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从嵌入到互构:中国安宁疗护本土化发展的挑战与机遇

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中国的安宁疗护在过去十多年间取得了令人瞩目的发展.全国各地相继出现了安宁疗护的病区、科室、护理院等,以及与之相关的公众科普与宣传活动.但是,安宁疗护作为一项新的医疗实践引入当下中国的医疗体系,需要经过本土化过程才能真正落地.基于对各级医疗与养老机构中安宁疗护实践的调查,本文通过"嵌入"和"互构"两个概念来呈现中国安宁疗护本土化过程中发生的变化,着重分析其面临的挑战和发展动力,并对未来发展做出展望.首先,由于中国的安宁疗护往往并不以独立机构的形式出现,而主要是嵌入在现有的医疗或养老机构中,安宁疗护工作的开展面临诸多固有制度与社会文化的掣肘.另一方面,随着安宁疗护实践的深入,其逐渐与现有医疗场域的制度和文化互相影响、互相建构,在这种互动中获得发展的动力和机遇.展望未来,要发展符合国情的安宁疗护,应该发掘本土资源,找到安宁疗护与我国文化与制度相契合之处,鼓励安宁疗护根据中国社会的现实环境而进行调整.同时,也需要在制度和文化方面打通一些关键的环节,如建立合理的支付制度,保障多渠道资金来源,以及转变从业者和民众的观念.如何面对中国安宁疗护所带来的风险与挑战,仍是未竟的课题.
From Embedding Relations to Constitutive Relations:Challenges and Opportunities of the Indigenization of Hospice Care in China
Hospice care in China has made remarkable progress over the past decade.It is now practiced at vari-ous kinds of hospitals and care homes across the nation,with a stronger presence in media and public cam-paigns.However,hospice care as a new set of practices needs to go through a process of indigenization in order to be fully developed in China.Based on research conducted at different levels of medical institu-tions and care homes,this paper draws on the concepts of"embedding relations"and"constitutive rela-tions"to reveal the challenges and opportunities of the indigenization of hospice care in Chinese medical settings.On the one hand,hospice care is deeply embedded within the specific institutions where it is car-ried out,therefore facing many institutional obstacles and cultural constraints.On the other hand,hospice care and existing institutions constantly influence and change each other's practices.Such constitutive re-lations are the driving force behind the development of hospice care.For future development,practices of hospice care needs to better adjust to the institutional and cultural environment of the Chinese society,while also calling for updated policies and value systems,e.g.more suitable payment arrangements,more resource input,and better education campaigns.

涂炯、梅笑

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中山大学社会学与人类学学院 广州510275

复旦大学社会发展与公共政策学院 上海200433

安宁疗护 本土化 健康中国 嵌入性 互构

2024

广东社会科学
广东省社会科学院

广东社会科学

CSSCICHSSCD北大核心
影响因子:0.765
ISSN:1000-114X
年,卷(期):2024.(2)
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