Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza MS 420, Houston, TX 77030-3411, USA.
Bioethics. 2011 Feb;25(2):66-74. doi: 10.1111/j.1467-8519.2010.01867.x.
Bioethics has a founding story in which medical paternalism, the interference with the autonomy of patients for their own clinical benefit, was an accepted ethical norm in the history of Western medical ethics and was widespread in clinical practice until bioethics changed the ethical norms and practice of medicine. In this paper I show that the founding story of bioethics misreads major texts in the history of Western medical ethics. I also show that a major source for empirical claims about the widespread practice of medical paternalism has been misread. I then show that that bioethics based on its founding story deprofessionalizes medical ethics. The result leaves the sick exposed to the predatory power of medical practitioners and healthcare organizations with only their autonomy-based rights to non-interference, expressed in contracts, to protect them. The sick are stripped of the protection afforded by a professional, fiduciary relationship of physicians to their patients. Bioethics based on its founding story reverts to the older model of a contractual relationship between the sick and medical practitioners not worthy of intellectual or moral trust (because such trust cannot be generated by what I call 'deprofessionalizing bioethics'). On closer examination, bioethics based on its founding story, ironically, eliminates paternalism as a moral category in bioethics, thus causing bioethics to collapse on itself because it denies one of the necessary conditions for medical paternalism. Bioethics based on its founding story should be abandoned.
生物伦理学有一个创始故事，其中医学家长主义——为了患者的临床利益而干预患者的自主权——是西方医学伦理学历史上的一种公认的伦理规范，并且在临床实践中广泛存在，直到生物伦理学改变了医学的伦理规范和实践。在本文中，我表明生物伦理学的创始故事误解了西方医学伦理学历史上的主要文本。我还表明，关于医学家长主义广泛实践的经验主张的一个主要来源被误解了。然后我表明，基于其创始故事的生物伦理学使医学伦理学非专业化。其结果是，病人暴露在医疗从业者的掠夺性权力之下，而只能依靠合同中表达的不受干涉的自主权来保护自己。病人被剥夺了医生与其病人之间专业的、信托关系所提供的保护。基于创始故事的生物伦理学恢复了旧的模式，即病人与医疗从业者之间的契约关系，这种关系不值得信任（因为这种信任不能通过我所谓的“使生物伦理学非专业化”来产生）。仔细观察，基于创始故事的生物伦理学，具有讽刺意味的是，将家长主义作为生物伦理学中的一个道德范畴消除了，从而导致生物伦理学自身崩溃，因为它否认了医学家长主义的必要条件之一。基于创始故事的生物伦理学应该被抛弃。
