Interhorcruxicity: Beyond the Individualism-Familism Dichotomy Regarding Patient Autonomy
The Patient Right to Autonomy Act, enacted in 2019, is the first “patient-centered” act in Taiwan. Until then, the meaning of “autonomy” had gone through a long-standing debate. Although a consensus acknowledging the primacy of the patient’s will as well as the assistant role of the patient’s family was finally achieved, the tension between western individualism and eastern familism remains far from resolution. Some scholars maintain that “relational autonomy” would be a suitable ethical basis for this consensus and a midway between the two ideologies above. We should be aware, however, that “relational autonomy” has its roots in the western context and should not be transplanted to Taiwan without modifications. Indeed, it is necessary for Taiwan to develop its own version of relational autonomy which tackles particularly the individualism-familism dichotomy. This article proposes the idea of “interhorcruxicity” as the core of such a version. Formulated through narrative inquiry into my experience as a physician, interhorcruxicity depicts the fact that we all store our memories, emotions, expectations, and identities in significant others, by which we make them our “horcruxes.” (Here I use J. K. Rowling’s fictional object as a metaphor.) Reciprocally, we become their horcruxes as well. The boundaries between the self and significant others, therefore, are not lines but gradient zones, and are not always equal to boundaries between bodies. It is then ethically legitimate for the patient’s family to express concern about how the patient treats their own body, and for the patient to take their family’s opinions into consideration. Meanwhile, the patient’s subjectivity and primacy are both guaranteed. This new idea of self and autonomy not only lays an ethical foundation to current legal consensus but also provides health professionals with a useful lens through which they can look into the complicated patient-family dynamics and bring out the best in both parties.
|關鍵詞||互為分靈體、尊重自主、預立醫療照顧諮商、關係式自我、關係式自主、interhorcruxicity、respect for autonomy、advance care planning、relational self、relational autonomy|