'To improve quality of life': Diverging enactments of a value in nephrology clinical practices.

IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Health Pub Date : 2024-09-01 Epub Date: 2023-09-29 DOI:10.1177/13634593231200128
Anna Mann
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引用次数: 0

Abstract

Quality of life has become a central value in the provision of healthcare for patients with chronic conditions. This has engendered debates in critical medical sociology on the non-neutral effects that valuing health and illness, medical interventions, and health care delivery in terms of quality of life yields. Focusing on the case of nephrology, this paper presents qualitative data collected in Austria of two dialysis units in which nephrologists initiated projects aimed towards 'the improvement of patients' quality of life'. Whereas the first involved nurses supporting patients in the administration of peritoneal dialysis at home, the second implied the provision of treatment and care exclusively focused on a well-being 'in the here and now' to patients. By conceptualising physicians as actors within networks of relations and values enacted in practices, it analyses how in both dialysis units reference to quality of life enabled nephrologists to problematise the provision of standard haemodialysis treatment to multi-morbid, elderly patients, to develop a new treatment protocol, and to interest and enrol others in the provision of healthcare according this new protocol. Valuing medical interventions in terms of quality of life not only leads to a governmentalization of living and an economisation of health. It also allows physicians to articulate a socio-medico-ethical problem - the availability of life-prolonging technologies for a growing population of elderly, multi-morbid patients - and develop solutions locally. What the solutions consist in may fundamentally differ, however.

“提高生活质量”:肾脏病临床实践中价值的不同体现。
生活质量已成为为慢性病患者提供医疗保健的核心价值。这在批判性医学社会学中引发了关于非中性影响的辩论,即从生活质量的角度来评估健康和疾病、医疗干预和医疗保健的提供。本文以肾脏病学为例,介绍了在奥地利收集的两个透析单位的定性数据,肾脏病学家在这两个单位启动了旨在“提高患者生活质量”的项目。第一个涉及护士在家支持患者进行腹膜透析,而第二个则意味着提供的治疗和护理只关注患者“此时此地”的福祉。通过将医生概念化为实践中制定的关系和价值观网络中的行动者,它分析了在两个透析单位中,参考生活质量如何使肾脏病学家能够对向多病老年患者提供标准血液透析治疗提出问题,以制定新的治疗方案,以及根据这一新协议感兴趣并让其他人参与提供医疗保健。从生活质量的角度重视医疗干预不仅会导致生活的政府化和健康的经济化。它还允许医生阐明一个社会医学伦理问题——为越来越多的老年多病患者提供延长生命的技术——并在当地制定解决方案。然而,解决方案可能存在根本性的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health
Health Multiple-
CiteScore
4.90
自引率
0.00%
发文量
0
期刊介绍: Health: is published four times per year and attempts in each number to offer a mix of articles that inform or that provoke debate. The readership of the journal is wide and drawn from different disciplines and from workers both inside and outside the health care professions. Widely abstracted, Health: ensures authors an extensive and informed readership for their work. It also seeks to offer authors as short a delay as possible between submission and publication. Most articles are reviewed within 4-6 weeks of submission and those accepted are published within a year of that decision.
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