den Hartogh Govert
University of Amsterdam, Staten Bolwerk 16, 2011ML, Haarlem, The Netherlands.
Med Health Care Philos. 2016 Mar;19(1):71-83. doi: 10.1007/s11019-015-9646-5.
On the standard view we assess a person's competence by considering her relevant abilities without reference to the actual decision she is about to make. If she is deemed to satisfy certain threshold conditions of competence, it is still an open question whether her decision could ever be overruled on account of its harmful consequences for her ('hard paternalism'). In practice, however, one normally uses a variable, risk dependent conception of competence, which really means that in considering whether or not to respect a person's decision-making authority we weigh her decision on several relevant dimensions at the same time: its harmful consequences, its importance in terms of the person's own relevant values, the infringement of her autonomy involved in overruling it, and her decision-making abilities. I argue that we should openly recognize the multi-dimensional nature of this judgment. This implies rejecting both the threshold conception of competence and the categorical distinction between hard and soft paternalism.
按照标准观点，我们在评估一个人的行为能力时，会考量其相关能力，而不考虑她即将做出的实际决定。如果她被认为满足某些行为能力的门槛条件，那么基于该决定对她产生的有害后果，其决定是否会被否决（“强硬家长主义”）仍是一个悬而未决的问题。然而在实践中，人们通常采用一种基于风险的可变行为能力概念，这实际上意味着在考虑是否尊重一个人的决策权威时，我们会同时从几个相关维度权衡她的决定：其有害后果、就个人自身相关价值观而言的重要性、否决该决定所涉及的对其自主权的侵犯，以及她的决策能力。我认为我们应该公开承认这种判断的多维度性质。这意味着既要摒弃行为能力的门槛概念，也要摒弃强硬家长主义和温和家长主义之间的绝对区分。
