Dekkers W J
Department of Ethics, Philosophy and History of Medicine, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Med Health Care Philos. 2001;4(2):185-92. doi: 10.1023/a:1011497901122.
In this article some of the presuppositions that underly the current ideas about decision making capacity, autonomy and independence are critically examined. The focus is on chronic disorders, especially on chronic physical disorders. First, it is argued that the concepts of decision making competence and autonomy, as they are usually applied to the problem of legal (in)competence in the mentally ill, need to be modified and adapted to the situation of the chronically (physically) ill. Second, it is argued that autonomy and dependence must not be considered as two mutually exclusive categories. It is suggested that decision making may take on the form of a more or less conscious decision not to be involved in making all kinds of explicit and deliberate decisions. Elaborating on Agich's distinction between ideal and actual autonomy, the concept of "Socratic autonomy" is introduced.
在本文中，对一些构成当前关于决策能力、自主性和独立性观念基础的预设进行了批判性审视。重点在于慢性疾病，尤其是慢性身体疾病。首先，有人认为，通常应用于精神疾病患者法律行为能力问题的决策能力和自主性概念，需要进行修改并适用于慢性（身体）疾病患者的情况。其次，有人认为自主性和依赖性不应被视为两个相互排斥的类别。有人提出，决策可能采取一种或多或少有意识的决定形式，即不参与做出各种明确和深思熟虑的决策。在阐述阿吉奇关于理想自主性和实际自主性的区别时，引入了“苏格拉底式自主性”的概念。
