最後一段旅程——剖析癌症病人在醫院的垂死歷程

The Final Stage of Life in the Hospital

本論文是一個探索性研究，主要探索醫療專業的發展對現代人垂死歷程的影響。以往對現代醫療體制的研究，大多是由結構，制度面著手，容易忽略了行動者主觀意義的詮釋，本研究乃企圖理解行動者認知感受的角度（包括：醫護人員，病人，病人家屬等）。以十個癌末病人為個案，透過醫院這套儀式化的「死亡處理」在醫療情境中的運作，來反省現今一般醫療機構在照顧臨終病人所產生的問題。本研究進一步將近年來國內大力推廣安寧療護的臨終關懷死亡處理，與一般醫療體制下的死亡處理做一個對照，問題焦點在比較兩組行動者的醫病關係與醫療處置。藉著剖析一群被標籤為“快要死的病人”，本研究總結指出現今醫療機構的深層問題。

This paper is an exploratory study of the influence of the modern medical profession on the process of dying. This study departs from conventional sociological studies on modern medical institution which have concentrated on analyzing the aspects of structure and/or institution by shifting the focus to the interpretation of the meanings constructed by actors involved in the dying process occurring in a medical institution such as the medical staff, patient, and the patient's family. In examining the cases of dying cancer patients, the paper analyzes hew ''ritualized'' management is given to a dying patient in a medical institution and discusses the essential problems caused by this kind of management. The study further compares the management given to dying patients by a conventional medical institution with that of hospices, which have been increasingly popular in Taiwan in recent years. Focusing on the two sorts of medical management given to dying patients and the professional-patient relationship existing among the actors involved in the process of dying, the paper discusses the major problems encountered by one who is labeled as a ''dying patient'' by the modern medical profession.