Short abstract:

The presentation considers the embodied ethics of care work in the increasing digitization and robotization of healthcare services and working environments. It discusses touch as a transforming professional skill and ethical stance in care work.

Long abstract:

Hands-on working through touch: assessing, diagnosing, handling, treating, manipulating, and monitoring bodies (Twigg et al. 2011), is perhaps most versatile in nursing; Z.R. Wolf and colleagues (2022) identified a total of 128 typical nursing interventions that nurses carry out on patients’ bodies using direct or instrumental/technology-mediated touch. These interventions consist of varied instrumental procedures as well as social/affective touches. The increased digitization and robotization of healthcare services and working environments has arisen new kinds of ethical dilemmas concerning not only the patient’s rights but the professionals’ workload. How to create a sense of physical presence and caring touch over distance through smartphone screen? What kind of physical touch is needed to soften the touch of technological devices and reduce their agency in the 'triadic' touch of the patient, professional and material artifacts/digital information (Parviainen & Pirhonen 2017)? Is it ethically sustainable that in the aftermath of COVID-19 pandemic, and amidst of aging societies and lack of nursing personnel, social robotics and other new technologies are developed to solve the problem of touch starvation - or do these technologies provide liberation from the affective reversibility of touch (Kinnunen et al. 2023; Paterson 2023)? The presentation is based of interviews of nurses working in various healthcare and social services. It discusses touch as a transforming professional skill and ethical stance in care work.

Short abstract:

The presentation will use simulation-based training in medical education as an example to illustrate developments in the medical profession. Additionally, it will provide an opportunity to analyse the sensory and material culture of medical education as a field of interest.

Long abstract:

Simulation-based training (SBT) involves the use of dummies, models, VR technology or simulation patients for medical education purposes. This teaching method challenges classical notions of professionalism. According to Abbott's theory, professions facilitate their professionalism through knowledge and its application as jurisdictional claims (Abbott 1988, S. 59–66). Therefore, the introduction of a new teaching method should be viewed as an indication of the (r)evolution of the profession. Accordingly, my research triangulates legal backgrounds, including university curricula, public discourse in the form of academic articles, and workplace-based interviews and ethnographic material. The aim is to illuminate medical educators' conceptions of SBT since the mid-1980s.

For the panel, I would like to highlight my workplace-based materials and other research that demonstrate the situational embeddedness of medical knowledge and its application, particularly through the use of medical instruments and the bodily postures expected of medical professionals (Harris 2011). This not only resonates with Abbott's notion of the production of professional workplaces and habits but also highlights the importance of commodities. Commodities are material representations of the abstract knowledge of a profession, to work with and around (Abbott 1991). In SBT, these are used to represent parts of the body, provide similar sensory experiences, and ultimately convey the expertise of professional movement. This contradicts the idea that SBT is solely digital, although virtual reality programs can be utilized nowadays, too (Wojcik 2022). These insights enhance the analysis of SBT and medical education overall by providing a deeper understanding of the sensory and material culture involved.

Short abstract:

Human patient simulations visualize and virtualize medical touch. Through an archival study on the early models of human patient simulation, this project brings forward a discussion on the empathic and caring aspect of haptic perception these simulations render.

Long abstract:

Practicing medicine has always been a tactile experience: physicians palpate the surface to diagnose, radiologists trace the internal structure on an X-ray photograph, and surgeons’ hands rummage through or graft back organs. In a closer look, it is a desperate attempt to grasp seemingly ungraspable things – a symptom, illness, internal systems that are invisible to the eye but can be visible through this haptic experience. This is best exemplified by recent developments in medical simulation where medical touch is delegated virtually. However virtual this touch may be, doctors still care for their patients – those virtual and hypothetical figures facing them now and in the future - through their touch. Through an archival study on early models of human patient simulation from the 1960s to 1980s - namely, 1) Resusci-Anne (1960), 2) Sim One (1967), and 3) CASE (1986) - this project purports to bring forward a discussion on the caring aspect of haptic perception these simulations render. Drawing from the aesthetics of haptic perception by Riegl, Merleau-Ponty, and Vischer, this paper argues that the experience of kinesthetic attunement, haptic visual perception, and empathetic imagination through the medical simulation construct a haptic perceptive realism that enforces ethical limits of operational practice. Situating this development in its historical context, where these simulations were developed in tandem with the adoption of patient rights and standardized patients, this paper puts forward a broader argument that this haptic experience of care is a corporealization of an empathic self in the medical experience.

Short abstract:

The aim of the presentation is to show how expert phenomenologies related to haptics in rehabilitative environments reformulate the ethnographer's reflexivity and sensitivity to fieldwork.

Long abstract:

In a recent study on ethnographic practice, Holmes and Marcus note that “our subjects are themselves fully capable of doing superb ethnography in their own idioms” (2021: 26). In the same study the project of “para-ethnographic epistemic partnerships with expert interlocutors” (Marcus and Boyer 2021: 13) is evoked. Drawing on my experience of having conducted ethnographic sociological fieldwork in a variety of centers and labs in robotics in which medical technologies of motor rehabilitation such as exoskeletons were developed, I argue that within this type of research the resulting knowledge was fundamentally based on epistemic alliances with fellow experts. Especially, haptic competence and skills essential in these sociotechnical landscapes asked me to rethink how experts, users but also myself as ethnographer engage in partnerships that forged my object of study. The fact of having interviewed engineers specialized in robotics, but also physiotherapists, ergonomists or neuroscientists besides users engaged me in modes of knowledge production that were essentially relational and that allowed me to theorize specific phenomenologies of expertise. The experts’ analysis and critical perspective on the technology they were actively contributing to design forged my own ethnographic reflexivity and compelled me to include additional phenomenologies than those of the users within these epistemic collaborations.

Short abstract:

This paper explores a series of tensions and ambiguities in the sociotechnical construction of haptics for the da Vinci Surgical System and considers their relationship to surgical experience and expertise.

Long abstract:

Robotic surgery constitutes an increasingly large share of surgeries performed globally every year. The increase in robotic surgeries has shifted the way robotic surgeons train and operate by reorienting the work of their hands and eyes. Positioned at the control console of a robot, away from the patient, surgeons glide grips with their fingers and press pedals with their feet while immersing themselves in the high-definition 3D space of a viewing hood.

This paper uses the da Vinci surgical system as a case study to explore what it means for human surgical touch to become medically mediated robotic touch. An analysis of empirical data from documents and interviews with engineers who designed the da Vinci reveals haptic ambiguities that both obscure touch and bring it to the surface. The evidence reveals political and economic decisions driving development of visual systems rather than touch systems and considers the implications of those decisions on surgical expertise. The analysis also considers how treating touch from a functionalist and instrumentalist perspective meant to make touch usable for a surgical robot ultimately reduces human touch to forces that render the surgeon’s touch suspect, prone to error, in need of assistance, and desirable in the act of performing surgery, but not necessarily essential.