明愛醫院合乎指引不近人情

【明報專訊】一個病人在明愛醫院門外心臟病發，就是因為只差幾步，沒有踏進醫院門內，結果醫院員工覑病人家屬致電999求救，病人在26分鐘後才送到急症室，最終不治。院方說員工是按指辦事，但這情猶如有人在警署門外遇劫，但警員卻覑你打999同樣荒謬。這個「引」的做法，實在太不合常理、不近人情，不能接受。

病人上周六下午2時43分到達明愛醫院門外的馬路，不支昏倒，病人兒子的朋友跑進醫院大堂，向詢問處一個文員求助。文員沒有通知急症室，反覑求助人打 999，其間醫院一個外科醫生經過，立即上前急救，並致電醫院急症室，但急症室沒有派人前來救助。病人在2時43分到醫院門外，幾經輾轉，2時53分消防急救人員到場，3時09分病人才被送到近在咫尺的急症室，足足花了26分鐘！

院方昨日解釋說，詢問處文員的做法沒有違反指引，在醫院門外有病人求助，應該覑他們致電999，因為派出急症室醫生到場要一段時間，現場亦與急症室有距離，致電999後救護人員可盡快到場。院方如此解釋實在難以令人接受。

醫院門外有人昏倒，醫院員工應如何做，實在不需要指引，當日途經現場協助救援的外科醫生韋樂申就做了最好的示範。

若根據指引，韋醫生根本毋須拔刀相助，一走了之也沒有人會怪他，但事實是韋醫生不單立即主動替病人施行體外心臟按摩，還致電急症室求助。醫護人員應盡之責，在韋醫生身上清楚看到——根據現場情，即使指引沒有規定要做的，也應立即施援。

要處理這次事件，按照常理，醫院員工應該立即聯絡急症室，看看可否派人來，又或是在醫院內找一張輪椅或擔架脇，送病人到急症室。據本報記者了解，從事發現場走到急症室，最多只是數分鐘路程，絕對不需要26分鐘，院方當日只要稍為變通，情已大大不同。

院方表示，日後要檢討若有病人在醫院附近求救，急症室應如何處理，這只是治標不治本之法，若以後指引說在醫院100米範圍內急症室要派人協助，那麼，病人在 101米外出事又如何？院方承認，這次若病人是在醫院範圍內昏倒，情會不同，原來是短短幾步之距令人陰陽相隔。除了「僵化」、「只按規則辦事」、「冷血」之外，實在難以找到其他詞彙來形容院方的思維。

制度是死的，人是活的，在制度之外靈活變通，盡力救活一條生命，這是作為一個人應盡的責任。這次事件，公眾實在看不到明愛醫院是盡了這個責任。

Review of Mark Leonard on Why Europe Will Run the 21st. Century

This book, published by Fourth Estate in 2005, is focused on the regionalizing aspect of ‘global influence’ and argues for the continued rise of European economic power and political influence and the relative decline of that of the United States. What is its thesis? How ought we to evaluate Leonard’s arguments?

The conventional view, according to Leonard, is that American power will hold good for another fifty years and then Asia will predominate, with India, and more especially China being the engines of world trade and the new superpowers. Leonard’s thesis is that American power has already shown serious signs of slipping. Its arsenal is huge; its willingness to threaten and to bully is based on this ‘hard power’ but its faith in the exercise of such power is over-confident, even misplaced. Branding states as rogue states and threatening them with military action is counter-productive. Such threats merely encourage them, as in the case of North Korea, in the very behavior that the United States is wishing to prevent. The more that the United States in its ‘war on terror’ attempts to exercise its military option, the more its ‘soft power’ (influence; diplomacy) is eroded. Indeed, the limits of American power are perfectly illustrated by the debacle in Iraq and by the fact that authoritative regimes in the Middle East have been reinforced rather than encouraged to change.

