龔鵬程x S. 洛克蘭·珍｜公共衛生是司法問題而非其它

龔鵬程對話海外學者第八十四期：在后現代情境中，被技術統治的人類社會，只有強化交談、重建溝通倫理，才能獲得文化新生的力量。這不是誰的理論，而是每個人都應實踐的活動。龔鵬程先生遊走世界，并曾主持過“世界漢學研究中心”。我們會陸續推出“龔鵬程對話海外學者”系列文章，請他對話一些學界有意義的靈魂。范圍不局限于漢學，會涉及多種學科。以期深山長谷之水，四面而出。

S. 洛克蘭·珍教授（Professor S. Lochlann Jain）

美國斯坦福大學人類學教授、倫敦國王學院全球健康和社會醫學客座教授

龔鵬程教授：您好。您的《惡性：癌癥如何成為了我們》一書中，您討論了癌癥對社會的影響。醫療事故在您著作中是一個重要的話題。正如您所指出的，醫生是人，醫療失誤是不可避免的。但社會如何處理這些失誤，將對患者的健康產生巨大的影響。您認為社會該如何應對醫療事故?

S. 洛克蘭·珍教授：龔教授，您好。關于系統和個人錯誤的問題很吸引人，特別是在醫療事故這種情況下，風險可能很高。一些研究發現，醫療事故是美國最大的單一死因，但它作為一個公共衛生問題卻幾乎不為人知。

醫生在復雜的醫療系統中工作，同時與經濟系統與社會系統相關聯。幾個關鍵的事實使問題復雜化：醫學是一個地位高、利潤高的經濟領域，不幸的是，這往往意味著，否認醫療事故是一個結構性的問題，其中有重大利害關系。例如，病人不可能知道外科醫生犯了多少錯誤（記錄根本沒有保存），甚至不可能知道自己的手術過程中發生了什么（外科醫生寫了記錄，但病人是無意識的）。即使病人確實對他們的醫生的質量有一個準確的描述，他們的保險在看病的人找醫生方面，可能也不會給他們太多的選擇。

有許多歷史上的例子表明，利潤勝過了醫療事故，成為公共衛生問題。例如，在20世紀60年代和70年代，乙型肝炎是美國血液供應中流行的一種病毒。醫院沒有使用現有的方法來減少病毒的傳播，而是辯稱提供更清潔的血液供應并不符合“當前的醫療標準”，從而避免了訴訟。由于法院接受了這一推理，病人在接受手術時別無選擇，只能承擔感染乙型肝炎的風險。同樣，只是在過去的十年里，一些醫院才找到了鼓勵醫生定期洗手的方法，并設計出了更難以在給藥過程中犯錯的系統。關鍵是，雖然犯錯是人之常事，但人類所工作的系統可能更容易犯錯、更容易否認或更容易彌補錯誤。

否認錯誤符合醫院的經濟利益，而病人幾乎沒有追索權時，很難看到前進的道路。因為除了最惡劣的案例外，這些失誤幾乎不可能被證實。然而，應對錯誤的方法是認真對待它們，讓獨立機構對每一個錯誤的經濟、心理、設計、社會和結構因素進行全面分析——換句話說，首先把它們理解為結構性問題，而不是個人責任問題（盡管在某些情況下確實是這樣）。這些調查可以在各機構之間共享，以確定改善系統和機構的方法。

The question of systems and personal errors is fascinating, and particularly in cases of medical error where the stakes can be high. Some studies have found medical error to be the single largest cause of death in the US, and yet it is virtually invisible as a public health issue.

Doctors work within complex medical systems that are both economic and social. They are also materially designed. A few crucial facts complicate the issue: medicine is a high-status and high profit area of the economy, which has tended to mean, unfortunately, that there are large stakes in disavowing medical error as a structural concern. For example, it would be impossible for a patient to find out how many mistakes a surgeon has made (records are simply not kept), or even to know what has happened during their own surgery (the surgeon writes the notes, the patient is unconscious). Even if a patient did have an accurate account of the quality of their doctor, their insurance will probably not give them much choice as to which doctors they can see.

There are many historical examples of situations in which profits have trumped medical error as a public health issue. For example, hepatitis B was a virus endemic to the American blood supply in the 1960s and 1970s. Rather than using established ways to reduce the circulation of the virus, hospitals protected themselves from litigation by arguing that it was not the “current medical standard” to provide a cleaner blood supply. Since the courts accepted this reasoning, patients had no choice but to take the risk of getting hepatitis B when they underwent surgery. Similarly, only in the last ten years have some hospitals found ways to encourage physicians to wash their hands regularly and devised systems to make mistakes in drug delivery more difficult. The point is that while to err is human, humans work in systems that can make errors more and less easy to make, to deny, or to compensate for.

