龔鵬程對(duì)話海外學(xué)者第七十三期：在后現(xiàn)代情境中，被技術(shù)統(tǒng)治的人類社會(huì)，只有強(qiáng)化交談、重建溝通倫理，才能獲得文化新生的力量。這不是誰(shuí)的理論，而是每個(gè)人都應(yīng)實(shí)踐的活動(dòng)。龔鵬程先生遊走世界，并曾主持過(guò)“世界漢學(xué)研究中心”。我們會(huì)陸續(xù)推出“龔鵬程對(duì)話海外學(xué)者”系列文章，請(qǐng)他對(duì)話一些學(xué)界有意義的靈魂。范圍不局限于漢學(xué)，會(huì)涉及多種學(xué)科。以期深山長(zhǎng)谷之水，四面而出。

羅杰·克里斯普教授（Professor Roger Crisp )

牛津大學(xué)圣安妮學(xué)院哲學(xué)系道德哲學(xué)教授

龔鵬程教授：您好。在過(guò)去的幾年中，有限的醫(yī)療資源給人們帶來(lái)了極大的挑戰(zhàn)。您的研究涉及對(duì)健康的評(píng)價(jià)和醫(yī)療資源的分配，卻可能令人疑惑。您所謂“質(zhì)量調(diào)整壽命年”和用道德倫理來(lái)衡量誰(shuí)可以獲得更多醫(yī)療資源的實(shí)踐是否存在問(wèn)題？我們應(yīng)該如何安排醫(yī)療資源的優(yōu)先級(jí)？ 是否應(yīng)根據(jù)質(zhì)量調(diào)整壽命年來(lái)做決定？這其中的道德挑戰(zhàn)有哪些？

羅杰·克里斯普教授：龔教授，您好。質(zhì)量調(diào)整壽命年（QALY）的概念，是在英國(guó)發(fā)展起來(lái)并被使用的，例如國(guó)家健康與護(hù)理卓越研究所，就會(huì)根據(jù)它來(lái)就最有效地利用醫(yī)療資源提供建議。它的基本理念是：人們健康生活的一年價(jià)值為 1，而健康狀況不佳的年份價(jià)值較低，甚至可能是負(fù)的。任何的有效干預(yù)都可以按“每個(gè) QALY”來(lái)計(jì)算。

人們常說(shuō)QALY 衡量標(biāo)準(zhǔn)非?！肮髁x”，但是只有當(dāng)它是分配衛(wèi)生保健資源時(shí)使用的唯一原則時(shí)才會(huì)如此。如果該衡量標(biāo)準(zhǔn)只是所有原則中的一個(gè)，那么它就反映了常識(shí)道德中的一個(gè)重要因素，即在其他條件相同的情況下，我們應(yīng)該提升整體幸福感而不是減少它。當(dāng) QALY 的判斷是基于那些患有某些疾病的人直接提供的信息時(shí)，它們就很可能對(duì)決策有所幫助。

然而，僅僅使用QALY來(lái)衡量醫(yī)療保健資源的分配則是錯(cuò)誤的，原因有兩個(gè)。首先，不僅是衛(wèi)生保健干預(yù)措施能帶來(lái)多少利益，如何分配這些利益也非常重要。比如許多人會(huì)認(rèn)為即使不能最大化 QALY，我們也應(yīng)該將年輕患者的生命延長(zhǎng) 10 年，而不是讓老年患者延長(zhǎng) 20 年。

其次，還有一個(gè)錯(cuò)誤的認(rèn)知，是在短期內(nèi)最大化 QALY可以最大化長(zhǎng)期利益。因?yàn)槲覀儗?duì)最佳人口水平知之甚少，而且由于我們每個(gè)人都在使用未來(lái)可能會(huì)被更有效地利用的資源，所以現(xiàn)在拯救生命可能會(huì)降低長(zhǎng)期的整體利益。

The notion of a quality-adjusted-life-year was developed in the United Kingdom, and is used there by, for example, the National Institute for Health and Care Excellence to advise on the most effective use of medical resources. The basic idea is that one year of healthy life is to be valued at 1, while years of poor health are valued less, perhaps even negatively. The effectiveness of any intervention can then be costed ‘per QALY’.

It is often said that the QALY measure is ‘utilitarian’. This will be the case, however, only if it is the sole principle used in the allocation of health care resources. If that measure operates as one principle among others, then it mirrors an important element of common-sense morality: that, other things equal, we should produce more overall happiness than less. If the QALY judgements are made on the basis of information provided directly by those suffering from certain conditions, then they are likely to be of some help in decision-making.

