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Medical Disinterestedness: an Archaeology of Scientificness and Morality in the Canadian Medical Profession

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Medical Disinterestedness: an Archaeology of Scientificness and Morality in the Canadian Medical Profession Medical Disinterestedness: An Archaeology of Scientificness and Morality in the Canadian Medical Profession by Helen Hyunji Kang M.Sc. (Public Health Sciences), University of Toronto, 2005 B.A.Sc. (Arts and Science), McMaster University, 2002 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in the Department of Sociology and Anthropology Faculty of Arts and Social Sciences © Helen Hyunji Kang 2013 SIMON FRASER UNIVERSITY Spring 2013 All rights reserved. However, in accordance with the Copyright Act of Canada, this work may be reproduced, without authorization, under the conditions for “Fair Dealing.” Therefore, limited reproduction of this work for the purposes of private study, research, criticism, review and news reporting is likely to be in accordance with the law, particularly if cited appropriately. Approval Name: Helen Hyunji Kang Degree: Doctor of Philosophy (Sociology) Title of Thesis: Medical Disinterestedness: An Archaeology of Scientificness and Morality in the Canadian Medical Profession Examining Committee: Chair: Dr. Stacy Pigg, Professor of Anthropology Dr. Cindy Patton Senior Supervisor Professor of Sociology Dr. Dany Lacombe Committee Member Professor of Sociology Dr. Zoë Druick Committee Member Associate Professor, School of Communication Dr. Lara Campbell Internal Examiner Associate Professor, Gender, Sexuality and Women’s Studies Dr. Nancy Tomes External Examiner Professor, Department of History SUNY Stony Brook University Date Defended/Approved: April 17, 2013 ii Partial Copyright Licence Abstract In this dissertation I consider the emergence of and the shifts in the scientific and moral standards in the Canadian medical profession, or what I call medical disinterestedness. I examine editorial content from medical journals as a discursive space in which professional norms are constituted. I draw on the works of Pierre Bourdieu in order to argue that doctors are enmeshed in a unique system of rewards that cannot be explained by an economic model based on profit. I investigate three crisis moments during which Canadian doctors faced accusations from the public, the media and the government for not acting with scientific and moral judgment. The first crisis moment I examine occurs in the nineteenth century when doctors faced a hostile government that refused them the right to govern all aspects of medicine. During this time, doctors drew on middle-class masculine codes of etiquette and their privileged access to university education in order to claim that they were learned gentlemen acting on behalf of the public. This claim was called into question during the 1950s-1960s, however, when the Canadian media shamed the medical profession for opposing the proposal for a universal health care system. In this second crisis moment, in order to restore their moral credibility, doctors upheld general practice and public health as humane forms of medicine and adopted media relations strategies aimed at improving their image. Opening the doors to the media created complications, however, as demonstrated in the third crisis moment when the editors at the top Canadian medical journal were fired in 2006. This event revealed that the supposedly pure intellectual space of medical science collides with media-market forces, professional politics and journalism in ways that have troubling ramifications for medical practice. My analysis of these crisis moments demonstrates that morality, objectivity and ethics are not fixed concepts but are rather shaped in relation to historical, social, cultural, political and economic factors. This dissertation extends ethical discussions in medicine to include the ways in which doctors define and communicate what it means to act with integrity in relation to the state, professional politics and the media. iii Keywords: Medical ethics; medical science; medical profession; history of medicine; discourse analysis; Pierre Bourdieu iv Dedication To my partner, my family, my found family and my dissertation committee. v Acknowledgements This dissertation was not a personal achievement but rather the result of a communal effort by many people whom I want to thank and acknowledge: The “lab rats” at the Health Research and Methods Training facility at Simon Fraser University, past and present: Byron Lee, Sarah Berry, Lisa Weeks, Marguerite Pigeon, Brian Richter, Saydia Kamal, Karen-Marie Elah Perry, Hye Jin Kim, Cathy McCabe, Eli Manning, Dimitry Zakharov, and others whom I have missed. But especially John Liesch, who not only introduced me to the amazing world of gay square dancing but who also put up with me for the past eight years and even took on the monumental