Witt Karsten
J Med Ethics. 2017 Jun;43(6):384-390. doi: 10.1136/medethics-2016-103684. Epub 2017 Mar 20.
In this paper, I focus on a kind of medical intervention that is at the same time fascinating and disturbing: identity-changing interventions. My guiding question is how such interventions can be ethically justified within the bounds of contemporary bioethical mainstream that places great weight on the patient's informed consent. The answer that is standardly given today is that patients should be informed about the identity effects, thus suggesting that changes in identity can be treated like 'normal' side effects. In the paper, I argue that this approach is seriously lacking because it misses important complexities going along with decisions involving identity changes and consequently runs into mistakes. As a remedy I propose a new approach, the 'perspective-sensitive account', which avoids these mistakes and thus provides the conceptual resources to systematically reflect on and give a valid consent to identity-changing interventions.
在本文中，我关注的是一种既引人入胜又令人不安的医学干预措施：身份改变干预。我的指导性问题是，在当代生物伦理主流观念极为重视患者知情同意的框架内，此类干预措施如何能在伦理上得到正当辩护。如今通常给出的答案是，应告知患者身份影响，这意味着身份改变可被视作“正常”副作用来对待。在本文中，我认为这种方法严重不足，因为它忽略了涉及身份改变的决策所伴随的重要复杂性，因而会陷入错误。作为一种补救措施，我提出一种新方法，即“视角敏感解释”，它能避免这些错误，从而提供概念资源，以便系统地思考身份改变干预并给予有效同意。
