(A) Consequence theory

Consequence theory is an important theory of ethics, also known as teleology or effect theory, which takes the consequences of moral behavior as the ultimate basis for determining moral norms. It believes that the purpose of determining moral norms is to adjust people's interests, and morality regulates the interest relationship between people, so that moral behavior can achieve good behavior results. According to the difference of moral utility subject (moral beneficial subject), the consequence theory mainly includes egoism, utilitarianism and public welfare theory.

Egoism is the consequence theory of determining moral norms according to whether the behavior takes its own interests as its direct purpose. Egoism can be divided into extreme egoism and reasonable egoism. The former believes that the established moral norms must be directly conducive to the realization of their own interests, regardless of the interests of others, even if it hurts the interests of others. For example, Steiner of Germany put forward the extreme egoism theory of "I am everything". The latter is to pursue personal interests without harming the interests of others. "Subjectively for yourself and objectively for everyone." Such as French helvetius, German Feuerbach and Russian Chernyshevski all hold this view.

Utilitarianism is the consequence theory of determining moral norms according to whether the behavior takes the interests of stakeholders as the direct purpose. The principle of utilitarianism is "the happiness of the majority". Utilitarianism holds that a certain moral standard must be directly beneficial to the happiness of most people. For example, Hume, Adam Smith, Bentham and Mill in Britain all hold this view.

Public welfare theory is the consequence theory of determining moral norms according to whether the behavior takes social public interests as the direct purpose. With the continuous socialization of human beings, different groups, countries and even the whole world have the same long-term interests, which are closely related to everyone's interests. The concept of public welfare has existed since ancient times. Nowadays, people in the world are facing a series of practical problems, such as environmental pollution, resource shortage, population explosion and the gap between the rich and the poor, which makes people's sense of public welfare unprecedentedly strong. According to the theory of public welfare, the determined moral norms must be directly beneficial to the common interests of mankind.

(B) the theory of medical consequences

The theory of medical consequences is an important theory of medical ethics, which takes the consequences of medical moral behavior as the ultimate basis for determining medical moral norms. It is believed that the purpose of determining medical ethics is to adjust people's interests, and medical ethics adjusts the interest relationship between people, so that medical ethics can achieve good behavior results.

The theory of medical consequences is also one of the ancient and eternal medical ethics theories, and it is the implementation of the theory of consequences in the medical field. The earliest theory of medical consequences can be traced back to Hippocrates' medical ethics. His principles of "benefiting patients" and "not hurting patients" have the ultimate goal of medical ethics and become the starting point of medical behavior and medical ethics. Since then, a large number of medical moral norms (medical moral obligations) in medicine, such as confidentiality, kindness, loyalty to medical skills, kindness and modesty, seriousness and pragmatism, are based on two basic principles revealed by Hirsch, which embodies the ultimate goal of medical morality.

With the socialization of medicine, especially the birth of medical institutions, the doctor-patient relationship has changed from a single doctor to a single patient to many medical personnel (not just doctors) to many clients (not just patients themselves). The medical interface needs to consider the interests of customers and other "stakeholders" and needs the guidance of utilitarianism. For example, contemporary bioethics puts forward the principle of justice, which requires that when treating patients (in order to meet the interests of patients), we should consider whether other patients need treatment more.

Today, medicine has become a public welfare undertaking. All mankind, different nationalities, countries and groups have their own long-term interests, and they also need to consider the guidance of social welfare and public welfare theory. 1973, a seminar on protecting health and changing values was held in the United States. At the meeting, Professor Johnson of the University of California School of Medicine and Hull Negus, director of the Institute of Human Reproduction and Bioethics of Georgetown University, put forward the theory of public welfare. With the deepening of people's understanding that reproductive technology, genetic technology and other medical high-tech will affect the long-term health interests of mankind and future generations, the theory of public welfare has attracted more and more attention and admiration.

Second, the benefits of the theory of medical consequences

(a) the interests of customers

1, the interests of patients

The clients of medicine are generally patients, but with the development of medical science and medical practice, many healthy people have also become clients of the medical profession.

The "patient benefits" here mainly refer to the health benefits such as eliminating patients' pain and treating diseases, as well as the material benefits related to patients.

2. Interests of stakeholders

With the continuous socialization of medicine, the medical interface faces not only one patient, but also other patients; Not only the patient himself, but also the relatives of the patient. The interest relationship faced by the medical industry has become complicated. When the theory of medical consequences requires the determination of medical ethics, not only the health and material interests of patients should be put in the first place, but also the interests of other clients and even relatives of patients should be considered.

