臨床研究と生命倫理ジャーナル

概要

Asymmetries of Patient Autonomy and Paternalism

Dragan Pavlovic and Alexander Spassov

It has been questioned whether it is morally acceptable for a husband or son [the closest family members] to be permitted to convince a terminally ill patient, an 83-year-old woman, contrary to her initial will, to continue to receive intensive but "futile" therapy. This implies another question: whether by this act of persuasion, the patient's autonomy is being seriously violated. We think that reviving the motivation to continue to live is not necessarily violating a person's autonomy, even if the objective quality of life would be unsatisfactory and that such an act also cannot be characterized as a restriction of a person's autonomy. Here it is maintained that there is an important asymmetry in the meaning of the principle of autonomy and of paternalism: while being quite permissive, when applied in cases of an eventual decision in favour of life, they are quite limited when applied as principles of conduct for decisions concerning the termination of life. The emotional concerns of some other actors in the patients close emotional circle [family members], could also be important for such decisions, if they had played an important role in the development of the patient's ethical and moral motives and attitudes during his/her lifetime. It would be similarly appropriate for psychologists and social psychiatrists to devote intensive attention to this question. If the latter failed to reach a rational decision, then it must be accepted that the "pro vita" decision cannot be refuted and that probably some forms of encouragement to accept advanced forms of life maintenance should be offered to the patients by those who are within her/his close emotional circle.