Between professional values and the social valuation of patients: the fluctuating economy of pre-hospital emergency work.
A number of authors have shown how medical decisions are influenced by social values; others have minimized the putative influence of values and have argued that medical decisions are predominantly constrained by the organization of medical work. Based on fieldwork in France and the USA observing pre-hospital resuscitations, we seek to resolve these views by showing that while judgments about the social value of a patient do influence professional decisions, so do judgments about the work that must be accomplished to manage a case. Pre-hospital emergency work has many facets that are variably valued by different professionals at different moments of an emergency's trajectory. These values compete with each other in what we call a "fluctuating economy". This article analyses the role of social, technical, medical or surgical, heroic, and competence values in the course of pre-hospital emergency work. We show how these values may conflict or align with each other, forcing professionals to constantly establish priorities during an emergency trajectory.
Nurok
Michael
M
Division of Surgical Critical Care, Cardiac and Thoracic Anesthesia, Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, CWN-L1, Boston, MA 02115, USA. mnurok@partners.org
Henckes
Nicolas
N
D002321:Career Choice; D019090:Case Management / Q000191:economics / Q000941:ethics; D016265:Conflict of Interest; D003431:Cross-Cultural Comparison; D003657:Decision Making / Q000941:ethics; D004632:Emergency Medical Services / Q000191:economics* / Q000941:ethics*; D004634:Emergency Medical Technicians / Q000193:education / Q000523:psychology; D005602:France; D006292:Health Priorities / Q000191:economics / Q000941:ethics; D006801:Humans; D007600:Judgment; D011361:Professional Competence; D040841:Resource Allocation / Q000191:economics / Q000941:ethics; D016414:Resuscitation Orders / Q000941:ethics / Q000523:psychology; D012945:Social Values / Q000208:ethnology*; D012962:Sociology, Medical; D014481:United States