从技术主义到生命自决:乳腺癌预后知识的生产与转向  

From Technocracy to Self-Determination:On the Production and Shift of Prognostic Knowledge Concerning Breast Cancer

作　　者：姚泽麟[1] 陈蕾 YAO Ze-lin;CHEN Lei

机构地区：[1]华东师范大学社会发展学院,上海200241 [2]南京大学社会学院,南京210095

出　　处：《华东师范大学学报（哲学社会科学版）》2023年第3期106-118,172,共14页Journal of East China Normal University（Humanities and Social Sciences）

基　　金：国家社科基金一般项目“当代中国的医生职业伦理研究”(项目编号:18BSH082)。

摘　　要：对于疾病的医学知识阐释常常处于黑箱之中,这与民众对病痛的巨大知识需求形成了割裂。其中,癌症的预后知识关乎患者的疾病进展和未来生活,但既有研究多将其视作基于生物医学原理的技术体系,而较少探究其生成过程和社会基础。不可否认,预后知识依托于分子层面的医学证据、基于对大量患者的跟踪调查和临床试验的资料建立了一套科学的生存指标体系来指示结果。然而,高度技术化的预后知识不仅面对着临床世界中的不确定性后果,也因受到患者的日常知识逻辑的挑战而变得高度情境化。在诊疗过程中,作为技术的预后知识往往会被临床经验和患者的日常实践所修正和取舍,呈现出从面向技术到面向患者主体的知识再建构趋势。本文基于乳腺癌疾病的诊断、治疗,勾勒出医学中的预后知识的内涵和患者对看似确定的权威知识的意义再阐释,进而提出患者群体在预后知识的生产过程中应当不断地从“被决定的生命”走向“生命自决”的位置。The interpretation of diseases is often in a black box,which forms a huge gap with the need for the understanding of diseases among the public.The prognostic knowledge of cancer is related to the disease progression and future life of patients,but few people understand its production and social basis,and only regard it as a technical system based on biomedical principles.It is undeniable that prognostic knowledge relies on molecular-level medical evidence and a set of scientific survival indicator systems to indicate results based on follow-up surveys of a large number of patients and data from clinical trials.However,highly technical prognostic knowledge not only faces the uncertainty in the clinical world,but also becomes highly contextualized by being challenged by the logic of patients’everyday-life knowledge.In the process of diagnosis and treatment,technologically constructed prognostic knowledge is often revised and selected by clinical experience and patients’daily practice,realizing the result of knowledge reconstruction from technology-oriented to patient-oriented.Based on the diagnosis and treatment of breast cancer,this paper outlines the connotation of prognostic knowledge in medicine and the meaning of patients’reinterpretation of seemingly definite authoritative knowledge and propose that patient groups should move from“determined life”to“life self-determination”in the understanding of prognostic knowledge.

关 键 词：预后知识 建构主义 主体性 乳腺癌 

分 类 号：C91[经济管理] R737.9[社会学]