安寧團隊的預期工作： 科學知識、情感與照護

"Anticipatory Palliative Care Work: Scientific Knowledge, Affective Force, and Care Practice"

安寧照護做為現代醫學制度的一部分，反思死亡醫療化，發展出面對死亡的科學知識與照護模式。因應生命末期照顧的不確定性，安寧團隊如何行動？本文使用「預期工作」，來統整醫事人員的核心照護活動，涉及科學預測、情感驅力與照護實作。研究資料包括2019-2020年的安寧病房參與觀察，以及深度訪談23位安寧團隊成員與21位病患家屬。本文發現：安寧團隊照護末期病人時，關注病人的存活期、醫療組織規範與病人的生命軌跡，分別代表臨床性、組織性與社會性時間。三種時間框架出現在安寧團隊的不同工作階段，包括預後評估、醫病溝通與照護實作。首先，安寧團隊以科學計算的方式，預測病人存活期。其次，醫病溝通時，安寧團隊呈現預測資訊，釐清病人家屬預想未來的情感，並規劃當下可行的行動。第三，安寧團隊為了預防病人受苦，進行身體舒適與情感層面的照護實作。安寧照護協助病人家屬預想近期之內的死亡，並在當下行動。安寧照護案例在幾個面向拓展了預期工作的分析範疇：一、社會成員除了寄望新的發展，也展望完滿的結束，也就是「善終」。二、末期照護進展快速且充滿不確定性，提升預測、溝通與行動的挑戰性，是所有預期工作之中最困難的一種。

"Palliative care in Taiwan is developing new scientific knowledge and new care practice standards. This paper uses the concept of ''anticipatory work'' to explore the nature of team-based palliative care work, including scientific predictions, affective forces, and care practices. Data were collected from interviews with caregivers and medical professionals plus one year of medical center participant observations. Three time frames were identified as central to palliative care team work: patient survival, medical institution regulations, and patient life trajectories, respectively representing clinical, institutional and social time frames. Palliative care teams estimate life expectancy, communicate predictions with patients and families, and enact care practices to minimize suffering, thus providing ways for patients and families to anticipate death and act in the present. To demonstrate the relevance of anticipatory work, this paper reframes palliative care as one in which individuals expect future progress while anticipating completion in the form of ''good deaths.''"