New publication: Constituting the “good patient”

Our paper (with Frans Birrer), Constituting the “good patient“, was published in the proceedings of the 2010 conference of the International Society for the Study of Argumentation (ISSA). Also here, the question is how innovation is related to the subjectivity of the patient, as Michel Foucault would put. The Dutch Personal Healthcare Budget – receiving “cash-for-care” instead of a treatment “in kind” – is presented as a scheme that ought to enhance innovation. By getting patients to control the budget, they are expected to become rational consumers who only spend their money on innovative care providers. This way of reasoning is often criticised. However, the discussion is built up around a large number of arguments, which make up a cluster that is hard to penetrate. Effectively, criticism is often evaded in these types of debates, as we show in the paper. The question is how this relates to political accountability. With respect to the patient, we may wonder if (s)he wil really turn out to be a “good patient”:

‘Is (s)he indeed a cash-supported, rational sovereign, who constantly shuffles elations with care givers and is putting pressure to break rigid healthcare institutions? On the basis of the problems that participants in the policy discussion raised, another image of the patient-subject appears. It could also be an overburdened individual, constantly involved in unequal power relations, suspect in the eyes of government and society, and, therefore, increasingly constrained. This points at an entirely different type of subject, a “problematised subject”, so to say’.

Presentations at EASST: constituting people

The first days of September, me and my colleagues presented two papers at EASST2010 in Trento, Italy. EASST is the conference of the European Association for the Study of Science and Technology. Both papers dealt with the question how people are “constituted” in society, how they are given a particular role. And a bit about how they constitute themselves. Michel Foucault has written many interesting things about this topic, about which you can read a bit more in the description of my research area.

The paper that I presented (together with Benoît Dutilleul and Frans Birrer) concerned the phenomenon of Living Labs, about which we have published before. Living Labs are local platforms that involve people  in “making what they use”. By now there are 212 of such sites throughout Europe. Internationally, Living Labs are considered a “movement”. Democratisation has never been an outspoken goal, but many have argued that they may contribute to society this way. Nevertheless, they are considered undemocratic by many commentators.  In our paper, we ask what is needed to democratise Living Labs. Our idea is that this would involve re-thinking how we want people to participate, and how people might want to participate themselves. In order to examine this question, we critically examined work by Eric Von Hippel, Andrew Feenberg and what is often called the “Scandinavian tradition” of participatory design. You can have a look at the slides of my presentation below. This was part of a track on “Speculation, Design, Public and Participatory Technoscience: Possibilities and Critical Perspectives”. Alex Wilkie, one of the convenors, provides more information on his blog.

Apart from that, my colleague Frans Birrer presented our other paper about policy changes in Dutch healthcare. This is a continuation of our earlier work on the Dutch electronic health record and the patient-owned personal health budget (persoonsgebonden budget in Dutch). As part of the session ‘The shaping of patient 2.0 – Exploring agencies, technologies and discourse in new healthcare practices’, we tried to establish how patients are constituted by such major changes in policy.

Other than that, EASST was a good conference. The best I have attended so far. Over 800 presentation, many of which very interesting. A conference in Italy. With good lunch. And good coffee. Served by waitors wearing black bow ties. In the mountains.