近代以医疗服务换取金钱的市场交易方式与以“利他”为核心特征的医业职业伦理构成了紧张关系，调适这对矛盾成为职业化的关键环节之一。本文利用民国时期的诊金论述，以关系运作为理论视角，剖析了医生群体为建构医疗服务市场的道德基础所做的道德与文化工作。他们明确了诊金的伦理基础，细致区分了医业与一般劳动、商业、慈善的差异，由此构建诊金特定的道德意涵。但这种围绕诊金重构医疗服务和医患关系性质的努力在新旧观念交汇之际遭遇了挑战。本文对当下的医患关系、医疗卫生体制改革乃至诸多行业的职业伦理建设等均有参考意义。

The modern market exchange of medical services for money and the professional ethics of the medical profession with "altruism" as its core characteristic constitute a tension, and the adjustment of this contradiction has become one of the key aspects of professionalization. This paper utilizes the discussion of consultation fees in the period of Republic of China (ROC) and analyzes the ethical and cultural work done by doctors groups to construct the ethical foundation of the medical service market from the theoretical perspective of relational work. They clarified the ethical foundation of consultation fees and made a careful distinction between medical care and general labor, commerce, and charity, so as to construct a specific ethical connotation of consultation fees. However, this effort to reconfigure the nature of medical services and the doctor patient relationship around consultation fees encountered challenges at the intersection of the old and the new ideologies. This paper has significant implications for the current doctor patient relationship, the reform of the healthcare system, and even the construction of professional ethics in many other professions.

本文系国家社会科学基金一般项目“当代中国的医生职业伦理研究”（18BSH082）的阶段性成果。

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