☆作者简介：

戴维·J.罗思曼（David J. Rothman），美国哥伦比亚大学内科与外科医师学院伯纳德·舍恩伯格社会医学讲席教授、社会与医学研究中心主任、哥伦比亚大学历史学教授。著有《发现庇护所》（The Discovery of The Asylum）和《良心与便利》（Conscience and Convenience）等作品。

☆译者简介：

潘驿炜，北京大学医学人文学院博士研究生，关注医学史上的法律和政策问题，译有《病患悖论：为什么“过度”医疗不利于你的健康？》（中国社会科学出版社），合译有《重来也不会好过现在：成年人的哲学指南》（广西师范大学出版社）。

David Rothman gives us a brilliant, finely etched study of medical practice today. Beginning in the mid-1960s, the practice of medicine in the United States underwent a most remarkable--and thoroughly controversial--transformation. The discretion that the profession once enjoyed has been increasingly circumscribed, and now an almost bewildering number of parties and procedures participate in medical decision making. Well into the post-World War II period, decisions at the bedside were the almost exclusive concern of the individual physician, even when they raised fundamental ethical and social issues. It was mainly doctors who wrote and read about the morality of withholding a course of antibiotics and letting pneumonia serve as the old man's best friend, of considering a newborn with grave birth defects a "stillbirth" thus sparing the parents the agony of choice and the burden of care, of experimenting on the institutionalized the retarded to learn more about hepatitis, or of giving one patient and not another access to the iron lung when the machine was in short supply. Moreover, it was usually the individual physician who decided these matters without formal discussions with patients, their families, or even with colleagues, and certainly without drawing the attention of journalists, judges, or professional philosophers. The impact of the invasion of outsiders into medical decision-making, most generally framed, was to make the invisible visible. Outsiders to medicine--that is, lawyers, judges, legislators, and academics--have penetrated its every nook and cranny, in the process giving medicine exceptional prominence on the public agenda and making it the subject of populardiscourse. The glare of the spotlight transformed medical decision making, shaping not merely the external conditions under which medicine would be practiced (something that the state, through the regulation of licensure. had always done), but the very substance of medical practice--the decisions that physicians made at the bedside.