Medical technology and the crisis of experience: The costs of clinical legitimation

Plough, Alonzo L.

doi:10.1016/0271-5392(81)90010-1

Cited by 5 publications

(2 citation statements)

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“…We can refer to an extant literature dating from the second half of the 20th century onwards where the relevant questions of expanding symptoms trajectory of various diseases have already been developed. [31][32][33][34] In sum, by extending life, modern medicine seems to have contributed to prolonging various disease states or creating new diseases, including new forms, symptoms, and treatments. This is the case for many others chronic conditions.…”

Section: Dbs As a "New Form" Of Iatrogenic Harms?mentioning

confidence: 99%

Incoming ethical issues for deep brain stimulation: when long-term treatment leads to a ‘new form of the disease’

Gilbert

Lancelot

2020

J Med Ethics

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Deep brain stimulation (DBS) has been regarded as an efficient and safe treatment for Parkinson’s disease (PD) since being approved by the Food and Drug Administration (FDA) in 1997. It is estimated that more than 150 000 patients have been implanted, with a forecasted rapid increase in uptake with population ageing. Recent longitudinal follow-up studies have reported a significant increase in postoperative survival rates of patients with PD implanted with DBS as compared with those not implanted with DBS. Although DBS tends to increase life expectancy for most patients with PD, this medical benefit does not come without attendant negative consequences. For example, emerging forms of iatrogenic harms are sometimes induced—harms which were not initially expected when clinicians proposed neurosurgery and patients or their guardians consented to the treatment. We report and discuss the clinical case of a patient who was implanted with DBS more than 20 years ago (at the time of writing) and is now experiencing unexpected stages of PD. This case illustrates how extending the life span without improving quality of life may introduce a burden of harms for patients and families. As well, this case shows why we should prepare for the expanding numbers of PD-implanted patients experiencing a gain of longevity but with severe stages of disease leading to diminution in quality of life. This newly observed effect of DBS treatment requires us to explore ethical questions related to iatrogenic harms, informed consent, end of life and caregivers’ burden.

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Section: Dbs As a "New Form" Of Iatrogenic Harms?mentioning

confidence: 99%

Incoming ethical issues for deep brain stimulation: when long-term treatment leads to a ‘new form of the disease’

Gilbert

Lancelot

2020

J Med Ethics

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“…There are, of course, several other threads of analysis that could be relevant to an examination of the time-space dimensions at play in our empirical cases. Some examples are: patients' biographical trajectories and experience of dialysis (Fagerhaugh et al 1986;Plough 1981;Russ et al 2005), professional groups' struggles and "geographies of knowledge" (Shapin 1998) by which they define and protect their epistemological and clinical terrain, the temporal structure of professional interactions around the use of health technology (for an analysis of radiologists, technicians, and CT scan, see Barley 1990), and the way dialysis units are regionalised (Giddens, 1984) and impose a certain zoning of time-space (cycles of presence/ absence, daily cycles of use).…”

Section: Notesmentioning

confidence: 99%

Displacement and Emplacement of Health Technology

Lehoux

Daudelin

Holmes

et al. 2008

Science, Technology, & Human Values

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The provision of "closer-to-patient" services has increased in most industrialized countries. However, the migration of services in non-traditional health care settings implies redefining the role of technical and human entities and transforming the nature and use of technologies and places. Drawing on various scholarly efforts to conceptualize space, place, and technology, this paper compares and contrasts satellite and mobile dialysis units implemented in two regions in the province of Quebec, Canada. The satellite units were hosted in two small, local hospitals where nursing staff had been recently trained. The mobile unit was a bus adapted to host five dialysis stations; nurses traveled back and forth between a university teaching hospital and two sites located within a radius of 7.6 miles. In both projects, nephrologists supervised from a distance via a videoconferencing system. Our aim is to illustrate the ways in which the displacement of technical and human entities gives shape to new forms of emplacement in non-traditional health care settings. The satellite and mobile units contributed to the culture of dialysis care and transformed the identity of nurses, doctors, patients, and technologies. By contrasting two projects involving different spatial and clinical logics, we analyze in what ways certain forms of recombination of human and technical entities can prove incomplete but nevertheless acceptable to providers and project managers.

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Gordon

Weiss²

1999

HEC Forum

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Medical technology and the crisis of experience: The costs of clinical legitimation

Cited by 5 publications

References 19 publications

Incoming ethical issues for deep brain stimulation: when long-term treatment leads to a ‘new form of the disease’

Incoming ethical issues for deep brain stimulation: when long-term treatment leads to a ‘new form of the disease’

Displacement and Emplacement of Health Technology

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