Suppr超能文献

《医生必须活下去》:对医生现代晚期苦难的关怀伦理探究

«Doctors must live»: a care ethics inquiry into physicians' late modern suffering.

作者信息

Engen Caroline

机构信息

Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.

Centre for the Study of the Sciences and the Humanities, University of Bergen, Bergen, Norway.

出版信息

Med Health Care Philos. 2025 Jun;28(2):275-290. doi: 10.1007/s11019-025-10258-7. Epub 2025 Feb 5.

Abstract

In 2023, thousands of young Norwegian physicians joined an online movement called #legermåleve (#doctorsmustlive) and shared stories of their own mental and somatic health issues, which they considered to be caused by unacceptable working conditions. This paper discusses this case as an extreme example of physicians' and healthcare workers' suffering in late modern societies, using Vosman and Niemeijer's approach of rethinking care imaginaries by a structured process of thinking along, counter-thinking and rethinking, bringing to bear suffering as a heuristic device. Thinking along, taking the physicians' stories and arguments literally, reveals an image of an unbearable workload. Counter-thinking resituates their suffering within the broader conditions of late modernity, suggesting that the root cause may lie not in the quantity of the workload itself but in its qualities and in its perceived threat to their integrity as caregivers through epistemic and moral injury and an inability to respond to this threat. In rethinking, the ambiguity of suffering- its dual potential as both a constraint and an opening- becomes central. Following the physicians' own interpretations and the solutions emerging from this framing, both their suffering and that of their patients could paradoxically be exacerbated by further decentering physicians and reinforcing utilitarian, data-driven approaches. However, staying with their suffering and reinterpreting its causes opens possibilities to leverage critiques of medicalization at large and of their own suffering in particular, challenging the assumption that the weight of care must always grow heavier. From this reframing, I argue, it is possible to reclaim and reimagine care and the clinical space as a nexus of epistemic and moral privilege, recentering response-ability both relationally and socially.

摘要

2023年,数千名年轻的挪威医生参与了一场名为#legermåleve(#医生必须生存)的线上运动,分享了他们自身身心方面的健康问题,他们认为这些问题是由不可接受的工作条件导致的。本文将此案例作为现代晚期社会中医生和医护人员苦难的极端例子进行探讨,运用沃斯曼和尼迈耶的方法,即通过顺向思考、逆向思考和重新思考的结构化过程来重新审视护理想象,将苦难作为一种启发式手段。顺向思考,即照字面理解医生们的故事和论点,揭示出不堪重负的工作量的图景。逆向思考则将他们的苦难置于现代晚期更广泛的背景中,表明根本原因可能不在于工作量本身的数量,而在于其性质以及通过认知和道德伤害对他们作为护理者的正直感构成的感知威胁,以及无法应对这种威胁。在重新思考中,苦难的模糊性——它作为一种限制和一种契机的双重潜力——变得至关重要。遵循医生们自己的解释以及由此框架产生的解决方案,进一步使医生边缘化并强化功利主义、数据驱动的方法可能会自相矛盾地加剧他们以及患者的苦难。然而,直面他们的苦难并重新解释其原因,为利用对整体医学化尤其是对他们自身苦难的批判开辟了可能性,挑战了护理负担必然总是越来越重的假设。我认为,通过这种重新构建,可以将护理和临床空间重新夺回并重新想象为认知和道德特权的纽带,在关系和社会层面重新确立回应能力的中心地位。

相似文献

1
«Doctors must live»: a care ethics inquiry into physicians' late modern suffering.
Med Health Care Philos. 2025 Jun;28(2):275-290. doi: 10.1007/s11019-025-10258-7. Epub 2025 Feb 5.
2
From Doctors' Stories to Doctors' Stories, and Back Again.
AMA J Ethics. 2017 Mar 1;19(3):272-280. doi: 10.1001/journalofethics.2017.19.3.nlit1-1703.
3
Appropriateness of care and moral distress among neonatal intensive care unit staff: repeated measurements.
Nurs Crit Care. 2016 May;21(3):e19-27. doi: 10.1111/nicc.12206. Epub 2015 Sep 18.
4
Reporting of euthanasia and physician-assisted suicide in the Netherlands: descriptive study.
BMC Med Ethics. 2009 Oct 27;10:18. doi: 10.1186/1472-6939-10-18.
5
Physicians' strikes and the competing bases of physicians' moral obligations.
Kennedy Inst Ethics J. 2013 Sep;23(3):249-74. doi: 10.1353/ken.2013.0010.
6
Physicians' Professionally Responsible Power: A Core Concept of Clinical Ethics.
J Med Philos. 2016 Feb;41(1):1-9. doi: 10.1093/jmp/jhv034. Epub 2015 Dec 14.
8
Physicians' perceptions of palliative sedation for existential suffering: a systematic review.
BMJ Support Palliat Care. 2020 Jun;10(2):136-144. doi: 10.1136/bmjspcare-2019-001865. Epub 2019 Sep 3.
9
Registered nurses' and physicians' reflections on their narratives about ethically difficult care episodes.
J Adv Nurs. 1994 Aug;20(2):245-50. doi: 10.1046/j.1365-2648.1994.20020245.x.
10

本文引用的文献

1
Addressing burnout in the healthcare workforce: current realities and mitigation strategies.
Lancet Reg Health Eur. 2024 Jun 11;42:100961. doi: 10.1016/j.lanepe.2024.100961. eCollection 2024 Jul.
3
Sociotechnical imaginaries in academic medicine strategic planning: a document analysis.
Adv Health Sci Educ Theory Pract. 2024 Sep;29(4):1435-1451. doi: 10.1007/s10459-024-10339-x. Epub 2024 May 27.
4
Job satisfaction and work stress among physicians in Norway and Germany-A cross-sectional study.
PLoS One. 2024 Jan 5;19(1):e0296703. doi: 10.1371/journal.pone.0296703. eCollection 2024.
5
A compassionate health service.
Tidsskr Nor Laegeforen. 2023 Nov 6;143(16). doi: 10.4045/tidsskr.23.0724. Print 2023 Nov 7.
6
The path to sustainable working conditions for doctors.
Tidsskr Nor Laegeforen. 2023 Aug 24;143(13). doi: 10.4045/tidsskr.23.0547. Print 2023 Sep 26.
7
Foucault and medicine: challenging normative claims.
Med Health Care Philos. 2023 Dec;26(4):539-548. doi: 10.1007/s11019-023-10170-y. Epub 2023 Sep 25.
9
Physician burnout and symptom of anxiety and depression: Burnout in Consultant Doctors in Ireland Study (BICDIS).
PLoS One. 2023 Mar 21;18(3):e0276027. doi: 10.1371/journal.pone.0276027. eCollection 2023.
10
Erosion of the 'ethical' doctor-patient relationship and the rise of physician burn-out.
Med Humanit. 2023 Sep;49(3):390-395. doi: 10.1136/medhum-2022-012506. Epub 2022 Dec 16.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验