基于死亡叙事的医疗社会生态分析  

Medical Social Ecology Viewed from Death Narrative

作　　者：景军[1] JING Jun

机构地区：[1]清华大学社会学系,北京100084

出　　处：《思想战线》2022年第1期105-117,共13页Thinking

摘　　要：自2009年中共中央、国务院颁发《关于深化医药卫生体制改革的意见》以来,我国基本医疗卫生服务的可及性持续改善,医疗保障覆盖面逐步扩大,人民群众健康水平进一步提升。与此同时,医药卫生体制改革的深化受制于一系列来自医疗社会生态的严峻挑战。医疗社会生态是指,影响临床医学实践的卫生政策和医疗制度、支配政策制定和制度建设的价值观和思想意识、人们的健康需求和就医行为,以及关联医患关系的职业道德和社会信任。患者家属有关亲人病故经历的叙事可以作为审视医疗社会生态的一面透镜,其中折射而出的尖锐问题之一即是尊严死之难。这一难题的主要成因包括死亡的医学化、医疗机构的市场化、重大医事抉择的去主体化以及医疗家庭主义的固化。Since the CPC Central Committee and the State Council jointly issued the Proposals on Deepening Reform of Medical and Health System in 2009,China’s basic medical and healthcare serv⁃ices have become more accessible to the public,providing people with a greater coverage of medical security and a remarkable improvement of their health level.At the same time,medical reform has met challenges from China’s medical social ecology.By which we mean the health policy and medical sys⁃tem that affect clinical medical practice,the values and ideology that dominate policy formulation and system construction,people’s health needs and medical behavior,as well as the professional ethics and social trust related to the doctor-patient relationship.Narratives by relatives of deceased patients can be used as a lens to examine this ecology,through which we may find that one of the main prob⁃lems is the difficulty of death with dignity,which results partly from the market-oriented operation of the medical institutions,partly from the absence of the subjects in major medical decision-making,and partly from excessive dependence on families for last care.

关 键 词：死亡叙事 医疗社会生态 尊严死 死亡医学化 

分 类 号：C913[经济管理]