安寧照顧的運作語意：自主善終

Operational Semantics of Hospice Care: Autonomous Good Death

本文將安寧照顧視為一個社會系統，透過語意的分析來討論關於安寧照顧這個論題的社會溝通。我將指出，安寧照顧的成功依賴於將「善終」視為重要的溝通議題。在經久的溝通嘗試中，社會沉澱出「自主善終」這個新的歷史語意，更新傳統的善終意義，建立新的行為期待架構。在每次的運作中，安寧照顧必須一再區分好死／不得好死、尊嚴／喪失尊嚴、自主／失去自主。這確保了當下情境的動態性，同時保留說明在現代醫學及安寧照顧中不安寧、不得善終及不自主等照顧黑暗面及壓迫的可能性。一旦形成自主善終的期待框架及心理的感知結構，同時也會引入實際狀況的失望潛能，進而提供支持安樂死的可能條件。

By analyzing semantics, this article treats hospice care as a social system and will discuss the social communication of this theme. I will point out that the evolutional success of hospice care depends on taking good death as a communication medium. After society tries to experiment with different communicative possibilities, the new historical semantics term“autonomous good death”has received much attention, which renews the traditional concept of good death, building new expectations of social behaviors and new cognitive structure. In each operation, hospice care has to differentiate between good death vs. bad death, dignity vs. losing dignity, and autonomy vs. losing autonomy. Therefore, it maintains the dynamics of actual practice, while it can also reflect on the possibility of bad death, unpeaceful death and lack of autonomy. As soon as the expectational frame of autonomous good death emerges, it also brings the potential for disappointment. This opens up the possibility of euthanasia.