Saad Toni C
Cardiff University School of Medicine, UHW Main Building, Heath Park, Cardiff, CF14 4XN, Wales, UK.
Med Health Care Philos. 2018 Mar;21(1):125-137. doi: 10.1007/s11019-017-9781-2.
Respect for Autonomy (RFA) has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress' in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons.
自20世纪70年代末博尚和奇尔德雷斯将尊重自主性（RFA）奉为生物医学伦理学四大原则之一以来，它一直是医学伦理学的支柱。本文追溯了这一现代概念从古代到当今的发展历程，关注其在康德和卢梭思想中的启蒙起源。接着，在战后时期和美国社会政治思想的背景下，探讨了生物伦理学和RFA在20世纪的快速发展。基于这一哲学历史叙述，讨论了RFA的有效性和实用性。结论是，为保护患者免受强制或家长作风的影响，不一定非要信奉自主性伦理；相反，自主性的主导地位有可能破坏那些帮助医生将患者视为人并予以尊重的因素。
