Beyond ideal speech situations: Adapting to communication asymmetries in health care

Abstract

Inclusive, unconstrained and honest communication is widely advocated as beneficial and ethical. We critically explore this assumption by reflecting upon our research in acute care, informal care and public health. Using Habermas’ ideals of dialogue to conceptualise ideal speech, we concur with observations that health care is often characterised by intractable exclusions and constraints. Rather than advocating implementing the ideals of dialogue, however, we examine how people adapt to these difficult and intransigent contexts. Non-ideal contexts, we find, sometimes call for non-ideal responses. Deception and furthering personal interests, and thus departing from the ideals of dialogue, can be adaptive responses.

‘You're there because you are unprofessional’: patient and public involvement as liminal knowledge spaces

“…As Gillespie et al . () have pointed out, Habermas’ ideals of dialogue are aspirational, goals to be worked towards. External conditions, economic and political, affect the time and the resources that are available.…”

Anticipating or Accommodating to Public Concern? Risk Amplification and the Politics of Precaution Reexamined

“…Actions by local community protesters are found both to have gained national media attention and to have prefigured a key parliamentary debate that articulated citizen concerns and spurred the government recognition of MTT and health as an important public issue warranting further regulatory attention in the months immediately preceding the appointment of the IEGMP. Furthermore, the risk amplification processes observed characteristically embodied adaptive responses by citizens to “non‐ideal” circumstances that called for creative risk communicative solutions in order to surmount immutable asymmetries contained within MTT network siting practices (Gillespie et al., ; Murdock et al., ). The form and dynamics of risk amplification were underpinned by socioculturally embedded processes of active sense‐making and adaptive use of knowledge and communication resources and skills, which animated the political possibilities for a vulnerable community to represent risk, escalate controversy, mobilize networks of resistance and counter expertise, and renegotiate power relations, in contravention to accepted government policy and scientific opinion (Hess & Coley, ; Kinsella et al., ; Löfstedt et al., ; Motion et al., ).…”

“…We recommend that studies that invoke or employ the SARF specify, if not indeed explicitly test, which underlying communication models best apply to describe risk amplification processes and mechanisms, and how this varies over time, because uncritical assumptions about the context and characterization of risk amplification and its effects may otherwise be misaligned or misplaced (Wardman, ). In some cases, criticism of ostensibly reasonable community responses and precautionary arguments that have arisen adaptively to fit the context of public vulnerabilities to risk, institutional constraints, and industry practices might be misdirected (Gillespie et al., ). Incorporating these contextual considerations more explicitly into the SARF would help to foreground attention to the forming of linkages between community knowledge, performance, and social relations in the rhetorical identification, production, and negotiation of institutional subsystem boundaries thought to be key elements in bridging Stage 1 and Stage 2 risk amplification processes.…”

“…Contributing to this literature, we wish to theoretically elaborate how practices of risk amplification by citizens can help to elevate personal vulnerability and objections to risk beyond a “local matter of concern” to produce wider impacts at different social, political, and economic scales over time (Kasperson & Kasperson, ; Smit & Wandel, ). Particularly, we argue that risk amplification may at times characteristically reflect an “adaptive” communicative response that is undertaken by citizens in “non‐ideal” contexts when local communities are confronted by intractable constraints and instrumental exchanges of risk‐related information that are perceived to be against community interests (Gillespie, Reader, Cornish, & Campbell, ; Murdock et al., ). For example, past research indicates that citizens can assure wider public attention especially when they are able to rhetorically establish and renegotiate the boundaries of expertise and power underlying policy decisions, irrespective of official declarations of acceptable risk, even in cases of mandatory technology rollout (Bröer, de Graaff, Duyvendak, & Wester, ; Drake, ; Hess & Coley, ; Kasperson et al., ; Kinsella, Kelly, & Autry, ; Motion, Leitch, & Weaver, ; Pidgeon et al., ; Wynne, ).…”

A Habermasian perspective on joint meaning making online: What does it offer and what are the difficulties?

“…Reducing asymmetry is a challenge for those exploring the implications of Habermas's thinking in f2f settings (e.g. Gillespie et al, 2014) and a general focus for those seeking to establish more democratic civic online networks (e.g. Pinkett, 2003); experiences in both cases point to the size of the challenge and the resources needed to address it.…”