This article discusses the notion of emergent concerned groups and explores how these groups contribute to shaping the relations between technoscience, politics, and economic markets. The first part presents the case of the French Association of patients suffering from muscular dystrophies. This history suggests that under certain conditions, emergent concerned groups are able to impose a new form of articulation between scientific research and political identities by directly linking the issues of research content and results to that of their place (...) in the collective. The second part argues that the evolution of economic markets, combined with that of science and technology, leads to a multiplication of those emergent concerned groups. The study of the conditions under which these emergent groups become legitimate stakeholders as well as the analysis of their impact on market organization and technoscientific institutions are key research topics for the near future. (shrink)

During the past decade, the “script” concept, indicating how technologies prescribe human actions, has acquired a central place in STS. Until now, the concept has mainly functioned in descriptive settings. This article will deploy it in a normative setting. When technologies coshape human actions, they give material answers to the ethical question of how to act. This implies that engineers are doing “ethics by other means”: they materialize morality. The article will explore the implications of this insight for engineering ethics. (...) It first augments the script concept by developing the notion of technological mediation. After this, it investigates how the concept of mediation could be made fruitful for design ethics. It discusses how the ambition to design behaviorinfluencing technologies raises moral questions itself and elaborates two methods for anticipating technological mediation in the design process: performing mediation analyses and using an augmented version of constructive technology assessment. (shrink)

Since the 1980s the concept of ANT has remained unsettled. ANT has continuously been critiqued and hailed, ridiculed and praised. It is still an open question whether ANT should be considered a theory or a method or whether ANT is better understood as entailing the dissolution of such modern ‘‘genres’’. In this paper the authors engage with some important reflections by John Law and Bruno Latour in order to analyze what it means to ‘‘do ANT,’’ and, doing so after ‘‘doing (...) ANT on ANT.’’ In particular the authors examine two post-ANT case studies by Annemarie Mol and Marilyn Strathern and outline the notions of complexity, multiplicity, and fractality. The purpose is to illustrate the analytical consequences of thinking with post-ANT. The analysis offers insights into how it is possible to ‘‘go beyond ANT,’’ without leaving it entirely behind. (shrink)

According to policy makers, telemedicine offers “huge opportunities to improve the quality and accessibility of health services.” It is defined as diagnosis, treatment, and monitoring, with doctors and patients separated by space but mediated through information and communication technologies. This mediation is explored through an ethnography of a U.K. teledermatology clinic. Diagnostic image transfer enables medicine at a distance, as patients are removed from knowledge generation by concentrating their identities into images. Yet that form of identity allows images and the (...) expert gaze to be brought into potentially lifesaving proximity. Following Latour’s thread, images must be captured and then mobilized to the knowledge base, where they must be stabilized into standard diagnoses, then combined with different images, waiting lists, skin lesions, dermatologists, paper records, and beds, so that ultimately, outcomes are produced. This huge task requires new knowledges and a widening of agency that, if unacknowledged, may see telemedicine projects continue to founder. (shrink)

The emergence of the field of health care at a distance, or “telehealth,” has been embedded within discourses of high ambition about health improvement, seamless services, empowerment, and independence for patients. In this article, the authors examine how telehealthcare technologies assume certain forms of patients—or “telepatients”—who can be mobilized and combined with images and artifacts that speak for them in the clinical encounter. Second, a tentative intervention is made in these emerging identities in the form of facilitating some alternative discourses (...) about telehealthcare. The aim is to stimulate debate by presenting and contrasting these different approaches to technology development. Such differences take material and discursive shape in the making and unmaking of telepatients, showing important interferences in the shaping of identity and possibilities for governance and participation. (shrink)

By now, the laboratory tradition, crafting transportable knowledge that allows for comparison, has been amply studied. However, other knowledge traditions, notably that of the clinic, deserve further articulation. The authors contribute to this by unraveling some specificities of rehabilitation practice. How do laboratory and clinical traditions in rehabilitation relate to independence? The first seeks to quantify people's independence; the latter attends to qualitatively different ways of being independent. While measuring independence is a matter of aggregating scores on a priori established (...) dimensions, clinical rehabilitation concerns coordinating different ways of being independent. While independence scales map a linear development in time, rehabilitation participants juggle with time, including uncertain futures in their present. In clinical practice, then, independence is neither a single, coherent, fact nor a clear-cut, stable goal. Instead, professionals as well as patients work by creatively doctoring with the large variety of elements that are relevant to daily life with long-term disabilities. (shrink)

