Frank Arthur W
Department of Sociology, University of Calgary, Alberta, Canada.
Theor Med Bioeth. 2002;23(3):219-32. doi: 10.1023/a:1020851509738.
The issue of boundaries in clinician-patient encounters is considered through narrative analysis of four clinical stories in which boundaries crossings are a self-conscious topic. One story is by a physician as patient, two are by physicians, and one is by a palliative care nurse. The stories are discussed using Walter Benjamin's distinction between the painter, who maintains distance and sees the whole, and the cameraman, who uses technology to penetrate realities and then reassembles fragments. The essay argues that distance and closeness are ethical issues that constitute the possibility of clinical encounters but the encounter also changes the clinician's sense of boundaries. The relevant ethics of boundary decisions in most clinical encounters are not procedural ethics but an ethics of self-creation: in orienting to boundaries as doctors do, they create themselves in their relations to others.
通过对四个临床故事的叙事分析，探讨了医患互动中的边界问题，在这些故事中，越界是一个自觉的主题。其中一个故事是医生作为患者的经历，两个是医生的经历，一个是姑息治疗护士的经历。运用沃尔特·本雅明对画家和摄影师的区分来讨论这些故事，画家保持距离并能看到整体，而摄影师利用技术深入现实然后重新组合片段。本文认为，距离和亲近是构成临床互动可能性的伦理问题，但这种互动也会改变临床医生的边界感。在大多数临床互动中，边界决策的相关伦理不是程序伦理，而是自我创造的伦理：就像医生确定边界一样，他们在与他人的关系中塑造自我。
