Savulescu J, Momeyer R W
Green College, Oxford, Ohio, USA.
J Med Ethics. 1997 Oct;23(5):282-8. doi: 10.1136/jme.23.5.282.
Our aim is to expand the regulative ideal governing consent. We argue that consent should not only be informed but also based on rational beliefs. We argue that holding true beliefs promotes autonomy. Information is important insofar as it helps a person to hold the relevant true beliefs. But in order to hold the relevant true beliefs, competent people must also think rationally. Insofar as information is important, rational deliberation is important. Just as physicians should aim to provide relevant information regarding the medical procedures prior to patients consenting to have those procedures, they should also assist patients to think more rationally. We distinguish between rational choice/action and rational belief. While autonomous choice need not necessarily be rational, it should be based on rational belief. The implication for the doctrine of informed consent and the practice of medicine is that, if physicians are to respect patient autonomy and help patients to choose and act more rationally, not only must they provide information, but they should care more about the theoretical rationality of their patients. They should not abandon their patients to irrationality. They should help their patients to deliberate more effectively and to care more about thinking rationally. We illustrate these arguments in the context of Jehovah's Witnesses refusing life-saving blood transfusions. Insofar as Jehovah's Witnesses should be informed of the consequences of their actions, they should also deliberate rationally about these consequences.
我们的目标是拓展关于同意的规范性理念。我们认为，同意不仅应基于充分信息，还应基于理性信念。我们认为持有真实信念能促进自主性。信息之所以重要，是因为它有助于一个人持有相关真实信念。但为了持有相关真实信念，有行为能力的人还必须进行理性思考。就信息很重要而言，理性思考也很重要。正如医生在患者同意进行医疗程序之前，应旨在提供有关这些程序的相关信息一样，他们还应协助患者更理性地思考。我们区分理性选择/行动和理性信念。虽然自主选择不一定是理性的，但它应基于理性信念。这对知情同意原则和医学实践的启示是，如果医生要尊重患者的自主性并帮助患者更理性地选择和行动，他们不仅必须提供信息，还应更关注患者的理论理性。他们不应任由患者陷入非理性状态。他们应帮助患者更有效地思考，并更注重理性思考。我们在耶和华见证者拒绝接受救命输血的背景下阐述这些论点。就耶和华见证者应了解其行为的后果而言，他们也应理性思考这些后果。
