Sjöstrand Manne, Eriksson Stefan, Juth Niklas, Helgesson Gert
*Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Tomtebodavägen 18A, Stockholm 171 77, Sweden.
J Med Philos. 2013 Dec;38(6):710-24. doi: 10.1093/jmp/jht049. Epub 2013 Oct 24.
Different ideas of the normative relevance of autonomy can give rise to profoundly different action-guiding principles in healthcare. If autonomy is seen as a value rather than as a right, it can be argued that patients' decisions should sometimes be overruled in order to protect or promote their own autonomy. We refer to this as paternalism in the name of autonomy. In this paper, we discuss different elements of autonomy (decision-making capacity, efficiency, and authenticity) and arguments in favor of paternalism for the sake of autonomy that have been proposed in the bioethical debate. We argue that if autonomy is valuable, then paternalism for the sake of autonomy may be justified. However, policies allowing paternalism in the name of autonomy may be self-defeating.
关于自主性的规范性关联的不同观念，可能在医疗保健领域引发截然不同的行动指导原则。如果将自主性视为一种价值而非一项权利，那么可以认为，有时为了保护或促进患者自身的自主性，患者的决定应被否决。我们将此称为以自主性之名的家长主义。在本文中，我们讨论自主性的不同要素（决策能力、有效性和真实性），以及在生物伦理辩论中提出的支持以自主性之名的家长主义的论据。我们认为，如果自主性是有价值的，那么以自主性之名的家长主义可能是合理的。然而，允许以自主性之名实行家长主义的政策可能会适得其反。
