Health: current issue

Enacting death in the intensive care unit: medical technology and the multiple ontologies of death

Hadders, H. — Mon, 19 Oct 2009 04:21:15 PDT

This article explores various ways health personnel enact death in connection with mechanical ventilation treatment withdrawal in the intensive care unit (ICU) at Trondheim University Hospital. The main focus is on sedated terminal patients who undergo mechanical ventilator treatment withdrawal and relatives’ presence at this time. Mol’s (2002) praxiographic orientation of the actor-network approach is followed while exploring this medical practice. Utilizing this interdisciplinary science and technology studies approach this article describes what Timmermans and Berg (2003) have called ‘ technology-in-practice’. Thus the main focus of the analysis is on medical interventions, and enactments of death within medical practice. The article argues against a ‘social essentialist’ approach to medical technology, which views technology as a passive force empowered by social relations. It explores how various enactments of death are intrinsically linked with and shaped by the use of medical technology within clinical practice. A praxiographic inquiry into how death is enacted carefully takes notice of how medical practice and techniques make death audible, tangible, visible, knowable and real. Mol’s praxiographic approach also enables a description of how the multiple enactments of death connect within end-of-life care through various forms of coordination. This article is based on interviews with 28 nurses and two physicians in a Norwegian intensive care unit.

A metasynthesis of midwives' experience of hospital practice in publicly funded settings: compliance, resistance and authenticity

O'Connell, R., Downe, S. — Mon, 19 Oct 2009 04:21:15 PDT

Worldwide, increasing percentages of women are giving birth in centralized hospitals in the belief that this maximizes safety for themselves and their babies. In parallel, there is international recognition that the number of birth interventions used in the routine care of labouring women is rising. This is fuelling concern about iatrogenesis, and, particularly, maternal and infant morbidity and mortality. It also has an adverse impact on the economics of health care. National and international policy characterizes midwives as the guardians of normal childbirth. This guardianship appears to be failing. The objective of this metasynthesis is to explore midwives’ perceptions of hospital midwifery with a focus on labour ward practice to examine professional discourses around midwifery work in the current modernist, risk averse and consumerist childbirth context. Based on an iterative search strategy, 14 studies were selected for the metasynthesis. Three overarching themes were identified: ‘power and control’; ‘compliance with cultural norms’; and ‘attempting to normalize birth’. Most midwives aimed to provide what they characterized as ‘real midwifery’ but this intention was often overwhelmed with heavy workloads and the normative pressure to provide equitable care to all women. This raises questions of authenticity, both in terms of midwives living out their beliefs, and in terms of acknowledgement of the power to resist. The theoretical insights generated by the metasynthesis could have resonance for other professional and occupational groups who wish to offer autonomous individualized services in an increasingly risk-averse target driven global society.

Identities under construction: Women hailed as addicts

Aston, S. — Mon, 19 Oct 2009 04:21:15 PDT

Despite continuing investigations of the efficacy of Canadian addiction treatment services and supports across a range of health care settings and socio-cultural groups, many systemic, geographic and ideological barriers to service provision for women still exist. Determining how current services and supports can become more congruent with women’s gender-specific needs is a current research focus. Drawing on Butler’s reformulation of Althusser’s interpellation, this article explores the power of hailing, where hailing power lies, and how hailing operates in discourses about addiction that appear in women’s talk of their encounters with addiction services and supports. The article briefly outlines Butler’s understanding of interpellation and examines ways by which gender operates as both condition and effect in women becoming addicts. I argue that women’s narratives reveal patterns of interaction that intersect and generate complex social meanings and identities, and serve to get women’s attention in terms of seeing themselves as addicts. Further, I argue that powerful competing discourses concerning gender and the medicalization of addiction, hailed through these interactions, are taken up as lived realities by some women and resisted by others. Knowing how women are hailed to take up as their own, or resist, aspects of traditional and gendered discourses within addiction treatment and recovery communities can inform gender-compassionate service provision.

Spaces of care in the third sector: understanding the effects of professionalization

Carey, G., Braunack-Mayer, A., Barraket, J. — Mon, 19 Oct 2009 04:21:15 PDT

Increasingly the health and welfare needs of individuals and communities are being met by third sector, or not-for-profit, organizations. Since the 1980s third sector organizations have been subject to significant, sector-wide changes, such as the development of contractual funding and an increasing need to collaborate with governments and other sectors. In particular, the processes of ‘professionalization’ and ‘bureaucratization’ have received significant attention and are now well documented in third sector literature. These processes are often understood to create barriers between organizations and their community groups and neutralize alternative forms of service provision. In this article we provide a case study of an Australian third sector organization undergoing professionalization. The case study draws on ethnographic and qualitative interviews with staff and volunteers at a health-based third sector organization involved in service provision to marginalized community groups. We examine how professionalization alters organizational spaces and dynamics and conclude that professionalized third sector spaces may still be ‘community’ spaces where individuals may give and receive care and services. Moreover, we suggest that these community spaces hold potential for resisting the neutralizing effects of contracting.

Food allergy and food intolerance: towards a sociological agenda

Nettleton, S., Woods, B., Burrows, R., Kerr, A. — Mon, 19 Oct 2009 04:21:15 PDT

This article asks what sociological insights an analysis of food allergy and food intolerance might afford. We outline the parameters of debates around food allergy and food intolerance in the immunological, clinical and epidemiological literatures in order to identify analytic strands which might illuminate our sociological understanding of the supposed increase in both. Food allergy and food intolerance are contested and contingent terms and it is salient that the term true food allergy is replete throughout medico-scientific, epidemiological and popular discourses in order to rebuff spurious or ‘nonallergic’ claims of food-related symptoms. Complexity theory is introduced as a means of gaining analytic purchase on the food allergy debate. The article concludes that the use of this perspective provides a contemporary example of the ‘double hermeneutic’, in that the meanings and interpretations of contemporary explanations of food allergy are both permeated by, and can be made sense of, through recourse to complexity thinking.

Book review: The circulation of children: Kinship, adoption, and morality in Andean Peru Jessaca B. Leinaweaver. Durham, NC: Duke University Press, 2008. ISBN13 978--0--8223--4197--0 (pbk) $US21.95

Swift, K. — Mon, 19 Oct 2009 04:21:15 PDT

Book Review: Injury: The politics of product design and safety law in the United States Sarah S. Lochlann Jain. Princeton, NJ: Princeton University Press, 2006. 214 pp. ISBN 9780691119076 (pbk) $US22.95

Patterson, P., Rock, M. — Mon, 19 Oct 2009 04:21:15 PDT