Department of Philosophy, Dalhousie University, Halifax, NS, Canada.
Health Expect. 2011 Jun;14(2):182-90. doi: 10.1111/j.1369-7625.2010.00638.x. Epub 2010 Oct 28.
To review critically the traditional concept of autonomy, propose an alternative relational interpretation of autonomy, and discuss how this would operate in identifying and addressing ethical issues that arise in the context of nursing home care for older adults.
Respect for patient autonomy has been the cornerstone of clinical bioethics for several decades. Important though this principle is, there is debate on how to interpret the core concept of autonomy. We review the appeal of the traditional approach to autonomy in health care and then identify some of the difficulties with this conception.
We use philosophical methods to explain and discuss the traditional and relational conceptions of autonomy and we illuminate our discussion with examples of various contextual applications.
We support the relational conception of autonomy as offering a richer, more contextualized understanding of autonomy which attends to the social, political and economic conditions that serve as background to an agent's deliberations. To illuminate these ideas, we discuss the situation of frail older adults who frequently find their autonomy limited not only by their medical conditions but also by cultural prejudices against the aged and by the conditions commonly found within the nursing homes in which many reside. We propose ways of improving the relational autonomy of this population.
批判性地回顾自主性的传统概念，提出自主性的替代关系解释，并讨论如何在识别和解决老年人在养老院护理背景下出现的伦理问题时运用这一解释。
几十年来，尊重患者自主性一直是临床生物伦理学的基石。尽管这一原则非常重要，但对于自主性的核心概念应该如何解释存在争议。我们回顾了传统的医疗保健自主性方法的吸引力，然后指出了这种观念的一些困难。
我们使用哲学方法来解释和讨论自主性的传统和关系概念，并通过各种语境应用的例子来说明我们的讨论。
我们支持自主性的关系概念，因为它提供了一种更丰富、更具情境性的自主性理解，关注作为代理人审议背景的社会、政治和经济条件。为了阐明这些观点，我们讨论了身体虚弱的老年人的情况，他们的自主性经常不仅受到医疗条件的限制，还受到对老年人的文化偏见以及许多人居住的养老院中常见的条件的限制。我们提出了提高这一人群的关系自主性的方法。
