创伤性脑损伤后自主性受损的神经认知基础：临床与伦理考量
The neurocognitive basis of compromised autonomy after traumatic brain injury: clinical and ethical considerations.
作者信息
Lux Warren E
机构信息
Program in Human Research Ethics, Office of the Science Advisor, U.S. Environmental Protection Agency, Washington, DC 20460, USA.
出版信息
Neurotherapeutics. 2007 Jul;4(3):525-30. doi: 10.1016/j.nurt.2007.04.002.
It is widely accepted, based on the principle of respect for autonomy, that there are ethical constraints on the range of tactics that persons may use to influence the decisions and behaviors of others. However, accurate ascriptions of autonomy to either persons or acts may vary considerably, depending on properties of the person, the situation, or both. Traumatic brain injury affects cognitive domains that are critical for the effective exercise of autonomy, and so offers a context for further examination of this variability. Analysis of the neuropathology of traumatic brain injury and its neurocognitive consequences provides a foundation for understanding cases in which autonomy is compromised even though legal competency may be preserved. Respecting autonomy in these cases is not always straightforward; it may entail both special ethical obligations and consideration of tactics that would not be morally permissible under other circumstances.
基于尊重自主性的原则，人们普遍认为，对于个人用以影响他人决策和行为的策略范围存在伦理限制。然而，对个人或行为自主性的准确归属可能会有很大差异，这取决于个人的特质、具体情境或两者皆有。创伤性脑损伤会影响对有效行使自主性至关重要的认知领域，因此为进一步研究这种变异性提供了一个背景。对创伤性脑损伤的神经病理学及其神经认知后果的分析，为理解即使法律行为能力得以保留但自主性却受到损害的案例奠定了基础。在这些案例中尊重自主性并非总是直截了当的；这可能既需要特殊的伦理义务，又需要考虑在其他情况下在道德上不被允许的策略。
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