漂移之作：由血液透析病患的存在與行動談社會本體論

Driftworks Ontology: An Ontological Exploration of Heamodialysis Patients' Modes of Existence and Action

當前的醫療研究中，病患的處境與醫療操作往往被化約為特定思考角度，或研究脈絡下的問題與現象。不論是結構或後結構對結構面向的探討，或是現象學與詮釋學、以行動為焦點的研究方向等，這些取徑由其本體論預設，探討了現實經驗變動中的部分現象，但卻無法理解在行動中變動的病患存在樣態。以血液透析病患行動的例子，本文以訪談、參與觀察、歷史文獻資料呈現病患在不同醫療相關處境下被中介的諸多存在樣態，提出一種在行動中介中變動的存在方式。藉此，本文提出「漂移之作」(driftworks)概念作為新的社會本體論思考 架構。漂移之作本體論致力於思考現實經驗中，異質、中介與開展中的社會存在。而此以經驗考察為基礎鋪陳的動態本體論，能化解過去社會理論常見的集體與個體存在的對立。這個思考方向希望能對其他研究領域中，同樣困惑於許多既有解釋架構中，將多元現象化約為單一現實以及殘餘現象，無法釐清社會性與物質性的關連、集體性與個體性交錯的研究者，指出一個不同於既有思考的概念工具與方向。

Equipped with patients' different ontological presumptions, structuralist, post-structuralist, phenomenological and hermeneutical, and action-oriented studies of medical practices reduce the phenomena of patients in action to issues of particular contexts. Based on fieldwork materials from interviews, an onsite ethnography, and documents that present the mediated existences of haemodialysis patients in action, this paper explores 'being in action' and proposes an alternative 'driftworks' ontology. This driftworks ontology is a means to investigating hetero geneous, mediated, and unfolding social existence in empirical experiences. Such an empirically based, dynamic ontology can transcend the antagonistic opposition of the individual and collective existences in social theory. It is hoped that this approach will be useful for researchers to tackle existing theoretical frameworks that reduce changing phenomena into a single reality and other residues and keep them from being trapped in dilemmas of intertwining materiality and sociality, and individuality and collectivity in other fields of research.