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尊重自主是生命伦理学基本原则,关于该原则存在两种代表性主张,一种将自主理解为密尔式的个人自主;一种则将自主理解为康德式的原则自主。由于康德伦理学原则存在形式与内容的分裂以及绝对化等问题,奥尼尔关于生命伦理应回归康德原则自主的主张并不恰当。相比之下,个人自主观念在生命伦理中是更有希望的,它反映出当今社会的广泛伦理共识,且比原则自主观念更有利于患者或受试者权益的保护。不过,密尔的个人自主观念本身还存在缺陷,为了提升尊重自主原则在生命伦理中的指导力和辩护力,必须对密尔式尊重自主原则进行修正和补充。
Respect for autonomy is the basic principle of bioethics. There are two representative ideas about this principle, one that understands autonomy as the Mill’s personal autonomy, and one that comprehends autonomy as Kant’s principle autonomy. Owing to the existence of the divisions and absolute forms of the Kantian ethics principle and other issues, it is not appropriate for O’Neill’s claim that bioethics should return to Kant’s principle autonomy. In contrast, the idea of individual autonomy is more promising in bioethics. It reflects the broad ethical consensus in today’s society and is more conducive to the protection of patients or subjects’ rights than the concept of principle autonomy. However, Mill’s personal concept of self-existence is still flawed. In order to enhance the guiding and defense power of respecting the principle of autonomy in bioethics, it is necessary to revise and supplement the principle of self-determination of Mill.