Gardner John, Cribb Alan
Science and Technology Studies Unit, Department of Sociology, University of York, York, UK.
Department of Education and Professional Studies, Kings College London, London, UK.
Sociol Health Illn. 2016 Sep;38(7):1043-57. doi: 10.1111/1467-9566.12431. Epub 2016 Jul 27.
This article explores power relations between clinicians, patients and families as clinicians engage in patient-centred ethical work. Specifically, we draw on actor-network theory to interrogate the role of non-human elements in distributing power relations in clinical settings, as clinicians attempt to manage the expectations of patients and families. Using the activities of a multidisciplinary team providing deep brain stimulation to children with severe movement disorders as an example, we illustrate how a patient-centred tool is implicated in establishing relations that constitute four modes of power: 'power over', 'power to', "power storage" and "power/discretion". We argue that understanding the role of non-human elements in structuring power relations can guide and inform bioethical discussions on the suitability of patient-centred approaches in clinical settings.
本文探讨了临床医生、患者及其家属之间的权力关系，在此过程中临床医生开展以患者为中心的伦理工作。具体而言，我们运用行动者网络理论，审视非人类因素在临床环境中权力关系分配方面所起的作用，因为临床医生试图管理患者及其家属的期望。以一个多学科团队为患有严重运动障碍的儿童提供深部脑刺激的活动为例，我们阐述了一种以患者为中心的工具如何在建立构成四种权力模式的关系中发挥作用，这四种权力模式分别是“支配权”“行动权”“权力储存”和“权力/自由裁量权”。我们认为，理解非人类因素在构建权力关系中的作用，可以为关于以患者为中心的方法在临床环境中的适用性的生物伦理讨论提供指导和参考。
