维持高水平医药道德

Renowned French philosopher Michel Foucault （1926-1984） hits the nail on the head when he wrote in his book “The Birth of the Clinic” that a doctor is not able to look at the various physical signs in a patient and immediately know what disease the patient is suffering from. He can only do his best to give an assessment and diagnosis based on his “clinical gaze”。

　　Yet by virtue of his exalted status, the doctor is endowed with much power over his patients. In Foucault's view, a clinic is a place where knowledge is power.

　　Let's not go into the complex details of Foucault's theory.

　　Recent reports of unrelated incidents of unethical medical practices here are enough to set us thinking.

　　The first case that comes to mind is a clinical research project by the National Neuroscience Institute on Parkinson's disease which was accused of breaching rules of ethics.

　　The researcher conducted drug testing on 127 Parkinson's patients without their informed consent. Worse still, some patients experienced a drop in blood pressure, difficulty in moving and discomfort.

　　In another incident, a dental surgeon at an NTUC Denticare clinic refused to attend to a Tan Tock Seng Hospital executive.

　　These episodes may, in a way, well serve as examples of the negative consequences of the knowledge-power relationship elaborated by Foucault.

　　We can point the finger at the researcher and dentist for lacking in professional ethics or even question whether they subscribe to these ethics at all in the first place.

　　We can also accuse the dental surgeon of being unsympathetic and the researcher of being unscrupulous for selfish reasons. They have both failed in their duty.

　　As I see it, their conduct is just a manifestation of the preoccupation of modern medicine with the development of scientific knowledge and equipment which inadvertently or otherwise, overlooks the importance of human elements.

　　This is not suggesting that the present health care system should be rejected or abolished. There is, however, a need to be mindful of the shortcomings in this man-made and highly-institutionalised system in order to improve it.

　　An over-emphasis on scientific knowledge, modernisation, equipment and high technology may blind us to the fundamental fact that the system is created to serve human needs.

　　Ignore this and we are likely to see unethical conduct similar to the cases mentioned earlier repeat itself.

　　The research project may have good scientific and medical reasons. Still, the manner in which it was carried out was objectionable - the researcher was experimenting with precious human lives.

　　The dentist could argue that he acted in the interests of the majority of patients. But there is no denying that he has forgotten that his duty as a doctor is to help patients who are in need regardless of race, occupation, political affiliation or the fact that they may have diseases other than the one they seek treatment for.

　　Without this strong sense of duty, behaviour like selfishness （turning away patients） and avoidance （the recent untimely resignations of some Taiwanese doctors） will become inevitable.

　　Doctors should not be equipped only with the knowledge and skills required of the profession, they should always bear in mind the need to care for and feel a sense of compassion for patients.

　　Of course, doctors are only human and are not spared from unpleasant feelings and the ups and downs in life.

　　Patients also need to be understanding, reasonable, and cooperative for a healthy doctor-patient relationship to develop.

　　。The writer is a PhD candidate at NUS. Translated by Yap Gee Poh.

　　法国思想家福柯（1926-1984）在他的《诊所的诞生》（1963）一针见血指出,现代医学的诊断中,医生并不能完全探知所有疾病“纸牌”的数量和图案,他也只是通过自己的目光观察病人,从而给出相应的判断与勾勒。

　　当然,作为医生,居高临下的地位赋予了他无上的权力。在福柯看来,诊所不过是知识和权力互化和转换的社会机器,里面充满了社会权力。

　　抛开福柯繁复的理论缠绕不谈,我们在仔细阅读最近接二连三、看似偶然的医学事件后,难免感触良多。

　　首先是国立脑神经医学院一项帕金森临床研究被指违反道德标准,其研究员未经批准,便在127名帕金森病人的身上进行药物测试,而且,要命的是,该测试曾经导致一些病人血压骤降、产生运动障碍及身体不适的现象出现。

　　其次是陈笃生医院职员牙痛到职总牙科保健合作社属下诊所求诊,遭一名牙医拒绝看诊。

　　耐人寻味的是,恰恰就在我们力图避开福柯所言的权力关系时,我们发现上述事件恰恰仍然是现代医学权力网络生成并发展的恶果表现之一。

　　我们自然可以指责那名研究员和医生缺乏职业道德,甚至可以追问和质疑这种道德的底线。当然,我们或许也可以愤愤不平地指责他们缺乏同情心,为了某种目的,违背了他们的职责。

　　在我看来,问题的关键在于他们的表现不过是他们整个学科走向科学化、机械化,而有时无意或故意罔顾了人性的弘扬的一个小小的注脚而已。我们自然不能完全否认或*目前的医疗制度,问题在于,我们在推行这些人为的、长期延续下来的制度时,该怎样反思并修补制度中的缺陷。

　　如果我们过分强调科学、现代、机械化、高科技等的巨大功用,忽略了所有的制度和制造,不过是为人类服务的工具这样的本质时,我们仍然会持续不断的重蹈类似的覆辙,物于物而非物物。

　　毋庸讳言,哪怕那名研究员是真正为了研究的需要和科学精神而进行了实验,他的这种标准与规范职业道德也自然有其可疑之处,因为,他还是将活生生的生命（尽管是有缺憾的）当成了了无生气的试验品。而那名牙医即使是打着为了大多数病人的利益的旗号,他仍然忘记了作为一个医生的荣誉和精神生命是：不分种族、职业、政党、病种等的对病人的热忱的“救死扶伤”。如果不能以此作为神圣使命,自私（拒绝病人）和逃避（比如台湾某些医生不合时宜的辞职）则不可避免。

　　某种意义上讲,我们灌输给医生的不应仅仅是职业素质,他们的心中还应该始终涌动着弘扬普遍人性的潮流。当然,需要指出的是,作为凡夫俗子中的一员,医生自然也有喜怒哀乐、七情六欲,作为（可能）病人的我们的体谅、尊重和积极配合也是人类整体得以长期共存的必需。