不理性的人也有权利:在决策能力评估中超越理性
1Academy for Medicine & the Humanities, Icahn School of Medicine at Mount Sinai, 140 Claremont Ave #3D, New York, NY, 10027, USA. jacobmappel@gmail.com.
Journal of bioethical inquiry
|March 9, 2026
概括
目前用于评估患者决策能力的"四个能力"模型在法律上是不一致的,可能会否认长期偏好的患者的自主权. 建议采用基于价值观或一致偏好的替代方法.
科学领域:
- 生物伦理学生物伦理学
- 医疗法 法律 医疗法
- 法律哲学 法律哲学
背景情况:
- 主导的"四个能力"模型评估决策能力严重依赖患者的推理.
- 这种模式被认为是一种法律异常,与其他关于社会和经济决策的法律领域不一致.
- 该模型可能会拒绝对那些有深入偏好的患者的自主权,而这些患者无法表达他们的推理.
研究的目的:
- 批评决策能力评估的"四个能力"模型.
- 提出一种评估决策能力的替代模型.
- 倡导一种更具包容性的方法,尊重患者的自主权.
主要方法:
- 对"四种能力"模式的法律和哲学分析.
- 与社会和经济决策中的法律标准进行比较.
- 开发一种基于价值观和一致偏好的替代模式.
主要成果:
- "四种能力"模型的依赖于理性思维与更广泛的法律原则是不一致的.
- 该模型无法适应患者长期存在但尚未表达的偏好.
- 提出了一个替代模型,结合了基于价值的方法和一致的偏好方法.
结论:
- "四个能力"模型需要进行重大修订,以确保患者的自主权.
- 基于价值观或一致的偏好方法为评估决策能力提供了更公平的框架.
- 改革决策能力评估对于维护患者在医疗保健中的权利和自治至关重要.
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