Brione Rebecca
New Bioeth. 2015;21(1):71-86. doi: 10.1179/2050287715z.00000000058.
Approaches to supporting autonomy in medicine need to be able to support complex and sensitive decision-making, incorporating reflection on the patient's values and goals. This should involve deliberation in partnership between physician and patient, allowing the patient to take responsibility for her decision. Nowhere is this truer than in decisions around pregnancy and Caesarean section where maternal autonomy can seem to directly conflict with foetal interests. Medical and societal expectations and norms such as the expectations of a ‘mother’, constraints of making decisions in an emergency, and the role of technology in viewing the foetus as a separate patient and surgery as a guarantor of results can all act to limit a woman's autonomy. In considering decisions about Caesarean section, maternal interests in bodily integrity can be dismissed as being less important than the foetus's own interests and the mother's duties to it, despite the inherent risks and impacts of such a major surgical procedure. Maternal autonomy must be respected through support for informed deliberation, incorporating patients' own values and risk tolerance, with the aim of minimizing the effect of those factors that would tend to limit autonomy.
医学中支持自主的方法需要能够支持复杂且敏感的决策制定，包括对患者价值观和目标的思考。这应该涉及医生与患者之间的合作商议，让患者对自己的决定负责。在围绕怀孕和剖腹产的决策中，这一点尤为正确，因为在这些决策中，产妇的自主权似乎与胎儿的利益直接冲突。医疗和社会期望及规范，比如对“母亲”的期望、在紧急情况下做决策的限制，以及将胎儿视为独立患者且将手术视为结果保障的技术作用，都可能限制女性的自主权。在考虑剖腹产决策时，尽管这种大型外科手术存在固有风险和影响，但产妇对身体完整性的利益可能会被认为不如胎儿自身利益以及母亲对胎儿的责任重要。必须通过支持知情商议来尊重产妇自主权，将患者自身的价值观和风险承受能力纳入其中，目的是尽量减少那些倾向于限制自主权的因素的影响。
