Gibbon Sahra, Kampriani Eirini, Zur Nieden Andrea
Department of Anthropology, University College London, 14 Taviton Street, London WC1H OBW, UK.
Institut für Geschichte der Medizin, Heinrich-Heine-Universität Düsseldorf, Postfach 10 10 07, Düsseldorf D-40001, Germany.
Biosocieties. 2010 Dec 1;5(4):440-466. doi: 10.1057/biosoc.2010.28. Epub 2010 Nov 22.
The relationship among genetic technologies, biosocial identity and patient subjectivity has been the focus of an increasing range of social science literature. Examining mainly European and North American contexts this work has demonstrated the variable configurations of genetic knowledge-practices and the diverse implications for at-risk individuals and populations. This article brings together ethnographic research on genomic medicine, public health and breast cancer in Cuba, Greece and Germany. Although each case study addresses different publics/patients, institutional settings and risk-related practices, they all critically examine 'neoliberal' subjectivity and BRCA patienthood, at the intersection of political rationalities, medical discourses, social conditions and moral codes. In the Cuban case, cultural articulations of inherited and other embodied risks relating to breast cancer are analysed in relation to state provision of 'community genetics', and the shifting dynamics of public health in response to global social processes. The Greek case explores how culturally embedded values, notions of inherited risk and care inform or are re-articulated through institutional practices and ambivalent subject positions, at the meeting point between individualised medicine, religious philanthropy and the particularities of public health. In the German context, diverging patient subjectivities are examined against the background of prevailing social discourses and institutionalised risk management practices that promote proactive individuality. Drawing on deconstructive and feminist analyses, these case studies reveal how normative 'neoliberal' patient subjects are only 'partially reproduced' in situated contexts, neither stable nor homogeneous, as different actors and publics variously articulate, embrace or engage with transnational as well as culturally embedded discourses and health practices.
基因技术、生物社会身份与患者主体性之间的关系，已成为越来越多社会科学文献关注的焦点。这项研究主要考察欧洲和北美的情况，展示了基因知识实践的多样形态，以及对高危个体和人群的不同影响。本文汇集了对古巴、希腊和德国的基因组医学、公共卫生及乳腺癌的人种志研究。尽管每个案例研究涉及不同的公众/患者、机构环境及与风险相关的实践，但它们都在政治理性、医学话语、社会状况和道德规范的交叉点上，批判性地审视了“新自由主义”主体性和乳腺癌患者身份。在古巴的案例中，分析了与乳腺癌相关的遗传及其他身体风险的文化表述，以及国家提供的“社区遗传学”，还有公共卫生应对全球社会进程的动态变化。希腊的案例探讨了文化中根深蒂固的价值观、遗传风险观念和护理观念，如何通过机构实践和矛盾的主体地位得到体现或重新表述，这处于个性化医疗、宗教慈善事业与公共卫生特殊性的交汇点。在德国的背景下，以促进积极个性的主流社会话语和制度化风险管理实践为背景，审视了不同的患者主体性。借助解构主义和女性主义分析，这些案例研究揭示了规范性的“新自由主义”患者主体如何在特定情境中只是“部分再现”，既不稳定也非同质，因为不同的行为者和公众以不同方式表达、接受或参与跨国及文化中根深蒂固的话语和健康实践。
