AIAND PHILOSOPHY

HOUSE AND PHILOSOPHY

P50

Further, we cannot simply choose what we are going to take responsibility for and what we are not. Just as we expect the faultless driver to feel some sort of regret for killing a child. Walker suggests that  “responsibilities outrun control.” The larger context of our lives requires us take to responsibility for many events and outcomes that we would not have chosen. This is a part of what it is to be human, and the reason that we praise those whose grace and integrity allow them to deal with events and outcomes well. If this is true, then moral luck does not undermine human moral agency, but rather offers it more opportunities in which to practice different virtues.

Certainly House would be the wrong show from which to expect too much moral purity. A consideration of the problems involved in moral luck shows us that maybe we should not even try. Rather than thinking that moral responsibility means having control over all of our actions and their consequences, we should recognize the large degree to which actions and consequences are beyond our control. House teaches us that in the midst of this uncertainty, we must have the confidence to act when not to act is almost certainly fatal. We must do the best we can, and be realistically prepared to accept, and take responsibility for , dire consequences.

這一段論證了道德的重要性。我們不可能控製事物的發生，但當災難性的事件發生時，負罪感與責任感是我們最基本的人性。隻有這樣，我們才能在麵對災難性事件的不確定性發生時，有信心從現實出發做出決定，並做出行動。這是人性的基本必要條件，也是做為一個有道德思想的人必有的情操。也就是所謂的“道德的造化”，其暗示了正是因為道德感的存在，影響了事物往正麵的方向發展。

         掠奪是動物的天性，是在大自然裏物競天擇，適者生存這一規律下體現的生物的本能。但在人類社會裏，野蠻也許在初期建立社會時體現它的價值，在社會發展期與持續期，這種價值將淪落為一把砍向自己，也砍向別人的刀；這時候，文明以一種迫切的姿態展現，對於統治階層，它體現於法律秩序的建立、人文文化的持續與繼承等等。換句話說，就是什麽是公德？個人理解，公德應該是適用於各種階層、各種年齡、各種膚色與種族的人們的道德體係。而對於個體，什麽是私德？個人在社會中生存下去的，一種在生存背景與社會發展下自發的道德覺醒，或者說自覺遵守社會準則，並自發維護社會秩序，自願服務於社會體係，並體現個人在社會中的價值。

        人無完人，掠奪是人類最原始的本性，也可以說是欲望的一種，而道德正是約束人類欲望無限發展與膨脹失控的最佳方式，它需要統治階層與社會基礎的共同努力與維係。由此依法治國，建立一個共同的法律體係是根本。而道德在個體發展中，也是至關重要的。

P158

In 1973, at the age of twenty-five, Dax suffered severe burns over much of his body as a result of a propane gas explosion. In spite of his persistent and repeated protests and a psychiatrist‘s finding that he was competent, Dax was forced to undergo extremely painful burn treatments. He survived, but he was blind and badly scarred, he lost the use of his arms, and his fingers had to be amputated. Ultimately, Dax was satisfied with his quality of life. However, he remained angry that his wishes were not respected, and he became an advocate for patient rights, in particular the right to refuse medical treatment.

 

暫記如此。

想起童年那個高中班上的被燒傷的姐姐，因為點著蠟燭在蚊帳中看書，弟弟被燒死了，而她成為幸存者。一九八幾年的中國，沿海地區還比較保守，即使是夏天，她也會將自己捂得嚴嚴實實，隻是臉與頭是無法遮掩的，因為我們要呼吸空氣。她的大半個頭皮，祼露著，長不出頭發，半邊臉上布滿了深紅色的疤，一隻眼睛被疤痕牽扯著，會現出幾分猙獰，嘴角也有一處被疤痕拉扯著，她的整個麵孔讓人感覺害怕。這個姐姐很少笑，至令也想不起她的名字，隻知道她以麵孔醜陋而在校聞名，不懂事的一些學生會說：“不要去看她，晚上會做惡夢的。“

