药经济利益及其平衡、医药技术与人的关系等等问题都出现了许多新的特征。这种背景下，传统的医药伦理价值和规范远远不能适应新的情境，其遭遇解构，新的社会情境迫使个人和社会所持有的医药价值、信念以及伦理理想发生新的改变，而处于转型期间的医药高科技产业，还并没有来得及建构适宜的伦理价值和相应的伦理原则以引导人的行为，结果是，人们易于陷入价值困惑，造成医药实践中的选择困境。本章结合医药高科技产业的现实实践，对医药高科技产业出现的问题进行梳理，剖析其伦理实质，分析伦理问题的内容、变化和新的特征，探寻核心问题，阐明医药高科技产业伦理研究的迫切性。
第二章：价值反思。当代医药是一个既传统又现代的产业建制，它的厚重的历史使其积淀了深厚的价值；它的当代发展、它所处的现代社会情境，又使它渗透着当代思想方式和价值；同时，医药高科技产业也是一个趋向国际化的产业，国际上对医药伦理和思想方式影响较大的价值也将渗透在我们的理念中；各种社会文化传统和伦理价值都对当下价值选择有着深刻的影响。本章对医药价值进行反思，从现代工业思想方式及物本主义、人的内在价值理念的角度追寻医药伦理价值失范和造成困惑的深层根源，并遵循历史逻辑分析传统医药文化伦理、现代医药伦理以及国外典范性医药伦理等各种伦理价值的特征，从其探讨各种医药伦理价值对医药行为可能产生的作用，以求认识和借鉴合理的医药伦理价值。
第三章：价值原则。医药高科技产业应当确定自身特有的伦理价值理念和原则，以确定它的发展和实践方向。公正是这个产业的最高价值原则。但是，医药高科技产业是包括研究、制造、流通和服务各环节、其各种性质不完全相同的活动，各种活动的交往方式、活动的规则和规律都不尽相同，活动的价值诉求是多元的、伦理原则是多样的，例如效率、公平、技术、人道、安全，这些原则都具有合理性和公正性，都必须予以关注，忽略任何一个方面的做法都是片面、不可持续的。然而它们之间也可能出现冲突或矛盾，人们进行价值原则的选择时往往难以顾及全面。作为一项社会公益性事业，医药高科技产业必须从其整体本质出发，关注必须优先考虑的价值原则，选择最大的公正。这就需要确立价值原则的优先性次序，寻求最大的公正、确立核心的公正伦理价值和道德原则，以确立产业的内在秩序。公正是医药高科技产业多元伦理价值的集合体。本章从现实出发，并以医药高科技本身的基本价值为逻辑依据，分析医药高科技产业的伦理价值原则系列，阐明伦理原则选择的优先性次序和核心价值，从而提出确立医药高科技产业良性秩序的基本方法。
第四章：价值重构。医药高科技产业要迈向良性发展，必须走出价值误区，重构伦理价值、重建伦理理想，回归并提升医药科技的根本意义。医药高科技具有丰富和深刻的价值蕴涵，如科学和技术价值、经济价值、人道价值等各种内在价值，价值重构应当正确理解其深刻蕴涵，在现实医药活动中，又必须权衡和恰当选择各种价值，并应当从医药的根本意义和价值出发，聚焦于人，以人为根本目的和价值。以人为根本，是所有医药高科技产业活动的最终依归，一切医药高科技产业的活动都围绕这个核心而具有意义。聚焦于人的价值指向，保证现实医药活动的正确方向和基本目的的实现。本章分析医药高科技的内在价值意蕴以及核心价值，分析医药科技聚焦于人的根本价值意蕴，剖析医药高科技产业的科学精神、伦理精神以及公正伦理价值在现实医药活动中的现状，探讨在当代社会中重构医药的基本精神和公正伦理价值的特点和途径。
第五章：对当前医药高科技产业伦理建设的建议。本章基于医药伦理价值和价值原则的分析，结合医药实践，提出医药高科技产业伦理建设的若干建议。认为，首先，必须加强医药高科技产业的行政伦理建设。医药行政伦理是迫在眉睫的、最重要的伦理问题，因为其涉及到政府如何履行应当之职责、如何处理医药行政与医药产业之间的关系、如何起到政府的示范和先锋作用，因而最迫切地需要研究和建设。医药行政伦理建设应当走制度化路径。其次，必须协调医药高科技的产业利益与公众利益之间的关系。医药高科技产业种种矛盾的焦点实质上就在于不同共同体之间利益的纷争。在公众利益和产业利益之间，公众利益应当具有优先性，但并不能忽略产业利益，二者之间应当取得合理的平衡；产业利益是公众利益的基础，但其应具备相应的伦理担当。最后，提出医药高科技产业伦理建设制度化的具体建议。伦理制度化是伦理建设的有效途径。从国际经验看，这也是必然的选择。在当代制度化社会，单纯依靠道德自律调节人的行为已经不再切实可行。医药高科技产业的公正价值原则和各种伦理规范的落实，应当、而且也能够藉以一定的具体制度化途径来保证。
目 录
前 言
第1章 问题的提出
1.1 医药高科技产业及其特点
1.1.1 医药高科技产业
1.1.2 我国医药高科技产业的特点
1.2 当前医药高科技产业的主要问题
1.2.1 创新能力难以提升
1.2.2 医疗公正问题凸现
1.2.3 道德水平急剧下降
1.2.4 制度体系备受诟病
1.3 医药高科技产业伦理研究的迫切性
1.3.1 论域及其研究的迫切性
1.3.2 核心问题
第2章 医药高科技产业的价值反思
2.1 医药价值的迷失
2.1.1 道德失范
2.1.2 道德失范与物本主义
2.1.3 道德失范与“人性”
2.2 追溯：中国传统社会的医药价值
2.2.1 以“宗法”“礼法”为中心的伦理传统
2.2.2 传统医药建制的价值特点
2.2.3 以“仁术”为中心的伦理价值
2.3 反观：中国计划经济时期的医药价值
2.3.1 社会主义健康意识形态的理想
2.3.2 以公平价值为优先的医药伦理价值
2.4 借鉴：国外医药价值举要
2.4.1 公平的典范
2.4.2 新普遍主义
2.4.3 药品管制与公正
第3章 医药高科技产业的价值原则
3.1 公正：医药高科技产业的最高价值
3.1.1 基本的公正理念
3.1.2 制度的公正价值
3.2 医药高科技产业的多元价值原则
3.2.1 效率价值原则
3.2.2 公平价值原则
3.2.3 技术价值原则
3.2.4 安全价值原则
3.2.5 人道价值原则
3.3 价值原则的优先性次序
3.3.1 安全价值原则的优先性
3.3.2 效率与公平之间
3.3.3 技术与人道之间
3.3.4 公正：多元价值的集合体
第4章 医药高科技产业的价值重构
4.1 认识医药高科技产业的多元价值
4.1.1 科学和技术价值
4.1.2 经济价值
4.1.3 社会价值
4.1.4 聚焦于人
4.2 建构医药高科技产业的基本精神
4.2.1 建构科学精神
4.2.2 建构伦理精神
4.2.3 建构公正价值
第5章 对我国医药高科技产业伦理建设的若干建议
5.1 加强医药高科技产业的行政伦理建设
5.1.1 行政伦理问题
5.1.2 行政伦理建设
5.2 协调医药高科技产业利益与公众利益之间的关系
5.2.1 保障公众利益的优先性
5.2.2 产业的利益与伦理担当
5.3 促进医药高科技产业伦理的制度化
5.3.1 公正原则的制度化
5.3.2 伦理规范的制度化
5.3.3 政府的责任
参考文献
致 谢