It would, however, be a mistake to useonly the QALY measure to distribute health care resources, for two reasons. First, it matters not only how much good is produced by health care interventions, but how that good is distributed. Many will believe that, for example, we should extend the lives of younger patients for, say, 10 years rather than older patients for 20 years, even if this does not maximize QALYs. Second, it would be a mistake to think that maximizing QALYs in the short term will maximize the good in the long term. We have very little idea of the optimum population level, and since each of us uses resources that may be more effectively used in future, saving lives now may lower the overall good in the longer term.

龔鵬程教授：您的著作《實(shí)踐倫理學(xué)中道義上的惡》，感覺(jué)很像中國(guó)荀子的“性惡論”。性惡論和孟子的性善論，被認(rèn)為是中國(guó)人性論獨(dú)立的兩派。但其實(shí)孟子說(shuō)的是：無(wú)論人有多少獸性，人之本性卻是善的，與禽獸不同。荀子說(shuō)性惡，則不是說(shuō)人本性就是惡的，而是說(shuō)人生下來(lái)只是自然狀態(tài)，后來(lái)與社會(huì)接觸，在生活實(shí)踐上卻會(huì)走向道義上的惡。您的論點(diǎn)也接近這個(gè)意思嗎？

羅杰·克里斯普教授：我認(rèn)為，荀子和孟子的理論都可以理解為人性中存在善惡的元素，而我們每個(gè)人生來(lái)都有成為善或惡的能力。這一立場(chǎng)與亞里士多德的立場(chǎng)產(chǎn)生了共鳴，亞里士多德認(rèn)為，我們是否有道德，其實(shí)“取決于我們自己”。

我完全理解為什么這些哲學(xué)家和許多其他哲學(xué)家持有這樣的觀點(diǎn)。似乎我們從小就能夠真正自由地做出或善或惡的選擇，而這些選擇最終培養(yǎng)出我們善或惡的性格。

但我發(fā)現(xiàn)我很難領(lǐng)會(huì)這里的“自由”是什么意思。我所做的任何“選擇”都發(fā)自我在做選擇時(shí)的信念和欲望。這些信仰和欲望本身不是被選擇的，而是先前的信仰、欲望和其它無(wú)法控制的狀態(tài)的結(jié)果。

如果世界是由自然法則規(guī)定的，那么我，所做的任何事情都是在我出生之前很久就發(fā)生的事件的結(jié)果。盡管如此，因?yàn)槲以谧鲞x擇時(shí)并沒(méi)有受到任何脅迫，我還可以回應(yīng)所做選擇，所以從某種意義上來(lái)說(shuō)我的選擇是“自由的”。

但是，我對(duì)自己理由的信念本身是由它們自己決定的（或者說(shuō)是隨機(jī)的），因此，讓我對(duì)因這些信念而產(chǎn)生的問(wèn)題負(fù)責(zé)是不合理的。當(dāng)一個(gè)人出生時(shí)，我們不知道他們是否會(huì)成為我們所說(shuō)的善或惡，從這個(gè)意義上來(lái)看，我們可以說(shuō)這兩種結(jié)果都都是“有可能的”。

但是，他們的所作所為，以及他們的性格，將是他們無(wú)法控制的事件的結(jié)果。人的行為和性格有善惡之分，但他們的善惡只是方式上的，比如桃子是善的，因?yàn)樗梢詭?lái)快樂(lè)，而地震是惡的，因?yàn)樗鼤?huì)帶來(lái)痛苦。

I take it that both Xunzi and Mengzi can be understood as claiming that there are both good and evil elements in human nature, and that each of us is born with the capacity to become either good or evil. This position resonates with that of Aristotle, who believe that it is ‘up to us’ whether we become virtuous or not.

