国家卫生建设与医患纠纷生产——民国时期与当代的比较研究

National Hygiene Construction and the Generation of Doctor-Patient Dispute:A Comparative Analysis between the Republic of China and Contemporary China

近代以来,对应国家卫生建设从文化轴心向制度轴心、从国家本位向社会本位的两轮周期性转变,医患纠纷在民国时期与当代出现了两次从“隐而不彰”向“公共问题”的转化。在民国时期,国家卫生建设在“医学殖民”的危机环境下采取了激进效仿西方的形式理性路线,普通民众被置于“卫生行政规训”的客体位置,中西医之间不同的价值伦理与技术手段引发了医疗秩序失衡,医患纠纷集中于东南沿海城市地区的西医领域;在当代,因应新自由主义全球扩张的“市场化医改”,国家采取了财政支持弱化与卫生行政控制的辩证策略,缺乏制度保障的患者与缺乏职业自主性的医生不相适应使得“国家-医生-患者”的关系结构发生了系统性分离,医患纠纷集中于城市公立医院并呈现出风险演化趋势。在跨越时空情境的比较研究中,本文发现:民国时期与当代医患纠纷的共性在于医疗场域中社会性与公共性之间的张力未能得到有效化解,但中国卫生现代化的不可逆性亦决定了国家卫生建设需要在发展中寻求秩序。这要求我们对当前医疗场域中社会团结弱于社会连结的失衡现象保持警惕,在“厚民生”的治理主旨下打造“国家在场、社会有序”的卫生建设格局。

Since modern times,corresponding to the two cyclical transitions of national hygiene construction,doctor-patient disputes have transformed twice in the period of the Republic of China and contemporary times from“latency”to“public issues”.In the period of the Republic of China,national hygiene construction imitated the west radically under the crisis of medical colonization,in which the ordinary people were given the object status of hygiene administrative discipline.The imbalance of medical order was caused by different value ethics and technical methods between Chinese and Western medicine.Doctor-patient disputes were concentrated in the western medical field of the southeast coastal cities.In the contemporary era,conformed with the global expansion of neoliberalism,marketization medical reform has taken the dialectical strategy of financial support weakening and hygiene administrative control.The incompatibility of patients who lack institutional guarantees and doctors who lack professional autonomy has resulted in a systematic separation of the relationship of“state-doctor-patient”.Doctor-patient disputes are concentrated in the urban public hospitals and are risky increasingly.In this study,it is noticeable that the tension between sociality and publicity is the Key to generating doctor-patient disputes in the two periods.However,the irreversibility of China’s hygiene modernization also determines that national hygiene construction need seek order in development.It requires us to stay on guard against the imbalance of social solidarity weaker than social connection in current medical field and to foster the hygiene construction pattern of“state at presence and society in order”under the governance theme of enhancing people’s livelihood.