Suchergebnisse

Suspicious deaths have been with us since the first hominids, or before. Better scientific explanations have often come at the cost of full social understanding.

Since Durkheim's pioneering study, official suicide statistics have been suspected of underreporting the true suicide rate. A majority of researchers asserts that mistakes are minimal and not systematic while a minority claims that suicide statistics are systematically biased. Lingering uncertainties about suicide rate accuracy call into question the claims of scholarship and the efficacy of prevention programs. From the perspective of the sociology of professions, the critique of suicide accuracy challenges the professional authority of death investigators. Ethnographic observations show that medical examiners tend to underclassify suicides because the suicide classification requires positive proof of suicidal intent and because false negatives do not challenge the authority of medical examiners as much as false positives. Sufficient proof for suicide results from medical examiners' privileging of pathological evidence, the legal threshold to interpret evidence, and close relationships with law enforcement and clinicians. The same professional characteristics that safeguard forensic authority result in suicide underreporting: medical examiners protect their authority by determining suicide conservatively. Relatives acting to avoid the stigma of suicide and public health officials concerned with underreporting have a marginal influence on suicide determinations. This article contributes to the sociology of professions literature by analyzing how a professional group maintains authority in spite of profound criticism from outside parties.

In this paper, I discuss the many contributions of a versatile black technician, Vivien Thomas, to surgical animal research between 1930 and 1979 at Vanderbilt University and Johns Hopkins University. Thomas' experimental work led to a surgical solution for a life-threatening heart defect, called tetralogy of Fallot. Children with this condition lack sufficient oxygenation and were referred to as `blue babies'. Following Thomas' research trajectory and his relationship with surgeon Dr Alfred Blalock, I review the conditions under which differing expectations towards race and occupation clashed, creating a status dilemma for Thomas. While the torsion originated in the laboratory where technical skills are valued, the research locale also facilitated a temporary, fragile solution for the status dilemma, because it separated Thomas from public view. Yet, Thomas' dexterity as a laboratory researcher enhanced his dilemma, because credit kept eluding him. In order to track the dynamics of race and occupational subordination as lived experience in the laboratory, I argue for an analysis of the process of crediting people for their scientific accomplishments.

This paper explores the role of Western Reserve University cardiac surgeon Claude S. Beck in convincing the world of the merits of electric defibrillation to treat the life‐threatening heart arrhythmia ventricular fibrillation. Before Beck, the method of electric defibrillation had been experimentally explored at least four times but it never caught on as a medical or first‐aid life‐saving technique. Beck succeeded because he synchronized three activities: he refined the technique and provided clinical applications, he built a communication infrastructure, and he formulated a vision of who should use the technique under what kind of circumstances.

This article applies a theoretical framework developed by the late American sociologist Anselm Strauss to the discovery of a new resuscitation technique, closed-chest cardiac massage. The discovery, which took place in the laboratories of Johns Hopkins University between 1956 and 1960, is analyzed as the collective management of a trajectory over time. The article follows the discovery trajectory from its origins in defibrillator research to the establishment of closed-chest cardiac massage and cardiopulmonary resuscitation (CPR) as a universal life-saving method. The analytical focus on the experimental, clinical, and promotional activities performed by the different actors interacting with the emerging technology allows one to critically question the value of concepts such as closure, stabilization, and black boxing in sociology of science and technology. Instead of prematurely freezing the analysis of technoscience, a trajectory conceptual framework emphasizes the ongoing dynamic between actors and medical technology to define the scope, effectiveness, and multiple interpretations of the technology-actor interaction.

In this paper, I address the relationship between social death and clinical‐biological death during resuscitative efforts. In Western societies, resuscitative efforts are the medical intervention of choice when sudden death occurs. The widespread use of this technology puts emergency department staff in a difficult gatekeeping position. They are expected to save lives, but, at the same time–when their efforts become futile–to prepare for a dignified death. I show that certain groups of patients are much more likely to be considered socially dead regardless of their clinical viability, while others are less likely to be considered socially dead even when irreversible biological death has set in. The result is an implicit rationing of the lifesaving endeavors based on the social worth of the patient. This rationing annihilates initiatives, such as advance directives, which were instituted to empower patients. Social scientists usually suggest that the solution to the negative effects of rationing is to increase accessibility for all populations; however, resuscitative efforts are a prime example in which less access for all groups–instead of for some–might be preferable. This paper is based on observations of 112 resuscitative efforts during a fourteenth‐month period and interviews with 42 health care providers.

Debates why and how some practices become universal – taking as a case in point closed‐chest massage (CCCM). Points out that CCCM was recognized in 1960 and its use generated heated debates, which altered the technique and reshuffled existing infrastructures. Claims that debates act as a catalyst for university. Investigates the emergence of CCCM, the debate on the merits (or otherwise) of closed versus open‐chested cardiac massage, and who could use the method of CCCM. Indicates that CCCM only became universally practised when it was incorporated into the infrastructure for dealing with emergency cases, and thus became taken for granted.

Using the example of resuscitation techniques, I explore how technology helps to mediate the attribution and acquisition of identities. I argue that certain identities are pre-written in resuscitation scripts. If we follow the person through the resuscitation process, we see a double identity transformation. The resuscitation technology facilitates certain medical identities, and renders others irrelevant. When the outcome of the resuscitative attempt is known, this process is reversed, and some previously irrelevant attempt are now reinstated. Some identities can also be lost for ever, and new identities added to the multiple configuration. I examine the implications of this analysis of the stabilization of technology.