沙市职业大学“十二五”专业建设规.ppt

Too much medicine? Richard Smith Editor BMJ /talks What I want to talk about What is medicalisation? Medicalisation of birth, death, and sexuality What is normal? What is a disease? Creating “diseases”: disease mongering Why does medicalisation matter? What are the forces driving medicalisation? How should we respond? What is medicalisation? Medicalisation is the process of defining an increasing number of life’s problems as medical problems Medicalisation of birth Caesarean section rates are rising consistently around the world 90% of babies are delivered by caesarean section in some parts of Brazil It has at some times and in some places been normal to give women giving birth a general anaesthetic In Britain in the 30s upper class women were more likely to die in childbirth than poorer women--because of excessive intervention Rise in caesarean sections Why have Caesarean section rates risen? Losing the skills needed for less dramatic interventions Medicolegal pressures More involvement of doctors, less of midwives Private practice Not involving women in decision making Medicalisation and demedicalisation of birth When my first son was born in 1982 my wife had an enema, her pubic hair shaved, and the baby monitored (and would have had an episiotomy if she had not had an emergency Caesarean section) When my daughter was born in 1991 all this had gone There was no evidence that any of it works Yet it’s still common practice in much of the world--for example, Spain and Taiwan Why demedicalisation? The women’s movement Organisations like the Natural Childbirth Trust Evidence based medicine (evaluating the effectiveness of interventions) “Radical midwives” Medicalisation of death Ivan Illichs critique of the medicalisation of dying A loss of the capacity to accept death and suffering as meaningful aspects of life A sense of being in a state of total war against death at all stages of the life cycle A crippling of personal and family care, and a devaluing of traditio