Supported Decision-Making: Non-Domination Rather than Mental Prosthesis
Supported Decision-Making: Non-Domination Rather than Mental Prosthesis
复制标题
支持决策：非支配而非精神假体
作者：
Allison M. McCarthy;D. Howard
摘要近年来，生物伦理学家和联合国残疾人权利委员会（UNCRPD）倡导为智障患者提供医疗决策支持。但是，支持决策真正需要什么？安妮塔·西尔弗斯（Anita Silvers）和莱斯利·弗朗西斯（Leslie Francis）的心理假体解释是一个令人信服的框架，他们将辅助决策设想为一个过程，在这个过程中，受托人仅仅是病人意志的附属物;受托人提供病人实现自我利益概念所需的认知工具。我们认为，支持决策将被更好地理解为一个协作的过程，让智障患者有机会在与信任他人的尊重关系中做出决定。我们提供了一个替代帐户的支持决策的主要约束是保护病人从受托人的统治。这有利于保持真正合作的前景，因为心智假体方法最终强化了孤立病人自决的有问题的理想。
Abstract Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination.