De Clercq E, Elger B S, Wangmo T
Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
Eur J Cancer Care (Engl). 2017 Nov;26(6). doi: 10.1111/ecc.12651. Epub 2017 Feb 8.
Illness narratives have become very popular. The stories of children, however, are rarely ever studied. This paper aims to provide insight into how children, parents and physicians make sense of progressive childhood cancer. It also explores how this meaning-giving process interacts with cultural dominant stories on cancer and dying. The presented data come from 16 open-ended face-to-face interviews with palliative paediatric patients, their parents and physicians. The interviews were carried out in eight paediatric oncology centres in Switzerland. Data analysis followed Arthur Frank's dialogical narrative analysis. Quest narratives were relatively rare compared to both chaos and restitution stories. All participants welcomed chaos stories as a liminal haven between quest and restitution. The possibility that the child could die was either ignored or briefly contemplated, but then immediately pushed away. Except for one patient, children never directly addressed the topic of death. The way in which death was presented raises important questions about how the social discourse on dying is framed in terms of choice, autonomy and individuality. This discourse not only determines the way in which children and adults relate to the minor's death, it also constitutes an obstacle to children's participation in decision-making.
疾病叙事已变得非常流行。然而,儿童的故事却很少被研究。本文旨在深入了解儿童、父母和医生如何理解进行性儿童癌症。它还探讨了这个赋予意义的过程如何与关于癌症和死亡的文化主导故事相互作用。所呈现的数据来自对16名姑息治疗儿科患者、他们的父母和医生进行的开放式面对面访谈。访谈在瑞士的八个儿科肿瘤中心进行。数据分析采用了亚瑟·弗兰克的对话式叙事分析方法。与混乱和复原故事相比,探索叙事相对较少。所有参与者都欢迎混乱故事,将其视为探索与复原之间的阈限避风港。孩子可能死亡的可能性要么被忽视,要么被短暂思考,但随后立即被推开。除了一名患者外,孩子们从未直接提及死亡话题。死亡呈现的方式引发了关于社会对死亡的论述如何在选择、自主性和个性方面构建的重要问题。这种论述不仅决定了儿童和成年人与未成年人死亡的关系方式,也构成了儿童参与决策的障碍。