I entirely understand why these philosophers, and many others, hold this view. It seems that we are able to make genuinely free choices from an early age, and that these choices may themselves be good or evil, and lead to our developing a good or evil character. But I find it hard to grasp what is meant by the idea of ‘freedom’ here. Any ‘choice’ I make will flow from the beliefs and desires I have at the time of making the choice. Those beliefs and desires are not themselves chosen, but are themselves the result of previous beliefs, desires, and other states, over which I have no control. If the world is determined by natural laws, then anything I do is the result of events which took place long before my birth. It might be said that, nevertheless, my choice is ‘free’ in the sense that I am not coerced, and am responding to the reasons I take myself to have. But the beliefs I have about my reasons are themselves determined (or random), and so it strikes me as unreasonable to hold me responsible for what issues from those beliefs. When someone is born, we do not know whether they will become what we call good, or what we call evil, and in that sense we can say that either outcome is ‘possible’. But what they do, and their character, will be the result of events over which they have no control. There are good and evil actions and characters, but they are good and evil only in the way that, say, a peach is good in that gives pleasure, or an earthquake is evil in that it causes pain and suffering.

龔鵬程教授：您認(rèn)為我們現(xiàn)在需要什么樣的商業(yè)倫理？

羅杰·克里斯普教授：人們可能會(huì)認(rèn)為，只要不參與商業(yè)活動(dòng)就不需要了解任何商業(yè)道德，但這是一個(gè)錯(cuò)誤的想法。 我們每個(gè)人都應(yīng)該了解商業(yè)道德的基礎(chǔ)，以便能夠批評(píng)或?qū)で蟾淖兤髽I(yè)的做法（甚至贊揚(yáng)和鼓勵(lì)他們）。

企業(yè)的最終價(jià)值，就像任何事物的價(jià)值一樣，僅存在于它們對(duì)現(xiàn)在和未來(lái)世界上大眾福祉的影響。有時(shí)可以直接判斷這些影響，例如，開(kāi)發(fā)酷刑工具并將其出售給暴君的企業(yè)顯然很糟糕； 而發(fā)現(xiàn)可以大大減少人類痛苦的某種形式的廉價(jià)醫(yī)療企業(yè)，就是一家好企業(yè)。

但也有可用于評(píng)估企業(yè)的道德?tīng)顩r的“次要原則”，例如誠(chéng)信廣告、給予工人的薪酬和條件，或?qū)沙掷m(xù)性的承諾。

我們所有人都應(yīng)該了解這些原則，并盡我們所能要求企業(yè)對(duì)他們的承諾或缺少的承諾負(fù)責(zé)。當(dāng)然，首先是經(jīng)營(yíng)企業(yè)的人需要了解這些主要和次要原則，并盡力按照它們行事。 但我們所有人都有責(zé)任尋找有關(guān)企業(yè)行為的信息，并從道德的角度考慮它們。

It might be thought that someone who is not involved in business does not need to know anything about business ethics. This would be a mistake. Every one of us should know the basis of business ethics, so as to be in a position to criticize or seek to change the practices of businesses (or indeed to praise and encourage them).

The ultimate value of businesses, like the value of anything, lies solely in the effects they have on the well-being of living beings in the world now and in the future. Sometimes these effects can be judged directly: a business which develops instruments of torture and sells them to tyrants, for example, is clearly bad; while a business which discovers some form of cheap medical treatment which will greatly decrease the sum of human suffering is good.

But there are also ‘secondary principles’ which can be used to assess the moral status of businesses, concerning, say, honesty in advertising, the pay and conditions of workers, or commitment to sustainability. All of us should be aware of these principles, and, as far as we can, hold businesses to account for their commitment, or lack of commitment, to them. Primarily, of course, it is those who run businesses who need to be aware of these primary and secondary principles, and to do their best to act in accordance with them. But all of us have a responsibility to seek out information about the actions of businesses and to consider them from the ethical point of view.

龔鵬程教授：如今有許多關(guān)于言論自由的爭(zhēng)論，主要是關(guān)于社交媒體和互聯(lián)網(wǎng)。有些人認(rèn)為言論應(yīng)該是不受限制的自由，因?yàn)椴磺宄钦l(shuí)才應(yīng)該擁有言論權(quán)威；而另一些人則認(rèn)為這樣可能會(huì)很危險(xiǎn)。例如，人們可能會(huì)故意向人們提供有關(guān)氣候變化等生存威脅的錯(cuò)誤信息。您對(duì)言論自由及其潛在的局限性有什么看法？

羅杰·克里斯普教授：是否可以擁有完全的言論自由權(quán)，與誰(shuí)應(yīng)該有權(quán)限制言論自由是不同的問(wèn)題。可能我沒(méi)有道德權(quán)利說(shuō)出某個(gè)命題 P，但沒(méi)有人有權(quán)阻止我說(shuō)出它。