It's difficult to see a way forward when disavowal of mistakes is in the financial interests of hospitals and patients have little recourse since mistakes are practically impossible to prove except in the most egregious cases. Still, constructive ways to respond to mistakes would be to take them seriously and have independent agencies provide a thorough analysis of the economic, psychological, design, social, and structural elements that have gone into each – in other words, to understand them first as structural rather than as a question of individual blame (although it some cases it certainly is that). These investigations could be shared across institutions to identify ways of ameliorating the systems and institutions.

龔鵬程教授：在您的《傷害》一書中，您討論了美國的傷害文化。什么是美國傷害文化？它是如何影響美國人的生活方式的？

S. 洛克蘭·珍教授：我的書《傷害》對美國人身傷害法的具體歷史和作用進行了分析。我的目的是描述在整個20世紀，美國的產品責任和侵權法是如何與圍繞消費品的監管（往往是由于相關監管的缺乏）結合在一起出現的。這一領域的法律平衡了制造商的利益（為了利潤，他們可能會出售未經充分研究和測試的市場產品）和個人的利益（他們可能沒有能力做所有的研究來尋找合格的產品）。

在汽車發展史上，關于安全帶的爭論中可以找到一個很好的例子來說明這個說法的變化。幾十年來，人們知道安全帶每年可以挽救成千上萬的生命，這些生命都是在“低速”撞擊中喪生的。制造商沒有增加安全帶，而是聲稱 "安全帶不賣"，車禍是由于司機的錯誤造成的。法院在很大程度上支持這些主張。受傷的原告認為車禍是可以預見的，因此在設計汽車時應該考慮到潛在的傷害，但這種論點一直被駁回。隨著民權和消費者權益運動的興起，這種觀點在20世紀60年代發生了根本性的改變。到1968年，法院認為制造商應該設計出在低速撞擊中保護車內人員的汽車。

我想，這種構建公共衛生的方式不僅是美國特有的，而且被大多數人誤解。因此，美國人很容易被操縱，使他們的利益與企業捆綁在一起。

我認為這種將公共衛生視為司法問題而非監管問題的思維方式，會產生廣泛的影響。美國人面臨著巨大的不安全感，因為一次傷害就可能摧毀他們的積蓄和身心健康。即使是那些有保險的人，受傷也需要和保險公司打幾個小時的電話。

My book,Injury, offers an analysis of the specific history of and role played by personal injury law in the United States. I aimed to describe a very particular way in which product liability and tort law emerged throughout the twentieth century in the US in conjunction with- and often because of the dearth of – regulation around consumer products. This area of law balances the interests of manufacturers (who in the interests of profit may sell products that have not been adequately researched and tested on the market) and the interests of individuals (who may not be able to do all the research required to find save products).

A good example of the shifting terrain of this equation can be found in the history of automobility with the debates about seatbelts. For decades it was known that seat belts could save thousands of lives a year, lives that were lost in low-speed collisions. Rather than add seatbelts, manufacturers claimed that “seatbelts don’t sell,” and that crashes were due to driver error. The courts largely stood behind these claims, and so injured plaintiffs’ arguments that crashes were foreseeable and that therefore cars should be designed with potential injuries in mind consistently failed. This view radically changed in the 1960s with the rise of Civil Rights and Consumer Rights movements. By 1968, courts found that manufacturers should design cars to protect occupants in low-speed collisions.

I suggested that this way of framing public health was both particular to the United States, and peculiarly misunderstood by most people. Therefore, Americans could be easily manipulated to ally their interests with corporations rather than with themselves as susceptible to injury.

I think the effects of this way of thinking about public health as a judicial rather than a regulatory issue has broad effects. Americans face tremendous insecurity since one injury can destroy their savings and well-being. Even for those with insurance, an injury will requires hours on the phone with insurance companies.

龔鵬程教授：圖像在您的書中發揮了重要的作用，最近您寫了一本名為《藝術之物：充滿迷人好奇心的圖像動物園》的繪畫小說。該書比您的其他作品更通俗易懂，因為任何人都可以閱讀并學到一些知識。您創作這本書的目的是什么？它是否比您的其他作品更能吸引更廣泛的觀眾？您是如何選擇書中不同的主題的？