This article is about the materiality of difference, about race, sex and sexual differences among others. To find out about these differences and their materialities, this article looks not into bodies but rather at how bodies are positioned in spaces and how they are enacted in practice. In the first part of the article, the focus is on the relationality of identities and how they are made and unmade in specific practices. The second part of the article attends to the (...) various histories and practices that are drawn together in one specific body and how they help to enact a particular version of the body. Differences, it is argued, are not given ‘entities’ out there, awaiting dis-covery; rather they are effects that come about in relational practices. This indicates that materiality is not simply a given that can be taken on board, but it is the very configuration through which differences can be articulated. (shrink)

We all know that we have and are our bodies. But might it be possible to leave this common place? In the present article we try to do this by attending to the way we do our bodies. The site where we look for such action is that of handling the hypoglycaemias that sometimes happen to people with diabetes. In this site it appears that the body, active in measuring, feeling and countering hypoglycaemias is not a bounded whole: its boundaries (...) leak. Bits and pieces of the outside get incorporated within the active body; while the centre of some bodily activities is beyond the skin. The body thus enacted is not self-evidently coherent either. There are tensions between the body’s organs; between the control under which we put our bodies and the erratic character of their behaviour; and between the various needs and desires single bodies somehow try to combine. Thus to say that a body is a whole, or so we conclude, skips over a lot of work. One does not hang together as a matter of course: keeping oneself together is something the embodied person needs to do. The person who fails to do so dies. (shrink)

Suitable for students and scholars, this title challenges the assumption that skepticism, rather than established belief, lies at the heart of scientific discovery.

In this engaging study, the authors put casuistry into its historical context, tracing the origin of moral reasoning in antiquity, its peak during the sixteenth and early seventeenth century, and its subsequent fall into disrepute from the mid-seventeenth century.

Telecare, the provision of care through remote interaction enabled by information and communication technology, is quickly developing. Integration with other technological developments is to be expected and will create systems that enable more intense, continuous and unobtrusive monitoring of health, and more personalised feedback and instructions. One of the goals of telecare is enhancing the independence and self-management of patients. In this article three degrees of self-management are described and a distinction is made between compliant and concordant forms of self-management. (...) It is argued that telecare merely promotes forms of self-management in which compliance to medical instructions is central. Technological developments and normative policy considerations may enforce this trend to implement an interpretation of self-management in which compliance to a strict medical regime is prominent. Against this, a plea is made for developing telecare systems that incorporate concordant and collaborative forms of self-management, in which the patient’s own perspective is empowered. (shrink)

This paper describes the approach of empirical ethics, a form of ethics that integrates non-positivist ethnographic empirical research and philosophy. Empirical ethics as it is discussed here builds on the ‘empirical turn’ in epistemology. It radicalizes the relational approach that care ethics introduced to think about care between people by drawing in relations between people and technologies as things people relate to. Empirical ethics studies care practices by analysing their intra-normativity, or the ways of living together the actors within these (...) practices strive for or bring about as good practices. Different from care ethics, what care is and if it is good is not defined beforehand. A care practice may be contested by comparing it to alternative practices with different notions of good care. By contrasting practices as different ways of living together that are normatively oriented, suggestions for the best possible care may be argued for. Whether these suggestions will actually be put to practice is, however, again a relational question; new actors need to re-localize suggestions, to make them work in new practices and fit them in with local intra-normativities with their particular routines, material infrastructures, know-how and strivings. (shrink)

Objectivity has a history, and it is full of surprises. In Objectivity, Lorraine Daston and Peter Galison chart the emergence of objectivity in the mid-nineteenth-century sciences--and show how the concept differs from its alternatives, truth-to-nature and trained judgment. This is a story of lofty epistemic ideals fused with workaday practices in the making of scientific images. From the eighteenth through the early twenty-first centuries, the images that reveal the deepest commitments of the empirical sciences--from anatomy to crystallography--are those featured in (...) scientific atlases, the compendia that teach practitioners what is worth looking at and how to look at it. Galison and Daston use atlas images to uncover a hidden history of scientific objectivity and its rivals. Whether an atlas maker idealizes an image to capture the essentials in the name of truth-to-nature or refuses to erase even the most incidental detail in the name of objectivity or highlights patterns in the name of trained judgment is a decision enforced by an ethos as well as by an epistemology. As Daston and Galison argue, atlases shape the subjects as well as the objects of science. To pursue objectivity--or truth-to-nature or trained judgment--is simultaneously to cultivate a distinctive scientific self wherein knowing and knower converge. Moreover, the very point at which they visibly converge is in the very act of seeing not as a separate individual but as a member of a particular scientific community. Embedded in the atlas image, therefore, are the traces of consequential choices about knowledge, persona, and collective sight. Objectivity is a book addressed to anyone interested in the elusive and crucial notion of objectivity-- and in what it means to peer into the world scientifically. Lorraine Daston is Director at the Max Planck Institute for the History of Science in Berlin, Germany. She is the coauthor of Wonders and the Order of Nature, 1150-1750 and the editor of Things That Talk: Object Lessons from Art and Science. Peter Galison is Pellegrino University Professor of the History of Science and of Physics at Harvard University. He is the author of Einstein's Clocks, Poincaré's Maps: Empires of Time, How Experiments End, and Image and Logic: A Material Culture of Microphysics, and other books, and coeditor of The Architecture of Science. (shrink)