The power of the world’s most successful economic union, the EU, is of a different kind, according to Leonard. Whereas American power is ‘shallow and narrow’, that of the EU is ‘broad and deep’: ‘once sucked into its sphere of influence, countries are changed for ever’. Where America sees only ‘potential enemies’, Europe prefers to see ‘potential friends’. Leonard argues that it is the lack of a significant military option that has encouraged Europe to think of new ways of engaging the wider world. European power as experienced by and through the European Union is ‘transformative power’ accomplishing though negotiation and trade, democratic change in historically undemocratic nations. By operating through the existing ‘shell of political structures’ Europe has achieved a relatively silent political revolution within itself. The structures within the initial members remain the same but the key political process is that of a continuous engagement with other states within the European Union, a kind of ‘Network Europe’ (similar in function to the network that supports ‘Visa’). New states wishing to join participate in the process long before admission and are transformed as a result. Poland and Turkey and changes made in these countries are cited as part of the evidence for the existence of this ‘transformative power’. Key ideas are related to the development of European law: stable democratic institutions; the rule of law; human rights and a market economy. These changes are undertaken voluntary as a result of negotiation and diplomacy, whereas the changes in Iraq (such as they are) are imposed by force. At the same time, international companies are also regulated through changes in EU law, giving Europe a role in setting global regulatory standards. The model for further global developments, according to Leonard, is not that of the United States but rather regional groupings associated with Europe and constructed in similar ways.

China is on the rise and is starting to look at its own regional spheres of influence, aware of its need for sources of raw materials to further its industrial development. India is growing rapidly. The world cannot simply be run, Leonard argues, with out-of-date international institutions. The EU provides an effective model for increased regionalization. This has influenced the development of the North American Free Trade Association (NAFTA) between Canada, the United States and Mexico. This is not, however, a politically popular agreement, as far as I can judge, and has little scope for further development. Demands for protectionism are likely to be on the rise in the United States, especially given the recent changes in the composition of the Congress. Newly elected Democrats are not necessarily trade friendly. Leonard sees a ‘post-America world’ to which America can chose to adapt by becoming more interested in international law and institutions, world opinion and the soft power options of negotiations and alliances or to which it can turn its back. Leonard sees the European way as becoming by adoption, and adaptation, the world way, with or without the United States.

This book paints with a large brush and on a very large canvas so it does not give as much attention to China as may be required or to any backsliding in EU members or potential members who were once in the Soviet bloc. It does not pay much attention to the reform process within Europe (agricultural policy; export subsidies; the drive for increased competitiveness though it is true that this process is underway) nor does it give enough attention to the confusion in Russia and the growing leverage Russia has over trade in gas and oil with respect to Western Europe and elsewhere. Nor does it look at cooperation and competition in Central Asia between Russia, China, the United States and Europe. A significant theme is on trade and on the next stages of globalization i.e. on the rise of regionalism leading, in Leonard’s view, to a world of regional units modeled, more or less, on the EU. Such a world looks more and more like a possible world, in my view, especially given the collapse of the Doha Round. These are no doubt weaknesses in the coverage. However, the strength of the book is found in contrasting the steady progress of EU ‘transformative power’ with the problems in the recent policy of the United States, including the erosion of both ‘hard’ and ‘soft power’ by the demands of the ‘war on terror’ as recently constructed. Leonard may overplay his hand but the book is an interesting read even if it is short on detail.

