Abstract
STEM disciplines are the dominant culture in K-12 education. With its study of organs and diseases that afflict patients’ bodies, Western evidence-based medicine is seen and understood in the modern cultural paradigm as a science and as the practice in which a subject, the doctor, acts on an object; the patient’s body—a dominant culture in the patient’s journey. However, with the continually evolving high-technological and medical knowledge, life-saving therapeutic options are life-changing. They can range from changes in the diet, requiring structural and cultural changes in family life, to changes related to the experiences of learning to live tethered to a machine that is partly inside and partly outside one’s body or with somebody else’s heart. In this article, we show how competing needs to personalize care for the patient as a person forcefully emerge in response to evidence-based medicine’s global cultural dominance. We highlight two fundamental issues emerging in decision-making processes: (1) Framing evidence-based knowledge, uncertainties of the course of the disease and options, and (2) working with different, equally important, and often at odds conceptions of time in the care for the Other. Through the longitudinal analysis of moment-to-moment interactions in high-tech medicine encounters of a patient, his family, and the team caring for them, we show how framing and different conceptions of time emerge as issues, are profoundly interconnected, and are addressed by participants to care for a patient confronting existential decisions.
Highlights
This manuscript is part of the special issue Contemplative Inquiry, Wellbeing and Science Education, guest edited by Kenneth Tobin
How to care for a person catapulted into a world that is unfamiliar, where the person confronts choices that infringe on the lived experiences and where the person’s needs and queries are often in sharp contrast to those acknowledged by the dominant culture?
In all the STEM disciplines, there is a long-lasting discussion on how to best implement what Gloria Ladson-Billings defines as culturally relevant pedagogy (1995) that is responsive to different ways of knowing (Gutiérrez & Rogoff, 2003), inhabiting the world (Elmesky & Seiler, 2007) with religious beliefs (Roth, 1997), lived experience, cultural norms and values (Meyer & Crawford, 2011) that are in contrast to those accepted in the scientific paradigms and classroom context (Mavuru & Ramnarain, 2020)
Summary
La cultura scientifica ha un ruolo dominante nell’istruzione scolastica negli USA. Con lo studio degli organi e delle malattie che affliggono il corpo dei pazienti, la medicina occidentale, basata sulle prove di efficacia clinica, è vista e intesa nel paradigma culturale moderno sia come scienza sia come attività pratica in cui un soggetto, il medico, agisce sull’oggetto, il corpo del paziente – la medicina è la cultura dominante del percorso che deve intraprendere il paziente. As Mr Spencer recounts: Western medicine with its study of organs and diseases that afflict patients’ bodies is seen and understood in the modern cultural paradigm as a science and as the practice in which a subject, the doctor, acts on the object, the patient’s body (Timmermans & Almeling, 2009) In this paradigm, issues of objectivity (Daston & Galison, 2009) and objectification for the subject to understand, study and control things and other beings (Haraway, 1988) are considered important and necessary (Harding, 2015) but are incompatible with Mr Spencer’s agentic sense of being a person, not an object, and his aversion for overtreatment and potential futility (Clark, 2007) of high-tech medicine. How to frame the possibilities, the uncertainties, and course of the disease in high-tech
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