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- Convenors:
-
Susanne Brucksch
(Teikyo University)
Naonori Kodate (University College Dublin)
Patrick Grueneberg (Kanazawa University)
Kaori Sasaki (Sapporo Medical University)
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- Chair:
-
Susanne Brucksch
(Teikyo University)
- Section:
- Anthropology and Sociology
- Sessions:
- Wednesday 25 August, -
Time zone: Europe/Brussels
Short Abstract:
The panel explores varying socio-technical settings in medical contexts in a specific locale like Japan. Specifically, three papers reflect on emerging high-technology and the arising requirements and controversies regarding patient security, end-of-life decisions and evaluation of novel devices.
Long Abstract:
Over the past decades, there has been an increase in technological innovation in hospitals, influencing medical practices and regulatory requirements alike. Medical instruments and technologies can be used to manipulate the human body, ranging from general devices with extremely low risk to such ones highly invasive to patients. Many technologies and electronic appliances nowadays in use took their roots in the second half of the 19th century, and were increasingly merged into clinics and hospitals during the following century. At present, there can be observed a thrust of technological progress at high pace in the field of biomedical engineering and medical informatics, which contribute additionally to new configurations of technological landscapes in hospitals in Japan. The meaning of socio-technical settings in the medical field changes not only with their professional, disciplinary or organisational context, but also with the specific locale. This panel therefore elucidates how the relationship between humans and technology can be specified in medical contexts when the sociocultural dimension of a particular locale is included. More precisely, the panel explores the ways in which socio-technical settings in medical contexts find varying articulations in a specific locale like Japan. Specifically, three papers will reflect on emerging high-technology and the arising requirements and controversies regarding aspects such as patient security, end-of-life decisions and evaluation of novel devices. The papers will situate their case studies of technological landscapes in hospitals in their given semantic, pragmatic, organisational and/or historical context, thereby enriching academic discussions on socio-technical settings in medical contexts amongst affiliated disciplines. Before, the panel provides a brief introduction to theoretical approaches by specifying the Japanese locale (genba) as an example when examining technological landscapes in medical contexts. The panel is based on a forthcoming book project on "Humans and Devices in Medical Contexts. Case Studies from Japan" (by Susanne Brucksch and Kaori Sasaki).
Accepted papers:
Session 1 Wednesday 25 August, 2021, -Naonori Kodate (University College Dublin)
Paper short abstract:
This paper compares how hospitals in Japan and England use their respective reporting systems as a source of learning, and highlights the importance of cultural and institutional contexts when examining sociotechnical settings in healthcare.
Paper long abstract:
Safety has been given serious attention in many high-risk domains in Japan and elsewhere. Healthcare has been relatively slow in responding to the development of safety science. However, attempts have been made to reform the regulation of risks to patients since the 1990s in many countries, and Japan is no exception. Nationally, the Japan Council for Quality Health Care manages the web-based reporting system and collects data about serious adverse events and incidents on a voluntary basis. This paper compares how hospitals in Japan and England use their respective reporting systems as a source of learning, and highlights the importance of cultural and institutional contexts when examining sociotechnical settings in healthcare. While this study was modelled upon that previously carried out in England, the scope of this paper is broader, and targeted at country-level comparison. Moreover, semi-structured interviews were conducted with patient-safety managers in three different types of hospitals in Japan and experts in four European countries. Our findings from the various frameworks and the patient safety managers' perceptions suggest that web-based reporting became an important tool but human-to-human interactions and national policy contexts remain critical for understanding incident reporting and patient safety.
Kaori Sasaki (Sapporo Medical University)
Paper short abstract:
This presentation explores how the Japanese brain-death diagnostic procedure was formulated in the 1980s-1990s. It considers how various socio-culturally constructed images of trust and national presages were inscribed in medical device vis-a-vis the brain-death diagnostic procedure.
Paper long abstract:
> This presentation explores the ways in which the Japanese brain-death diagnostic procedure was formulated in the 1980s-1990s. From 1968 to the early 1980s, countries such as the UK, USA, and Taiwan had seen the definition of end of life change from cardio-respiratory failure to irreversible deep coma―later termed brain-death; meanwhile the medical authorities of those countries established standardised brain-death diagnostic procedures. These changes derived from the emergence of the clinical application of an automatic artificial ventilator, and of cardiac transplantation. The transplantation procedure requires a surgeon to extract a pumping heart from a donor; the ventilator device allows the cardio-respiratory function of an irreversible deep coma patient to continue despite a total failure in brain function. Therefore, a beating heart could be taken from a brain-dead donor's body for transplantation. In Japan, the medical community attempted to follow these precedents but there arose a controversy as to which medical technology should be applied: electroencephalogram (EEG), auditory brainstem response (ABR), and/or cerebral angiography. Whilst the then leading Japanese neurologists found specific advantages in ABR, their choice was complicated by a confrontation with cultural politics over the value of evidence produced by certain medical devices. It owes much to this situation: British brain-death diagnostic standard adopted none of these; other Euro-American ones adopted either EEG or cerebral angiography Consequently, the Japanese brain-death diagnostic procedure was shaped alongside intensive reflection over not only which medical technology would be more reliable and feasible to confirm brain-death accurately, but also which cultural position should be taken; that is, whether Japan should follow British, US or Swedish practice, or adopt an alternative approach. This study hence shows what significance was articulated and then rearticulated with each medical device (i.e. EEG, ABR and cerebral angiography). Examination of this controversy illuminates how socio-culturally constructed images were inscribed in the usage of each of the medical technologies relevant to the brain-death diagnostic procedure.
Patrick Grueneberg (Kanazawa University)
Paper short abstract:
Human-machine interaction is gaining increasing importance in healthcare. While ethical considerations usually center around potential risks to the patient, the Cybernics approach to the robotic rehabilitation system HAL implements a capability-oriented approach aiming at human empowerment.
Paper long abstract:
With the development of robotics-based technologies for human healthcare, human-machine interaction is gaining increasing importance. Corresponding ethical considerations usually concern the condition of impaired humans and potential risks regarding the patient's integrity. Engineering and related ethical approaches beyond stances prevailing in countries in Europe or America are easily disregarded. This paper investigates the Cybernics approach to the robotic rehabilitation system HAL (Hybrid Assistive Limb) as a socio-technological conception of human-machine relations. Contrary to common individualistic conceptions, this heterarchical approach to empowerment technologies (ET) builds on an intrinsic relation between human and machine, thereby considering machines primarily a supplement and not a threat to impaired humans. This leads to the question of how ET are constructed and legitimized in Japan, and what relationship between humans and machines is envisioned in the context of healthcare. In referencing Society 5.0 as the developmental framework for ET in Japan, the Cybernics approach to ET as employed at the University of Tsukuba and a case study of the HAL system as enabling an interactive unity of human and machine show that the socio-technological conception proposes a capability-oriented approach with built-in ethics, hence offering a complementary view to prevailing accounts of human-machine relations.