Vanderbilt University, Nashville, TN, USA.
Soc Sci Med. 2011 Feb;72(4):545-52. doi: 10.1016/j.socscimed.2010.11.017. Epub 2010 Nov 27.
This paper develops the concept of "biosecuritization" to describe new instantiations of the technological imperative in healthcare. Many discourses and practices surrounding hospitals' new investments in information and communication technologies tend to revolve around security provision. Often times, however, scenarios of extreme and exceptional circumstances are used to justify the implementation of identification and tracking technologies that may be more about managerial control than patient care. Drawing upon qualitative research in 23 U.S. hospitals from 2007 to 2009, our analysis focuses on hospitals' deployment of identification and location technologies that manage patients, track personnel, and generate data in real-time. These systems are framed as aiding in the process of managing supplies and medications for pandemic flu outbreaks, monitoring exposure patterns for infectious diseases, and helping triage or manage the location and condition of patients during mass casualty disasters. We show that in spite of the framing of security and emergency preparedness, these technologies are primarily managerial tools for hospital administrators. Just as systems can be used to track infection vectors, those same systems can be used on a daily basis to monitor the workflow of hospital personnel, including nurses, physicians, and custodial staff, and to discipline or reward according to performance. In other words, the biosecuritization modality of the technological imperative leads to the framing of medical progress as the "rationalization" of organizations through technological monitoring, which is intended to promote accountability and new forms of responsibilization of healthcare workers.
本文提出了“生物安保化”这一概念，用以描述医疗保健领域新技术指令的新体现。围绕医院在信息和通信技术方面的新投资，许多论述和实践往往围绕着安全保障展开。然而，在许多情况下，往往会援引极端和特殊情况的场景来证明实施识别和跟踪技术的合理性，而这些技术可能更多的是用于管理控制，而非患者护理。本文通过对 2007 年至 2009 年间美国 23 家医院的定性研究，分析了医院部署识别和定位技术以管理患者、跟踪人员并实时生成数据的情况。这些系统被构建为辅助管理大流行性流感爆发期间的供应品和药物、监测传染病的暴露模式，以及帮助分诊或管理大量伤亡灾难期间患者的位置和状况。我们表明，尽管这些技术被框定为安全和应急准备措施，但它们主要是医院管理人员的管理工具。正如系统可以用于跟踪感染源一样，这些系统也可以每天用于监控医院人员（包括护士、医生和保洁人员）的工作流程，并根据绩效进行纪律处分或奖励。换句话说，技术指令的生物安保化模式导致将医学进步框定为通过技术监控实现组织的“合理化”，旨在促进问责制和医疗工作者新形式的责任承担。
