Ahlin Marceta Jesper
Division of Philosophy, KTH Royal Institute of Technology, Stockholm, Sweden.
Med Health Care Philos. 2019 Sep;22(3):387-395. doi: 10.1007/s11019-018-9879-1.
Respect for autonomy is a central moral principle in bioethics. The concept of autonomy can be construed in various ways. Under the non-ideal conceptualization proposed by Beauchamp and Childress, everyday choices of generally competent persons are autonomous to the extent that they are intentional and are made with understanding and without controlling influences. It is sometimes suggested that authenticity is important to personal autonomy, so that inauthenticity prevents otherwise autonomous persons from making autonomous decisions. Building from Beauchamp and Childress's theory, this article develops a non-ideal authenticity-based conceptualization of personal autonomy. Factors that indicate inauthentic decision-making are explicated, and the full concept is defended from three expected objections. The theory is then tested on a paradigm case which has concerned theorists and practitioners for some time, namely the possible inauthenticity of anorexia nervosa patients' decision-making. It is concluded that the theory seems to be fruitful in analyses of the degree of autonomy of patients' decision-making, and that it succeeds in providing reliable action-guidance in practical contexts.
尊重自主性是生物伦理学中的一项核心道德原则。自主性的概念可以有多种解释方式。在博尚和奇尔德雷斯提出的非理想概念化框架下，一般有行为能力者的日常选择只要是出于自愿、基于理解且不受控制因素影响，那就是自主的。有时有人认为本真性对个人自主性很重要，因此非本真性会妨碍原本自主的人做出自主决策。本文以博尚和奇尔德雷斯的理论为基础，发展出一种基于非理想本真性的个人自主性概念化。阐述了表明非本真决策的因素，并针对三个预期的反对意见为这一完整概念进行了辩护。然后，该理论在一个令理论家和从业者关注了一段时间的典型案例上进行了检验，即神经性厌食症患者决策可能存在的非本真性。结论是，该理论在分析患者决策自主性程度方面似乎卓有成效，并且成功地在实际情境中提供了可靠的行动指导。