S. 洛克蘭·珍教授：《藝術之物》比我的其他書要短，它是以一系列的圖畫和幾篇短文的格式組成的。我對這個項目有兩個想要達成的目標。首先，我想對形式進行實驗，其次，我想更好地理解收藏背后的政治。

我在整個系列中使用了一種非常具體的格式：每一頁都包含一個標題和下面一些帶標簽的繪圖。這種繪畫集合的形式與圖片明信片、植物色板、棒球交易卡相呼應，每張圖片都與標簽相呼應，因為每張圖片解釋了標簽上的名稱，而標簽標明了圖像的名稱。書名提供了一個元標簽，使整個信息結構形成一個閉環。動物園、博物館和其他教育機構在提供信息時就采用了這一框架。

我想嘗試使用一種想當然的形式，將其解構為“從內部”構建意義的項目。當我們收集東西的時候，我們會賦予它們一種相似的結構，也會對什么東西應該放在哪里做出判斷。誰屬于“美麗”的范疇？這些結構是偶然的和可變的；然而沒有它們，我們就無法正常工作。

但是，作為一個混合種族、混合性別、混合國籍的人，我一直在掙扎并質疑這種安置模式。

這個項目是作為一個游戲提出來的，一種例如我在等公交車的時候可以打發時間的方式。在早期階段，我可能會隨機地問自己：有哪些東西是綠色的？我可以把一件什么意想不到的東西扔在那里？例如，回憶一下古老的謎語：“什么東西是黑色白色的，和紅色組成的：報紙”或者更可怕的答案是是“一只被打傷的企鵝”。當我繼續畫這些畫時，我意識到這種形式可以做幾件事。我玩起了怪異的歷史（復活溺水者的方法）和突出某些物體（武器）的方法。我用這些作品來思考更抽象的符號概念，如否定和修辭。在某些內容中，我提供了元評論，例如藝術運動（即帶有標簽的內容）。

換句話說，我幾乎是隨機地發現了一種方法，我可以用一種可辨認的形式來解讀形式本身，我發現這相當有趣，并在業余時間繼續研究它。當多倫多大學出版社表示有興趣在他們的EthnoGraphics系列中出版它時，我非常高興。

Things that Art is shorter than my other books, and it is written as a series of drawings accompanied by several short articles. I had two intertwined goals with the project. First, I wanted to experiment with form, and second, I wanted to better understand the politics of collection.

I used a very specific form across the series: each page consists of a title and a number of labeled drawings underneath. This form of a drawn collection echoes the picture postcard, the botanical color plate, the baseball trading card in that each image illustrates the label and the label names the image. The title offers, if you will, a meta-label such that the whole informational structure forms a closed loop. Zoos, museums, and other educational institutions adopt this scaffold in their informational offerings.

I wanted to experiment with using a taken-for-granted form to deconstruct it as sense-making project “from the inside”. When we collect things, we impute a structure of similarity to them, and also a judgement about what belongs where. Who belongs in the category of “beautiful”? These structures are contingent and mutable; and yet without them, we can’t really function. Still, as a mixed race, mixed gender, mixed nationality, etc., person, I’ve always struggled with and questioned this mode of placement.

The project stated as a game, a way of filling empty time as I waited for bus, for example. At the early stages I might have asked myself, randomly: What are a few things that are green? What is an unexpected thing I could throw I there, recalling, for example, the old riddle“what is black and white and red all over: a newspaper.” Or more gruesomely, “a mauled penguin.” As I continued to make of these drawings, I realized that this form could do several things. I played with bizarre histories (ways to resuscitate the drowned) and ways to highlight certain facets of objects (things that are weapons). I used the works to contemplate more abstract semiotic notions such as negatives and figures of speech. In some I offer a meta commentary on, for example, art movements (things that are labelled, things that are not a pipe).

In other words, I nearly randomly came upon a way that I could use a recognizable form to unpack the form itself, and I found that quite fun and continued to work on it in my spare time. When the University of Toronto Press showed interest in publishing it in their EthnoGraphics series I was quite chuffed.

You ask about capturing that elusive thing we call a“broader audience.” For that I think a series of elements have to magically come together for that to happen: it’s about marketing, personal connections, book design and writing style, timing – and of course it’s also about how one’s book fits into the categories already in place. Two of the best books I’ve ever read never found a publisher, let alone a broad audience, whereas some authors unexpectedly find themselves with six figure advances. In other words, as with everything, there is a lot of chance to this business and it isn’t something I’ve become terribly invested in.

龔鵬程教授：您目前正在進行一個關于肺和空氣的歷史的漫畫小說項目，這聽起來很吸引人。您能介紹一下這部作品嗎?

