Tilburt Jon
Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
J Med Philos. 2011 Apr;36(2):148-69. doi: 10.1093/jmp/jhr003. Epub 2011 Mar 4.
This paper explores the practical consequences that Enlightenment ideals had on morality as it applies to clinical practice, using Alisdair MacIntyre's conceptualization and critique of the Enlightenment as its reference point. Taking the perspective of a practicing clinician, I critically examine the historical origins of ideas that made shared decision making (SDM) a necessary and ideal model of clinician-patient relationship. I then build on MacIntyre's critique of Enlightenment thought and examine its implications for conceptions of shared decision-making that use an Enlightenment justification, as well as examining contemporary threats to SDM that the Enlightenment made possible. I conclude by offering an alternative framing of SDM that fits with the clinician's duty to act on behalf of and along with patients but that avoids the tenuous Enlightenment assumptions that MacIntyre's work so vocally critiques.
本文以阿拉斯戴尔·麦金太尔对启蒙运动的概念化和批判为参照点，探讨启蒙运动理想在适用于临床实践的道德方面所产生的实际影响。从执业临床医生的角度出发，我批判性地审视了那些使共同决策（SDM）成为医患关系必要且理想模式的观念的历史起源。然后，我在麦金太尔对启蒙运动思想批判的基础上展开，审视其对使用启蒙运动正当理由的共同决策概念的影响，以及审视启蒙运动可能导致的对共同决策的当代威胁。最后，我提出了一种共同决策的替代框架，它符合临床医生代表患者并与患者共同行动的职责，但避免了麦金太尔著作强烈批判的那些脆弱的启蒙运动假设。
