title: The dispositions of things: the non-human dimension of power and ethics in patient-centred medicine.
abstract: This article explores power relations between clinicians, patients and families as clinicians engage in patient-centred ethical work. Specifically, we draw on actor-network theory to interrogate the role of non-human elements in distributing power relations in clinical settings, as clinicians attempt to manage the expectations of patients and families. Using the activities of a multidisciplinary team providing deep brain stimulation to children with severe movement disorders as an example, we illustrate how a patient-centred tool is implicated in establishing relations that constitute four modes of power: 'power over', 'power to', "power storage" and "power/discretion". We argue that understanding the role of non-human elements in structuring power relations can guide and inform bioethical discussions on the suitability of patient-centred approaches in clinical settings.
authors.affiliation: Science and Technology Studies Unit, Department of Sociology, University of York, York, UK.
authors.forename: John
authors.initials: J
authors.lastname: Gardner
authors.affiliation: Department of Education and Professional Studies, Kings College London, London, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Cribb
mesh_terms: D000884:Anthropology, Cultural; D001675:Bioethics; D003657:Decision Making; D006801:Humans; D018802:Patient-Centered Care / Q000941:ethics*; D010817:Physician-Patient Relations; D011209:Power, Psychological
keywords: actor-network theory; bioethics; empirical ethics; shared decision-making