《应用伦理评论》第61期.PDF

應用倫理評論第 61 期，2016 年 10 月，頁37-57 Applied Ethics Review, Vol. 61, 2016, pp. 37-57 對自主的再思考：關係取向 林雅萍∗ 摘 要 本文從教學及臨床現場的觀察與反思出發，重新思考主流醫 學倫理學界所採取的自由個人主義式自主觀援引女性主義取向 的關係自主論點，本文論證自主不該被窄化為獨自做決定的個人 權利，而且僅強調資訊與選擇的知情同意，亦無法使自主性獲得 實質的提升尤其在臺灣的醫療社會文化脈絡中，我們必須深化 對自主與尊重自主的理解，構思一套兼容獨立與相互依賴，並敏 於社會關係與權力結構的關係自主觀 關鍵詞：自主關係自主醫學倫理醫病關係共決策 ∗ 長庚大學醫學系人文及社會醫學科副教授 E-mail: arete@.tw 38 應用倫理評論第61 期 Rethinking Autonomy: A Relational Approach Ya-ping Lin∗ Abstract Starting from my preliminary observations and reflections on cases in teaching and clinical settings, I examine the liberal individualistic conception of autonomy employed in mainstream bioethics and medical ethics. Drawing on a feminist approach to relational autonomy, this article argues that autonomy should be characterized as more than an individual right to independent decision making and informed consent. Promoting relational autonomy in socio-cultural and medical context in Taiwan, it is argued, needs to develop a richer and more complex conception of autonomy and respect for autonomy which accommodates independence and interdependence while being sensitive to the social and power relations. Keywords: Autonomy, Relational autonomy, Medical ethics, Physician-patient relationships, Shared decision making ∗ Associate professor, Department of Medical Humanities and Social Sciences, Chang Gung University. E-mail: arete@.tw 對自主的再思考：關係取向 39 對自主的再思考：關係取向 林雅萍 一、引言：來自教學與臨床現場的反思 過去幾年我在醫學院教授病人自主的相關課程中，最常使用的 教學方式是先以經典案例入，引導學生或醫護人員思考並討論該 案例所涉及的倫理議題，這些案例多半是病人本身拒絕治療，而醫 師究竟是要尊重病人意見或依照醫療專業判斷強制治療的兩難情 況以我們討論多次的Dax’s