Greaney Anna-Marie, O'Mathúna Dónal P, Scott P Anne
Department of Nursing and Healthcare Studies, Institute of Technology, Tralee, Co. Kerry, Ireland.
Med Health Care Philos. 2012 Nov;15(4):383-95. doi: 10.1007/s11019-011-9356-6.
This paper aims to critique the phenomenon of advanced patient autonomy and choice in healthcare within the specific context of self-testing devices. A growing number of self-testing medical devices are currently available for home use. The premise underpinning many of these devices is that they assist individuals to be more autonomous in the assessment and management of their health. Increased patient autonomy is assumed to be a good thing. We take issue with this assumption and argue that self-testing provides a specific example how increased patient autonomy and choice within healthcare might not best serve the patient population. We propose that current interpretations of autonomy in healthcare are based on negative accounts of liberty to the detriment of a more relational understanding. We also propose that Kantian philosophy is often applied to the healthcare arena in an inappropriate manner. We draw on the philosophical literature and examples from the self-testing process to support these claims. We conclude by offering an alternative account of autonomy based on the interrelated concepts of relationality, care and responsibility.
本文旨在在自我检测设备这一特定背景下，对医疗保健中患者高度自主和选择的现象进行批判。目前有越来越多的自我检测医疗设备可供家庭使用。许多此类设备的基本前提是，它们帮助个人在健康评估和管理方面更加自主。患者自主性的提高被认为是一件好事。我们对这一假设提出质疑，并认为自我检测提供了一个具体例子，说明医疗保健中患者自主性和选择的增加可能并非最有利于患者群体。我们认为，当前对医疗保健中自主性的解释基于对自由的消极理解而损害了更具关联性的理解。我们还认为，康德哲学在医疗保健领域的应用方式往往并不恰当。我们借鉴哲学文献以及自我检测过程中的例子来支持这些观点。最后，我们基于关联性、关怀和责任等相互关联的概念，提出了一种自主性的替代解释。