First Published in 1993. Routledge is an imprint of Taylor & Francis, an informa company.

In this engaging study, the authors put casuistry into its historical context, tracing the origin of moral reasoning in antiquity, its peak during the sixteenth and early seventeenth century, and its subsequent fall into disrepute from the mid-seventeenth century.

The Body Multiple is an extraordinary ethnography of an ordinary disease. Drawing on fieldwork in a Dutch university hospital, Annemarie Mol looks at the day-to-day diagnosis and treatment of atherosclerosis. A patient information leaflet might describe atherosclerosis as the gradual obstruction of the arteries, but in hospital practice this one medical condition appears to be many other things. From one moment, place, apparatus, specialty, or treatment, to the next, a slightly different “atherosclerosis” is being discussed, measured, observed, or stripped away. (...) This multiplicity does not imply fragmentation; instead, the disease is made to cohere through a range of tactics including transporting forms and files, making images, holding case conferences, and conducting doctor-patient conversations. The Body Multiple juxtaposes two distinct texts. Alongside Mol’s analysis of her ethnographic material—interviews with doctors and patients and observations of medical examinations, consultations, and operations—runs a parallel text in which she reflects on the relevant literature. Mol draws on medical anthropology, sociology, feminist theory, philosophy, and science and technology studies to reframe such issues as the disease-illness distinction, subject-object relations, boundaries, difference, situatedness, and ontology. In dialogue with one another, Mol’s two texts meditate on the multiplicity of reality-in-practice. Presenting philosophical reflections on the body and medical practice through vivid storytelling, The Body Multiple will be important to those in medical anthropology, philosophy, and the social study of science, technology, and medicine. (shrink)

Medicine Under the Nazis Robert Proctor. and environment in a wide range of bodily traits; he derived his data from the study of several thousand identical and nonidentical twins (see Figure 8). Verschuer's studies were followed by hundreds  ...

“When Species Meet is a breathtaking meditation on the intersection between humankind and dog, philosophy and science, and macro and micro cultures.” —Cameron Woo, Publisher of Bark magazine In 2006, about 69 million U.S. households had pets, giving homes to around 73.9 million dogs, 90.5 million cats, and 16.6 million birds, and spending over $38 billion dollars on companion animals. As never before in history, our pets are truly members of the family. But the notion of “companion species”—knotted from human (...) beings, animals and other organisms, landscapes, and technologies—includes much more than “companion animals.” In When Species Meet, Donna J. Haraway digs into this larger phenomenon to contemplate the interactions of humans with many kinds of critters, especially with those called domestic. At the heart of the book are her experiences in agility training with her dogs Cayenne and Roland, but Haraway’s vision here also encompasses wolves, chickens, cats, baboons, sheep, microorganisms, and whales wearing video cameras. From designer pets to lab animals to trained therapy dogs, she deftly explores philosophical, cultural, and biological aspects of animal-human encounters. In this deeply personal yet intellectually groundbreaking work, Haraway develops the idea of companion species, those who meet and break bread together but not without some indigestion. “A great deal is at stake in such meetings,” she writes, “and outcomes are not guaranteed. There is no assured happy or unhappy ending—socially, ecologically, or scientifically. There is only the chance for getting on together with some grace.” Ultimately, she finds that respect, curiosity, and knowledge spring from animal-human associations and work powerfully against ideas about human exceptionalism. One of the founders of the posthumanities, Donna J. Haraway is professor in the History of Consciousness Department at the University of California, Santa Cruz. Author of many books and widely read essays, including The Companion Species Manifesto: Dogs, People, and Significant Otherness and the now-classic essay “The Cyborg Manifesto,” she received the J. D. Bernal Prize in 2000, a lifetime achievement award from the Society for Social Studies in Science. (shrink)

