近期公共卫生事件

LANGUAGE NOTE | Document text in Chinese; abstract also in English. COVID-19疫情的爆發，突顯出公共健康倫理中自主性與公共健康之間的緊張關係。以“publichealth”、“ethics”、“autonomy”為主題詞在WebofScience核心合集數據庫中進行文獻收集，借助CiteSpace6.1軟件進行信息可視化分析，發現2020年1月1日至2022年5月14日期間，生命倫理/公共健康倫理領域對於“自主性”概念的討論大體上集中在“知情同意”、“健康保健政策"、“健康質量”、“信息技術”和“老年歧視/老年群體”範圍。本文在此基礎上提煉分析COVID-19疫情中的四個“自主性‘‘難題    如何避免以公共健康/公共利益為名過度限制自主性、在數字技術應用中如何保障自主性、如何保障老年群體的自主性和生命權，如何通過促進自主性來推動公共健康目標的實現。COVID-19疫情是一個重塑公共健康倫理自主性概念的歷史契機。冷酷的病毒已經作為一種媒介把人類的命運緊密地聯繫起來，而基於關懷倫理和共同體倫理重塑的自主性概念則有望給疫情下的世界帶來團結、温暖和希望。 In the field of public health ethics, the COVID-19 pandemic has highlighted the tension between autonomy and public health. Using CiteSpace 6.1 software and information visualization analysis, we performed a search of literature in the Web of Science core collection database using thematic words such as “public health”, “ethics” and “autonomy”, we found that from January 1, 2020 to May 14, 2022, discussions on the concept of “autonomy” within the field of bioethics/public health ethics were generally focused on the following topics: “informed consent”, “health care policy”, “health quality”, “information technology”, “ageism” and “elderly group”. In this paper, we distill and analyze four controversial issues: how can we avoid excessive restrictions on autonomy in the name of public health/public interest? How can we protect autonomy when using digital technology? How can we protect the autonomy and rights of the elderly? How can we advance the goals of public health by promoting autonomy? The COVID-19 pandemic is a unique historical opportunity to reshape the concept of autonomy within the field of public health ethics. Although the virus has bound the fate of humanity together, a reinvented concept of autonomy based on care and community ethics holds the promise of bringing solidarity, comfort, and hope to the world in the midst of the pandemic.

Helping behaviors are considered critical for business and societal recovery in light of economic crises and natural disasters, including the COVID-19 pandemic that has both economic and health disaster elements. However, because the current COVID-19 pandemic has both of these elements, it is unclear how helping may be impacted. Economic crisis research suggests that such events are associated with less helping, whereas disaster research suggests that such events are associated with greater helping. We pair the event system theory (Morgeson, F. P., Mitchell, T. R., & Liu, D. (2015). Event system theory: An event-oriented approach to the organizational sciences. Academy of Management Review, 40(4), 515-537) with these two logics (economic downturn and disaster) to suggest that health and economic threats within the COVID-19 pandemic operate with potentially opposing forces on helping-related outcomes. To test these ideas at a macro-level, we examined internet search volume for recession, COVID-19, and interest in helping. At a micro-level, we examined the relationships between work- hour insecurity and perceived job-related COVID-19 risk—two salient COVID-19-related economic and health threats—and helping customers and coworkers. Consistent with economic crisis logic, macro-level concern about recession was negatively associated with interest in helping. Moreover, at the individual level, work-hour insecurity negatively predicted helping coworkers. Consistent with disaster logic, at the individual level, perceived job-related COVID-19 threat was positively associated with helping coworkers and negatively associated with helping customers. These findings suggest that the specific feature of the COVID-19 event system (economic versus health) and the target (organizational insiders versus outsiders) matter for shaping helping behavior. These findings have implications for helping during crises that involve economic and/or disaster elements.

「全球衛生治理」（global health governance, GHG）的初始概念發軔於19世紀的歐洲，基於拿破崙戰爭（Napoleonic Wars）結束後國內產業發展及國際貿易之需求，歐洲國家意識到對具傳播感染力的疫病跨境有必要以合作的方式進行控管。然而，2020年一場自中國爆發，隨之擴散全球的新型冠狀病毒肺炎（novel coronavirus pneumonia or COVID-19）凸顯出國際合作在公共衛生治理的力不從心。透過對現行GHG定義的回顧與反思，輔以世界衛生組織（World Health Organization, WHO）與主權國家因應COVID-19之具體事例；本文指出：（1）WHO現行制度設計上的瑕疵；（2）GHG在任務與工作範圍的過於寬泛；（3）以及「大政府」勢力的相對抬頭，等三個主要因素導致國際社會目前缺乏有效的集體行動治理COVID-19。由於涉足疫情治理的行為者眾多且橫跨國內和國際兩個層次，導致彼此間的利益衝突不易調和，因此無論是關於COVID-19的政府間合作還是納入非國家行為者的全球治理，在可預期之將來皆難以形成，或即便形式上存在也無法產生具體成效。 The concept of Global Health Governance (GHG) emerged in 19th-century Europe Based on the demand for domestic industrial development and international trade after the end of Napoleonic Wars, European nations began to feel the need for controlling contagious diseases that could cause cross-border infections through cooperation Yet, the 2020 novel coronavirus pneumonia (COVID-19) that began in China and later spread globally has demonstrated the weakness of international cooperation on matters of public health Through the review of and reflection on the current definition of GHG to analyze recent events of how the World Health Organization (WHO) and nations respond to COVID-19, this article points out that: (1) there are flaws in the institutional design of WHO;(2) the definition of GHG is overly broad and vague;(3) the relative rise of the power in the hands of big governments around the world All of these are the main cause for the international society to lack collective action to govern COVID-19 In other words, the facts that the pandemic governance involves many actors and entails both national and international levels lead to unresolvable conflict of interest Therefore, neither international cooperation nor global governance for COVID-19 is achievable in the foreseeable future Even if it is achievable, it will very likely fail to produce desirable outcome