Savulescu J
University of Oxford.
J Med Ethics. 1995 Dec;21(6):327-31. doi: 10.1136/jme.21.6.327.
This paper argues that doctors ought to make all things considered value judgments about what is best for their patients. It illustrates some of the shortcomings of the model of doctor as 'fact-provider'. The 'fact-provider' model fails to take account of the fact that practising medicine necessarily involves making value judgments; that medical practice is a moral practice and requires that doctors reflect on what ought to be done, and that patients can make choices which fail to express their autonomy and which are based on mistaken judgments of value. If doctors are properly to respect patient autonomy and to function as moral agents, they must make evaluations of what their patients ought to do, all things considered. This paper argues for 'rational, non-interventional paternalism'. This is a practice in which doctors form conceptions of what is best for their patients and argue rationally with them. It differs from old-style paternalism in that it is not committed to doing what is best.
本文认为，医生应该综合考虑各种因素，对什么对患者最有利做出价值判断。它阐述了将医生视为“事实提供者”这一模式的一些不足之处。“事实提供者”模式没有考虑到行医必然涉及价值判断这一事实；医疗实践是一种道德实践，要求医生思考应该做什么，而且患者可能会做出无法体现其自主性且基于错误价值判断的选择。如果医生要恰当地尊重患者的自主性并履行道德行为者的职责，他们就必须综合考虑各种因素，对患者应该做什么进行评估。本文主张“理性的、非干预性的家长式作风”。这是一种医生形成对患者最有利的观念并与他们进行理性争辩的做法。它与旧式家长式作风的不同之处在于，它并不致力于做最有利的事情。
