【作者】 郭燕霞；

【导师】 赵万里；

【作者基本信息】 南开大学 ， 社会学， 2013， 博士

【摘要】 随着科学技术的日益分化和高度专业化,某个领域的专家在该领域之外也可能只是外行公众,公众在特定情境之中也会获得一定专门知识。专门知识与公众之间的关系成为当代学术界的重要论题之一。在医疗实践中,我国自2007年实行扩大免疫规划以来,疫苗事件增多,儿童疫苗接种争论不断显现；同时,儿童疫苗的总体高接种率在某种程度上掩盖了公众接种需求和选择原因,理解家长缘何和如何为孩子接种具体种类的疫苗成为研究焦点。而专门知识的增加、公众角色的专业化使其选择儿童疫苗接种的范围不再局限于第二类疫苗,甚至扩展到第一类疫苗中来,典型呈现出专门知识与公众选择之间关系这一主题。本研究以山西省太原市儿童疫苗接种为个案,运用深度访谈研究方法,透过知识社会学的透镜,探讨医疗实践中的专门知识与公众选择的多样关系,检视专门知识的生成过程以及如何对公众选择儿童疫苗接种发挥作用。进而揭示多种因素共同建构公众选择,折射医学与公众、科学技术与当代中国社会之间关系的多样态特征。按照专门知识的获得途径不同,本研究将专门知识划分为三个层次：专业技能知识、互动性专门知识和常识性专门知识；依据公众选择接种儿童疫苗的种类和结果不同,将公众选择儿童疫苗接种分为三种类型：接种全部疫苗、接种部分疫苗和拒绝接种疫苗。在公众选择接种儿童疫苗过程中,一方面,由于专门知识的结构不同,掌握不同层次专门知识的公众选择接种不同种类的儿童疫苗；另一方面,由于其他些因素与专门知识的共同影响,掌握不同层次专门知识的公众呈现出选择接种相同种类的儿童疫苗。具体而言,掌握儿童疫苗接种的专业技能知识的群体包括接种医生和专家。来自国家免疫规划制度、接种实践以及角色认知的专业技能知识,促使接种医生不仅为孩子接种全部疫苗,而且试图说服公众接种全部疫苗。专业技能知识与接种医生选择儿童疫苗接种之间呈现出正向关联。专家以专家知识为依据,完全从医学原理来考究接种每一种疫苗的必要性,并尊重和遵守国家免疫规划制度,从而选择接种第一类疫苗的所有种类、第二类疫苗中的部分疫苗。当受到特殊个人体验的直接影响、实证主义思想居上以及认知到国家免疫规划制度的非惩罚性,他们不仅拒绝接种第二类疫苗和某些第一类疫苗,甚至全部疫苗。互动性专门知识以公众既有的默会知识为载体,通过经验获得,这种经验是阅读文献和语言交流而非某领域实践的产物。在儿童疫苗接种中,公众通过个体经验、互联网、专业书籍、接种证以及与医务专业技术人员的互动等获得互动性专门知识。由于互动性专门知识的结构不同,以及受到个人体验的影响,公众选择接种全部疫苗与接种部分疫苗。当进行风险—收益分析、出于国家免疫规划制度和科研成果的应用不完全信任的考虑,这部分公众选择接种第一类疫苗的所有种类、拒绝接种第二类疫苗的所有种类。对接种疫苗的利弊、国家免疫程序、接种疫苗的风险等形成的总体认知或者经验式判断,成为背景知识与其自身的默会知识彼此竞争、相互融合,生成与本地文化和实践相联系的常识性专门知识。这种常识性专门知识与其他因素,共同建构公众选择儿童疫苗接种。当体验到国家免疫规划制度的福利性、受到接种医生的权威建构、个人体验的强化以及从众心理的导引时,这部分公众为孩子接种全部疫苗。当信任并受到国家免疫规划制度的制约,同时由于对接种医生的不信任而放弃与接种医生的互动时,他们凭借已有知识和自身经验选择接种部分疫苗。当受到社会网络的主导影响或者经济因素的制约时,他们选择接种第一类疫苗的所有种类、拒绝接种第二类疫苗的所有种类。本研究发现,第一,具有互动性专门知识的公众非常乐意通过多种途径获得更多的专门知识,并试图以这些专门知识为依据做出专家式的儿童疫苗接种选择。究其原因,他们不是为了成为专家、超过内行,而是试图在特定文化构架之下,对自己的生活和相关现象有所认识。第二,具有常识性专门知识并选择接种全部疫苗的公众,将自身定位于被动的接受者,满足于服从接种医生的权威意象,充分享受着福利性的儿童疫苗接种政策,认为没有必要通过其他途径来获取儿童疫苗接种的信息。具有常识性专门知识并选择接种部分疫苗/拒绝接种疫苗的公众,凭借已有知识和自身经验判断接种疫苗的必要性,要求成为参与者、使用者；但他们仍然将自己视为外行,并不喜欢增加的医学知识,认为知识的增加使其处于不知该如何选择的困境之中。因而,在儿童疫苗接种中,已有的单向线性传播模式难以适应公众专业化的需求,应当根据公众专门知识的不同层次重新建构医学知识的传播模式。而且,管理和决策部门应当针对不同群体传递其所需要的知识和信息,重新定位长远目标与短期目标,重新审视个体权利和群体利益,从而促进儿童疫苗接种政策的合理制订与实施。更多还原

