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与风险相关的能力标准:延续关于与风险相关的能力标准的争论。

Risk-related standards of competence: continuing the debate over risk-related standards of competence.

作者信息

Cale Gita S

出版信息

Bioethics. 1999 Apr;13(2):131-48. doi: 10.1111/1467-8519.00137.

Abstract

This discussion paper addresses Ian Wilks' defence of the risk-related standard of competence that appears in Bioethics 11. Wilks there argues that the puzzle posed by Mark Wicclair in Bioethics 5 against Dan Brock's argument in favour of a risk-related standard of competence -- namely that Brock's argument allows for situations of asymmetrical competence -- is not a genuine problem for a risk-related standard of competence. To show this, Wilks presents what he believes to be two examples of real situations in which asymmetrical competence arises. I argue that insofar as Wilks equivocates two senses of competence in his examples -- namely, competence to perform a task and competence in performing a task -- Wilks is unable to illustrate the existence of real situations of asymmetrical competence. By examining the way in which Wilks equivocates two senses of competence in his examples, and by applying the results of this examination to the problem of patient competency within the medical field, I argue that not only does Wilks fail to show that situations of asymmetrical competence exist, but he is also unable to provide a foundation for understanding how the risk-related standard of competence can strike a balance between an individual's autonomy and benevolent intervention. I thus conclude that insofar as Wilks fails to answer the objections raised by Wicclair and others against the risk-related standard of competence, the risk-related standard of competence continues to be undermined by the problem of asymmetrical competence.

摘要

这篇讨论文章探讨了伊恩·威尔克斯对《生物伦理学》第11期中出现的与风险相关的能力标准的辩护。威尔克斯在文中认为,马克·威克莱尔在《生物伦理学》第5期中针对丹·布罗克支持与风险相关的能力标准的论点所提出的难题——即布罗克的论点允许存在能力不对称的情况——对于与风险相关的能力标准来说并非真正的问题。为了说明这一点,威尔克斯给出了他认为是能力不对称情况出现的两个真实场景的例子。我认为,由于威尔克斯在其例子中混淆了能力的两种含义——即执行一项任务的能力和在执行任务中的能力——威尔克斯无法说明真实的能力不对称情况的存在。通过审视威尔克斯在其例子中混淆能力两种含义的方式,并将这一审视结果应用于医学领域中的患者能力问题,我认为威尔克斯不仅未能表明能力不对称情况的存在,而且他也无法为理解与风险相关的能力标准如何在个人自主性和善意干预之间取得平衡提供一个基础。因此,我得出结论,鉴于威尔克斯未能回答威克莱尔及其他人针对与风险相关的能力标准提出的异议,与风险相关的能力标准继续受到能力不对称问题的削弱。

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