Добірка наукової літератури з теми "資源分配"

LANGUAGE NOTE | Document text in Chinese; abstract also in English.一個道德上公正的醫療保健制度，不僅應該保障人人都可以均等地獲得基本的衛生保健服務，還應該是財務上可持續的。醫療保健制度籌資責任主體一般包括政府、個人、家庭等，各籌資主體責任大小對實現一國或一地區衛生資源的有效配置、為當地居民提供公平而又有效的醫療衛生服務至關重要。本文將建國以來中國城鎮地區醫療保健制度的發展演進劃分為四個階段，分別是計劃經濟時期、經濟制度轉軌時期、市場經濟初期、全民基本醫療保險時期，基於儒家生命倫理原則，對中國（內地）城鎮地區衛生籌資責任主體進行回顧、反思，分析認為中國衛生籌資責任主體發展經歷了「政府大包大攬、個人及家屬免費享受」——「政府財政逐漸退出、個人及家庭負擔加重」——「 政府責任回歸、個人負擔有所下降」——「政府、市場、個人責任逐漸趨於均衡」這一過程。基於儒家衛生正義觀，本文認為「仁政」不是絕對平均主義，也非個人全權負責；「家庭本位」的傳統文化在中國一直活躍至今，制度安排亟需家庭責任的回歸。在儒家看來，一個道德上合理的衛生籌資責任，應該是個人、家庭和政府的平衡與和諧。A morally justifiable health care system should not only ensure that everyone has equal access to basic health care services, but also be financially sustainable. It is normally supposed that governments, individuals and families take joint responsibility for health care in a certain country or region. Their levels of financial responsibility are a significant factor in the effective allocation of healthcare resources and fair delivery of health care services.This paper divides the historical evolution of health care financing responsibilities in urban China since 1949 into four periods: a planned economy period, an economic system transition period, an initial period of market economy and a universal health coverage period. Based on Confucian ethical principles, the author reflects on financing responsibilities in urban China. She determines that the financing responsibilities of different periods have changed from government- to individual-dominant, finally achieving a balance between government, the market and the individual. The author argues that from a moral standpoint, according to Confucian ethical appeals on health justice, a benevolent government should practice neither the doctrine of absolute equalization nor the principle of individual liberalism. As the idea that the family comprises the primary community is still active in contemporary China, family responsibility should be emphasized along with health care financing policy. According to Confucianism, a morally just health care financing responsibility requires a proper balance and harmony between individuals, families and governments.DOWNLOAD HISTORY | This article has been downloaded 401 times in Digital Commons before migrating into this platform.

LANGUAGE NOTE | Document text in Chinese; abstract also in English.正義是一個歷史範疇，任何具有實踐品格的正義理論都只能是與特定道德共同體特殊的善的規定相聯繫的正義論，從這一意義上說，儒家當然也有自己的正義論。儒家正義論是以天道性命的邏輯關係為起點，通過仁、禮、義三維一體的倫理結構而表現的正義論。這種正義論將社會正義與個人正義統一起來，總體上體現為一種“厚生”的思想意識和行動。由於“生”具有不同的實踐領域和境界層次，從而使儒家正義論具有多維的展現向度。把這種正義論應用於醫療公正領域，儒家主張醫療保健政策必須以維護國民的生命意義和完整實現為前提，主張政府應提供一種基礎性的全民性的醫療保障和保健制度。但儒家不認同單級的平等主義的分配制度，而是強調資源的差等分配，但資源差等分配的前提不在於每個人實際的貧富狀態，而取決於人的修德程度或者說後天努力與貢獻的程度。個體對自我生命的完整實現負有天定的義務，因此儒家主張在醫療保健領域應當賦予個體和家庭以更多的自主權。In the West, “justice” is a complex ethical principle, with meanings that range from the fair treatment of individuals to the equitable allocation of healthcare resources. Justice in bioethics is perhaps the most contested and controversial principle. This paper argues that the Confucian notion of justice is neither rights-based nor distributive; rather, it is based on the virtues of humanness and benevolence (ren), correct behavior and propriety (li), and uprightness and appropriateness (yi). Those virtues cherished in the Confucian tradition constitute what can be called a Confucian concept of justice, the primary principle of which is to respect human life. This means that in the healthcare system, the Confucian idea of justice is approached from the perspective of equality and fairness. On the one hand, the government should provide basic care for all persons according to the virtue of humanness/benevolence; on the other hand, the government should allow for diversity and differences in medical treatment and healthcare resource allocation according to the virtues of propriety and appropriateness, given that medical resources are limited and China supports a huge population. In other words, the government has the responsibility of providing public health care to those who cannot afford to pay for their own basic healthcare needs. At the same time, the government should allow for alternatives and should permit people to choose between ways of dealing with their medical issues.Clearly, the language of “rights” is absent from the Confucian tradition. However, this essay argues that because the Western notion of justice, particularly in the legal sense, does not take into account what is good, the Confucian virtue-based justice better fits the cultural milieu of medical practice in China. From the standpoint of Confucianism, healthcare and bio-medical ethics should be more concerned about what is good for society, family, and the individual than about absolute equality or the principle of fair equality, which engender both moral and economic hazards.DOWNLOAD HISTORY | This article has been downloaded 259 times in Digital Commons before migrating into this platform.

