Ahlin Marceta Jesper
Division of Philosophy, KTH Royal Institute of Technology, Stockholm, Sweden.
Monash Bioeth Rev. 2020 May;38(1):1-14. doi: 10.1007/s40592-020-00108-y.
Respect for autonomy is a central moral principle in bioethics. It is sometimes argued that authenticity, i.e., being "real," "genuine," "true to oneself," or similar, is crucial to a person's autonomy. Patients sometimes make what appears to be inauthentic decisions, such as when (decision-competent) anorexia nervosa patients refuse treatment to avoid gaining weight, despite that the risk of harm is very high. If such decisions are inauthentic, and therefore non-autonomous, it may be the case they should be overridden for paternalist reasons. However, it is not clear what justifies the judgment that someone or something is inauthentic. This article discusses one recent theory of what justifies judgments of inauthenticity. It is argued that the theory is seriously limited, as it only provides guidance in three out of nine identified cases. There are at least six authenticity-related problems to be solved, and autonomy theorists thus have reason to engage with the topic of authenticity in practical biomedicine.
尊重自主性是生物伦理学中的一项核心道德原则。有时有人认为，本真，即“真实”“真诚”“忠于自己”或类似的特质，对一个人的自主性至关重要。患者有时会做出看似不真实的决定，比如（有决策能力的）神经性厌食症患者拒绝治疗以避免体重增加，尽管这样做的伤害风险非常高。如果这样的决定是不真实的，因此是非自主性的，那么出于家长主义的原因，这些决定可能应该被推翻。然而，尚不清楚是什么证明了某人或某事是不真实的这一判断的合理性。本文讨论了一种最近关于证明不真实性判断合理性的理论。有人认为，该理论存在严重局限性，因为它仅在九个已确定的案例中的三个案例中提供了指导。至少有六个与本真相关的问题有待解决，因此自主性理论学家有理由在实际的生物医学中探讨本真这一话题。
