How Experts Draw Boundaries. Dealing with Non-Knowledge and Uncertainty in Prenatal Testing

Abstract

Science, Technology & Innovation Studies, 2005, Nr. 1, 17-37 Categorical distinctions such as healthy/sick or dead/alive serve to provide orienta- tion and to facilitate decision-making in medicine. This is a major issue in the the- ory of reflexive modernisation. Recently, new scientific insights within genetics have increasingly prompted the re-drawing of such boundaries. Taking the exam- ple of prenatal testing, with particular reference to late term abortion, I investigate the governing rationalities of experts' boundary politics. It will be shown that boundary drawing is structured with reference to society's guiding principles and notions of normality. In those problematic cases where the medical frame is un- able to deliver sufficient interpretative power, this reference to societal value orien- tations turns out to be functional for maintaining the experts' professional author- ity. In the case of prenatally diagnosable disabilities, for example, experts often do not know how to deal with such diagnoses. This ambiguity is for the most part understood as (cognitive) uncertainty amenable to more research, rather than in- terpreted as non-knowledge with reference to the level of social action which re- sults from the interpretative failure of biomedical frames. Thus, the interpretation of non-knowledge appears to become unambiguous, which undermines any pend- ing politicisation of non-knowledge. The alignment with society's guiding princi- ples turns out to be functional for maintaining the claim to be able to provide ade- quate and relevant information and terms for decision-making processes; in other words, for maintaining professional authority. On the basis of the observation that experts have to deal with uncertainty and non-knowledge, the article asks in con- clusion whether this could point to the possible emergence of a reflexive type of expert.