Treatments, Conclusion: Toward an Ethics of Failure, Diablog Part 5

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In Diedrich's conclusion, she ends with a discussion of an ethics of the experience of failure (body, conventional/alternative medicine, and/or language) that she reads through two illness narratives. The first is Atul Gawande's Complications that focuses on the doctor side of the doctor-patient binary and the next is Gillian Rose's Love's Work, from the patient's side (148). Diedrich borrows from Lyotard and Scarry's respective works to highlight the "experience of pain" that attempt to draw out methods for "idioms which do not yet exist" (148). Diedrich also lends significant attention to Croce's "the undiscussable" (148-149) as she aims to highlight her own "undiscussable"-the possibility and reality that doctors and their patients may "get things wrong" and thus may not have a language or an ethics of getting it wrong (149). Lyotard's "differend" becomes important in Diedrich's discussion of "unstable states" where something cannot be put into language or phrases. An example of this differend, for Diedrich, is the hyphen that separates the two subject positions in the doctor-patient relationship (150).
Diedrich begins her discussion of the ethics of failure with Gawande's focus in Complications that medicine is an "imperfect science." Gawande's experiential statements assert the "fallibility, mystery, and uncertainty" (150) that surround western medicine. Simply by questioning the credibility and power of medicine, Gawande opens up the discussion to allow for failure. Pointing to the "undiscussable" and "messy" and "uncertainty" that is a reality of medicine, Diedrich calls Gawande's narrative a "differend" (151).

Errors--
Through Gawande's narrative, Diedrich is able to bring attention to the way that errors are treated in the medical world. "learning is hidden, behind drapes and anesthesia and the elisions of language" (152).
Read Gawande's passage regarding training on the "humblest of patients" on page 152.
Diedrich goes on to state that errors create a differend in medicine and not because errors do not happen, but because there is not public language (idiom) with which to engage in a discussion about it. She notes that the only public language to discuss errors is malpractice, and/or the discussion of "bad doctors" (153).
Gawande suggests that we begin to understand error as a structural problem rather than an individual one, we may begin to address it more effectively (153). Diedrich asserts that a critical analysis of all medical practices (errors included) will contribute to the efficacy of medicine in general.

Suffering--
Diedrich articulates that because there is not idiom to articulate a patients' suffering, medicine often "gets it wrong." Diedrich shares Gawande's take on two feelings of suffering pain and nausea.
Interestingly, pain is a feeling that causes doctor's much distress, confusion in that they cannot offer "treatment" for a patients' chronic pain. Gawande refers to the feeling of pain as perplexing similar to that of nausea which is "aversive" (155). The discussions of these feelings as differend are that they are "beyond the control" of both the patient and the doctor. Diedrich offers another take to the ethics of failure called "practicing at a loss" in which doctors refuse to play into the "myth of control" and bear witness to the failure without denying it. Questioning what autonomy has meant for patients and doctors, Diedrich complicates the negotiation and "decision making." Diedrich asserts, "Many feminist scholars have argued that selves and bodies in the world are not autonomous and sovereign, but always come into being in relation to others" (158). Roses' memoir, speaks of the "uncertainty and contingency" of her ovarian cancer while touching on the power dynamics of the patient side of the patient-doctor relationship. Different than Gawande's work, Rose offers a personal account of love and work in her illness while disrupting the binaries of "inside/outside public/private" (164). Diedrich articulates that for Rose, "an ethics will never come from dissolving 'the difficulty of living, of love, of self and other, of the other in the self' it will come from being at a loss yet exploring various routes" (165). Finally, Diedrich wraps up by asserting that we must "risk failure and risk relation" to open up possibilities for new treatments and understandings of experience.

Questions:
How does Diedrich explain "health capital" in training and receiving care?
How might Gawande's proposed idiom of Morbidity and Mortality (m&m) help with the discussion of ethics of failure? What might it look like?
What is at stake in looking at errors as structural as opposed to individual? For whom is this most important?
What does can an ethics of failure teach us about illness, death and grieving?
What do you thin of Diedrich's critique of autonomy? Do you agree? why or why not? (158)

3 Comments

P.s."messy" and "undiscussable" made me think of the way that Anzaldu'a's work has been referred to as a "messy"...it does "too much" or is "too personal"? One my favorite Anzaldu'a quotes is from This Bridge Called my Back where she states, "What does being a thinking subject, an intellectual, mean for a woman of color from working class origins? It means not fulfilling your parents expectations by exceeding them. It means being in alien territory and suspicious of the laws and walls. It means being concerned about the ways knowledges are invented. It means continually challenging institutional discourses. It means being suspicious of the dominant culture's interpretation of "our" experience, of the way they "read" us. It means being what Judy Baca terms 'internal exiles.'"

This can also relate to the discussion of representation and "experience"...also being outside the experience of illness narratives...what is "too much" and for whom?
Anyone else think of this? Or of another example of messiness?

I was very much struck with Gawande's "critical incident analysis" and your question about what this might mean for an ethics of failure. While it seems that one of the central points about an ethics of failure is being able to dwell in the sometimes unbearable reality that we come up short (sometimes even at the expense of someone's life) and directly acknowledge this fact without making it understood as a "fault" I also think that Gawande's "critical incident analysis" harkens to Eve Sedgwick's reparative knowledge. While we want to be able to openly discuss failure as such, not as merely accidental, but as intrinsic to our beings, "critical incident analysis" allows us to make failure a productive ethical practice. It even seems to resonate the "messiness" of the illness narrative. Failure breaks things apart, just as Lorde talks about how the act of writing about her experiences breaks those experiences up, because she cannot find language to represent herself in a precise state of being at a precise time. Rather, her productive process of writing is reparative, not only in the sense that it is productive, but also in the sense suggested by Diedrich earlier in the book, where she says that writing one's experience is a practice of self-making that has the potential to repair old damage to the self.

Thoughts on the ethical practice of failure, memoir, and reparative knowledge??

wow. lots of great connections! I was also struck by the potential possibilities for "critical incident analysis" because as you state it could allow us to make failure a productive ethical practice. And also, through critical incident analysis, error/failure is a given. I *love* Diedrich's question about Gawande's "error" on page 153. She asks, "Would he have been able or wiling to tell this story if it had not ended well?" I think this speaks of the intricacies/complexities of error as differned. Your question of "reparative knowledge" especially for Sedgwick is telling of the self-making or "mucking about in" (45) that Diedrich speaks of. This can also be the fragmented language or messiness of experience, wouldn't you say?

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