Priest Maura
Department of Philosophy, Arizona State University, Tempe, Maricopa, AZ, USA.
HEC Forum. 2018 Sep;30(3):297-318. doi: 10.1007/s10730-018-9355-6.
In this paper, I aim to demonstrate that the consequences of the current United States health insurance scheme on both physician and patient autonomy is dire. So dire, in fact, that the only moral solution is something other than what we have now. The United States healthcare system faces much criticism at present. But my focus is particular: I am interested in the ways in which insurance interferes with physician and patient autonomy. (I do not consider The Affordable Care Act much of a change in this aspect of the system, for it still relies heavily on private insurance, albeit often subsidized.) I will argue in favor of an expansion of the traditional conception of what I call "medical autonomy" or "healthcare autonomy" and the usual role it plays in bioethical discussions. More generally, I show that in morally designing or evaluating any healthcare system, serious attention should be paid to how this system helps foster what I call active autonomy.
在本文中，我的目标是证明当前美国医疗保险计划对医生和患者自主权所产生的后果是极其严重的。事实上，严重到唯一符合道德的解决方案是采用与我们现有的不同的方案。目前，美国医疗保健系统面临诸多批评。但我的关注点较为具体：我感兴趣的是保险干扰医生和患者自主权的方式。（我认为《平价医疗法案》在该系统的这一方面并没有太大改变，因为它仍然严重依赖私人保险，尽管通常有补贴。）我将主张扩大我所谓的“医疗自主权”或“医疗保健自主权”的传统概念，以及它在生物伦理讨论中通常所起的作用。更一般地说，我表明在从道德层面设计或评估任何医疗保健系统时，应认真关注该系统如何有助于培养我所说的积极自主权。
