【作者简介】王杰,福州大学人文社会科学学院副教授,主要研究方向为医务社会工作、基层治理。。

【文章来源】《社会建设》2023年第4期

【内容提要】善终具有主观性与文化性，可以视作一种主观建构的叙事。现实中的患者往往处于过度治疗和临终关怀不足的两极，又因为拖累家人感到自责和内疚，在身心煎熬下，形成了难以善终的叙事困境。患者叙事处于多元主体叙事竞争的结构张力之中，基于专业权威的医学叙事与基于伦理的家庭叙事将患者本身的叙事挤压到边缘位置。叙事重构拓宽了传统叙事治疗的范畴，不仅关注主观维度的叙事治疗，也同时关注叙事的现实基础与叙事竞争，社会工作者可以通过临终关怀、生前预嘱、叙事治疗等多重举措，帮助患者重构积极叙事，促进患者善终。

【关键词】善终；癌症；叙事；重构；社会工作

【基金项目】教育部人文社会科学青年项目“晚期癌症患者的善终困境与社会工作介入研究” (20YJC840024)。

【全文链接】https://shjs.ruc.edu.cn/CN/Y2023/V10/I4/72

How to Have a Good Death: Narrative Dilemmas and Narrative Reconstruction in Patients with Advanced Cancer

Wang Jie

Abstract: A good death is subjective and cultural, and can be regarded as a subjectively constructed narrative.Patients often fall into the polar poles of overtreatment and inadequate hospice care, and feel self-blame and guilt for dragging down their families.Under physical and mental suffering, patients form a narrative dilemma that it is difficult for them to die a good death.The patient narrative is in the structural tension of multi-subject narrative competition.The medical narrative based on professional authority and the family narrative based on ethics squeeze the patient's own narrative to the edge.Narrative reconstruction broadens the scope of traditional narrative therapy, focusing not only on the subjective dimension of narrative therapy, but also on the reality basis and narrative competition of narrative.Social workers can help patients reconstruct positive narratives through hospice care, living will, narrative therapy and other measures to promote a good death for patients.

Keywords: Good Death;Cancer;Narrative;Reconstruction;Social Work