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Conscientious Object-ion: Rhetoric, Professional Communication, and Medical Controversy Heidi Yoston Lawrence Dissertation submitted to the faculty of the Virginia Polytechnic Institute and State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy In Rhetoric and Writing Bernice L. Hausman Paul V. Heilker Kelly E. Pender Carolyn D. Rude April 25, 2013 Blacksburg, Virginia Keywords: vaccination, medical rhetoric, professional communication Copyright © 2013 Heidi Y. Lawrence Conscientious Object-ion: Rhetoric, Professional Communication, and Medical Controversy Heidi Yoston Lawrence ABSTRACT Vaccination is power—power to prevent disease, power to shape populations, power to define sickness and health, and power to compel scientific beliefs into the bodies of people around the globe. It is unsurprising, therefore, that vaccinations have garnered centuries of dissent. Specifically, the conscience—the parent or patient’s perceived right to make vaccination decisions based on personal perceptions of acceptable risks—has been used since vaccination’s inception as a rationale for individual rights to refuse vaccines in the face of the very public health goals that vaccinations aim to achieve. Existing studies of vaccine disputes in medical literature have understood vaccine questions to be a problem of scientific knowledge or literacy, claiming largely that vaccine skepticism arises from a lack of proper comprehension or understanding of the scientific and medical bases for vaccination or statistical evidence proving vaccines are safe and effective. Studies of vaccination controversy in social science, communications, and historical literatures have largely examined the role that alternative notions of risk valuation, sources of trusted health information (such as preferring the advice of friends and neighbors to doctors), or conceptions of uncertainty have played in largely parental decision making about childhood vaccinations. Despite these extensive studies of vaccine sentiment, vaccine skepticism and refusal remains a small, though significant, voice in public debate. This dissertation examines vaccine discourses as object-oriented rhetorics—as rhetorics shaped and defined by the physicality of the vaccine’s operation—as a way of re-conceptualizing the vaccine debate. Using object-oriented theories from computer programming, philosophy, and rhetoric, this research examines the professional and public voices that make up contemporary vaccine controversy. Through three data sets, including interviews with physicians, parent discourses produced on the Internet, and survey responses from young adults, this dissertation observes that vaccines function as objects that have multiple, coexisting operations for different actors across the medical system. Consequently, vaccination controversy can be conceptualized not as accurate versus inaccurate understandings of science or as a conflict of perspectives, but instead as a by-product of multiple ontologies of vaccines at work under competing disease exigencies. ! Dedication I dedicate this dissertation to my friends and family, without whom I never could have completed this work. To all of the bosses, mentors, and co-workers who have shaped and inspired my professional, intellectual, and personal lives, especially: Steve George, Steve Lowery, Dr. Byron Hawk, Dr. Eric Anderson, Kimberly Bibbee, and Gregg Nugent. Your leadership, support, advice, and counsel at key moments in my career have made every subsequent step I have taken possible. To my dearest friends, Kellie Bryan, Shelley Groves Rakip, Kimberly Hall, and Abby Waldron. Your long conversations, timely emails, and much-needed laughter have brought joy and comfort at key moments throughout my PhD program and entire career. I am inspired by you all and the lives, careers, and families you have built. To the amazing members of my PhD cohort at Virginia Tech, Dr. Libby Anthony, Dr. Kerry Dirk, Dr. Scott Kowalewski, Dr. Molly Scanlon, and Dr. Matt Sharp. I am proud to leave Tech alongside such talented colleagues, all of whom I am also glad to call friends. Kind of like honey love on your computer. To my friend and colleague, Dr. Libby Anthony. I never could have done this without your support, camaraderie, and, most of all, humor. I will always be grateful for the times we shared during this often-arduous process—in our offices, in coffee shops, in the library, and in the rolling hills and hollers of Southwest Virginia—toiling away at writing, research, or whatever task was demanded of us, all while hysterically laughing at it all. We have endured so much together, and I’m forever thankful for your friendship. To my sisters, Aubree and Hannah Lawrence. Although most people love their siblings, not everyone is fortunate enough to like them as much as I genuinely like you both. Although we are all so different and have lived very different parts of our lives together, I love that we can share—in alternating moments—a mutual love of books, coffee, How I Met Your Mother, language, kittens, wine, politics, and