School of Philosophy, Australian National University, Canberra, Australian Capital Territory, Australia
Plunkett Centre for Ethics, Australian Catholic University and St Vincent's Health Australia, Sydney, New South Wales, Australia.
J Med Ethics. 2024 Feb 20;50(3):212-218. doi: 10.1136/medethics-2021-107942.
Respect for patient autonomy is a central principle of medical ethics. However, there are important unresolved questions about the characteristics of an autonomous decision, and whether some autonomous preferences should be subject to more scrutiny than others.In this paper, we consider whether -preferences that are based on and that may perpetuate social injustice-should be categorised as autonomous in a way that gives them normative authority. Some philosophers have argued that inappropriately adaptive preferences do not have normative authority, because they are only a reflection of a person's social context and not of their true self. Under this view, medical professionals who refuse to carry out actions which are based on inappropriately adaptive preferences are not in fact violating their patient's autonomy. However, we argue that it is very difficult to articulate a systematic and principled distinction between normal autonomous preferences and inappropriately adaptive preferences, especially if this distinction needs to be useful for clinicians in real-life situations. This makes it difficult to argue that inappropriately adaptive preferences are straightforwardly non-autonomous.Given this problem, we argue that there are significant theoretical issues with contemporary understandings of autonomy in bioethics. We discuss what this might mean for the practice of medicine and for medical ethics education.
尊重患者自主性是医学伦理的核心原则。然而，关于自主性决策的特征，以及某些自主性偏好是否应该比其他偏好受到更严格的审查，仍存在一些悬而未决的重要问题。在本文中，我们考虑了基于并可能使社会不公正永久化的偏好是否应被归类为具有规范权威的自主性。一些哲学家认为，不适当的适应性偏好没有规范权威，因为它们只是一个人社会背景的反映，而不是他们真实自我的反映。根据这种观点，拒绝执行基于不适当适应性偏好的行为的医疗保健专业人员实际上并没有侵犯患者的自主权。然而，我们认为，很难在正常自主性偏好和不适当适应性偏好之间划出一个系统的、有原则的界限，尤其是如果这种区别对于临床医生在现实生活中的情况需要有用的话。这使得很难说不适当适应性偏好是完全非自主性的。鉴于这个问题，我们认为，当代生物伦理学中对自主性的理解存在重大的理论问题。我们讨论了这对医学实践和医学伦理教育意味着什么。
