George Mason University.
University of Pennsylvania.
Am J Bioeth. 2021 Nov;21(11):4-18. doi: 10.1080/15265161.2020.1863507. Epub 2020 Dec 29.
This article argues that supported decision making is ideal for people with dynamic cognitive and functional impairments that place them at the margins of autonomy. First, we argue that guardianship and similar surrogate decision-making frameworks may be inappropriate for people with dynamic impairments. Second, we provide a conceptual foundation for supported decision making for individuals with dynamic impairments, which integrates the social model of disability with relational accounts of autonomy. Third, we propose a three-step model that specifies the necessary conditions of supported decision making: identifying domains for support; identifying kinds of supports; and reaching a mutually acceptable and formal agreement. Finally, we identify a series of challenges for supported decision making, provide preliminary responses, and highlight avenues for future bioethics research.
本文认为，辅助决策对于那些认知和功能动态受损、处于自主边缘的人来说是理想的选择。首先，我们认为监护和类似的代理决策框架可能不适合那些有动态损伤的人。其次，我们为有动态损伤的个人提供了一个辅助决策的概念基础，该基础将残疾的社会模式与自主的关系性解释结合起来。第三，我们提出了一个三步模型，规定了辅助决策的必要条件：确定支持的领域；确定支持的种类；达成一个相互接受和正式的协议。最后，我们确定了辅助决策面临的一系列挑战，提供了初步的回应，并强调了未来生物伦理学研究的途径。
