van Beinum Amanda
Department of Sociology and Anthropology, Carleton University, Ottawa, Ontario, Canada; Centre for Health Law, Policy and Ethics, University of Ottawa, Ottawa, Ontario, Canada.
Soc Sci Med. 2023 Mar;321:115769. doi: 10.1016/j.socscimed.2023.115769. Epub 2023 Feb 17.
Intensive care units are considered life-saving medical services and a vital component of healthcare systems. These specialized hospital wards contain the life support machines and technical expertise to sustain seriously ill and injured bodies. However, as the COVID-19 pandemic has demonstrated, intensive care is an expensive, finite resource which is not necessarily available to all citizens, and which may be unjustly rationed. As a result, the intensive care unit may contribute more towards biopolitical narratives of investment in lifesaving than measurable improvements in population health. Drawing from ethnographic fieldwork and a decade of involvement in clinical research, this paper examines everyday activities of lifesaving in the intensive care unit and interrogates epistemological assumptions upon which they are organized. A closer look at how healthcare professionals, medical devices, patients, and families accept, refuse, and modify imposed boundaries of bodily finitude reveals how activities of lifesaving often lead to uncertainty and may even impose harm when they deny possibilities for desired death. Refiguring death as a personal ethical threshold, rather than inherently tragic ending, challenges the power of the logic of lifesaving and instead insists on greater attention towards improving conditions for living.
重症监护病房被视为挽救生命的医疗服务，也是医疗保健系统的重要组成部分。这些专门的医院病房配备了维持重症患者和受伤者生命的生命支持设备和专业技术。然而，正如新冠疫情所表明的那样，重症监护是一种昂贵且有限的资源，并非所有公民都能获得，而且可能会被不合理地分配。因此，重症监护病房对挽救生命的生物政治叙事的贡献可能更多地体现在投资方面，而非对人群健康有可衡量的改善。本文基于人种志田野调查以及十年来参与临床研究的经验，审视了重症监护病房中挽救生命的日常活动，并审视了这些活动所基于的认识论假设。仔细观察医疗保健专业人员、医疗设备、患者及其家属如何接受、拒绝和修改强加于身体有限性的界限，揭示出挽救生命的活动往往会导致不确定性，甚至当它们剥夺了期望死亡的可能性时可能会造成伤害。将死亡重新定义为个人的道德界限，而非固有悲剧的结局，挑战了挽救生命逻辑的力量，转而坚持更加关注改善生活条件。
