McNamara B, Waddell C, Colvin M
Department of Anthropology, University of Western Australia, Nedlands.
Soc Sci Med. 1994 Dec;39(11):1501-8. doi: 10.1016/0277-9536(94)90002-7.
There has been some recent concern in Britain and North America that the increasing institutionalization of hospice care may compromise the movement's founding ideals. The threats posed by the encroachment of mainstream medicine and the medical technological imperative to treat, are also a source of concern to hospice administrators and staff. This study uses Australian data based on interviews with nurses and participant observation in an in-patient hospice unit and a community based hospice service to investigate whether the Good Death ideal, as central to the hospice philosophy, is compatible with the institutionalization of hospice care. The issues that arise, although interrelated are conceptualized as the following five challenges to hospice care: (1) encroachment of mainstream medicine and the medical technical imperative; (2) competing motivations; (3) delimitation of intellectual structures; (4) organizational maintenance; and (5) routinization of the Good Death. This conceptual framework is based on the way in which nurses and other health care professionals have used shared logic and strategies to negotiate the daily demands of their work and illustrates the tension that arises between the maintenance of the ideal and the maintenance of the organization.
最近在英国和北美出现了一些担忧，即临终关怀护理机构化程度的不断提高可能会损害该运动的创始理想。主流医学的侵蚀以及治疗的医疗技术必要性所带来的威胁，也是临终关怀管理人员和工作人员所关注的问题。本研究利用澳大利亚的数据，这些数据基于对护士的访谈以及在一家住院临终关怀病房和一项社区临终关怀服务中的参与观察，以调查作为临终关怀理念核心的“善终”理想是否与临终关怀护理的机构化相兼容。所出现的问题虽然相互关联，但被概念化为对临终关怀护理的以下五个挑战：（1）主流医学的侵蚀和医疗技术必要性；（2）相互冲突的动机；（3）知识结构的界定；（4）组织维持；以及（5）“善终”的常规化。这个概念框架基于护士和其他医疗保健专业人员用以协商其日常工作需求的共享逻辑和策略的方式，并说明了在维护理想与维护组织之间所产生的紧张关系。
