Savulescu Julian
Bioethics. 1997 Apr;11(2):115-29. doi: 10.1111/1467-8519.00049.
I contrast Robert Veatch's recent liberal vision of medical decision-making with a more rationalist liberal model. According to Veatch, physicians are biased in their determination of what is in their patient's overall interests in favour of their medical interests. Because of the extent of this bias, we should abandon the practice of physicians offering what they guess to be the best treatment option. Patients should buddy up with physicians who share the same values -- 'deep value pairing'. The goal of choice is maximal promotion of patient values. I argue that if subjectivism about value and valuing is true, this move is plausible. However, if objectivism about value is true -- that there really are states which are good for people regardless of whether they desire to be in them -- then we should accept a more rationalist liberal alternative. According to this alternative, what is required to decide which course is best is rational dialogue between physicians and patients, both about the patient's circumstances and her values, and not the seeking out of people, physicians or others, who share the same values. Rational discussion requires that physicians be reasonable and empathic. I describe one possible account of a reasonable physician.
我将罗伯特·维奇最近关于医疗决策的自由主义观点与一种更为理性主义的自由主义模式进行了对比。根据维奇的观点，医生在确定什么符合患者的整体利益时存在偏见，偏向于他们自身的医疗利益。由于这种偏见的程度，我们应该摒弃医生提供他们认为是最佳治疗方案的做法。患者应该与价值观相同的医生结成伙伴关系——“深度价值配对”。选择的目标是最大程度地促进患者的价值观。我认为，如果关于价值和重视的主观主义是正确的，那么这一举措是合理的。然而，如果关于价值的客观主义是正确的——即确实存在对人们有益的状态，无论他们是否渴望处于其中——那么我们应该接受一种更为理性主义的自由主义替代方案。根据这种替代方案，决定哪种方案最佳所需的是医生与患者之间就患者的情况和她的价值观进行理性对话，而不是寻找价值观相同的人，无论是医生还是其他人。理性讨论要求医生通情达理且富有同理心。我描述了一种关于通情达理的医生的可能解释。
