de Roubaix Malcolm
Centre for Applied Ethics, Department of Philosophy, University of Stellenbosch, South Africa.
Med Law. 2008 Jun;27(2):365-99.
I discuss the significance of respect for personal autonomy in bioethics with reference to its practical expression: rational informed patient choice. The question is whether, given the apparent practical limitations to this notion, bioethical autonomy should be seen as an absolute. After a historical review of informed consent and its development, I discuss the requirements for informed consent. Some inherent tensions are evaluated, as is the applicability of the notion that in order to be legitimate, autonomy should do some ethical work. Limits to the notion of informed consent are explored with reference to six examples: the right of women to reproductive autonomy; the autonomy of legally minor Jehovah's Witnesses; autonomy in cosmetic surgery; inappropriate treatment; autonomy and human medical research, and euthanasia and other end-of-life options. The discussion is within a South African framework with reference to other jurisdictions and decisions where appropriate. I conclude that whilst some unusual instances of limitation of bioethical informed consent might be ethically justifiable, the arguments presented point to the opposite: the unfounded limitation of informed consent.
我结合尊重个人自主权在生物伦理学中的实际表现形式——理性的知情患者选择，探讨了尊重个人自主权在生物伦理学中的重要性。问题在于，鉴于这一概念明显存在实际限制，生物伦理自主权是否应被视为绝对的。在对知情同意及其发展进行历史回顾之后，我讨论了知情同意的要求。评估了一些内在的紧张关系，以及为了具有合法性自主权应发挥某种伦理作用这一观念的适用性。参照六个例子探讨了知情同意概念的局限性：妇女的生殖自主权；法定未成年的耶和华见证人的自主权；整容手术中的自主权；不适当治疗；自主权与人体医学研究，以及安乐死和其他临终选择。讨论以南非为框架，并酌情参考其他司法管辖区和判决。我的结论是，虽然生物伦理知情同意的某些不寻常的限制情况在伦理上可能是合理的，但所提出的论点却指向相反的方向：对知情同意的无端限制。