任何人在道德上，都被允許在任何時(shí)候說(shuō)任何話，即使這似乎是非常難以置信的。 以?shī)W利弗·溫德?tīng)枴せ裟匪梗∣liver Wendell Holmes）的判斷得出的經(jīng)典案例為例：一個(gè)人不應(yīng)該在擁擠的劇院里大喊“著火了！”。與商業(yè)道德的情況一樣，我們可以根據(jù)言論本身的優(yōu)點(diǎn)來(lái)考量言論，以及建議使用哪些原則來(lái)管理言論。

在這里，我們可以向約翰·斯圖爾特·穆勒學(xué)習(xí)。根據(jù)他的說(shuō)法，如果不能帶來(lái)具有最高總體幸福感的事態(tài)，任何言語(yǔ)、行為都是錯(cuò)誤的（相反，我們可能認(rèn)為幸福感不應(yīng)該被最大化，而是以某些非最大化的方式來(lái)分配）。

然而，我們?nèi)祟悩O易犯錯(cuò)，因此我們需要次要原則來(lái)規(guī)定我們自己和他人的言語(yǔ)行為。用穆勒的一個(gè)例子，沒(méi)人能阻止我在報(bào)紙上發(fā)表一封說(shuō)玉米經(jīng)銷商正在讓窮人挨餓的信，但是當(dāng)著一群聚集在玉米經(jīng)銷商家附近的憤怒的暴徒面前大喊大叫，又是另一回事。

或許可以理解的是，穆勒對(duì)于有權(quán)了解人類公正地接受信息、考慮信息、然后進(jìn)行平衡與判斷的能力，比我們更為樂(lè)觀。

我們現(xiàn)在更好地理解了我們所有人其實(shí)都容易受到的各種思維偏見(jiàn)和錯(cuò)誤的影響。例如，當(dāng)沒(méi)有可靠的欺詐證據(jù)時(shí)，數(shù)以百萬(wàn)計(jì)的美國(guó)公民繼續(xù)相信2020 年的選舉是由唐納德·特朗普贏得的。只有當(dāng)公民根據(jù)證據(jù)形成自己的信仰時(shí)，民主才能很好地發(fā)揮作用，而且如果要生存下去，我們必須教育年輕人了解人類的非理性以及那些試圖將其用于破壞顛覆這一目的的人。

Whether there is a right to complete freedom of speech is a different question from that of who should have authority to limit speech.It may be that I have no moral right to utter some proposition P, while no one has the right to prevent my so uttering it.

It seems highly implausible that anyone is morally permitted to say anything, at any time. Consider for example the classic case derived from a judgement of Oliver Wendell Holmes: one should not shout ‘Fire!’ in a crowded theatre. As in the case of business ethics, we can consider the utterance on its own merits, and also which principles it would be advisable to use to govern speech.

Here we can learn from John Stuart Mill, according to whom any speech act is wrong – like any act – if it does not produce the state of affairs with the greatest overall level of well-being (we might believe instead that well-being should not be maximized, but distributed in certain non-maximizing ways). We humans are highly fallible, however, so we need secondary principles to make decisions about our own speech acts, as well as those of others. To use one of Mill’s examples, I should not be prevented from publishing a letter in a newspaper arguing that corn-dealers are starving the poor; but shouting this in the presence of an angry mob that has gathered by a corn dealer’s house is a different matter. Mill was, understandably perhaps, more optimistic than we are entitled to be about the capacities of human beings to take in information impartially, consider it, and then form a well-balanced judgement. We now understand better the various biases and errors in thinking to which all of us are susceptible. Millions of US citizens, for example, continue to believe that the 2020 election was won by Donald Trump, when there is no reliable evidence of fraud. Democracy can function well only when citizens form their beliefs in the light of the evidence, and it may be that if it is to survive then we must educate young people about human irrationality and those who attempt to use it for subversive purposes.

龔鵬程，1956年生于臺(tái)北，臺(tái)灣師范大學(xué)博士，當(dāng)代著名學(xué)者和思想家。著作已出版一百五十多本。

辦有大學(xué)、出版社、雜志社、書(shū)院等，并規(guī)劃城市建設(shè)、主題園區(qū)等多處。講學(xué)于世界各地。并在北京、上海、杭州、臺(tái)北、巴黎、日本、澳門(mén)等地舉辦過(guò)書(shū)法展?，F(xiàn)為中國(guó)孔子博物館名譽(yù)館長(zhǎng)、美國(guó)龔鵬程基金會(huì)主席。