LANGUAGE NOTE | Document text in Chinese; abstract also in English.基因醫學的進步，有朝一日將使得一個人在出生時的基因組合，不再只是純然的運氣，而是社會體制可以影響和決定的。會這一天來臨時，社會正義是否要求社會提供給父母親必要的基因醫療資源，以避免讓下一代因為基因差異而在機會上不平等？是否要求社會應該提供所有成員必要的基因醫療服務，以確保人與人之間在基因組合上平等？本文從合理契約論的角度來分析對這兩個問題，提出負面的答案。合理契約論的正義觀結合了亞里斯多德與羅爾斯對於正義之概念的分析，主張：社會有欠於每個成員去選擇一個他不能合理拒絕的體制。在這個架構下，本文把基因差異所衍生出來的機會不平等，置於分配正義的脈絡來考察。本文分析了泛公平式的機會平等原則、中立化基因差異原則、基因平等原則，並且指出這些原則的困難。本文認為，為了避免社會成員因為基因缺陷而有生不如死的抗議，社會有義務要做到讓所有的人帶有一定程度的基因品質。但由於基因工程可能會改變人的同一性，本文論證，在合理契約論的架構下，社會並沒有義務去提供必要的基因醫療資源來中立化基因差異，更沒有義務去落實基因平等。但本文也論證，在允許資源不平等、尊重家庭自主性的體制裡，公平式的機會平等要求社會必須補償基因組合較差者。而為了避免補償不足，社會也許應該提供基因醫療資源，縮小人與人之間因為基因差異而衍生的機會不平等，雖然這並不是社會有欠於基因組合較差者的義務。Genetic medicine has made so many unthinkable things possible these days that someday we might be able to determine the features of anyone's genetic profile. Once this is feasible, then the distribution of genetic profiles is no longer a matter of natural lottery. It is then to be decided by social institutions and to be assessed in term of social justice. This paper is concerned with the questions as to whether society then should provide genetic medical resources for parents so that the impact on opportunity of genetic inequalities could be neutralized or minimized, and whether society should bring about genetic equality. I answer both questions negatively from the perspective of a conception of justice, which I have been developing. I call this conception reasonable contractarianism, which holds that society owes to each member a duty to choose an institutional scheme that he or she (if properly motivated) could not reasonably reject. I argued that the brute luck view of equal opportunity, which might give positive answers to the questions I pose, is implausible. In my view, society is obligated to make sure that no one could complain that given his genetic profile, he would rather prefer not being born at all to living. To discharge this obligation, I argue, society should provide gene-based medical resources to help parents give birth to genetically healthy babies. Such provision is necessary for society to do what it owes to its members. I also argue that choosing an institutional scheme that respects the autonomy of family allows unequal distribution of resources, amounts to choosing a scheme that is unfair to those who are genetically inferior. Society should compensate for them. In the end, I suggest that in order not to fail to provide sufficient compensation, society might have to reduce the inequality of opportunity induced by the autonomy of family via genetic measures, despite that this is not what society owes to those who would come to exist with genetically inferior profiles.DOWNLOAD HISTORY | This article has been downloaded 24 times in Digital Commons before migrating into this platform.

