Welie J V
Department of Ethics, Philosophy and History of Medicine, Catholic University of Nijmegen, The Netherlands.
Theor Med. 1994;15(3):211-25. doi: 10.1007/BF01313338.
Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous.
当代医学伦理学家越来越意识到有必要为他们的各种应用伦理模型阐明一个基础。这些理论中的许多都受到患者自主权与提供者行善之间明显不相容性的启发。患者自主权原则目前的首要地位在很大程度上源于其法律渊源。然而，这一原则似乎与临床现实不一致。在生物伦理文献中，本真的概念已被提议作为自主权的替代基础原则。本文参照各种存在主义哲学家（海德格尔、萨特、加缪和马塞尔）来审视这一提议。得出的结论是，自主权原则未能做到它通常被认为能做到的事情：提供一个可用于解决患者与提供者之间道德争议的区分标准。存在主义的本真概念至少在一个关键方面更有前景：它承认，如果生命的时间特征被简化为一系列当下的决定和行动，人类生命的本质就会消失不见。这也意味着，寻求一个能让医生在不求助于患者过去或未来的情况下，区分是否尊重患者突然、意外的生死决定的标准是错误的。
