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不干预作为一种护理形式:临终时的医疗实践协商

Not intervening as a form of care: Negotiating medical practices at the end-of-life.

作者信息

Cohn Simon, Borgstrom Erica, Driessen Annelieke

机构信息

Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.

School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK.

出版信息

Med Anthropol Q. 2025 Mar;39(1):e12881. doi: 10.1111/maq.12881. Epub 2024 Aug 27.

Abstract

Biomedicine is organized around interventions. Despite growing concern about overtreatment in healthcare systems, not intervening can still raise questions about potential negligence and the quality of care. Based on ethnographic fieldwork with palliative care teams in England, we explore the work palliative care specialists do to reduce and sometimes halt interventions for patients at the end-of-life, in a general medical environment that is largely interventionist. We describe how judgments about what is an action or not aren't based on obvious or agreed criteria, but ultimately according to what different actors feel constitutes the best form of care. In other words, the underlying values that shape ideas of care determine how action and inaction are nominated, and not the other way around.

摘要

生物医学围绕干预措施展开。尽管医疗系统中对过度治疗的担忧日益增加,但不进行干预仍可能引发对潜在疏忽和护理质量的质疑。基于对英国姑息治疗团队的人种志实地研究,我们探讨了在一个大体上倾向于干预的普通医疗环境中,姑息治疗专家为减少甚至有时停止对临终患者的干预所做的工作。我们描述了关于什么是行动或不作为的判断并非基于明显或一致的标准,而是最终取决于不同行为者认为什么构成最佳护理形式。换句话说,塑造护理观念的潜在价值观决定了如何界定行动和不作为,而不是相反。

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