外人看到她尚有不適之處，而做為她本人，有誰能理解她以多大的毅力在活？十多年以後，阿康釣魚時，被高壓電打了，他也成了幸存者。他在當地的以治燒傷聞名的醫院治療電擊傷時，他為自己能成為有手有腳，而沒有造成任何嚴重性傷殘感到慶幸。在中國，有多少個高壓電線杆下有醒目標識？又有多少個高壓杆矗立在民居與農田四周，而沒有設製一定的安全距離?又有多少個中國人能知道或被教育知道高壓有害，遠離高壓？而不是為盜取那些銅線去換取買麵包的錢？而又有哪條法律製定了在此方麵，政府應承擔的責任與賠償？

一場災禍的發生，不僅僅是私德的問題，也是公德的問題!!!

從另一方麵也反映了，作為工程師或設計師，如果身懷責任感，而不是追求短暫的經濟利益，那麽對一個城市的規劃，比如下水道的設計，交通樞紐的設計等等，應該是跨時代的整體布局，而不僅僅是眼前的利益。

一些統治者高高在上，掠奪著民生，卻忘了在塔尖上的人隻占著世界人口的百分之一或千萬分之一，而建立金字塔的人占著另外的百分之九十九。沒有了塔底，哪來的塔尖？

而社會的蛀蟲們的生存，本是社會製度給了他們生存的土壤，與他人無關。怎麽可能為了一隻蛀蟲而禍害他人？玩起了封建社會，株連九族的連帶責任。每個人都以個體存於社會，相互依附。公德的建立，正是王了犯法，與民同罪。所以法律麵前，人人都是平等的，這也真正體現了社會的公德與價值。

P72

The Principle of Sufficient Reason (PSR)

P158

治與被治（生命的質量與生命的長度，哪個更重要？）

Why, it might be asked, is Dax angry and resentful? After all, he admits that he is enjoying life, and but for the medical paternalism of his doctors, he would be dead. In a documentary about him entitled Dax’s case, he offers two reasons. First, he believes that the means (the excruciating pain and extreme suffering associated with the burn treatments that he endured for months) did not justify the end (preventing his death). Accordingly, Dax says that even if he knew the outcome would refuse treatment. Second, he says he values freedom and the ability to choose for himself. Accordingly, he is angry that others (his mother and physicians) decided for him.

Dax’s first reason helps to expose a fallacy in the notion that a brilliant clinician such as House knows what is best for patients. Due to their medical training and expertise, physicians may know best how to keep their patients alive. However, keeping a patient alive will not necessarily promote the patient’s good or best interests. When there are treatment options (non-treatment is always one option), determining which is best for a particular patient (evaluating the potential benefits and harms) depends on that patient’s distinctive preferences and values. As a popular saying puts it, “Different strokes for different folks.” (人上一百，形形色色。)For Dax, but not necessarily for all patients in a similar situation, avoiding the pain and suffering associated with burn treatments was more important than preventing death. Accordingly, even though the outcome in his case was good, it cannot be said that treating him against his wishes promoted his best interests better than forgoing treatment would have.

Dax’s case also challenges the recurrent notion in the series that medical paternalism is justified because House and his team provide patients what they need. What do patients need? House’s answer is health and longevity. But, as Dax illustrates, patients can have various goals and values other than health or longevity. Dax valued freedom and the absence of pain, and he assigned higher priority to both than to health and longevity. As House himself illustrates in “Three Stories,” patients can value bodily integrity more than life, as shown by the fact that they are willing to bear an increased risk of death in order to keep a limb or breast or in order to reduce the risk of incontinence, sterility, or impotence. …… Clearly, then, although patients may need certain medical interventions to stay alive, it does not follow that they need those interventions to promote their good (the goals that matter most to them).