3. Medical public welfare

Public welfare in medicine is the interest of groups and society, and it is the long-term interest of mankind. With the development of medical science and the emergence of new medical model, medicine has developed into a social undertaking, and medical activities are closely related to the interests of a certain group, the whole society and even all mankind, not only to the current interests, but also to the long-term interests; It concerns not only the interests of contemporary people, but also the interests of future generations. The public welfare fields in the medical field mainly include: controlling population, improving population quality, protecting environment, protecting resources, protecting the coordination of gender ratio, and maintaining the continuity and purity of human species.

(B) the interests of the medical industry

Traditional medical ethics pays attention to safeguarding the interests of patients and avoids the interests of the medical profession. In fact, the doctor-patient relationship is the basic ethical relationship of medical ethics, and the most basic mission of medical ethics is to rationally adjust the interest relationship between the medical community and the clients. The interests of the medical profession are obviously an important part of the theory of medical consequences.

When medical scientific research and medical and health practice become the profession of medical personnel, the interests of medical profession are an unavoidable problem, and medical profession becomes the condition for medical researchers and medical and health workers to survive. Under the condition of market economy, although China's health service is a social public welfare service that the government implements certain welfare policies, medical and health services must be market-oriented and adapt to the development needs of market economy. Medical and health units are also market players, and the services they provide also participate in social exchanges. The market mechanism also plays a role in the allocation of social resources in this field and between societies. It's just that these market players have been treated specially by the state and society, and these resource allocations have been more specially intervened by the state and society.

The interests of the medical profession must be safeguarded, which is the responsibility of the "social" subject of medical ethics. Today, the development of medical ethics has broken through the stage of medical self-discipline, and the main body of medical ethics is the whole society. From the perspective of social moral governance, we should not only safeguard the individual and overall interests of the clients, the current and long-term interests, but also safeguard the interests of the medical industry. Only in this way can we safeguard the interests of patients, ensure the normal development of the medical industry, and better safeguard the interests of patients.

Thirdly, the application of medical consequences theory in medical ethics.

The theory of medical consequences is the theoretical basis for formulating, testing and coordinating medical ethics. Whether it is beneficial to obtain medical consequences is the basis of formulating, testing and coordinating medical ethics, and it is also the ultimate standard of medical ethics.

(A) in the formulation of medical ethics.

Meta-ethics of medical ethics tells us that excellent medical ethics can only be deduced and formulated from behavioral facts through the purpose of creating medical ethics by society, which is the ultimate standard of medical ethics. The purpose of medical ethics is "whether it is beneficial to medical effect", that is, to better safeguard the interests of clients and medical circles. From the purpose of medical ethics, we can deduce the ultimate standard of medical ethics: one general principle-increasing the total interests of clients and medical circles, and two sub-principles-increasing the total interests of clients and medical circles when people's interests do not conflict, that is, increasing the total interests without hurting one party; When people's interests conflict and cannot be balanced, the principle of "maximizing the interests of the client and the medical profession", that is, the principle of net balance of interests: when the interests of the medical profession and the client conflict, it is manifested as the principle of "the happiness of the majority"; When the interests of customers conflict with those of the medical profession, it embodies the principle of "customer interests first". On this basis, a series of medical ethics can be formulated.

(B) test the role of medical ethics

In the history and reality of the development and practice of human medicine, a large number of medical ethics have been put forward, and the quality of these ethics, "whether it is conducive to the acquisition of medical effects" is the ultimate criterion for testing. All medical ethics conducive to medical effect are excellent; Any medical ethics that is not conducive to medical effect is not good. For example, in a long historical period, autopsy was considered immoral in China, but today, it is ethical to conduct autopsy according to certain moral norms, such as "informed consent of patients and their families, respect for corpses, medical and judicial purposes", which is conducive to the development of medical science and medical education, and ultimately to "the interests of the parties and the medical community". Through the theory of medical consequences, it is proved that the moral standard of "prohibiting autopsy" in ancient times is bad; Today's autopsy is ethical, and the medical ethics of "informed consent of patients and their families, respect for corpses, and medical and judicial purposes" is excellent.