Posted by William Henderson on November 21, 2006

沈睿：《中国怎样想？》：中国改革思想的地形图

英国学者马克·里奥纳德的《中国怎样想？》是一本非常新的书。这种新，不仅仅是本书出版于今年――二月在英国，四月在美国，十一月在台湾翻译出版，而是因为内容新。这本书跟踪描述和详细讨论的是中国目前活跃的经济学家、思想家们的主要思想，这些有影响的中国知识分子直到2006-7年在做什么和想什么；以及他们的所做所想又怎样影响了中国政府的各种政策，影响了中国发展方向。 ( http://www.tecn.cn )
本书描述中国改革三十年来，特别是近十五年来中国改革过程中思想轨迹。全书共有五章。前言题为《思想解放》，讨论中国知识分子在中国社会和改革中的作用。这个题目不仅隐喻中国八十年代的思想解放，也隐喻崔之元于1993年的文章中提出的从对西方资本主义的无条件的羡慕的解放。结论为《中国围墙内的世界》，讨论中国未来的影响。其他三章分别题为《黄河资本主义》讨论中国的经济改革思想和变化；《云雾中的民主》讨论中国的政治改革试验；以及《综合国力》讨论中国军事和外交思想。从以上各个方面，这本书试图描绘中国的思想地形图，并为这个地形图标注了主要界标。这些主要界标就是中国思想舞台上有政治影响力的人物诸如张维迎、崔之元、甘阳、汪辉、王绍光、王小东、杨毅、郎闲评、潘维，潘岳、俞可平、郑必坚、阎学通等等。这些“新右”或“新左”、保守主义或自由主义的思想对中国政府实施的各种各样政策有深浅不同的影响，左右着中国进步的方向。 ( http://www.tecn.cn )
写作这本书的出发点，据里奥纳德说是首先是他个人与中国知识分子接触的经验。他第一次来到中国，来到中国社科院，才意识到中国有这么多知识分子，他们给改革出谋划策，他们自己对改革中的每一个问题，每一个步骤进行争论和争辩。他认为中国的知识分子，因为中国的特殊政治制度，其在社会的作用比西方一般意义的知识分子作用大得多。中国的知识分子是中国社会改变、经济改革发展的顾问和谋士。个人的经验使他意识到，西方看到中国的经济发展，但是对促成中国经济改革、社会变革的思想一无所知，对中国思想界和主要思想一无所知。西方往往从自己的角度看待中国，或是争论中国会不会走向民主，或是把中国还是看出一党专制的权威主义或极权主义国家，以为中国根本没有真正的知识分子等等。中国思想界在想什么？在辩论什么？在做什么？里奥纳德相信，不知道这些问题的答案，人们根本无法真正理解当代中国，也无法理解中国在世界上的作用。他说，中国不仅是一个日益崛起的经济超级大国，也日益成为一个政治超级大国。事实是，中国还应该被看成是一个思想超级大国，“在中国发展出来的很多设想将会对世界其他地方产生影响。”在本书的开篇，他说: “中国，已经加入美国和欧洲成为塑造世界秩序的一员”。 ( http://www.tecn.cn )
里奥纳德认为中国改革开放的最初十年是新右派思想占主导。新右知识分子提倡市场经济，认为中国必须一步步市场化；主张解体国家企业，反对计划经济；提倡“小政府”，认为政府应当缩权。这些主张在很大意义上都被中国政府采纳，所以经济改革进行得相当迅猛。但是，与此同时，另一派知识分子“新左派”也提出反对意见。他们的思想建立在中国的经济发展现有成效之上，认为要正视收入不均造成的贫富差距等问题。自2002年以来，中国政府的很多政策都向新左理论靠拢，强调关注老百姓，建设和谐社会等等。从新右与新左两个学派出发，里奥纳德试图描绘分析中国经济发展的道路和全球化过程中“中国模式”形成的过程。