A Research of Clinical Sociology on the Process of Dying and Listening in the Terminal Care of Cancer Patients

临终关怀已成为医疗护理的重要专业领域之一。它把自己的医学控制对象定义为死亡过程。本研究旨在探讨临终关怀如何将临终过程视为社会心理过程，以及临终关怀如何控制这一过程。它分析了癌症患者在临终关怀环境中的叙述，并得到了重要的发现。首先，明确了临终病人与医生、护士、家属等社会关系的特点。在这些社会关系的背景下，探讨临终病人如何科普死亡面前的身份危机。第二，医生、护士和家属的倾听对临终病人有影响。它鼓励他们接受自己的死亡，并找到自己生命的意义。因此，死亡过程被规范为理想的模式，“好死”，这是由终端护理专业人员。第三，垂死的病人几乎无法通过讲述个人经历来认识自己的死亡。医生、护士、家属等临终病人周围的听众在心理学知识的影响下，对临终角色有提前的期待，典型的是Kubler=Ross的五阶段模型。他们通过倾听将治疗的目光锁定在垂死病人的内心主观世界上。临终病人的内心世界是由倾听叙述的交流所塑造的，并由医疗护理所控制。将临终关怀作为医疗保健的特殊领域，意味着医疗化的进一步扩大。

Terminal Care has become one of the important special fields of medical care. It makes out it's own subject of medical control as dying process. This Research investigates how terminal care makes out the dying process as social and psychological one and how it controls this process. It analyzes narratives of cancer patients in the terminal care settings and gets important findings. First, it makes clear the characteristics of the social relations of dying patients to doctors, nurses, families and other peoples. It discusses the way how dying patients cope with their identity crisis in front of death in the context of those social relations. Second, the listening by doctors, nurses and families has influence upon dying patients. It encourages them to accept their own death and to find the meanings of their own life. So dying process is normalized as ideal pattern, ‘good death', which is made by terminal care professionals. Third, dying patients can barely recognize their own individual death by narrating personal experiences. Doctors, nurses, families and other people, these listeners around dying patients have expectation of dying role in advance under the influence of psychological knowledge, typically the five stage model of Kubler=Ross. They fix their therapeutic gaze on the inner subjective worlds of dying patients by listening. The inner worlds of dying patients are cast by narrative-listening communication and controlled by medical care. The establishment of terminal care as special fields of medical care means further expansion of medicalization.