The Real Housewives. Thank you both for being such amazing sisters and friends. To my parents, Richard and Dorothy Lawrence. Thank you for the high standards you always set for our whole family—from an early age, there was never such a thing as getting up too early, staying up too late, or working too hard to meet the goals we set for ourselves. You both always led by example, holding yourselves to incredibly high standards as parents and professionals, showing your three daughters that anything was possible with enough hard work. These values have made everything I’ve attained possible. I am so proud to be your daughter. To Ryan. My companion and partner, my life. With you, life has been limitless, only bound by what we’ve been able to imagine for ourselves. You have taught me that, in pursuing our dreams, we will gain more than we could have ever expected, sacrifice more than we thought we could give, endure even the most heart-wrenching loss, and love more deeply than we knew we could love. Thank you for everything you have done to make my life as full as it is. I love you. iii Acknowledgements I would like to thank everyone who made the work of this dissertation possible. I thank all of my research participants, particularly the eight doctors who consented to be interviewed for the research presented in Chapter 4. Their candor and insight into vaccines and the roles they play in the practice of medicine informed and inspired not only that chapter but the larger theoretical frame and arguments this research aims to make. I thank past members of the Vaccination Research Group (VRG) at Virginia Tech for their research, insights, and diligent work, including: Megan Casady, Jonathan Chapman, Lauren Cobert, Erica Frempong, Jessica Fuller, Leanne Shelley, Carly Smith, Kelsey Soppet, Aubrey Sozer, Josh Trebach, and Andria Wallen. In particular, I thank Rachel Dinkins, Olivia Kasik, Dasha Nesterova, and Karen Spears. Their hard work made much of this research possible, particularly the physicians’ interviews and flu survey. They have indelibly shaped this research, and I feel incredibly fortunate to have learned so much from them. I thank the faculty in Virginia Tech’s Rhetoric and Writing program for their insight, generosity, and support throughout my graduate study, particularly Dr. Clare Dannenberg, Dr. Carlos Evia, Dr. Diana George, and Dr. Katy Powell. I thank Dr. Dannenberg and Dr. Powell, in particular, for their mentorship in research and professional assistance throughout my time at Tech. My work has been forever shaped by their perspectives on research methods and how they determine the way we ask questions and gain answers when addressing issues of Rhetoric in Society. I’m also so thankful for their candor, their support, and mostly, their humor. I thank my dissertation committee members, Dr. Paul Heilker, Dr. Kelly Pender, and Dr. Carolyn Rude. I have been honored by their participation on my committee and their contributions to this project. Dr. Heilker’s unwavering confidence in me has inspired my work in ways words fail to describe. I thank him, so much, for his constant faith in me as a student and scholar. Dr. Pender’s smart sensibility and unwavering ethics as a teacher, researcher, and rhetorician are all qualities to which I aspire. I have learned so very much from her and thank her for never hesitating to ask the tough questions. Dr. Rude’s commitment to the study, practice, and teaching of professional communication will forever inspire my work, and I remain amazed by the ways she drives the field—and herself—into new pedagogical and political terrain. I thank her for shaping my career in such lasting, significant ways. My most sincere thanks go to my dissertation director, Dr. Bernice Hausman. From the moment I began working with her, I knew that she would push me to learn and be and accomplish things far beyond what I could imagine for myself. At every turn, she has never disappointed. From coursework, to my work with the VRG, through exams, and now with this dissertation, Dr. Hausman has influenced my work in countless ways, sometimes pushing back, sometimes getting out of my way, always guiding with necessary questions and critique. She introduced me to this topic, encouraged me to pursue it for my dissertation research, and provided extensive support in both time and resources, all of which truly made this work possible. Through all of this, she has also been an amazing example—as a person, as a teacher, as a scholar. I thank her for everything, particularly for all of the confidence she has had in me, always. iv Table of Contents TABLE OF CONTENTS V LIST OF FIGURES VII LIST OF TABLES VIII LIST OF ABBREVIATIONS IX INTRODUCTION. “I HAVE A CONSCIENTIOUS OBJECTION TO CHILD MURDER”: OBJECTS, RHETORICS, AND VACCINE CONTROVERSY 1 STANDARD HISTORY OF VACCINATION AND VACCINE CONTROVERSY 5 VACCINE CONTROVERSY TODAY 10 VACCINES AND DELIVERY MECHANISMS 14 ON VACCINE REQUIREMENTS 15 OBJECT-ORIENTED RHETORICS AND VACCINE ONTOLOGY 20 CHAPTER 1.

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