task of putting together my bibliography. I thank him for the chats at the lab about science fiction, problematic research studies, square dance calls and funny academic blogs. The “BBB” reading group, Megan Humphrey, Rodney Hunt and Shari Laliberte, who helped me to read dense theoretical texts and whose political energies helped to nurture my sense of social justice. Mary Shearman and Jillian Deri for their company and laughter during our writings sessions at the window of Waves on Commercial Drive. Amy Hasinoff for her inspirational Facebook posts and generous professional advice. My writing group, Natasha Patterson and Joy Walcott-Francis, two brilliant scholars in the Gender, Sexuality and Women’s Studies at SFU, who allowed me the privilege of reading their writings and were also generous enough to read incomprehensible drafts of my dissertation. Our meetings over coffee and impromptu support sessions over text messages helped me get through the isolation and self-doubt of graduate school. Jesook Song for her energy in maintaining our friendship across the country and for being both a great friend and a generous senior colleague, a balance that is difficult to achieve. Hon-Yee Choi for patiently listening to Jesook and me talk shop for hours on vi end over brunch, for her gentle creative spirit and presence, and for opening their home and hearth to me whenever I visited them in Toronto. The members of Shoheijuku Aikido Canada for their friendship, kindness and a sense of play both on and off the mats. And especially Tamami Nakashimada sensei for her incredibly poignant life lessons at the end of each practice that kept me humble and grounded. The members of Sawagi Taiko—Linda Hoffman, Sachiko Yamaguchi, Catlin Renay, Mariko Heidelk, Kathy Shimizu, Lisa Mah, Jeanie Ow and Joscelyn Wong—for being such an amazing group of women. You have reminded me to laugh when I was down and to drum with my body and spirit when I was caught up with thoughts in my own head. Gina Whitfield for being there since my first day in Vancouver, from finding my apartment in the West End to giving me much needed pep talks. Margarita Hobbes for her creative spirit that inspired me to keep up with my crafts, a much needed distraction from dissertation writing. Shinobu Preston for her laughter, out-of-this-world dinner parties and effortless brilliance with children. Megan Tam for her kind, attentive presence, for her tenacity and strength, for rising up to the occasion and really listening, a rare and special quality. The von Roeders for embracing me into their family and for cheering me on from Ontario. Dr. Parin Dossa in the Department of Sociology and Anthropology who directed me to critical scholarship in Canada and Dr. Mary Petty at the Immunodeficiency Clinic at St. Paul’s Hospital for giving me the opportunity to be part of IHHS 402 at the University of British Columbia and for rooting for me since I started my PhD program. My committee members, Dr. Zoë Druick at the School of Communication and Dr. Dany Lacombe in the Department of Sociology and Anthropology for their brilliant and challenging comments, for engaging and stimulating conversations, and for supporting me in countless job applications, often with impossible deadlines. vii My senior supervisor, Dr. Cindy Patton, for being such a generous, patient and attentive mentor, right from the day that I emailed her in 2004 as a Master’s student asking for her advice on where to apply for graduate studies. I learned everything about being a conscientious scholar and teacher from her, lessons that I will cherish and pass on to future students who come my way. My found family, Robert Smith?, Shanta Varma and Shoshana Magnet, for being in my corner through tough times, for challenging me when necessary and for teaching me what lifelong friendship truly means. Mom, Dad and Maggie, for being the reason why I am the person I am today and for supporting me through years and years of school, even when there seemed to be no end in sight. And my partner Dietrich Bassewitz, for his kindness, generosity, patience, “dad sayings” and daily reminders that there is more to life than writing a paper or giving a presentation. For putting up with me during times that I have been unbearable to be around and for being the reason why I wake up daily knowing that I am the luckiest person in the world. viii Table of Contents Approval ............................................................................................................................. ii Abstract .............................................................................................................................. iii Dedication ............................................................................................................................v Acknowledgements ...........................................................................................................
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