Biomedical Engineering Reference
In-Depth Information
also that often a confl ict or struggle between these two worlds is manifested
in the encounter between the patient on the one hand and the doctor and
the health care system on the other hand. Here, a special problem is how
the voice of the patient is subordinated by the medical voice as the life
world experiences and knowledge is transformed into the language and
procedures of the medical world. Today, however, there is more discussion
about the voice of the patient not only as subordinated to medicine, but as
knowledgeable and articulated as for example in 'expert patients'.
The concepts of the life world and the medical world have been used
to relate the different types of experience, knowledge and attitudes to
each other in a dynamic way, and to discuss their potential confl icts and
transformations. In many ways it has been an alternative to the concepts of
lay and expert knowledge that establishes two realms of knowledge where
expert knowledge is being transformed and adopted by lay knowledge,
although always superior. The concept of a life world has also been used
by researchers who want to explore the experiences of the ill and suffering
person, particularly within phenomenological research traditions (see for
instance Toombs 1992).
Medical technology has a rationality, that is an aim and a working logic,
which has developed out of the world of medicine. Technological devices
have been constructed in order to solve problems and serve purposes that
are primarily part of the medical practice. They help and enhance medical
professionals in their work (cf. Mol 2002). In many cases this rationality
fi ts into the everyday rationality of patients: patients want the medical
professionals to help them remediate their diseases. In these cases medical
technology can be taken as a self-evident and given part of medical practice,
even if the patient does not necessarily understand the workings of the
technology. In other cases problems emerge when the medical rationality
does not immediately correspond to or is not possible to translate into the
logic of everyday life. This is the case for instance with many of the life-
supportive systems used in order to help patients live on, even when they
are severely ill (Robillard 1999). Medical technology has in these cases its
own rationality, which does not automatically correspond to the life world
rationality of the patient.
In other cases, medical technology can raise problems that are not part
of the medical world but are part of the everyday world. A typical example
is the type of moral problems that various types of screening technologies
(ultrasound, genetic screening) result in. When some sort of deviance is
found, the patient has to make a decision, for instance about having an
abortion or not. The moral problem is here part of the patient's life world,
his or her hopes and expectations, and can only be answered in that context.
A similar situation emerges when medical technology produces unwarranted
information as part of an examination, as for instance when parents learn
the sex of their expected baby at the ultrasound scan, without having asked
for or wanted this information.