中国的经济改革，他详细分析了珠江资本主义（深圳）和黄河资本主义（南街）的两种模式和思想，探讨这两种模式的意义。中国的政治改体，他介绍分析了中国的村庄选举制度，平昌和重庆的民主管理试验，以及某些知识分子对法制的提倡和对选举的怀疑。他探讨中国的“渐进、从下到上的民主、党内民主、商议民主”各种模式，认为中国的一党政权已经发展出越来越成熟有效的技巧，在某种程度上听取民意，适应民心，实现民愿，以延续其生存，证明其合法化，防止民众不满情绪的滋生扩大。中国政府在保持一党制的原则上推进经济改革发展，在体制民主改革上做各种试验，试图找到自己的与民众沟通的道路。这种方向发展下去，“中国模式”会对世界其他非西方民主国家有怎样的意义？ ( http://www.tecn.cn )
本书对中国经济改革思想和政治改革试验和思想的描述，给对中国所知不多的人提供了一副相当清晰的“中国在想什么”的图画，给研究当代中国的学者和学生既提供了一副比较全面理解中国的景图，也突出介绍了参与中国政策决定的知识分子。里奥纳德非常注重从中国的角度理解中国，从中国的视野看世界。这对西方了解中国来说是非常重要的。西方的媒体比较容易关注中国持不同证见者的意见，但是对参与中国经济改革和社会变革的知识分子往往持有偏见，以为这些人就是为中国政府服务的，忽视这些人在中国变革中的作用。这本书没有站在西方喜欢站的道德高人一等的立场看中国知识分子，而是努力了解这些探索中的思想者，他们的观点和试验，他们的立场和对未来的设想，叙述得相当清楚。这本书为中国改革思想勾画了一副精确的地形图。 ( http://www.tecn.cn )
本书既没有暗示中国威胁论也没有提倡与中国的对抗，相反，本书强调在现行状态下与中国的合作。作者认为世界必须从中国的角度理解中国，认知中国在世界舞台的经济、政治和思想的地位。作者还提出要高度重视在全球化的过程中“中国模式”的意义，指出“中国模式”已经在世界产生影响，并将产生越来越大的影响。通过对中国知识分子思想的描述，作者质疑西方所相信的西方的民主和经济发展方式在中国的可能性。强调中国特色，作者相信二十一世纪中期将是三足鼎立的状态：中国、美国和欧洲将塑造一个新的世界。中国的思想者们在为此铺平道路。理解这些思想者和参与决策的人，将是理解中国未来的钥匙。 ( http://www.tecn.cn )
这本书关注的是对中国的现行政策能出谋划策的人的主要观点和思想，因此重点是经济、政治、军事和外交，对中国社会和文化方面的思想变革和讨论讨论得非常不够。其实一个国家的经济结构是最容易变革的，政治体制变革也不那么难。中国在1911年一夜之间就推翻了两千年的帝制，建立了共和。中国这三十年从铁板一块的计划经济走向资本主义，三十年不过是历史的一瞬。但是，中国社会的进步、民主的真正实现和取得，恐怕还是要在中国文化上有根本的变革。中国的文化变革在近三十年来是怎样发展的？中国思想者怎样考虑中国的文化身份的？也许是因为本书写作的目的是为西方战略研究提供资源，中国文化的变革不是重要的议题。因此本书没有对此着墨，虽说是一个遗憾，也是可以理解的。 ( http://www.tecn.cn )
马克·里奥纳德本人是一个长期战略研究思想库的执行主任。这个思想库的名字是“外交关系欧洲协会”(The European Council on Foreign Relations)，主要研究国际关系长期战略和近期政策等等。里奥纳德的第一本研究著作是关于欧洲的：《《欧洲为什么将主导二十一世纪？》（Why Europe Will Run the 21st Century?）。《中国怎样想？》是他的第二本书。 ( http://www.tecn.cn )

