Autonomy in Tension: Reproduction, Technology, and Justice.
Autonomy in Tension: Reproduction, Technology, and Justice.
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紧张中的自主：再生产、技术和正义。
DOI：
10.1002/hast.788
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Johnston,Josephine
中科院分区：
文献类型：
--
作者：
King,LouiseP;Zacharias,RachelL;Johnston,Josephine
尊重自主性是生殖伦理的核心价值，但它可能是一个实现的挑战，有时是一个彻头彻尾的困惑。如果一名妇女在生育治疗期间要求移植两个、三个或四个胚胎，这个请求真的是自主的吗？如果临床医生质疑或拒绝执行这一决定，他们会不尊重她吗？再加上对正义的承诺，挑战可能会变得更加复杂。保险政策不包括为没有生育能力的人提供生育能力的费用，或者为失去生育能力的人恢复生育能力的费用，这是否不公平？面对对正义和自主的各种理解，面对日益复杂和昂贵的生殖技术，“公正的生殖”是什么样子？在今天美国关于生殖、医学和伦理的对话中，旧的伦理问题--比如女性是否应该被允许获得终止妊娠的权利--比几十年前更具争议性，而新技术--比如那些用于编辑人类胚胎基因的技术--表明我们人类可能面临前所未有的问题，即谁应该存在。当我们考虑与这些问题相关的讨论并考虑编写一份针对这些问题的特别报告时，我们发现自己一直在回到两项道德承诺上：尊重自治和追求正义。正如这本文集中的九篇文章中的一篇所问的那样，为什么某些妇女应该接受帮助来确定怀孕，而另一些妇女在流产或死胎时被关进监狱？如果个人有能力在充分知情和自愿的情况下作出选择，就必须尊重自主权。然而，尊重自主权是否需要接受患者或医疗保健消费者的所有选择？我们在黑斯廷斯中心报告的这份特别报告中考虑了这些和相关的问题。
Respect for autonomy is a central value in reproductive ethics, but it can be a challenge to fulfill and is sometimes an outright puzzle to understand. If a woman requests the transfer of two, three, or four embryos during fertility treatment, is that request truly autonomous, and do clinicians disrespect her if they question that decision or refuse to carry it out? Add a commitment to justice to the mix, and the challenge can become more complex still. Is it unfair for insurance policies to exclude from coverage the costs of giving fertility to those who lack it or restoring fertility in those who have lost it? What does “just reproduction” look like in the face of multifarious understandings of both justice and autonomy and in light of increasingly complex and costly reproductive technologies?In today's dialogue about reproduction, medicine, and ethics in the United States, old ethical issues—such as whether women ought to be allowed to access pregnancy termination—are more contested than they have been in decades, while new technologies—like those used to edit the genes of human embryos—suggest that our species could face unprecedented questions about who should exist. As we considered the discussions accompanying these issues and contemplated a special report responding to them, we found ourselves consistently circling back to two ethical commitments: respect for autonomy and the pursuit of justice. As one of the nine essays in this collection asks, why should certain women receive help to establish a pregnancy while others are thrown in jail when they miscarry or their child is stillborn? Respect for autonomy is required where individuals have the ability to make fully informed and voluntary choices. Yet does respecting autonomy require acceding to all the choices of patients or consumers of medical care? We consider these and related questions in this special report from the Hastings Center Report.
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