Research on Ethical Problems in China’s Medical High-tech Industry
ABSTRACT
The achievement of medical high-tech is a miracle in human civilization. Medicine and pharmacology did not unify closely and truly start to display the effect of treating diseases until the end of 19th century. In the earlier time, medical science and technology developed quite slowly with unsuccessful effect. But henceforth, it has rapidly, unceasingly and astonishingly disclosed new secrets of life, killed the bacterium, and treated more and more diseases. Especially after “the treatment revolution” in 1940s, the discovery of the DNA Double Spiral Structure by J.Watson and F.Crick in 1953 opened the secret of heredity, then the rapid development of genetics and molecular biology smoothed the way for gene engineering and rapidly founded a new industrial structure of biological technology. Therefore, medical high-tech industry has been established to safeguard people ‘s health and social economic growth on the basis of the progress and success of new disciplines and technology, drug manufacture industry, the global drugs market’s commercialization, hospital industry as well as medical insurance industry.
In recent decades, medical high-tech industry has had a rapid development in China. In the first half of the 20th century, China began to set up national capital pharmaceutical industry and a new system of medicine, which, generally speaking, was lopsided for that period of social unrest. After the founding of New China, a real significant progress has been made in the pharmaceutical industry. Under the leadership of the first session’s central government and through more than 20 years’ efforts, a relatively entire and effective medical system has been established, which included education, research, production, health care and security. It has made tremendous contributions to raise Chinese people’s health standard. Later, the policy of reform and opening up, the goal of “taking economic construction as our central task” and the strategy of “rejuvenating the country through science and education” have promoted the reform of the country's economic structure and the formation of a new pattern of modern medical high-tech industry. In the recent 20 years, the proportion of high-tech in the entire medical industry has been increasing, which is shown in medical institutions’ improvements with conditions, scale, technical standard and supply of services. The achievements in medical high-tech industries can be widely witnessed in the entire production chain from research, manufacturing, distribution to services and the construction of infrastructure, scale and technology. As an economic industry, it is a new economic growth point, meanwhile it significantly and effectively plays the role of protecting people's lives and health. It is by virtue of high-tech medical advances, the health and longevity of life has been more and more assured.
However, problems in China's medical high-tech industry today are so serious and alarming that this area has been severely questioned. A noble medical high-tech industry seems to fall into an evil and disorderly state where researchers deceive, officials corrupt and seek profits in terms of their power, doctors degrade for the sake of profits, medical services lose fair and hard to correct, and so on. These problems not only badly result in unhealthy social ethos, but also terrifically weaken medical technology’s original social function, cause serious physical or mental harm to people and hinder social unity and development. Thus we need to study and resolve the problems in medical high-tech industry which is important and closely related with people’s lives and health.
This thesis believed that problems in medical high-tech industry lie in its ethical and value concept. Idea is the forerunner of behavior. In this age of high-speed economic growth, people's values have already changed a lot. And values have got lost and fallen into crisis in medical high-tech industry in its way from planned economy to market economy that caused people's serious abnormal behaviors. Therefore, this thesis attempted to research on ethical problems in our country’s medical high-tech industry at present age.
Chapter 1: Raising problems. Presently, various problems exist in medical high-tech industry such as technical innovation, fairness in medical treatment, morality, system and so on, all of which are realistically rooted in ethics and value. Traditionally, ethical research on medical high-tech industry generally is limited to medical moral standard and sometimes involves some other occupational ethics like economic ethics. However, some conventional moral regulations have already lost their function in practice. In fact, the contemporary contact way of medical practice, and individual and social faith, beliefs and ethics have already changed so hugely that people are inclined to fall into value confusion and faith mistake and cause the choice dilemma in medical practice. Therefore, consideration of ethics and value need to be carried to ethically reflect on medical high-tech industry, which is of great theoretical and practical significance. This chapter proposed problems in medical high-tech industry, analyzed their ethical essence, and expounded the urgency of related research.
Chapter 2: Value reconsideration. Medicine is a domain both traditional and modern. Its heavy history contributes to its deep traditional value while its contemporary development and modern social environment fills it with the contemporary thinking way and value. At the same time, medical high-tech industry also is an internationalized industry, and international value about medical ethics and thoughts will be worth knowing and using. In short, each aspect of tradition and culture has profound influence on our present value choice. Therefore, this chapter attempted to analyze the features and roles of modern industry’s thinking way, traditional medicine’s culture and ethics, modern medical ethics as well as overseas typical medical ethics and so on, so as to gain some useful and reasonable ethics and value.
Chapter 3: Value principles. Medical high-tech industry should identify its unique ethical values and principles to determine its direction of development and implementation. However, the sectors in this industry includes research, manufacturing, distribution and services, which are distinct in their essence, contact way, activity rule and law, and value pursuit and principles. Therefore, choice of ethical values must concern different levels and aspects to be wholesome and sustainable, for they are all reasonable and impartial. Meanwhile, for the sake of the entire development of a great social undertaking, medical high-tech industry must pay more attention to assure priority order of value principles so as to achieve the biggest justice that is an aggregation of pluralistic values. This chapter analyzed various ethical and value principles in medical high-tech industry and expounded the priority order and core values to choose principles.
Chapter 4: Value reconstruction. To advance its sound development, medical high-tech industry must step out of value misunderstanding, reconstruct ethics and values as well as their ideals, and return to and enhance the fundamental significance of medical technology. Value reconstruction must firstly correctly understand rich value implications in medical high tech, which is the basis to make sure ethical values of medical high-tech industry, and secondly be good at weighing various values. Above all, people-oriented is the ultimate destination of medical high-tech industry. Therefore, this chapter analyzed the value implications and core values of medical high tech, explained the profound meaning of the people-oriented principle, and explored the building of scientific spirit, ethical spirit and just ethical values in medical high-tech industry.
Chapter 5: Suggestions for ethical construction in medical high-tech industry. Given the variety of problems in medical high-tech industry, ethical construction is an unavoidable problem. Based on the analysis of values and value principles, this chapter, in the face of reality, raised some suggestions for ethical construction. The foremost issue is this industry’s administrative ethics construction which is the root of all ethical problems in medical high-tech industry. Secondly, to strike a reasonable balance between public interests and industry interests out of ethical principles, for this industry has been getting entangled in interest disputes. In addition, to raise some specific ways for ethical institutionalization, which is the fundamental safeguard for ethical values and principles in medical high-tech industry.
Key words: medicine; high-tech industry; value; ethical construction
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