Acting in Anaesthesia : Agency, Participation and Legitimation

Goodwin, Dawn Samantha (2005) Acting in Anaesthesia : Agency, Participation and Legitimation. PhD thesis, Lancaster University.

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Abstract

In this thesis I examine the relationship between knowledge and action in anaesthesia. I begin by exploring the potential of Evidence Based Medicine (EBM) to guide anaesthetic practice and what implementing evidence based recommendations involves. This introduces a number of 'other' considerations that affect the course of an anaesthetic. I draw on ethnographic data of anaesthetic practice to explore how these 'other' elements contribute to shaping an anaesthetic trajectory. I consider the role of the patient who, being unconscious, can easily be overlooked. I suggest that it is the union of the patient and anaesthetic machine that affords the patient a form of agency. I then focus on the anaesthetist's work in crafting an account of a clinical situation that both renders the situation intelligible and indicates an appropriate course of action. I explore how accounts are legitimated and propose it is the legitimation of the accounts, more than their construction, which provides a lead for action. I also explore the processes that regulate the participation of Operating Department Practitioners (ODPs) and anaesthetic nurses and its consequences. I argue that their involvement is stratified in line with the professional identity to which they aspire and I consider the effects this has in terms of initiating action. Finally, I examine how the tools and devices may be said to contribute to shaping anaesthetic care. I discuss how the anaesthetist develops an awareness of the form, position and configuration of both humans and devices, and how this body of 'normal appearances' serves as a resource to anticipate and identify impending difficulties. This exploration of 'acting' in anaesthesia has necessitated a reconceptualisation of agency, provoked an examination of what it means to participate, illuminated the importance of legitimation when initiating action, and I propose, it calls for the reconfiguration of professional accountability.