"... Dr. Ihde brings an enlightening and deeply humanistic perspective to major technological developments, both past and present." —Science Books & Films "Don Ihde is a pleasure to read.... The material is full of nice suggestions and details, empirical materials, fun variations which engage the reader in the work... the overall points almost sneak up on you, they are so gently and gradually offered." —John Compton "A sophisticated celebration of cultural diversity and of its enabling technologies.... perhaps the best single (...) volume relating the philosophical tradition to the broad issues raised by contemporary technologies." —Choice "... important and challenging... " —Review of Metaphysics "... a range of rich historical, cultural, philosophical, and psychological insights, woven together in an intriguing and clear exposition... The book is really a pleasure to read, for its style, immense learning and sanity." —Teaching Philosophy The role of tools and instruments in our relation to the earth and the ways in which technologies are culturally embedded provide the foci of this thought-provoking book. (shrink)

An ethic of the fitting: a conceptual framework for nursing practiceNurses are expected to act within an ethos of care cognisant of duty, the right, and the good. Concepts of virtue theory, utilitarianism and deontology are used to outline a conceptual ethical framework for nurses in practice. This ‘Moebius’ framework aims to locate the virtues in a symbiotic relationship with the principles of utilitarianism and deontology. Under this framework, fitting ethical responses are sought. Within an ethic of the fitting, rules (...) and principles do not guarantee the most ethically justifiable outcomes. Within the Moebius approach, the nurse ought to respond with a sense of compassion that befits the moment rather than adhere to a rule at all costs. (shrink)

"Every word, like a sacred object, has its place. No _précis_ is possible. This extraordinary book must be read."—Edmund Carpenter, _New York Times Book Review _ "No outline is possible; I can only say that reading this book is a most exciting intellectual exercise in which dialectic, wit, and imagination combine to stimulate and provoke at every page."—Edmund Leach, _Man _ "Lévi-Strauss's books are tough: very scholarly, very dense, very rapid in argument. But once you have mastered him, human history (...) can never be the same, nor indeed can one's view of contemporary society. And his latest book, _The Savage Mind_, is his most comprehensive and certainly his most profound. Everyone interested in the history of ideas _must_ read it; everyone interested in human institutions _should _read it."—J. H. Plumb, _Saturday Review_ "A constantly stimulating, informative and suggestive intellectual challenge."—Geoffrey Gorer, _The Observer_, London. (shrink)

Good work in nursing is work that is scientifically effective as well as morally and socially responsible. The purpose of this study was to examine variables that sustain good work among entering nurses (with one to five years of experience) and experienced professional nurses despite the obstacles they encounter. In addition to role models and mentors, entering and experienced nurses identified team work, cohesiveness and shared values as levers for good work. These nurses used prioritization, team building and contemplative practices (...) to overcome obstacles. Entering professional nurses tended to avoid conflict in the work setting. Experienced nurses reported forming teams of decision makers who share similar values to resolve conflict. These findings have implications for nurse education and nursing practice. Reflection on the importance of values and virtue in sustaining good work is important. Entering professional nurses should be encouraged to seek positive role models and reflect on the lessons that can be learned from experienced exemplary nurses. (shrink)

Most clinicians take for granted a simple, reductionist understanding of medical knowledge that is at odds with how they actually practice medicine; routine medical decisions incorporate more complicated kinds of information than most standard accounts of medical reasoning suggest. A better understanding of the structure and function of knowledge in medicine can lead to practical improvements in clinical medicine. This understanding requires some familiarity with epistemology, the study of knowledge and its structure, in medicine. Michael Polanyi's theory of tacit knowing (...) is advanced as the basis for developing a more accurate understanding of medical knowledge. Tacit knowing, which explores the taken-for-granted background knowledge that underlies all human knowing, is explained in detail with a focus on its relevance for clinical medicine. The implications of recognizing tacit knowing in medicine and medical decisions are discussed. These include the ability to explain the importance of the clinical encounter in medical practice, mechanisms for analysing patient and doctor as persons, and the need for humility given the uncertainty that the tacit dimension injects into all medical decisions. This more robust medical epistemology allows clinicians to better articulate the nature and importance of patient-centred care, to avoid pitfalls inherent in reductionist approaches to medical knowledge, and to think more clearly about the relationships between medicine and health care at the individual and population levels. (shrink)

Dignity is a fundamental concept, but its meaning is not clear. This paper attempts to clarify the term by analysing and reconnecting two meanings of dignity: humanitas and dignitas. Humanitas refers to citizen values that protect individuals as equal to one another. Dignitas refers to aesthetic values embedded in genres of sociality that relate to differences between people. The paper explores these values by way of an empirical ethical analysis of practices of washing psychiatric patients in nursing care. Nurses legitimate (...) the washing of reluctant patients with reference to dignity. The analysis shows the intertwinement of humanitas and dignitas that gives dignity its fundamental meaning. (shrink)

