流行病防控的伦理分析

目前学界对流行病防控的伦理探讨尚十分欠缺,而现有的生命医学伦理学理论不能较好地解决流行病防控中的伦理问题,应用伦理学亟需对流行病防控做出伦理回应。流行病防控中主要涉及隐私、自由和正义三个方面的伦理问题,亦即个人权利或自由与公共健康的冲突问题。流行病防控对个人行为的家长主义干预,特别是对个人自愿自涉行为的强家长主义干预必须得到伦理证明。流行病防控与社会正义和人权也有十分密切的关系,促进正义与保护人权是流行病防控的应有之意。     

试论病人的自主性与医主之间的关系

病人具有自主性,应该受到医生的尊重。由于病人的自主性受到一些条件的限制,因而医主仍具有继续存在的价值。但是,除在一些特定情况下外,病人的自主性应优先于医主,然而医生又不能放弃自己的责任。     

A self-determination theory account of self-authorship: Implications for law and public policy

Self-authorship has been established as the basis of an influential liberal principle of legislation and public policy. Being the author of one’s own life is a significant component of one’s own well-being, and therefore is better understood from the viewpoint of the person whose life it is. However, most philosophical accounts, including Raz’s conception of self-authorship, rely on general and abstract principles rather than specific, individual psychological properties of the person whose life it is. We elaborate on the principles of self-authorship on the basis of self-determination theory, an empirically based psychological theory that has been at the forefront of the study of autonomy and self-authorship for more than 45 years. Our account transcends distinctions between positive and negative freedom and attempts to pinpoint the exact properties of self-authorship within the psychological processes of intrinsic motivation and internalization. If a primary objective of public policy is to support self-authorship, then it should be devised on the basis of how intrinsic motivation and internalization can be properly supported. Self-determination theory identifies three basic psychological needs: autonomy, competence, and relatedness. The satisfaction of these needs is associated with the support and growth of intrinsic tendencies and the advancement of well-being. Through this analysis, we can properly evaluate the significance of rationality, basic goods, and the availability of options to self-authorship. Implications for law and policy are discussed with an emphasis on legal paternalism and what many theorists call “liberal perfectionism,” that is, the non-coercive support and promotion of the good life.     

Autonomy gone awry: a cross-cultural study of parents’ experiences in neonatal intensive care units

This paper examines parents experiences of medical decision-making and coping with having a critically ill baby in the Neonatal Intensive Care Unit (NICU) from a cross-cultural perspective (France vs. U.S.A.). Though parents experiences in the NICU were very similar despite cultural and institutional differences, each system addresses their needs in a different way. Interviews with parents show that French parents expressed overall higher satisfaction with the care of their babies and were better able to cope with the loss of their child than American parents. Central to the French parents perception of autonomy and their sense of satisfaction were the strong doctor–patient relationship, the emphasis on medical certainty in prognosis versus uncertainty in the American context, and the sentimental work" provided by the team. The American setting, characterized by respect for parental autonomy, did not necessarily translate into full parental involvement in decision-making, and it limited the rapport between doctors and parents to the extent of parental isolation. This empirical comparative approach fosters a much-needed critique of philosophical principles by underscoring, from the parents perspective, the lack of emotional work" involved in the practice of autonomy in the American unit compared to the paternalistic European context. Beyond theoretical and ethical arguments, we must reconsider the practice of autonomy in particularly stressful situations by providing more specific means to cope, translating the impersonal language of rights" and decision-making into trusting, caring relationships, and sharing the responsibility for making tragic choices.     

On medicine, culture, and children's basic interests: a reply to three critics

Margaret Mohrmann, Paul Lauritzen, and Sumner Twiss raise questions about my account of basic interests, liberal theory, and the challenges of multiculturalism as developed in Children, Ethics, and Modern Medicine. Their questions point to foundational issues regarding the justification and limitation of parental authority to make decisions on behalf of children in medical and other contexts. One of the central questions in that regard is whether adults' decisions deserve to be respected, especially when they seem contrary to a child's or adolescent's basic interests. Questions about respect, in turn, focus attention on other's decisions about what seems good for families and children, decisions that may be paternalistic or utilitarian. Such decisions are further complicated by a child's or adolescent's budding autonomy and need for respect and recognition. Pediatric bioethics grounded in an account of a child's basic interests produces a theory of negative and positive rights for assessing adults' actions in relation to children, especially (but not only) when adults demand respect in their expressions of care.     

Autonomy, Slavery, and Mill's Critique of Paternalism

Critics have charged that John Stuart Mill's discussion as of paternalism in On Liberty is internally inconsistent, noting, for example, the numerous instances in which Mill explicitly endorses examples of paternalistic coercion. Similarly, commentators have noted an apparent contradiction between Mill's political liberalism – according to which the state should be neutral among competing conceptions of the good – and Mill's condemnation of non-autonomous ways of life, such as that of a servile wife. More generally, critics have argued that while Mill professes an allegiance to utilitarianism, he actually abandons it in favor of a view that values personal autonomy as the greatest intrinsic good. This paper presents an interpretation of Mill that provides a viable and consistent treatment of paternalism, thereby refuting each of the aforementioned critiques. Mill's views, it argues, are consistently utilitarian. Moreover, the interpretation accounts for all of Mill's departures from his otherwise blanket prohibition of paternalistic legislation. In particular, it explains his most notorious example, the condemnation of voluntary contracts for slavery. The interpretation emphasizes Mill's conceptual linkage between autonomy and utility, noting his implicit use of at least three different senses of the notion of autonomy.     

Resentment of Paternalism as System Change Sentiment: Hostile Sexism Toward Men and Actual Behavior in the 2008 U.S. Presidential Election

Taking inspiration from Glick and colleagues (2004), this study tested the idea that resentment of paternalism (which is part of the hostile sexism toward men construct) might approximate desire for system change by correlating this variable with actual behavior associated with system change in a single culture. Specifically, voting behavior in the 2008 U.S. presidential election was predicted from political party affiliation, measures of hostile and benevolent sexism toward both women and men, and egalitarian racial attitudes using a U.S. college student sample. Results indicated that the only significant predictors of voting behavior were political party affiliation, resentment of paternalism, and egalitarian racial attitudes. Higher levels of resentment of paternalism were in fact associated with voting for the ticket that represented system change—holding the other predictors constant.     

Is `Property' Necessary? On Owning the Human Body and its Parts

Courts usually treat control over human bodies and body parts as a property issue and find that people do not have property rights in themselves. This contradicts the liberal philosophical principle that people should be able to perform any self-regarding actions that do not cause harm to others. The philosophical inconsistencies under pinning the legal treatment of body parts arguably stem from a misplaced judicial preoccupation with‘property’. A better approach would be to hold a policy inquiry into the degree of liberty a society wishes to grant its inhabitants. Only once this substantive issue has been addressed should property be raised as a possible method of implementing the policy. This revised version was published online in August 2006 with corrections to the Cover Date.