Centre of Medical Law and Ethics, School of Law, King's College London, Strand WC2R 2LS.
Bioethics. 2011 Jul;25(6):326-33. doi: 10.1111/j.1467-8519.2009.01793.x. Epub 2009 Dec 30.
According to the principle of patient autonomy, patients have the right to be self-determining in decisions about their own medical care, which includes the right to refuse treatment. However, a treatment refusal may legitimately be overridden in cases where the decision is judged to be incompetent. It has recently been proposed that in assessments of competence, attention should be paid to the evaluative judgments that guide patients' treatment decisions. In this paper I examine this claim in light of theories of practical rationality, focusing on the difficult case of an anorexic person who is judged to be competent and refuses treatment, thereby putting themselves at risk of serious harm. I argue that the standard criteria for competence assess whether a treatment decision satisfies the goals of practical decision-making, and that this same criterion can be applied to a patient's decision-guiding commitments. As a consequence I propose that a particular understanding of practical rationality offers a theoretical framework for justifying involuntary treatment in the anorexia case.
根据患者自主性原则，患者有权自主决定自己的医疗护理，其中包括拒绝治疗的权利。然而，在判断决策能力不足的情况下，治疗拒绝可能会被合法推翻。最近有人提出，在评估能力时，应关注指导患者治疗决策的评估判断。本文从实践理性理论的角度来审视这一说法，重点探讨了一个被判断为有能力的厌食症患者拒绝治疗从而使自己面临严重伤害风险的困难案例。我认为，能力的标准标准评估治疗决策是否满足实际决策的目标，并且这个相同的标准可以应用于患者的决策指导承诺。因此，我提出，对实践理性的特定理解为在厌食症病例中提供了一个非自愿治疗的理论框架。
