临终关怀在我国乡村面临的困境与出路

Dilemma and Way out for Hospice Care in Rural China

在病重即将离开人世前,多数人往往会面临到难以言喻的身心折磨、生活不能自理的尴尬处境以及灾难性的医疗支出等窘况。2017年以来,我国政府先后在全国设立了70多个安宁疗护试点,这代表着一种以城市医院和城市社区卫生服务中心为依托的临终关怀模式正在逐步建立。本文通过探索乡村临终关怀多样化的实现途径,尝试破解农村居民的善终之难。对乡村临终关怀模式的研究,不仅有助于社会主义新农村建设,同时还能推动新农村文化的发展。20多年前,施榕提出的村医与家庭并联的乡村临终关怀模式——“施榕模式”,如今依然具有合理性,但却在实践过程中遭遇到严峻的挑战,其面临着如下困境:一是农村居民就医行为多元化引致临终地点不确定,二是村医缺乏从事临终关怀服务的积极性,三是村医普遍缺乏实施舒缓医学的经验、村医参与临终关怀服务能力不足等。本文基于福建七个村庄实地调查结果,试图阐释“施榕模式”在当前已经难以作为建构乡村临终关怀模式的蓝本,农村临终患者的就医情况、村医诊疗的实际情况均背离了施榕当年的设想。因此,临终关怀事业在我国农村的发展,需要针对“施榕模式”面临的困境,采取以下三个方面的破解策略:一是提升村医介入临终关怀的条件和能力,二是充分利用民间资源助力村医介入乡村临终关怀,三是发挥乡村老年协会的功能以增加“施榕模式”的亲和力。

Before approaching the end of life,most people tend to face unspeakable physical and mental suffering,an inability to take care of themselves,and catastrophic medical expenses.Since 2017,the Chinese government has set up over 70 pilot hospice care programs across the country,which represents the gradual establishment of a hospice care model based on urban hospitals and urban community health service centers.This paper tries to find solutions for providing good hospice care system for rural elderly through exploring the diversified measures of rural hospice care system.The study of rural hospice care can not only contribute to the construction of new socialist countryside,but also promote the development of new rural culture.More than 20 years ago,Shi Rong proposed the“Shi Rong Model”,a rural hospice care model connecting village doctors and families,which remains its rationality up until present.However,in practice,it encounters severe challenges as follows:first,the diversification of rural residents’medical preferences leads to uncertainty in setting up hospice care centers;second,village doctors lack the enthusiasm to engage in hospice care services;third,village doctors generally lack experience in implementing palliative medication,and they are not fully capable in participating hospice care services.Based on the field survey of seven villages in Fujian,this paper tries to explain that the“Shi Rong model”is no longer effective to be referred to when constructing the rural hospice care model.The medical treatment of rural dying patients and the actual situation of the diagnosis and treatment of village doctors have both deviated from Shi Rong’s assumption at that time.Therefore,the development of hospice care in China’s rural areas needs to adopt the following three aspects as difficulties faced by the“Shi Rong model”:first is to improve the conditions and ability of village doctors to intervene in hospice care;the second is to fully utilize private resources to help village doctors to intervene in rural hospice care;thirdly,to sufficiently enable the function of rural elderly association so as to optimize the affinity of“Shi Rong model”.