Beyond individualism: Is there a place for relational autonomy in clinical practice and research?
Beyond individualism: Is there a place for relational autonomy in clinical practice and research?
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DOI：
10.1177/1477750917704156
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发表时间：
2017-09
期刊：
影响因子：
--
通讯作者：
Prainsack B
中科院分区：
文献类型：
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作者：
Dove ES;Kelly SE;Lucivero F;Machirori M;Dheensa S;Prainsack B
在临床实践和研究中占主导地位的对自主性的个人主义理解，是基于这样一种观点：在理想状态下，人是独立的、自利的、理性的、利益最大化的决策者。近几十年来，这一范式受到了来自不同学科和知识方向的挑战。“关系自主”的支持者尤其认为，人们的身份、需求、兴趣——实际上还有自主性——总是由他们与他人的关系塑造的。然而，尽管针对自主性的个人主义理解提出了明确而微妙的批评，但到目前为止，这种批评对临床实践和研究中的伦理和法律工具几乎没有影响。在本文中，我们使用四个案例研究来探讨关系自治在多大程度上（如果有的话）可以为临床实践和研究中的伦理和实际问题提供解决方案。我们的结论是，某些形式的关系自治可以对临床实践和研究产生切实和积极的影响。这些解决方案将最终决定权留给了受影响最大的人，但鼓励并促进了这个人对他人的关心和责任的考虑。
The dominant, individualistic understanding of autonomy that features in clinical practice and research is underpinned by the idea that people are, in their ideal form, independent, self-interested and rational gain-maximising decision-makers. In recent decades, this paradigm has been challenged from various disciplinary and intellectual directions. Proponents of ‘relational autonomy’ in particular have argued that people’s identities, needs, interests – and indeed autonomy – are always also shaped by their relations to others. Yet, despite the pronounced and nuanced critique directed at an individualistic understanding of autonomy, this critique has had very little effect on ethical and legal instruments in clinical practice and research so far. In this article, we use four case studies to explore to what extent, if at all, relational autonomy can provide solutions to ethical and practical problems in clinical practice and research. We conclude that certain forms of relational autonomy can have a tangible and positive impact on clinical practice and research. These solutions leave the ultimate decision to the person most affected, but encourage and facilitate the consideration of this person’s care and responsibility for connected others.