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題名：醫療化理論的後進國批判：以臺灣慢性腎病治理的知識、專業與體制轉變為例
書刊名：臺灣社會學
作者：林文源 引用關係
作者(外文)：Lin, Wen-yuan
出版日期：2012
卷期：24
頁次：頁1-53
主題關鍵詞：醫療化；後進；科技治理；專業宰制；慢性腎病；Medicalization；Latecomer；Professional dominance；Technological governance；Chronic kidney disease；CKD
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(17) 博士論文(0) 專書(1) 專書論文(4)
  • 排除自我引用排除自我引用:11
  • 共同引用共同引用:135
  • 點閱點閱:128
台灣慢性腎病防治體制在近十年間迅速建立。相較於以先進國經 驗發展的醫療化理論，本文以此案例挑戰其缺乏國際與在地互動面向 的盲點，指出其中「自我後進化」的後進國醫療化。本文引入科技與 社會研究的科技治理觀點，深入本地脈絡，分析其中的知識、專業策 略與體制特質，並藉此批判醫療化理論的全稱式命題。2001 年後，面 臨透析醫療體制壓力的腎臟專業，藉由政策機制賦予規劃、執行、評 估合一的地位，忽視在地現實，以國際統計發展新國病論述並黑盒化 充滿爭議的臨床指標，迅速建立慢性腎病防治體制。此體制的影響 為：專業上，造成腎臟專業內部分化卻轉變其地位的專業擴權；體制 上，惡化既有院所失衡問題；臨床上，對篩檢出的病患支持不足，可 能造成「醫源病」。本案例凸顯「自我後進化」的後進國醫療化模式 為：計畫導向的政策機制，賦予醫療專業制度機會；醫療專業以片面 知識與論述策略，型塑問題與解決方案，以扭轉地位；爭議中的知識 則在此過程中，被黑盒化為先進、普遍知識而應用於後進化的在地。
A national chronic kidney disease (CKD) prevention system was established between 2001 and 2011 in Taiwan. Instead of following the theory of medicalization developed in the context of advanced countries, this paper draws on the perspective of technological governance from science, technology, and society studies and analyzes how a medical profession "promotes" the disease and transforms its status and the medical regime in a latecomer country. This study criticizes medicalization theory for ignoring this latecomer context. Since the millennium, the Taiwanese nephrological profession, faced with financial and professional pressure in the dialysis regime, has promoted a "new national disease" discourse on the basis of international statistics and the black-boxed clinical index of eGFR. The discourse and index facilitate the implementation of a CKD regime in a project-oriented policy-making mechanism at the expense of ignoring clinical, professional, and social complexities. This regime has the following consequences: It reverses the status of the nephrological profession but causes internal diversification; it worsens the imbalance between hospitals and local clinics; and its insufficient understanding of and support to diagnosed patients might cause iatrogenesis. In conclusion, this study specifies the "self-latecomerization" characteristics of the profession, knowledge, and policy-making mechanisms of latecomer medicalization.
期刊論文
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5.曾凡慈(20080600)。發現「遲緩兒童」：科學認知、權力技術與社會秩序。臺灣社會學，15，165-213。new window  延伸查詢new window
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圖書論文
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