【Abstract】 Followed with science and technology is increasingly differentiated and highly specialized, an expert in one field is a layman in other fields, and the public can also acquire some expertise in given context. The relationship between expertise and the public becomes one of the most important topics in contemporary academic circles. In medicine, since expanded programme on immunization is implemented in China in2007, there are increasing vaccination events and disputes on childhood vaccination. At the same time, in some extent, the high rate of overall childhood vaccination conceals the public demand and the decision-making reason. Then understanding why and how parents vaccinate for their children becomes the focus of study. The increasing expertise and the specialization of the public role makes their decision-making scope no longer confined to the second type of vaccination, and even extended to the first type of vaccination. So it typically shows the topic of the relationship between expertise and the public decision-making.Through the lens of the sociology of knowledge, this study takes childhood vaccination in Taiyuan city, Shanxi province as a case study, uses the depth interview method, explores the diversity relationship between expertise and the public decision-making in medicine, examines the generation process of expertise and how it plays the role on the public decision-making. Then it reveals that several factors together construct the public decision-making, reflects the diversity feature of the relationship between medicine and the public, science and technology and contemporary Chinese society.According to the different methods of acquiring expertise, expertise is divided into three levels:specialist expertise, interactional expertise, and commonsense expertise. In the light of the type and result of vaccination of the decision-making, the public decision-making of childhood vaccination is divided into three kinds:all vaccination, partial vaccination and rejecting vaccination. In the childhood vaccination, on the one hand, the public with the different level expertise have different decision-making because of the different structure of expertise; on the other hand, due to the effect of other factors and expertise together, the public with the different level expertise tend to do decision-making of the same kind of vaccination.Specially, the groups of specialist expertise include vaccination workers and experts. The specialist expertise of the vaccination workers stems from National Immunization Program system, the practice of vaccination and the cognition of their social role, which makes them not only for their own children do decision-making of all vaccination, but also try to persuade others to do so. Therefore, there is a positive correlation between the specialist expertise and the vaccination workers’ decision-making of vaccination. According to their expertal knowledge, the experts explore the necessity of each vaccination completely from medical principles and respect and observe National Immunization Program system, so they do decision-making of partial vaccination. When directly affected by their particular personal experience, the primal positivism thoughts and the understanding of non-penalty of National Immunization Program system, they reject all of the second type of vaccination and some kinds of the first type of vaccination, even all vaccination.Interactional expertise takes the tacit knowledge as a carrier, and is acquired through the public experience which is not from a field of practice but a product of reading literature and language communication. In the childhood vaccination, the public acquire interactional expertise through individual experience, the Internet, professional books, vaccination certificate, and the interaction with the medical professionals. Because of the different structure of international expertise and being influenced by personal experience, the public do decision-making of accepting all vaccination and partial vaccination. When making the risk-benefit analysis, not fully trusting for National Immunization Planning system and the application of the research achievements, the public will do decision-making of accepting all of the first type of vaccination and rejecting all of the second type of vaccination.The general cognition or experiential judgment on the advantages and disadvantages of vaccination, National immunization program and vaccination risks, has become the background knowledge, which competes and integrates with the public tacit knowledge each other, then forms commonsense expertise that links with local culture and practice. The commonsense expertise goes together with other factors to construct the public decision-making of childhood vaccination. When the public regard National Immunization Planning system as welfare experience, are constructed by vaccination workers’authority, strengthened by personal experience, and guided by herd mentality, they do decision-making of all vaccination for their children. When they both trust for and are restricted by National Immunization Planning system, distrust for and abandon the interaction with the vaccination workers, they make the decision of partial vaccination by virtue of current knowledge and their own experience. When leadingly influenced by social network or restricted by economic factors, they make the decision of accepting all of the first type of vaccination and rejecting all of the second type of vaccination.This paper has found that, first, for the public with interactional expertise, they are willing to acquire more expertise through various ways, and try to make similar decision of vaccination as the expert. However, their aims are not to become or pursue the experts, but to better understand their own daily life and related phenomenon under given cultural framework.Second, making the decision of all vaccination, the public with commonsense expertise still position themselves in passive recipients, are content to obey the image of vaccination workers’authority, and fully enjoy the childhood vaccination as a welfare policy, so they do not think it is necessary to get more information about childhood vaccination through other channels. Making the decision of accepting partial vaccination and rejecting all of the second type of vaccination, the public with commonsense expertise judge the necessity of vaccination by virtue of current knowledge and their own experience, and try to be as participants and users; but they still regard themselves as laymen and do not like increasing expertise which makes them not know how to do the decision-making of vaccination for their own children.Therefore, in the childhood vaccination, one-way linear model of dissemination has been not to adapt to the change of the public expertise, but to reconstruct the pattern of medical knowledge dissemination on the base of different level of the public expertise. Moreover, the departments of management and decision-making should reorient the long-term goal and the short-term goal, re-examine the individual rights and group interests, and transfer the knowledge and information for different groups according to their needs so as to promote the reasonable development and implementation of childhood vaccination policy.更多还原