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首页> 外文期刊>BMC Medical Ethics >Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature
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Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature

机译：关系自治：这是什么意思，它在临终护理中如何使用？对基于争论的伦理文学的系统回顾

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Respect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics. Using PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced. Fifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations. Three main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations.
机译：尊重自治是当代生物伦理学尤其是生命终结伦理学的一个关键概念。尽管有这种地位，但从不同的理论传统的角度来看，对自治的个人主义解释正在受到挑战。许多作者认为，尊重自治的原则需要从关系的角度重新概念化。沿着这些思路，关系自治的概念在医学伦理学中引起了越来越多的关注。然而，其他人则认为，关系自治需要进一步阐明，以便能够在医疗实践中得到充分运用。为此，我们在生命终结护理伦理学的特定文献中研究了关系自治的含义，基础和用途。我们使用PRESS和PRISMA程序，对生命医学中8个主要的生物医学，哲学和神学文献数据库进行了基于论点的伦理学出版物的系统综述，这些数据库重点关注生命终结护理中的关系自主性。筛选了全文。所有纳入的文章均经过严格评估，并进行了综合。五十种出版物符合我们的纳入标准。最近5年发表了28篇文章;出版物来自18个不同的国家。结果的组织根据：（a）对自治的个人主义解释; （b）对这种对自治的个人主义解释的批评; （c）理论上概念上的关系自治; （d）关系自主权，适用于临终情况下的临床实践和道德判断。得出三个主要结论。首先，关于关系自治的文献倾向于更多地是对个体自治的个人解释的“反应”，而不是积极的概念本身。二分法思维可以通过更深层次地发展自主性哲学基础来克服。其次，关系自治是一个丰富而复杂的概念，它是从不同的哲学渊源以互补的方式提出的。传统分歧观点之间的新对话将阐明其含义。第三，我们的分析强调在报废情况下的决策制定中需要对话发展。这三个要素的整合可能会导致在生命终结护理伦理学中关系自主的概念更加清晰。反过来，这应该可以在现实生活中做出更好的决策。

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