Why we have duties of autonomy towards marginal agents.

IF 1.1 3区 哲学 Q3 ETHICS Theoretical Medicine and Bioethics Pub Date : 2023-10-01 Epub Date: 2023-05-12 DOI:10.1007/s11017-023-09623-5
Anna Hirsch
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Abstract

Patients are usually granted autonomy rights, including the right to consent to or refuse treatment. These rights are commonly attributed to patients if they fulfil certain conditions. For example, a patient must sufficiently understand the information given to them before making a treatment decision. On the one hand, there is a large group of patients who meet these conditions. On the other hand, there is a group that clearly does not meet these conditions, including comatose patients or patients in the late stages of Alzheimer's disease. Then there is a group of patients who fall into the range in between. At the lower end of this range are so-called 'marginal agents,' which include young children and patients in the middle stages of Alzheimer's disease. They also do not meet the typical requirements for autonomy, which is why they are usually granted fewer autonomy rights. However, some of them are capable of 'pre-forms' of autonomy that express what is important to them. These pre-forms differ from mere desires and reflect the identification/authenticity condition of autonomy. They have something in common with autonomous attitudes, choices, and actions - namely, they express the value of autonomy. As I will argue, autonomy is a value worthy of protection and promotion - even in its non-reflexive forms. Against this background, it becomes clear why we have autonomy duties, more precisely positive, autonomy-enabling duties, towards marginal agents and why we should give them as much attention as autonomy duties towards competent patients.

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为什么我们对边缘代理人有自主权的义务。
患者通常被授予自主权,包括同意或拒绝治疗的权利。如果患者满足某些条件,这些权利通常归属于患者。例如,在做出治疗决定之前,患者必须充分了解提供给他们的信息。一方面,有一大群患者符合这些条件。另一方面,有一组人显然不符合这些条件,包括昏迷患者或阿尔茨海默病晚期患者。然后有一组患者属于介于两者之间的范围。这个范围的低端是所谓的“边缘因素”,包括幼儿和阿尔茨海默病中期患者。他们也不符合自治的典型要求,这就是为什么他们通常被授予较少的自治权。然而,他们中的一些人能够表达对他们来说重要的“预先形式”的自治。这些前提形式不同于单纯的欲望,反映了自主的身份/真实性条件。它们与自主的态度、选择和行动有一些共同点,即它们表达了自主的价值。正如我将要说的那样,自治是一种值得保护和促进的价值观,即使是以非反射形式。在这种背景下,我们为什么对边缘代理人负有自治义务,更确切地说,是积极的、赋予自治权的义务,以及为什么我们应该像对有能力的患者负有自治义务一样重视他们,这一点就变得很清楚了。
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来源期刊
CiteScore
1.80
自引率
14.30%
发文量
43
期刊介绍: AIMS & SCOPE Theoretical Medicine and Bioethics examines clinical judgment and reasoning, medical concepts such as health and disease, the philosophical basis of medical science, and the philosophical ethics of health care and biomedical research Theoretical Medicine and Bioethics is an international forum for interdisciplinary studies in the ethics of health care and in the philosophy and methodology of medical practice and biomedical research. Coverage in the philosophy of medicine includes the theoretical examination of clinical judgment and decision making; theories of health promotion and preventive care; the problems of medical language and knowledge acquisition; theory formation in medicine; analysis of the structure and dynamics of medical hypotheses and theories; discussion and clarification of basic medical concepts and issues; medical application of advanced methods in the philosophy of science, and the interplay between medicine and other scientific or social institutions. Coverage of ethics includes both clinical and research ethics, with an emphasis on underlying ethical theory rather than institutional or governmental policy analysis. All philosophical methods and orientations receive equal consideration. The journal pays particular attention to developing new methods and tools for analysis and understanding of the conceptual and ethical presuppositions of the medical sciences and health care processes. Theoretical Medicine and Bioethics publishes original scholarly articles, occasional special issues on important topics, and book reviews. Related subjects » Applied Ethics & Social Responsibility – Bioethics – Ethics – Epistemology & Philosophy of Science – Medical Ethics – Medicine – Philosophy – Philosophy of Medicine – Surgery
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