LANGUAGE NOTE | Document text in Chinese一系列病例使有關醫學治療何時有效、何時無效的爭端明確化、具體化，因而也使有關醫患關係、資源分配、醫患間的溝通交流、同情心、病痛的緩解、自主權、治療不足和治療過度、家長式的獨斷作風及姑息治療的爭端明確化、具體化。暸解有效和無效是相輔相成的概念，對我們的醫療實踐有益。對治療在爭議性病例是有效還是無效的判斷，有著共同的特點：（1）以醫學科學為依據；（2）反映多種價值；（3）處於或接近有效閾；（4）令人負擔沈重。我們應關注構成這些判斷基礎的經驗要素、倫理要素及評估要素的正當理由，而不是做出有關是醫生、病人，還是社會一致認同應成為最終決定因素的專橫決定。DOWNLOAD HISTORY | This article has been downloaded 20 times in Digital Commons before migrating into this platform.

LANGUAGE NOTE | Document text in Chinese本文討論了“無效爭端”的歷史及促進醫療衛生專業人員、醫療衛生提供者（指醫院及其它醫療衛生機構）、患者和代理人偏袒某種無效定義的動機。引起無效爭端的因素有：醫療衛生體制改革、財政責任轉移、技術醫學進展及醫療衛生資源的定量配給。對作為目前爭端的一個組成部分的無效的定義進行了探討；同時還對“醫療衛生專業人員、醫療衛生提供者、患者和代理人在接受醫學的目的、能力和局限性方面的各自態度”進行了探究。特別是，醫療衛生專業人員／醫療衛生提供者與患者／代理人之間缺乏坦誠地交流被認為是制定以醫療衛生為核心的無效政策的主要障礙。最後，對醫院制定無效準則的各種初步嘗試進行了評價，旨在發現問題所在及提出改進措施。DOWNLOAD HISTORY | This article has been downloaded 16 times in Digital Commons before migrating into this platform.

受疫情影響，各國關於民事訴訟之數位化，尤其是線上遠距審理，產生大幅躍進，並成為未來民事訴訟變革之方向。因應數位化發展，溝通媒介之改變，民事紛爭處理制度必須面對從紙本到電子文件、從實體場域到網路空間之轉變。本文從國外線上法院程序之發展狀況，探討線上民事法院之目的論，並以線上起訴及遠距審理為對象，分析傳統訴訟以紙本文書及到庭辯論所形塑之訴訟文書交換及送達、兩造言詞辯論、直接審理、公開審理等程序架構及基本原則，於民事訴訟數位化下所受之影響及挑戰。除個別面向之數位化外，由於線上程序具簡速性及經濟性，亦宜思考有無何類事件（例如：小額事件），適合增設全面性之線上程序，使當事人得合意選擇利用，以保障其近用法院及程序選擇之權利，亦可合理分配司法資源，使法院更有餘力處理複雜困難之案件。各國有關民事法院之數位轉型仍持續發展中，本文並不在於蓋棺論定，而是期待就此議題能激發更多之討論。<br />

Kyoto University (京都大学)
0048
新制・課程博士
博士(農学)
甲第8441号
農博第1125号
新制||農||801(附属図書館)
学位論文||H12||N3398(農学部図書室)
UT51-2000-F345
京都大学大学院農学研究科農林生物学専攻
(主査)教授 久野 英二, 教授 西岡 孝明, 教授 高藤 晃雄
学位規則第4条第1項該当