White W D
J Health Polit Policy Law. 1983 Spring;8(1):99-119. doi: 10.1215/03616878-8-1-99.
The law of informed consent expresses in legal form the ethical principle of autonomy and respect for autonomy. It is intended to enhance self-determination and rational decision-making in medicine. Three tests might be made of whether a law is a good law: (1) Is it clear and unambiguous enough to admit of fair, equal, and consistent enforcement? (2) Does it gain compliance, and widespread ideological agreement? (3) Does it enjoy a measure of success in achieving its intended goals? The law of informed consent does not impressively pass any one of these tests. It is deeply ambiguous, both in its formal structure and its pragmatic implementation. It has not won ideological agreement, doctors having been openly hostile to it, and legislatures having written statutes limiting it. There is little evidence that it has succeeded in its goals. Paradoxically, its pragmatic value might be rooted in its ostensible weakness, its ambiguity, in that this very quality keeps the discussion going. Perhaps the essential problem lies in the fact that the philosophical notion of autonomy is not a phenomenologically accurate description of the condition of the person who seeks medical help--the map is not the territory.
知情同意法则以法律形式体现了自主及尊重自主的伦理原则。其目的在于增强医学领域中的自我决定和理性决策。对于一部法律是否是一部好法律，可以进行三项检验：（1）它是否清晰明确，足以允许公正、平等且一致的执行？（2）它是否获得了遵守以及广泛的思想认同？（3）它在实现其预期目标方面是否取得了一定程度的成功？知情同意法则在这些检验中的任何一项上都没有给人留下深刻印象。它在形式结构和实际执行方面都存在深刻的模糊性。它没有赢得思想认同，医生们一直公开对其怀有敌意，立法机构也制定了限制它的法规。几乎没有证据表明它实现了其目标。矛盾的是，它的实际价值可能源于其表面上的弱点，即其模糊性，因为正是这种特质使得讨论得以持续。或许根本问题在于，自主的哲学概念并非对寻求医疗帮助者状况的现象学准确描述——地图并非实际地域。
