Tài liệu Medical Nemesis: The Expropriation of Health doc

Medical Nemesis:

The Expropriation of Health

[Includes acknowledgements, introduction and Part1 - Clinical Iatrogenesis]

IVAN ILLICH / Random House 1976

Ivan Illich, Pantheon Books, A Division of Random House, New York. First American

Edition. Copyright 1976 by Random House, Inc. All rights reserved under International

and Pan-American Copyright Conventions. Published in the United States by Pantheon

Books, a division of Random House, Inc., New York. Originally published in Great Britain

by Calder & Boyars, Ltd., London. Copyright © 1975 by Ivan Illich. Manufactured in the

United States of America. Library of Congress Catalog Card Number: 75-38118 ISBN: 0-

394-40225-1

Acknowledgments

My thinking on medical institutions was shaped over several years in periodic

conversations with Roslyn Lindheim and John McKnight. Mrs. Lindheim, Professor of

Architecture at the University of California at Berkeley, is shortly to publish The

Hospitalization of Space, and John McKnight, Director of Urban Studies at Northwestern

University, is working on The Serviced Society. Without the challenge from these two

friends, I would not have found the courage to develop my last conversations with Paul

Goodman into this book.

Several others have been closely connected with the growth of this text: Jean Robert and

Jean P. Dupuy, who illustrated the economic thesis stated in this book with examples

from time-polluting and space-distorting transportation systems; André Gorz, who has

been my principal tutor in the politics of health; Marion Boyars, who with admirable

competence published the draft of this book in London and thus enabled me to base my

final version on a wide spectrum of critical reaction. To them and to all my critics and

helpers, and especially to those who have led me to valuable reading, I owe deep

gratitude.

This book would never have been written without Valentina Borremans. She has patiently

assembled the documentation on which it is based, and refined my judgment and

sobered my language with her constant

v

criticism. The chapter on the industrialization of death is a summary of the notes she has

assembled for her own book on the history of the face of death.

IVAN ILLICH

Cuernavaca, Mexico January 1976

Contents

Introduction 3

PART I. Clinical Iatrogenesis

1. The Epidemics of Modern Medicine 13

Doctors

' Effectiveness—an Illusion

Useless Medical Treatment

Doctor-Inflicted Injuries

Defenseless Patients

PART II. Social Iatrogenesis

2. The Medicalization of Life 39

Political Transmission of Iatrogenic Disease

Social Iatrogenesis

Medical Monopoly

Value-Free Cure?

Medicalization of the Budget

The Pharmaceutical Invasion

Diagnostic Imperialism

Preventive Stigma

Terminal Ceremonies

Black Magic

Patient Majorities

vii

PART III. Cultural Iatrogenesis

Introduction 127

3. The Killing of Pain 133

4. The Invention and Elimination of Disease 159

5. Death Against Death 179

Death as Commodity

The Devotional Dance of the Dead

The Danse Macabre

Bourgeois Death

Clinical Death

Trade Union Claims to a Natural Death

Death Under Intensive Care

PART IV. The Politics of Health

6. Specific Counterproductivity 211

7. Political Countermeasures 221

Consumer Protection for Addicts

Equal Access to Torts

Public Controls over the Professional Mafia

The Scientific Organization—of Life

Engineering for a Plastic Womb

8. The Recovery of Health 261