HKU SPACE Community College - Philosophy, Hong Kong.
Bioethics. 2013 Nov;27(9):493-9. doi: 10.1111/j.1467-8519.2012.01973.x. Epub 2012 Apr 10.
Personal autonomy presupposes the notion of rationality. What is not so clear is whether, and how, a compromise of rationality to various degrees will diminish a person's autonomy. In bioethical literature, three major types of threat to the rationality of a patient's medical decision are identified: insufficient information, irrational beliefs/desires, and influence of different framing effects. To overcome the first problem, it is suggested that patients be provided with information about their diseases and treatment choices according to the objective standard. I shall explain how this should be finessed. Regarding the negative impact of irrational beliefs/desires, some philosophers have argued that holding irrational beliefs can still be an expression of autonomy. I reject this argument because the degree of autonomy of a decision depends on the degree of rationality of the beliefs or desires on which the decision is based. Hence, to promote patient autonomy, we need to eliminate irrational beliefs by the provision of evidence and good arguments. Finally, I argue that the way to smooth out the framing effects is to present the same information in different perspectives: it is too often assumed that medical information can always be given in a complete and unadorned manner. This article concludes with a cautionary note that the protection of patient autonomy requires much more time and effort than the current practice usually allows.
个人自主性预设了理性的概念。不太清楚的是，在何种程度上，以及如何，理性的妥协会削弱一个人的自主性。在生物伦理文献中，确定了三种主要类型的威胁患者医疗决策理性的因素：信息不足、非理性信念/欲望以及不同框架效应的影响。为了克服第一个问题，建议根据客观标准向患者提供有关其疾病和治疗选择的信息。我将解释如何巧妙地处理这个问题。关于非理性信念/欲望的负面影响，一些哲学家认为持有非理性信念仍然可以是自主性的表现。我反对这个论点，因为决策的自主性程度取决于决策所依据的信念或欲望的理性程度。因此，为了促进患者自主性，我们需要通过提供证据和良好的论据来消除非理性信念。最后，我认为，消除框架效应的方法是从不同的角度呈现相同的信息：人们通常认为，医疗信息总是可以以完整而不加修饰的方式给出。本文最后提出了一个警示，即保护患者自主性需要比当前实践通常允许的更多的时间和精力。
