Pellegrino E D
Universidad de Georgetown, Cátedra John Carroll de Medicina y Humanidades Médicas.
Bol Oficina Sanit Panam. 1990 May-Jun;108(5-6):379-90.
The emergence of autonomy as a sociopolitical, legal, and moral concept has had a profoundly influenced medical ethics. It has shifted the center of decision-making from the physician to the patient and reoriented the physician-patient relationship so that it is more open and frank, and more respectful of the dignity of the person of the patient. In general, the ascendance of autonomy has protected patients against the grosser violations of their autonomy and integrity, so widely accepted as ethically permissible in the past. However, the ethical principle of autonomy is not sufficient to guarantee the nuances, the subtleties, and the full meanings of respect for persons in medical transactions. As a foundation for medical relationships, the concept of integrity is richer, more fundamental, and more closely tied to what it is to be a whole human person--corporeally, psychologically, and axiologically. The moral implications of integrity are more demanding albeit more difficult to capture in legal language or in the procedures of informed consent. Yet, for the reasons outlined in this paper, we should deepen our grasp of the notion that autonomy depends upon preserving the integrity of persons--and that both depend on the physician being a person of integrity.
自主性作为一种社会政治、法律和道德概念的出现，对医学伦理产生了深远影响。它将决策中心从医生转移到了患者身上，并重新定位了医患关系，使其更加开放和坦诚，更加尊重患者的人格尊严。总体而言，自主性的兴起保护了患者免受过去被广泛认为在伦理上可接受的对其自主性和完整性的更严重侵犯。然而，自主性的伦理原则不足以保证在医疗交易中对人的尊重的细微差别、微妙之处和全部含义。作为医疗关系的基础，完整性的概念更丰富、更基本，并且与作为一个完整的人——在身体、心理和价值论方面——的含义联系更紧密。完整性的道德含义要求更高，尽管更难用法律语言或知情同意程序来把握。然而，出于本文所述的原因，我们应该加深对自主性取决于维护人的完整性这一观念的理解——而且两者都依赖于医生成为一个有诚信的人。
