摘要
在社会老龄化与技术主导型医疗模式的双重压力下,技术至上的诊疗逻辑削弱了患者叙事主体的地位,传统家庭伦理与个人自主权的矛盾在临终决策中尤为凸显,安宁疗护领域遭遇了传统伦理框架失效的危机。本研究基于叙事医学理论,探索通过医患叙事交互重构,革新伦理决策机制。叙事医学借助平行医疗叙事记录与共情理解,推动临床关注点从病理干预转向生命价值阐释,为伦理困境提供具象化分析路径。患者的疾病故事不仅映射其对临终尊严的核心诉求,更揭示家庭集体决策与个体意愿之间的复杂博弈。本研究提出“叙事-伦理”双轨评估框架,利用叙事解码故事中潜在的医患双方的价值取向,并创建多学科叙事对话平台,协调医生、患者和家属的立场,叙事伦理督导制度与融合情感分析技术,实现从理论向操作规范的转化。叙事医学通过确立患者的叙事主权,在技术异化的医疗中重塑基于叙事伦理正义的新型生态,为中国语境下的安宁疗护体系创新,提供兼具人文温度与制度理性的实践范式。
Under the dual pressures of social aging and a technologically driven medical model,the logic of technology-centered clinical practice has undermined patients'narrative agency.The tension between traditional family ethics and individual autonomy becomes particularly pronounced in end-of-life decision-making,leading palliative care into a crisis where conventional ethical frameworks no longer suffice.Drawing upon narrative medicine theory,this study explores the reconstruction of ethical decision-making mechanisms through narrative interaction between healthcare providers and patients.Narrative medicine,by means of parallel chart narratives and empathetic understanding,shifts the focus of clinical practice from pathological intervention to the interpretation of life values,offering a concrete analytical approach to ethical dilemmas.Patients'illness stories not only reflect their core aspirations for dignity at the end of life,but also reveal the complex interplay between collective family decisions and individual will.This study proposes a"narrative-ethics"dual-track evaluation framework that decodes underlying value orientations of both clinicians and patients through narrative analysis.It also establishes an interdisciplinary narrative dialogue platform to mediate the positions of doctors,patients,and families.By integrating narrative ethics supervision with emotion analytics technologies,the framework facilitates the transformation from theoretical insights into practical guidelines.Through affirming patients'narrative sovereignty,narrative medicine res hapes a new medical ecology grounded in narrative ethical justice amid technological alienation.This approach offers a practice paradigm for the innovation of palliative care systems in the Chinese context-one that combines humanistic warmth with institutional rationality.
作者
张玲希
谢小萍
陈新宇
Zhang Lingxi;Xie Xiaoping;Chen Xinyu(Zhejiang Hospital,Hangzhou 310013,Zhejiang,China)
出处
《叙事医学》
2025年第3期181-188,195,共9页
Narrative Medicine
关键词
医学伦理
叙事医学
安宁疗护
政策建议
Medical ethics
Narrative medicine
Palliative care
Policy recom mendations