这是马克·里奥纳德的网址：http://markleonard.net, 里面有他的很多文章，可供参考。
What Does China Think？ Mark Leonard. Fourth Estate Ltd， 2008

12/8/2008

Why Europe Won't Be Running the 21st Century

February 26, 2007

For a number of years now the European think tank world has been busy churning out report after report with ever more grandiose proposals for turning the European Union into a global superpower.

One of the more provocative essays in this genre is titled ‘Why Europe Will Run the 21st Century', which was written by Mark Leonard of the London-based Centre for European Reform. Leonard's thesis is that Europe will dominate this century because it is based on a new understanding of power, which is embodied in the institutions and norms of the European Union. He argues that the economic, political and social models of the European Union are irresistibly attractive to the countries around it, and as they adopt the European economic and legal framework, they are transformed from the inside out. By contrast, Leonard asserts, even though the United States might be able to use its military power to change regimes, it cannot change societies, and thus it is weak when compared to the ‘transformative' power of the European Union. This is why Europe will dominate the 21st century, or so Leonard would have us believe.

But is Europe really destined to become a global superpower? A growing body of research says no. Indeed, overwhelming evidence supports the view that contemporary Europe is beset by a mix of problems that is so complex, that apart from dramatic changes in public policy, Europe is headed toward certain decline, not ascendancy.

Demographic Collapse?

Although European elites imagine that their political and social models are so obviously attractive that they will be adopted by the rest of the world, ordinary Europeans don't seem to think so. In fact, demographic trends suggest that most Europeans don't even believe in the European ideal in sufficient numbers to want to pass it on to the next generation.

According to the European Commission, the average birth rate for the European Union as a whole is now 1.4 children per woman, which is well below the 2.1 replacement rate. By way of example, the country with lowest fertility rate in the world is Spain, where women have an average of only 1.07 children.

As a result, deaths will start out-numbering births in every member state of the European Union by as early as 2010. But some countries have already reached that point. According to Germany's Federal Statistics Office, more people died in that country in 2005 than were born. And Germany's demographic decline is the norm, not the exception in Europe. Indeed, Europe's population is forecast to decrease by more than 100 million by 2050.

But not only are Europeans declining in number, they are aging as well. According to the US Census Bureau, Europe in 2000 had the highest percentage of people aged 65 and older, and this figure is set to double by 2050.

Economic Uncertainty

Why should Europeans be worried about declining birth rates and aging populations? Economic stability is one reason. A shrinking workforce will find it increasingly difficult to pay for the rising costs of ever more retirees. Indeed, economists predict that European budget deficits will balloon as governments strain to reconcile declining tax bases with millions of elderly people who force up spending on pensions and health care.

But that's not all. German business leaders, for example, are already worried that the population decline with hurt their country's competitiveness. German demographers predict that by 2030, their country will have 7 million fewer people of working age than today, but 8.5 million more people of retirement age. So although today there are two workers supporting each retiree, within one generation the ratio will be one-to-one. Many economists say this will spell the end of the European social welfare state as we know it. And because Germany is Europe's largest economy, it serves as the benchmark for Europe as a whole.

Political Instability

As European countries edge closer to a pension crisis, political stability is another reason why Europeans should be concerned. Germany, for example, was brought to a standstill more than once by citizens protesting the Harz IV reform package. The aim of those reforms was to reduce payouts to unemployed people and to make it more difficult for them to refuse job offers. Although the government held firm, it was also voted out of office. In any case, two years later there is still no sign that the reforms have made Germany's stagnant economy any more competitive.

Economic frustrations among French and Dutch voters also contributed to their rejecting the European Constitution. Indeed, European citizens seem unwilling to sacrifice their social security benefits on the altar of further European integration. Der Spiegel, the leftwing German news magazine, recently ran a story in which it observed:

"Europe has become a continent of political crises with governments in Italy, France, Britain and Poland all suffering from paralysis or a lack of voter approval. Is the continent about to abandon its integration project and return to the old era of national rivalry?"

Geo-Political Decline

Europe's demographic situation is in stark contrast to that of the United States, where the population officially passed the 300 million mark in October 2006. The United States is now the third most populous country in the world, behind China and India. Moreover, the United States is growing faster than any other industrialized nation... in fact, it is virtually the only developed country expected to grow this century. All analysts agree that America's demographic dynamism will have major geo-political implications, especially for Europe.

Some Europeans are beginning to acknowledge this reality. The Paris-based EU Institute for Security Studies predicts that by 2025, Europe will represent only six percent of the world's population and that its relative share of global wealth and trade will have shrunk. It says that

‘the ongoing debate on the future of Europe suffers from a lack of perspective on the global developments that are changing the context of European integration itself...the risk is that the Union and its Member States will be increasingly subject to, rather than agents of, change.'