In 1995, the Dutch Minister of Health proposed that a randomized clinical trial (RCT) with heroin-maintenance for severe abusers be conducted. It took nearly four years of lengthy debates before the Dutch Parliament consented to the plan. Apart from the idea of prescribing heroin, the minister and her scientific advisers had to defend the quite high material and non-material costs that would arise from employing the randomized controlled design. They argued that the RCT represented the truly scientific approach and was (...) the royal way to unambiguous results. In the present article, I question this common dual justification of RCTs. First, I situate the historical origins and the basic assumptions of the ideal experiment in 20th-century economic liberalism. Secondly, using the Dutch heroin experiment as an example, I discuss human-science experimentation as an attempt to create reality rather than merely record it. Finally, I discuss some surprising responses by heroin users. These responses display the assumptions of RCTs discussed in the historical section, and underline the importance of the culture of heroin use. In the epilogue, I suggest that cultural aspects of heroin consumption can best be studied by thorough ethnographic research. (shrink)

Abstract.This paper responds to the Expert Patient initiative by questioning its over-reliance on instrumental forms of reasoning. It will be suggested that expertise of the patient suffering from chronic illness should not be exclusively seen in terms of a model of technical knowledge derived from the natural sciences, but should rather include an awareness of the hermeneutic skills that the patient needs in order to make sense of their illness and the impact that the illness has upon their sense of (...) self-identity. By appealing to MacIntyre’s concepts of “virtue” and “practice”, as well as Frank’s notion of the “wounded story-teller”, it will be argued that chronic illness can be constituted as a practice, by building a culture of honest and courageous story-telling about the experience of chronic suffering. The building of such a practice will renew the cultural resources available to the patient, the physician and the rest of the community in understanding illness and patient-hood. (shrink)

The “patient perspective” serves as an analytical tool to present patients as knowing subjects in research, rather than as objects known by medicine. This paper analyses problems encountered with the concept of the patient perspective as applied to long-term mental health care. One problem is that “having a perspective” requires a perception of oneself as an individual and the ability to represent one’s individual situation in language; this excludes from research patients who do not express themselves verbally. Another problem is (...) that the idea of “talk” as a representation of the world ignores the fact that talk is also performative in the world: it requires, at least, the ability to deal with an interview situation. To think up alternative ways of including patients as subjects in research, I develop an approach that takes this performativity as a starting point. Analysing practical situations and activities, I argue that patients enact appreciations, making known what they like or dislike by verbal or non-verbal means in a given material environment, in situations that are co-produced by others. Thus, subjectivity is linked to situations and interactions, rather than just to individual characteristics; to “patient positions,” rather than “patient perspectives.”. (shrink)

In this remarkable book Michel Foucault, one of the most influential thinkers of recent times, calls us to look critically at specific historical events in order to uncover new layers of significance.

In a new introduction, the authors describe how science and its social context were understood when this book was first published, and how the study of the history of science has changed since then.

This edition includes new essays by philosopher Michael Williams and literary scholar David Bromwich, as well as Rorty's previously unpublished essay "The ...

The currently developing fields of Ambient Intelligence and Persuasive Technology bring about a convergence of information technology and cognitive science. Smart environments that are able to respond intelligently to what we do and that even aim to influence our behaviour challenge the basic frameworks we commonly use for understanding the relations and role divisions between human beings and technological artifacts. After discussing the promises and threats of these technologies, this article develops alternative conceptions of agency, freedom, and responsibility that make (...) it possible to better understand and assess the social roles of Ambient Intelligence and Persuasive Technology. The central claim of the article is that these new technologies urge us to blur the boundaries between humans and technologies also at the level of our conceptual and moral frameworks. (shrink)

A scientific community cannot practice its trade without some set of received beliefs. These beliefs form the foundation of the "educational initiation that prepares and licenses the student for professional practice". The nature of the "rigorous and rigid" preparation helps ensure that the received beliefs are firmly fixed in the student's mind. Scientists take great pains to defend the assumption that scientists know what the world is like...To this end, "normal science" will often suppress novelties which undermine its foundations. Research (...) is therefore not about discovering the unknown, but rather "a strenuous and devoted attempt to force nature into the conceptual boxes supplied by professional education". (shrink)

A theoretical physicist and feminist theorist, Karen Barad elaborates her theory of agential realism, a schema that is at once a new epistemology, ontology, and ethics.