(C) the role in coordinating medical ethics

In the practice of medicine and health care, a large number of medical ethics often have contradictions and conflicts. "Whether it is conducive to the achievement of medical effects" is the ultimate standard to coordinate these medical ethics. For example, when a patient is diagnosed with an incurable disease such as cancer, do medical staff abide by the principle of "respecting the patient's right to know" and tell the patient the truth, or "keep the patient confidential and avoid bad stimulation" and not tell the patient? When a patient suffers from sexually transmitted diseases, should he abide by the principle of "respecting the patient's privacy" and keep the patient confidential, or should he abide by the principle of "not hurting the innocent" and inform the patient's spouse? Obviously, in these moral situations, there is a contradiction between "respecting patients' right to know" and "keeping secrets for patients", "respecting patients' right to privacy" and "not hurting innocent people".

According to the theory of medical consequences, coordination should be based on the purpose of medical ethics and the higher principle of "whether it is conducive to the achievement of medical effects", that is, the ultimate standard of medical ethics "the principle of one total and two divisions". The right to know should first avoid unnecessary harm to life, as bad stimulation may harm the right to life. Therefore, first of all, we should abide by the moral standard of "keeping secrets from patients and avoiding bad stimulation", and seek ways to "respect patients' right to know" on this basis, such as finding the right time, taking the right way and choosing the right occasion to inform patients. Compared with "not hurting the innocent", "not hurting the innocent" is more conducive to the utilitarian principle of "the happiness of most people". So tell your spouse first to avoid hurting him, but at the same time, keep it a secret from irrelevant people.

Fourthly, the significance and limitations of the theory of medical consequences.

(A) the significance of the theory of medical consequences

The theory of medical consequences is also an important part of medical ethics, and it is the fundamental theory to formulate medical ethics.

As mentioned above, medical ethics is a theoretical system about medical ethics, which is a complete medical ethics system composed of the following three aspects: meta-medical ethics: the method of formulating medical ethics; Standardize medical ethics: the formation of excellent medical ethics: the realization of excellent medical ethics. Based on meta-medical ethics, medical consequence theory constructs a medical moral system from two aspects: medical moral purpose and ultimate medical moral standard. Therefore, it has become an important part of medical ethics.

(2) limitations

Although the theory of medical consequences plays a fundamental theoretical guiding role in the formulation of medical ethics, it still needs the theory of medical obligation to put forward a large number of medical ethics, and also needs the theory of medical virtue to put forward a large number of medical ethics, so as to cultivate good medical ethics for medical staff.

Five, the relationship between medical virtue theory, medical obligation theory (morality theory) and medical consequence theory.

Medical ethics theory is a theoretical system about medical ethics (medical ethics quality); Medical deontology is a theory about moral obligations and responsibilities in the medical field (these obligations and responsibilities are absolute); The theory of medical consequences is a theory that takes the consequences of medical behavior as the moral standard of medical behavior. People often overemphasize starting from a certain theory, expounding its medical ethics thought and constructing its medical ethics system. In fact, these three theories are an organic part of medical ethics, and together they form a complete medical ethics system.

The theory of medical ethics reveals that the medical profession should cultivate good medical ethics and make medical staff cultivate good medical ethics, which is the destination of medical ethics. However, the premise of cultivating good medical ethics is that the society has formulated good medical ethics recognized by the medical profession, and medical staff consciously follow these and practice them persistently, so that they can form habits and form psychological self-medical ethics. Therefore, the theory of medical ethics alone cannot become a complete system of medical ethics, and medical ethics must have the theory of "putting forward medical ethics"-the theory of medical obligation.

Medical deontology puts forward medical ethics norms-medical ethics principles and rules in the form of "obligation and responsibility". These norms reflect people's understanding of moral life and provide a basis for people to solve medical ethics problems. The significance of medical deontology is that it clearly puts forward the contents of medical ethics that medical staff should follow, so that every medical behavior of medical staff can be followed at all times without rethinking and determining "how to do it?" Standardization has greatly improved the efficiency of medical ethics. It can be seen that the theory of medical obligation, like the theory of medical virtue, cannot become a complete medical ethics system independently, and medical ethics must have the theory of "determining, demonstrating and defending medical obligation-medical ethics-medical ethics principles and norms"-medical consequences theory.

The theory of medical consequences takes "the effectiveness of the consequences of medical actions" as the basis for formulating medical ethics and as the standard for judging whether specific medical actions are moral or not. Medical ethics is formulated by the society, and its purpose is to standardize people's medical ethical behavior and make people's medical ethical behavior have good consequences.

Therefore, the most fundamental theory of medical ethics is the theory of medical consequences; Medical ethics based on the theory of medical consequences and the theory of medical obligation defense; Medical staff always follow medical ethics, thus forming psychological self, which is the content of medical virtue theory-medical ethics.