Fassin Didier
Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux, Centre National de la Recherche Scientifique, Ecole des Hautes Etudes en Sciences Sociales, Université Paris 13 - 96 Boulevard Raspail, 75 006 Paris, France.
Soc Sci Med. 2008 Jul;67(2):262-70. doi: 10.1016/j.socscimed.2008.03.044. Epub 2008 May 1.
Ethics is generally seen as the application of universal and intangible principles. Empirical studies then consist in verifying the degree of adequacy of practices to the norms. Here, conversely, ethics is considered as everyday practice: professionals, whether nurses or doctors, act within routines and under constraints, and later give an account of their action. Fieldwork was conducted during one year in the emergency and admission wards of a large South African hospital. It was based on interviews and observation and included feedback meetings for health professionals and focus group discussions with inhabitants of the neighbouring township. Ten elementary forms of care were identified in terms of patients' expectations. Five concerned the person as patient: ailment, problem, pain, agitation, life. Five concerned the patient as person: recognition, sovereignty, respect, privacy, interest. Discrepancies between claimed norms and actual practices were justified by health professionals in terms of workload, lack of resources and social deviance of patients. Ethnography suggests a more complex interpretation: on the one hand, technique-oriented professional ethos and efficiency-oriented organizational imperative are consequences of both historical territorial segregation and present resource inequalities. On the other hand, the lack of social recognition felt by nurses and doctors is in turn reflected in their moral evaluation of patients, which goes beyond concepts of values and worthiness. Although inscribed in the specific context of post-apartheid South Africa, the present description and analysis of practices has a broader scope as it proposes a way of approaching the elementary forms of care.
伦理学通常被视为普遍且无形原则的应用。实证研究则在于验证实践与规范的契合程度。相反，在此处，伦理学被视作日常实践：专业人员，无论是护士还是医生，都在常规和限制条件下开展工作，随后对自己的行为作出解释。在南非一家大型医院的急诊科和住院部进行了为期一年的实地调查。调查基于访谈和观察，包括与医疗专业人员的反馈会议以及与邻近城镇居民的焦点小组讨论。根据患者的期望确定了十种基本护理形式。其中五种涉及作为患者的人：疾病、问题、疼痛、焦虑、生命。另外五种涉及作为人的患者：认可、自主权、尊重、隐私、利益。医疗专业人员以工作量、资源匮乏以及患者的社会偏差行为来解释宣称的规范与实际做法之间的差异。人种志研究提出了一种更为复杂的解读：一方面，以技术为导向的职业精神和以效率为导向的组织要求是历史地域隔离和当前资源不平等的结果。另一方面，护士和医生所感受到的社会认可的缺失反过来又体现在他们对患者的道德评价中，这超越了价值观和价值观念的范畴。尽管本文对实践的描述和分析是在南非后种族隔离的特定背景下进行的，但它具有更广泛的意义，因为它提出了一种探讨基本护理形式的方法。