The False Promise of Immigration

How did the United States, which turned 230 years old in July 2006, get so big so fast? American growth has been fuelled by a combination of economic stability, high birth rates and immigration. Indeed, the United States is the largest immigrant-receiving country in the world. Some 50 percent of the 100 million newest Americans are recent immigrants or their descendents.

Europe, however, is also a magnet for immigration: It will attract up to 1 million newcomers this year. But the European experience with immigration is quite different from that of America. Part of the reason is that many immigrants to Europe end up on welfare, while in the United States, almost all immigrants take one or more entry-level jobs and work their way up the economic ladder. Welfare is simply not the American way.

Islamic Conquest of Europe?

Moreover, most immigrants to the United States are fully integrated into American society by the second generation, regardless of their country of origin. By contrast, most immigrants to Europe are Muslims who refuse to assimilate and instead tend to cluster in marginalized ghettos on the outskirts of cities across the continent.

Here, too, the American experience is quite different. The best available estimates show that there are between 1.9 million and 2.8 million Muslims in the United States. And unlike their European counterparts, American Muslims generally do not feel marginalized or isolated from political participation. According to a 2004 Zogby Poll, American Muslims are more educated and affluent than the national average, with 59 percent of them holding at least an undergraduate college degree. Moreover, the majority of American Muslims are employed in professional fields, with one in three having an income over $75,000 a year.

But back to Europe: The Muslim population of Europe has more than doubled since 1980, and according to some estimates, there are some 25 million Muslims living on the continent today. Demographers predict that this figure may double by 2015, and that the number of Muslims could outnumber non-Muslims in all of Western Europe by mid-century. This prompted Princeton University's Bernard Lewis to tell the German newspaper Die Welt that ‘Europe will be Islamic by the end of the century.'

This reality is already influencing European foreign policymaking and does not auger well for the future of transatlantic relations. Indeed, many analysts believe that the steady weakening of Europe is the underlying cause for the widespread anti-American and anti-Israel bigotry found among Europe's elites, many of whom are bowing to pressure from Muslim residents as a way to buy a fake peace with radical Islamists. Says Fouad Ajami, a well-known authority of the Arab world: ‘In ways both intended and subliminal, the escape into anti-Americanism is an attempt at false bonding with the peoples of Islam.'

A European Crisis of Spirit

Some analysts believe that what ails Europe is not primarily a crisis of demography, but rather a crisis of spirit. Michael Novak of the Washington-based American Enterprise Institute (AEI) says that in their blind pursuit of reason, secularism and materialism,

"European elites have done their withering best to empty Europe of its Christian spirit. They have swept Europe clean just in time for the rapid rise of a rival faith [Islam] prolific with children, vitality, passion and confidence in long-term victory."

But by removing Judaism and Christianity from European cultural, intellectual and public life, secular Europeans are largely responsible for the lack of confidence ordinary Europeans have in the future. Indeed, the lack of faith not only in tomorrow-but also in God-begets hopelessness. And without hope for the future, one is less likely to want to bring children into the world.

Will Europe Become More Like America?

Most economists agree that demographic decline goes hand in hand with economic decline, and that economic decline, by definition, leads to a loss of influence on the global stage. Although European elites dream about a day when Europe will act as a counterbalance to the United States, the facts imply that Europe's future will be considerably more modest.

There are solutions to almost every problem facing Europe today. But ironically, those solutions imply that Europe must become more (not less) like the United States in its political, economic and social models.

That is to say, as long as European elites insist on building a Europe whose main purpose is to check American power, Europeans are certain to lose over the long run. But if they can bring their ambitions more into line with reality, both Europeans and Americans are set to win.

Soeren Kern is Senior Analyst for Transatlantic Relations at the Madrid-based Grupo de Estudios Estratégicos / Strategic Studies Group.