老龄社会的长寿制造:伦理情感与老年医疗支出的关联

Making Longevity in an Aging Society:Linking Ethical Sensibility and Medicare Spending

老龄化的社会、不断发展的延长生命的医疗干预、老年医保政策和个体决策的伦理,共同造就了美国日益严重的社会紧张:一方面要控制医保费用,一方面又要促进健康消费者使用生命维持技术。这些制造长寿的活动,就像许多其他的社会医疗实践一样,构成了生命管理以及新的伦理态度和社会参与的一个场所。这些活动——包括处理风险的必要性、对于循证干预的难以言"不"以及在临床条件下做出选择的义务——也处于卫生资源配给和改革的论争中心。心脏手术、器官移植和癌症治疗是三个延长生命的医学成功的范例,同时也是产生存在困境和社会困境之标志。医学人类学的视角彰显了生命制造与医疗支出之关联,也揭示了基于年龄配给医疗资源的持续的讨论。

An aging society, a growing array of life-extending medical inter- ventions. Medicare policy, and an ethic of individual decision making together contribute to the deepening societal tension in the United States between controlling health care costs and enabling health consumer use of life-sustaining technologies. The activities that constitute longevity making, like so many other sociomedical practices, comprise a site for the governing of life and the emergence of new forms of ethical comportment and social participation. Those activities - ineluding the necessity of treating risk. the difficulty of saying ＂ no＂ to evidencebased interventions, and the responsibility of choosing among clinical options - also lie at the heart of debates about health care rationing and reform. Cardiac procedures, organ transplantation, and cancer treatments are three examples of medicine＇s success in extending life and are emblematic of the existential and societal quandaries that result. A perspective from medical anthropology shows the way in which the making of life is linked to health care spending and the ongoing debates about age-based rationing.