以等级自主概念作为知情同意规范的基础何以可能?

How is it Possible to Take the Conception of Hierarchical Autonomy as the Foundation of Informed Consent Requirement?

一般认为,临床及研究领域的知情同意规范是为了尊重个人的自主选择。自主概念因而构成了知情同意规范的理论基础。从等级自主概念出发,一个人只有对引发自己的行动的一阶欲望进行二阶反思后予以认同,其行动才能被视为自主行动。现有知情同意理论的提出者法登和比彻姆对等级自主概念提出了批评,但是笔者认为他们对该概念的批评并不成立。等级自主概念要作为知情同意规范的基础面临至少两个问题。首先,等级自主概念不应当要求个人必须对自己的行动背后的动机进行反思,而只应当要求个人在做出行动时能够正常地发挥反思能力。其次,等级自主概念不应当只关注个人是否有能力通过二阶欲望对一阶欲望进行调控,还应当关注个人有能力实现多少符合二阶欲望的一阶欲望。

It is generally acknowledged that the purpose of informed consent requirement in clinical and research areas is to respect for the autonomous choices of individuals,and the concept of autonomy constitutes the theoretical basis of informed consent requirement.According to the conception of hierarchical autonomy,one's action can be regarded as autonomous only if one's second-order desire reflectively identify with his or her first-order desire which leads to the action.Although Faden and Beauchamp who proposed the existing theory of informed consent reject the conception of hierarchical autonomy,the author believes that their criticism of this conception is not tenable.However,in order to serve as the foundation of informed consent requirement,hierarchical autonomy is still faced with at least two problems.First,it should not require that one must reflect on his or her motive when taking an action,but only needs to require that one is able to reflect on his or her motive when taking an action.Second,it should not only be concerned with whether one is able to regulate his or her first-order desires with second-ordeT desires,but should also be concerned with how many first-order desires in accordance with second-order desires that one is able to realize.