Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Inter-Disciplinary Ethics Applied, University of Leeds, Leeds, UK
J Med Ethics. 2019 Nov;45(11):693-699. doi: 10.1136/medethics-2019-105511. Epub 2019 Sep 4.
This paper presents four arguments in favour of respecting Ulysses Contracts in the case of individuals who suffer with severe chronic episodic mental illnesses, and who have experienced spiralling and relapse before. First, competence comes in degrees. As such, even if a person meets the usual standard for competence at the point when they wish to refuse treatment (time 2), they may still be competent than they were when they signed the Ulysses Contract (time 1). As such, even if competent at time 1 time 2, there can still be a disparity between the of competence at each time. Second, Ulysses Contracts are important to protect people's concerns. Third, on the approach defended, the restrictions to people's liberty would be temporary, and would be consistent with soft paternalism, rather than hard paternalism: the contracts would be designed in such a way that individuals would be free to change their minds, and to change or cancel their Ulysses Contracts later. Finally, even if one rejects the equivalence thesis (the claim that allowing harm is as bad as doing harm), this is still consistent with the claim that, in , it can be as wrong to a harm as to do a harm. Nevertheless, controversies remain. This paper also highlights several safeguards to minimise risks. Ultimately, we argue that people who are vulnerable to spiralling deserve a way to protect their autonomy as far as possible, using Ulysses Contracts when necessary.
本文提出了四个论点，支持在患有严重慢性间歇性精神疾病且之前经历过病情恶化和复发的个人的情况下尊重尤利西斯契约。首先，能力是有程度之分的。因此，即使一个人在他们希望拒绝治疗时（时间 2）达到了通常的能力标准，他们在签署尤利西斯契约时（时间 1）可能仍然更有能力。因此，即使在时间 1 时是有能力的，在两个时间点之间，能力的程度仍可能存在差异。其次，尤利西斯契约对于保护人们的关注是很重要的。第三，在辩护的方法中，对人们自由的限制是暂时的，并且与软家长主义一致，而不是硬家长主义：合同将被设计成这样一种方式，即个人可以自由地改变主意，并在以后更改或取消他们的尤利西斯契约。最后，即使人们拒绝等价论点（允许伤害与造成伤害一样糟糕的说法），这仍然与这样的说法一致，即在某些情况下，避免造成伤害与造成伤害一样是错误的。尽管存在争议。本文还强调了一些保障措施，以最大程度地降低风险。最终，我们认为，那些容易病情恶化的人应该有办法尽可能保护他们的自主权，在必要时使用尤利西斯契约。
