An Ethical Study on Autonomy and Paternalism in Preventive Medicine

最近，日本实施了《健康促进法》，其中规定所有人都有责任管理自己的健康，女性出生时的预期寿命超过82岁。本文的目的是作为一个广泛的话语的义务，以实现良好的健康为人民自己的利益的关键调查。首先，我们回顾了古典公共卫生运动到新公共卫生运动的演变。传统的公共卫生致力于改善环境，如安装污水系统以预防感染，而自20世纪70年代中期以来的新公共卫生运动主要关注我们的生活方式。通过一些流行病学调查，研究人员和决策者都达成了一项共识，即改革“不健康”的生活方式比治疗性卫生保健做法更有效、更经济。因此，他们坚持认为，人们有义务通过自律来促进自己的健康和预防疾病，并且对人们的生活方式进行医疗干预是合理的。在这里，我们概述了今天关于促进健康责任的话语的基本特征如下：健康主义，现代医学的准宗教和道德特征，通过隐喻赋予疾病和疾病非凡的意义，我们日常生活的医学化，以及过度强调个人对疾病或疾病的责任，作为削减所需健康和社会项目的理由。正如我们将看到的，我们将详细研究这些预防医学的主张。总之，我们不能接受有义务促进人民健康的想法。相反，政府似乎有义务保护环境，确保食品、水、住房等日常商品的安全，并在没有家长式强制的情况下改善医疗保健服务。

Recently the Health Promotion Law, which prescribes that all people have a duty to administrate their own health, has been enforced in Japan, whereby the life expectancy at birth for females is over 82 years. This paper is intended as a critical investigation of widespread discourses on the obligation to achieve good health for the people's own sake. In the beginning, we review the evolution of classical public health to the new public health movement. While classical public health addressed the improvement of the environment such as installing sewerage systems for infection prevention, the new public health movement since the mid 1970s has largely been concerned with our lifestyles. With some epidemiological surveys, both researchers and policy makers reached agreement on the tenet that reforming 'unhealthy' lifestyles is more effective and economical than curative health care practices. Thus, they insist that people have an obligation to promote their own health and prevent disease by self-discipline, and that medical intervention in people's lifestyle is justified. Here we outline the essential features of today's discourse on the duty to promote health as follows : healthism, a quasi-religious and moral characteristic of modern medicine, giving extraordinary meaning to diseases and illnesses by metaphors, the medicalization of our everyday life, and an excessive emphasis on personal responsibility for disease or illness as rhetoric to justify cutbacks in required health and social programs. As will be seen, we examine these claims of preventive medicine in detail. In conclusion, we cannot accept the idea of the obligation to promote health for people. On the contrary, it rather seems that the government is obliged to preserve the environment, to assure daily commodities' safety such as food, water, housing and so forth, and to improve health care services without paternalistic coercion.