Medical reproductive technologies have generated two new types of patients: ‘couples’ in infertility treatment and ‘fetuses’ in prenatal medicine. Using concepts from science and technology studies, specifically Latour’s (1993) notions of hybridity, mediation and purification, this article argues that these new patients are constructed in the very process of technological intervention in women’s bodies, while at the same time their constitutive role is erased from the medico-scientific accounts of these practices. Focusing on two discursive patterns found in the scientific discourses (...) on IVF as a treatment for male infertility, and fetal surgery for various congenital problems, the article shows how conceiving of couples and fetuses as patients allows many of the actual interventions on women to be ‘deleted’ from the accounts, while simultaneously presenting these interventions as being primarily about the treatment of men and children. The article exemplifies how a (feminist) constructivist analysis of the co-constitutive relation between technology and bodies (‘nature’) can avoid essentalism while retaining a critical perspective. (shrink)

Health authorities increasingly request that general practitioners use information and communication technologies such as electronic patient records for accountability purposes. This article deals with the use of EPRs among general practitioners in Britain. It examines two ways in which GPs use the EPR for accountability purposes. One way is to generate audit reports on the basis of the information that has been entered into the record. The other is to let the computer intervene in the clinical process through prompts. The (...) article argues that GPs' ambivalence toward using the EPR makes them active in finding ways that turn the EPR into a meaningful tool for them, that is, a tool that helps them provide what they see as good care. The article's main contribution is to show how accountability and autonomy are coproduced; less professional autonomy does not follow from more requests to document one's work. Instead, new forms of autonomy are produced in the sociotechnical network that is made up by health policy and local engagements with patients and technology. (shrink)

In the medical-technological practice of in vitro fertilization, it is increasingly the couple, rather than an individual patient, that is considered the unit of treatment. This article traces some mechanisms involved in the construction of medical interventions on female bodies as appropriate and effective therapeutic solutions to problems and diagnoses pertaining to male bodies. It traces the transformation of male infertility through shifts in localization and definition of the problem, concomitant reconceptualizations of the techniques involved, redistributions of properties, and specific (...) ways of constructing "success. " It is argued that both the notion of the couple as the patient in cases of male infertility and the claim that IVF techniques are appropriate solutions to this couple's problem simultaneously presuppose and legitimize medical interventions on women's bodies. This double movement is produced by leaving exactly the required material work of physical interventions—and, consequently, the uneven distribution of costs between the sexes—out of scientific accounts of these practices. (shrink)

Biometrics is often described as `the next big thingin information technology'. Rather than IT renderingthe body irrelevant to identity – a mistaken idea tobegin with – the coupling of biometrics with ITunequivocally puts the body center stage. The questions to be raised about biometrics is howbodies will become related to identity, and what thenormative and political ramifications of this couplingwill be. Unlike the body rendered knowable in thebiomedical sciences, biometrics generates a readable body: it transforms the body's surfaces andcharacteristics into (...) digital codes and ciphers to be`read' by a machine. ``Your iris is read, in the sameway that your voice can be printed, and yourfingerprint can be read'', by computers that, in turn,have become ``touch-sensitive'', and endowed with seeingand hearing capacities. Thus transformed into readable``text'', the meaning and significance of the biometricbody will be contingent upon ``context'', and therelations established with other ``texts''. Thesemetaphors open up ways to investigate the differentmeanings that will become attached to the biometricbody and the ways in which it will be tied toidentity. This paper reports on an analysis of plans andpractices surrounding the `Eurodac' project, aEuropean Union initiative to use biometrics (specif.fingerprinting) in controlling illegal immigration andborder crossings by asylum seekers. (shrink)

In this paper we discuss expected and reported effects on care provider-patient relations of the introduction of electronic patient records (EPRs) in consultation settings by reviewing exemplary studies and literature on the subject from the past decade. We argue that in order for such assessments to be meaningful, talk of effects of “the” EPR needs to be replaced by an “unpacking” of EPR systems into their constituent parts and functionalities, the effects of which need to be assessed individually. Following from (...) this principle, the paper discusses EPR systems ranging from simple data entry and retrieval systems to more sophisticated multi-user and multifunctional on-line systems. On a second level, our analysis of the literature is informed by the question which model of ideal patienthood underlies the assessment of effects of EPRs. To this end, we identify three “models of patienthood” implicit in writing about benefits and drawbacks of EPRs for patients: the autonomy, the consumer, and the holistic models, and argue that assumptions concerning these models need to be reflected upon more critically to improve understanding of what exactly EPR use does to the doctor-patient relationship. (shrink)