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去医学化而非去专业化?重新定义兽医专业管辖权的医学和经济边界。

Demedication without demedicalization? Redefining the medical and economic boundaries of veterinary professional jurisdiction.

机构信息

IRISSO, CNRS, INRAE, Université Paris-Dauphine, PSL, Paris, France.

IRISSO, CNRS, INRAE, Université Paris-Dauphine, PSL, Paris, France; CESAER, Agrosup Dijon, INRAE, Université Bourgogne Franche-Comté, Dijon, France.

出版信息

Soc Sci Med. 2023 Sep;332:116109. doi: 10.1016/j.socscimed.2023.116109. Epub 2023 Jul 21.

Abstract

Veterinarians' professional jurisdiction is nowadays facing major challenges. Regulatory changes in the prescribing and dispensing of medicines, which have historically been at the heart of veterinary jurisdiction, could fragilize the medical power of this professional group. This article analyses the practices and strategies deployed by veterinarians to preserve and readapt their jurisdiction, by discussing recent work in sociology of professions and reflecting on how the case of veterinarians could help rethink the contrasting case of human doctors. This article is based on two field studies in France (in diverse livestock sectors) made of more than 40 interviews and 70 h of ethnographic observation of veterinary activity. We first show how veterinarians' jurisdiction over medicines was built up and how their professional autonomy is put under pressure by recent injunctions to demedicate livestock and to develop preventive approaches to animal health. We then detail how the economic and medical boundaries of veterinary jurisdiction are being redefined through dynamics of protocolization and contractualization of care which allow veterinarians to impose themselves as health managers. Finally, we demonstrate that this situation favors the emergence of new forms of professional legitimacy based on an "evidence-based veterinary medicine" that their competitors cannot contest, and on the development of economic infrastructures that supports and makes it possible to monetize this new professional expertise. Finally, this article discusses contemporary processes of medical professionalization. It argues that, unlike human medicine, veterinary medicine has been able to maintain its professional power even if its historical jurisdiction has been reshaped. This has required a redefinition of professional activity both as a medical (i.e. approaches to animal health) and economic (i.e. business model of veterinary companies) practice.

摘要

兽医的专业管辖权正面临着重大挑战。药品的开具和配药法规的变化,这些法规历来是兽医管辖权的核心,可能会削弱这一专业群体的医疗权力。本文通过讨论最近的职业社会学研究成果,并反思兽医案例如何有助于重新思考医生的对比案例,分析了兽医为维护和调整其管辖权而采取的实践和策略。本文基于在法国(在不同的畜牧业领域)进行的两项实地研究,其中包括对 40 多次采访和 70 多小时的兽医活动民族志观察的记录。我们首先展示了兽医对药品的管辖权是如何建立起来的,以及他们的专业自主权是如何受到最近要求家畜去专业化和发展动物健康预防方法的压力的。然后,我们详细介绍了兽医管辖权的经济和医疗边界是如何通过护理的规范化和契约化的动态重新定义的,这些动态允许兽医将自己定位为健康管理者。最后,我们证明,这种情况有利于基于“循证兽医”的新形式的专业合法性的出现,他们的竞争对手无法对此提出质疑,并且有利于支持和实现这种新的专业专业知识的货币化的经济基础设施的发展。最后,本文讨论了当代医学专业化进程。它认为,与人类医学不同,即使兽医的历史管辖权已经重塑,兽医仍能够保持其专业权力。这需要重新定义专业活动,既要作为一种医疗(即动物健康方法),又要作为一种经济(即兽医公司的商业模式)实践。

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