Roles of Technology in Medical Rhetoric   5 comments

The two readings from Judy Z. Segal’sHealth and the Rhetoric of Medicine and Mary M. Lay’s The Rhetoric of Midwifery present a number of examples of the roles that technology plays in medical thinking. I am referring first to rhetorical advantages technologies provide to entrenched power holders over those opposing them with respect to the rhetoric of death and dying and the debates over the status of midwifery in Minnesota. Segal argues that “end-of-life decision making frequently takes place in conversions between people who are medical experts and people who are not,” (94) a condition that often robs argumentation between medical experts and lay people of its grounds of validity, so that rhetors are “trapped inside the discourse that moved each of us to speak” (98). Here the epistemological authority of biomedicine “ summoned by its technologies in terms of both apparatus and language “ disables its interlocutor, always favoring the medical establishment. The Riverview study attempted to improve “the conditions for consensual decision making” (103) through rhetorical analysis, emphasizing the value of linguistic adjustments by both sides, but it “makes clear that the terms of a predominantly biomedical rhetoric of death and dying are not sufficient to provide a framework in which human beings can engage satisfactorily in a conversation about the end of life” (113).

The two chapters from Lay’s book, “Rhetorical Analysis and the Midwifery Debates” and “Licensing Rules and Regulations: Normalizing the Practice of Midwifery,” reiterate the point that entrenched, biomedical knowledge enables the established community to maintain its control and extend its power, in part by extending the domain of professionalism. Professionalism embodies technologies in its practices, its ways of learning, and especially its ways of communicating. Thus when the established medical community in the state of Minnesota tried to absorb the unlicensed, informal network of midwives during a number of hearings that Lay chronicles, a similar tension erupted. She notes, for example, that formal education and tests were initially proposed as requirements to allow midwives, even those with decades of experience, into the ranks of licensed practitioners. Both authors allude to Foucault for this role of technology as knowledge power (Segal in chapters 1 and 3; Lay on 31, 108, 130).

A second set of rhetorical advantages are successful actions taken by the opposition using specific technologies fostering rhetoric to counter the prevailing sway of the enfranchised power authorities, the hospitals and government agencies, what Feenberg calls tactics. Lay recounts a number of ways in which technologies played a mitigating role against the entrenched authority and its implicit rhetoric. Two examples Lay repeatedly mentions are the use of online text messaging communities and the use of shared documents. Listserv systems enabled rhetors among midwives to conduct dialogue in a common but geographically and temporally distributed environment giving them similar affordances as salaried, institutionalized workers, and also amenable to their desire for anonymity without sacrificing self regulation to the point that enlightened, scientifically rigorous, if necessary, argumentation could not be made. The Listserv-mediated discourse was joined with another technological tool, shared documents, for drafting reports and proposals, including the proposed legislation itself, by the midwife community, rather than forcing them to fill in the blanks on a ready made form provided by the establishment, the default technologies it enjoys whose possession supports its power.

These are what Feenberg might call tactics employed by the boundary, periphery, not-of-the-ruling-class. This is analogous to the position of witness in “the existing dominant discourses” that Jen brought up. My focus, though, is on the emancipatory technologies. Those of you who know me may see where this is going .. the free, open source option.  I believe it can inform our discussion of electronic health records.

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Posted September 14, 2010 by jbork in Uncategorized

5 responses to “Roles of Technology in Medical Rhetoric

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  1. Good thinking, John!

    In Dr. B’s class last semester, we read Ruth Oldenziel’s, _Making Technology Masculine_, and that was the first time I saw “professionalism” as a construct, a tactic used to exclude “others” from the good ole’ boy network of engineers. I always thought of professionalism as “best practices,” when it really started as a socio-political move to exclude those who could not meet the codes of professionalism, which had nothing to do with expertise, and everything to do with gendered expectations for behavior (167).

    I agree that our current reading lays out another, specifically gendered example of this.

    In terms of FOSS, I can see the potential for finding “work arounds,” but to what extent is it necessary to “legitimize” FOSS? Would it increase consumption or kill the movement?

  2. Jen, in your posting you state that “It is the action part that is the clincher. The ability to inspire action is part of a power dynamic that Lay explores.” Technology plays obvious and also subtle roles in regulating discourse, and importantly, fostering action. The FOSS paradigm, including open document standards and protocols, helps level the field so that participants are not constrained by expensive software tools required just to have a voice. It may seem like a small difference, almost trivial. But imagine if you could not even view a document about which your professional future may be at stake because you don’t have Office 2010. So I am not seeking to legitimize FOSS; I am trying to think through the roles of texts and technology in medical contexts.

  3. John,
    You bring up some great observations about the alternative discursive tools which the direct-entry midwives use to build autonomy. By using the listserv and file sharing, the midwives work around “the gender work of medicine in its claim of authority over scientific knowledge” (Lay 134).

    I thought it is also interesting that the same technology which can prove liberating in one rhetorical situation can reinscribe social constructions in another, as Segal shows in her discussion of hypochondriacs. She observes that hypochondria is “essentially dialogic [in] nature,” an internal dialogue fed by external, public rhetoric (82-83). The internet has broadened the scope and depth of this rhetoric to the point of meriting a new name, “cyberchondria” (86).

    I’m following your & Jen’s conversation about FOSS, and anything that breaks our communication options free from corporate-dominated and mandated platforms sounds like a good idea. Probably TOO good to survive the range wars.

  4. Relating your post to Genevieve’s, I think you explain how medical technology can be used as a form of inartistic proof, in Aristotle’s sense of that term.

    I like Jen’s question about what happens when FOSS meets regulatory issues such as certification around electronic health records?

  5. : I appreciated your thoughtful analysis and would emphasize that one of my “favorite” stories about the ways in which exclusive ownership of technology supports the power hierarchy of modern medicine is the invention of the forceps. Upon invention, this device was created and used exclusively by physicians; midwives were not permitted to own or use the device. Even though the forceps could save the lives of babies and women during difficult births, again midwives would not use them, a decision that moved many women into the hospitals to have their births, having been convinced that without such technologies they would experience unnecessary pain and danger. Another technology that excluded women from their own birthing experience was “twilight sleep,” a drug-induced state in which women was put into a deep sleep and their babies delivered, often again with the use of forceps; women seldom even recalled their labor and delivery and did not experience that immediate bonding with their babies. Direct-entry midwives today may use traditional techniques to avoid intervention into the birth process, but as you point out they do use shared document and listserv systems to enhance the communication. Moreover, they are experts in two discourses—their own and that of the medical community—an ability that adds to their credibility.
    Mary Schuster

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