S. 洛克蘭·珍教授：在繪制《藝術之物》時，我對以不同的形式認可、促成、鼓勵思想和感受這方面產生了興趣。學術界很清楚：經濟學家使用不同于哲學家的認識論框架，因此對類似問題有不同的“答案”。這一概念還可以進一步推廣：圖表、照片和獎章也是構建和表達社會問題的方式。

我目前正在積極從事的項目，是一部關于溺水的文化史，包括散文和藝術作品，名為《肺是一只鳥和魚》。

溺水，在十八世紀中期成為一種顯著的意外死亡形式。這種“顯然是被淹死的”尸體，在生與死之間搖搖欲墜，呈現出恐懼、厭惡和迷戀的對象。到了18世紀后期，人道協會在歐洲各地如雨后春筍般涌現，倡導城市設計改革，包括照明、護欄、獎懲制度和沿河警衛。與此同時，雖然有大量的溺水復蘇方法，但仍然無效；甚至在19世紀，歐洲海員普遍不會游泳。雖然助產護士廣泛使用人工呼吸來挽救新生兒，但在18世紀中期被認為是“粗俗的”并被禁止。

隨著海上貿易的興起、沉船事件的增多，以及繪畫和文學中對水的描繪的繁盛，溺水也成為歐洲文學、藝術和生活中的一種癡迷。位于塞納河岸邊的巴黎停尸房被稱為“溺水者博物館”，每天吸引了數千名游客。

這本書將這段以歐洲為中心的歷史與一系列平行的、更黑暗的歷史進行了追溯，比如奴隸在“中央航道”溺亡和非洲移民試圖前往歐洲。

總的來說，“肺是一只鳥和魚” 表明，人們所說的或爭論的內容，無法與它的呈現和交流方式區分開來，藝術成分是該項目的核心。每一種形式（報紙文章、法律文件、廣告、照片）都體現了不同形式的權威，并強調或否認任何研究項目不可避免的分歧、空白和不確定性。

因此，繪畫的目的不是為了說明所附的文字，也不是為了以不同的形式呈現一個相關的思想。相反，我想把繪畫作為一種獨立的認識論來思考：在繪畫中而不是在學術論文中排列源材料，會產生哪些不同的思維和感受模式？

通過這種方式，我的目標是可以略微取代學術寫作理想中的權威作者，并考慮一種通過圖像來回應社會現象的方式。

In drawingThings that Art, I became interested in the ways in which different forms allow, enable, encourage directions of thought and feeling. Academics know this: economists use different epistemological frameworks than philosophers, and thus have different “answers” to similar questions. This notion can be pushed further: charts, photographs, and medals are also ways to frame and express social issues.

The project I’m actively working on at the moment is a cultural history of drowning consisting of both prose and artworks calledThe Lung is a Bird and Fish. Drowning emerged as a notable form of accidental death in the mid-eighteenth century. “Apparently drowned” bodies, teetering between life and death, presented objects of fear, revulsion, and fascination. By the late 1700s, Humane Societies sprung up across Europe to advocate for urban design reform including lighting, guard-railing, systems of rewards and penalties, and watchmen along waterways. Meanwhile, drowning resuscitation methods, while plentiful, remained inefficacious and European seafarers generally could not swim even through the 19th century. Mouth-to-mouth resuscitation, while widely used by mid-wives reviving neonates, was deemed “vulgar” and banned by the mid-1700s. With the rise of maritime trade, increasing shipwrecks, and an effloresce of representations of water in painting and literature, drowning also became a virtual obsession in European literature, art, and life. The Paris Morgue, located on the bank of the Seine and dubbed“a museum for the drowned,” drew thousands of visitors a day. The book traces this Euro-centric history against a series of parallel, darker histories such as drownings among slaves in the Middle Passage and African migrants attempting to travel to Europe.

Overall,“The Lung is a Bird and a Fish” suggests that what is said or argued cannot be distinguished from how it is presented and communicated, and the art component is central to the project. Each form (a newspaper article, a legal document, an advertisement, a photograph) embodies different forms of authority and highlights or disavows the ambiguities, gaps and uncertainties that are an ineluctable aspect of any research project. The goal in the drawings is thus not to illustrate the accompanying text, nor to present an allied thought in a different form. Rather, I want to think about drawing as a separate epistemology: what different modes of thought and feeling altogether emerge from ordering source materials in a drawing rather than in an academic essay? In that way I aim to slightly displace the sovereign author required by academic writing and consider a way to respond to social phenomena in and through images.

龔鵬程，1956年生于臺北，臺灣師范大學博士，當代著名學者和思想家。著作已出版一百五十多本。

辦有大學、出版社、雜志社、書院等，并規劃城市建設、主題園區等多處。講學于世界各地。并在北京、上海、杭州、臺北、巴黎、日本、澳門等地舉辦過書法展。現為中國孔子博物館名譽館長、美國龔鵬程基金會主席。