Donchin A
Department of Philosophy, Indiana University, Indianapolis, IN 46202, USA.
J Med Philos. 2001 Aug;26(4):365-86. doi: 10.1076/jmep.26.4.365.3012.
Principle-based formulations of bioethical theory have recently come under increasing scrutiny, particularly insofar as they give prominence to personal autonomy. This essay critiques the dominant conceptualization of autonomy and urges an alternative formulation freed from the individualistic assumptions that pervade the prevailing framework. Drawing on feminist perspectives, I discuss the need for a vision of patient autonomy that joins relational experiences to individuality and acknowledges the influence of patterns of power and authority on the exercise of patient agency. Deficiencies in the current models of science and social relations guiding medical practice are analyzed, particularly (1) the tendency to disregard the patient's self-knowledge and (2) failure to recognize limitations on the generalizability of medical knowledge. Models of social relations such as mothering and friendship are explored to advance a conception of autonomy better suited to the practical activities of medicine. In conclusion, I consider how acknowledgement of the specificity and complexity of social relations can contribute to reconfiguration of other principles comprising the standard framework of bioethics, particularly beneficence, justice, and equality.
基于原则的生物伦理理论表述最近受到了越来越多的审视，尤其是在它们突出个人自主性方面。本文批判了自主性的主导概念，并敦促采用一种摆脱弥漫于现行框架中的个人主义假设的替代表述。借鉴女性主义视角，我讨论了一种将关系性体验与个体性相结合、并承认权力和权威模式对患者能动性行使的影响的患者自主性愿景的必要性。分析了当前指导医疗实践的科学和社会关系模式的缺陷，特别是（1）忽视患者自我认知的倾向，以及（2）未能认识到医学知识可推广性的局限性。探讨了诸如母性和友谊等社会关系模式，以推进一种更适合医学实践活动的自主性概念。总之，我思考了对社会关系的特殊性和复杂性的认识如何有助于重新构建构成生物伦理标准框架的其他原则，特别是行善、正义和平等原则。
