從“生物醫學模式”到“生物社會心理精神醫學模式”——西方醫學史的教訓

From Biomedicine to Biopsychosociospiritual Medicine: A Lesson in the History of Medicine in the West

Abstract

LANGUAGE NOTE | Document text in English; abstract also in Chinese.

生物－心理－社會－精神醫學在西方世界裡是一個歷史的產物。生物醫學發端於19 世紀後半葉，並在美國醫學中引發了一場大規模的醫學教育改革。這種科學的生物醫學在醫學實踐中表現出的冷冰冰的、無人格的態度，常常與病人的道德和精神需求相抵觸。為改善這種狀況，自20 世紀中葉起，醫生與倫理學家嘗試了多種方式的改革，包括生命倫理學，生物－心理－社會醫學，和生物－心理－社會－精神醫學。這些改革的共同社會歷史背景是世俗主義在美國的興起，而每一種改革也都以不同的方式試圖把握醫療照護中的超越維度，這一超越維度已被生物醫學的還原主義的態度所邊緣化。但是，因為生物醫學的科學主義態度，以上的改革都失敗了。雖然生物－心理－社會－精神醫學意圖以一種整全的方式照護病人，但是因為它仍然延續了一種科學主義的態度，以至於這種醫學模式不能滿足病人的道德和精神需求，也無法把握對病人而言超越的中心意義。

Biopsychosociospiritual medicine is a product of the long history of medicine in the Western world. Biomedicine began in the latter part of the 19th century, and, by the early 20th century, major medical education reforms had mandated a revised scientific curriculum for all U.S. medical schools. These reforms resulted in reductive scientific materialism. By the mid-20th century, however, scientific biomedicine was felt to be cold and impersonal, and was often deployed against the patient’s moral and spiritual desires. From the mid-20th century onward, several reforms were attempted that fall under the rubrics of bioethics, biopsychosocial medicine, and biopsychosociospiritual medicine. These reforms took place at a time when secularism was on the rise in the U.S., and each reform attempted to capture the transcendent dimension of medical care that had been marginalized by the reductive attitude of biomedicine. However, the reforms failed because of the scientist attitude of biomedicine. Although biopsychosociospiritual medicine purports to be a comprehensive approach to patient care, because it maintains that scientist attitude it fails to consider patients’ moral and spiritual desires and or to capture the centrality of transcendence for those who are sick and in need of health care.

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