医学史的人性化力量:对美国20世纪生物医学的回应

从19世纪末至今,医学史能够且应该作为使现代医学人性化的力量——这一观念在美国医学中是个永恒的话题。聚焦美国,探讨此观念为何恰巧出现在现代西方医学兴起之时。正是在极度信奉科学医学的医疗机构里,一些医学领袖开始告诫,对科学的忠诚在推动医学专业技术和文化成功的同时,也正在威胁着对于职业精神、医学艺术和文化凝聚来说至关重要的人文价值。他们将历史视为使现代医学重新人性化、对抗文化危机的途径。医学的"人文主义"所承载的含义一直以来是变化和多元的。但是,诚如文章所示,将历史作为人性化力量的观念显然在整个20世纪是经久不衰的。这一观念尤其在19世纪70年代得到复兴。当时,由于公认的美国医疗机构"去人性化"受到更加广泛的批评,一些人提倡将医学史作为塑造新型人文医生的工具,并且作为一种解决医疗体制中社会不公平现象的指导源泉。一直贯穿于始终的是,历史作为人性化力量这一观念几乎总是在谈论不足——对感知的生物医学、医疗机构和医学职业精神缺陷的响应。

The Humanizing Power of Medical History:Responses to Biomedicine in the 20th-Century United States

From the end of the 19th century through the present,the idea that medical history can and ought to serve modern medicine as a humanizing force has been a persistent refrain in American medicine.Focusing on the United States,this paper explores the emergence of this idea at precisely the moment when modern Western biomedicine became ascendant.At the same institutions where the new version of scientific medicine was most energetically embraced,some professional leaders began to warn that the same allegiance to science driving the professional technical and cultural success was also endangering humanistic values that were fundamental to professionalism,the art of medicine,and cultural cohesion.They saw in history a means for re-humanizing modern medicine and countering the risk of cultural crisis.The meanings attached to medical "humanism" have been changing and multiple,but,as this paper shows,some iteration of this vision of history as a humanizing force was remarkably durable across the 20th century.It was especially revitalized in the 1970s as part of a larger cultural critique of the putative "de-humanization" of the medical establishment,when some advocates promoted medical history as a tool for fashioning a new kind of humanist physician and a source of guidance in confronting social inequities of the health care system.What has persisted across time is the way that the idea of history as a humanizing force has almost always functioned as a discourse of deficiency — a response to the perceived shortcomings of biomedicine,medical institutions,and medical professionalism.