後麵故事太長，暫以達克斯案為例。

簡    譯：

達克斯對自己不能選擇治療的方案是憤怒和憎恨的。雖然母親與醫生對他的治療做了決定與計劃，但達克斯本人卻在治療的過程中忍受著巨大的痛苦與心理的創傷，這種痛苦不僅是肉體上的，還有精神與心靈的深層次的，並不被外人所能理解與看到，比如大小便失禁、生育能力的喪失或者性能力的喪失等等。就像在古時候，“淩遲”對於生命的痛苦遠遠大於“哢嚓一聲的砍頭”。醫生嚐試的各種各樣的對病人的醫療手段，從某種意義上來說，也是一種“淩遲”，隻是目標不一樣而已。

作為醫生，豪斯認為醫生的職責是救死扶傷，盡量讓病人健康與長壽是醫生應該去做的。而對於達克斯，麵對著每次治療方案的不同，需要忍受的肉體與精神的雙重痛苦，並且是長期的，這不是他所感興趣的。他更注重於他的自由選擇的權力與做一些他心裏真正想做的事，這些東西優先於他的“健康與長壽”，說白了，讓生活真正的快樂起來，做自己喜歡的事並能做自己喜歡的事，才是他內心裏真正的選擇。即使醫療技術可以不斷的改進，但並不意味著醫生們的選擇與建議真正有助於他的生活質量的提高，治療方案也許會因人而異，產生差別，最終的結果有可能出乎於所有人的期望與目標。其實對於一些讓肉體產生具大傷痛與傷害的疾病，“不治療”也是一種選擇。一些病人更願意自己的生命具有質量，而不是“苟活下去”的生命的長度。

如何考慮病人內在的需求？如何對決定對病人進行最好的治療手段？這是一把雙刃劍，它考量著社會的倫理與道德。東西方都有這種觀念的衝突，什麽是社會價值與個人價值？如何尊重與體現？這是個有趣的論題。西方更注重於個人的自由與價值，而中國人認為身體受之於父母，好死不如賴活著，這是為什麽有些晚期癌症病人或長期癱瘓的病人拖垮了一家人，像是因為一個病人，全家都生病了，全家都失去了生活的質量與樂趣、人生目標。如何讓病人理解自己真實的病況？醫生如何根據病人的真實情況，給予其必要的治療手段，這也是對良心的一種考量。畢竟在生命的麵前，大家都是平等的。

科學是有禁區的。

愛因斯坦在回答日本中小學生提問科學家是否對原子彈的毀滅性災難負有責任時是否定 的，認為那隻是政治家的事。但愛因斯坦去世前幾個朋在回複一位朋友的信中卻承認，科學家應當對原子弱這樣的大殺傷性武器負有責任。科學家在任何研究之前都要考慮其研究成果到底是給人類帶來災難還是幸福。

思考：愛因斯坦在晚年皈依了宗教，思其原因有二種可能，一是對原子彈造成的殺傷性災難的罪贖；二是對自己的科學試驗結果的災難性的預見不足的反悔性思考。

由此引起另一個問題：政治家是否要為戰爭負責？如何做出決策，才能成為有遠見而英明的政治家？

歸根到底，科學與政治都應遵循的四條原則：行善，自主，不傷害，公正。

更簡單的一句話就是：以人為本。

人工林與原生林的區別：

原生林具有自然瀋化，自我更新的能力，具備適合地貌與氣候的生態係統，對正常的自然災害有自適應和恢複能力，還有在自然進化的過程中產生的寶貴的動植物基因庫。

人工林，沒有一個由喬、灌、草、藤兼備的植物體係，維護與對抗天災需要耗費大量的人工與經濟成本。（2003年6月4日《中國經濟時報》）

人工智能與人腦的區別：
最顯著的區別：情感的不同

人工智能，是按照設計者的思路與思維進行創造與設計，而設計者本身逃脫不了對事物認知的有限與社會大背景的局限性。最大的優點：貯存量巨大，速度快。

人腦，最大的優點具有情感思維，在處理問題時，會根據當時的處境對事物進行靈活性處理。依外在與內在的環境不同，而、做出處理意見。

 

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