Tauber A I
Center for Philosophy and History of Science, 745 Commonwealth Avenue, Room 506, Boston University, Boston, MA 02215, USA.
Health Care Anal. 2001;9(3):299-319. doi: 10.1023/A:1012901831835.
Contemporary American medical ethics was born during a period of social ferment, a key theme of which was the espousal of individual rights. Driven by complex cultural forces united in the effort to protect individuality and self-determined choices, an extrapolation from case law to rights of patients was accomplished under the philosophical auspices of 'autonomy.' Autonomy has a complex history; arising in the modern period as the idea of self-governance, it received its most ambitious philosophical elaboration in Kant's moral philosophy. In examining the Kantian construction, it is evident that neither his universal moral imperative nor his rigorous application of self-legislated ethical action can sustain our own notions of moral agency in a pragmatic, pluralistic society. But the Kantian position is useful in highlighting that self-governance is not equivalent to 'autonomy,' and this distinction defines the limits of autonomy in the clinical setting. A critique of Engelhardt's idea of 'principle of permission' is used to illustrate autonomy's eclipse as a governing principle for medical ethics.
当代美国医学伦理诞生于一个社会动荡时期，其一个关键主题是对个人权利的拥护。在旨在保护个性和自主选择的复杂文化力量推动下，在“自主性”的哲学支持下，实现了从判例法到患者权利的推断。自主性有着复杂的历史；它在现代作为自我治理的理念出现，在康德的道德哲学中得到了最宏大的哲学阐释。在审视康德的建构时，很明显，在一个务实、多元的社会中，他的普遍道德律令以及他对自我立法的伦理行为的严格应用，都无法支撑我们自己关于道德行为主体的观念。但康德的立场有助于凸显自我治理并不等同于“自主性”，这种区别界定了临床环境中自主性的界限。对恩格尔哈特“许可原则”观点的批判被用来阐释自主性作为医学伦理主导原则的式微。
