Formal criteria and evidence-based guidelines commonly frame healthcare prioritisation, yet everyday prioritisation often occurs in organisational 'grey zones' where competing values coexist. Drawing on interviews with clinicians in two Norwegian cardiology wards, we examine how prioritisation is justified and enacted under institutional pluralism and moral ambiguity. Using Boltanski and Thévenot's framework of 'orders of worth', we show how clinicians develop discretionary compromises: situated adjustments that combine competing evaluative principles into hybrid justifications, making contested decisions actionable and morally defensible. Instead of switching between institutional logics, clinicians blend professionalism, managerialism, and economic rationality into 'good enough' moral narratives that uphold discretion and authority under constraint. These compromises rely on ethical decoupling, whereby conflicting moral concerns are acknowledged but temporarily set aside to enable action. By explaining how legitimacy is created through context-dependent justification, the article contributes to debates on valuation, professional change, and moral agency, while highlighting the often invisible moral labour of healthcare prioritisation.
Queer, transgender and nonbinary (QTNB) people access midwifery services, yet little is known about their experiences of midwifery care. Our qualitative study used critical narrative inquiry to examine how QTNB midwifery service-users in Ontario, Canada, experience cisheteronormativity in healthcare. Drawing on in-depth interviews with 14 participants, our analysis examines the effects of biomedicalisation on QTNB people who navigate these systems. Our findings show that QTNB people access and participate in technologies of pregnancy surveillance, which deploy information-seeking practices that collect information about the genetic makeup of the baby, conception and paternity. These 'lines of inquiry' present in mundane but insidious ways, embedded within cisheteronormative assumptions about paternity and conception. Stemming from broader biomedical discourse that views sex and gender as one and the same, genetically determined and binary, the discursive effects of lines of inquiry render invisible QTNB identities, family building processes and kinship structures. We explore this tension, showing how lines of inquiry have unequal effects of surveillance across queer family building, kinship and identity, and how QTNB resist dominant discourse around sex, gender and sexuality. Findings can be used by perinatal health professionals to better care for QTNB perinatal service-users as they navigate technologies of surveillance during pregnancy.
Life stories are widely promoted in person-centred dementia care as tools to preserve the identity of the 'person behind the dementia'. However, as cognitive decline progresses, staff often face dilemmas when current expressions of preference appear to contradict a person's documented past, for example, a devout Muslim requesting pork or a lifelong teetotaller showing interest in alcohol. The aim of this study is to explore how dementia care staff reason about situations in which life story information conflicts with a person's present identity and expressed preferences. Using Atchley's continuity theory (1989), we explore how staff conceptualise the relationship between external continuity (roles, habits and life patterns) and internal continuity (self-perception and identity). Based on six focus group interviews with dementia care staff in Sweden, we demonstrate that the frequently cited dichotomy between 'seeing the person' and 'seeing the condition' is overly simplistic; instead, staff adopt flexible and dynamic understandings of identity that accommodate change over time. Our findings suggest the need to move beyond binary framings and indicate that thinking in terms of the person before, behind and beyond dementia offers a more nuanced framework for understanding identity in dementia care.
This article examines how the legitimacy of physician associates (PAs) is constructed and contested in English medicine. Drawing on Critical Discursive Psychology, it analyses formal submissions to a government commissioned independent review of medical associate professions from the British Medical Association, General Medical Council and United Medical Associate Professionals to ask: What does conflict over PAs reveal about fractures in medical status and power? The findings show that these actors do not simply disagree about a new occupational role but mobilise shared concerns, especially around safety, standards and responsibility, through competing legitimacy logics. For the BMA, legitimacy is framed predominantly through boundary protection and the exclusivity of medical expertise; for the GMC, through regulatory governance and system assurance; and for UMAP, through workforce contribution and professional integration. Conceptually, this article extends jurisdictional accounts by showing that contemporary role disputes concern not only who controls clinical tasks but also which criteria and institutions are authorised to validate healthcare work. The PA controversy therefore reveals a pluralisation and institutional fragmentation of the grounds of medical authority, rather than its straightforward decline or reproduction.
Because of increasing pressure on healthcare resources in many countries, public health policies are increasingly occupied with how to optimise decision-making processes to ensure medical interventions are appropriate, necessary and aligned with the preferences and values of patients. One prominent example is the concept/model of shared decision-making (SDM) which target clinician-patient interactions in the clinic. Such public health goals raise renewed questions about what matters to people when seeking healthcare, which models such as SDM may not be able to fully account for. In this article, we draw on ethnographic fieldwork in two Danish shoulder clinics. We identify specific uncertainties as they manifest in guidelines and the clinic, and draw on pragmatist-inspired theory, to argue that decision-making emerges as interactional work in what has been conceptualised as the subjunctive mood, to make treatment proposals acceptable. In this process doubt and hope are inherent elements to be acknowledged and managed, rather than avoided. Thus, we argue that such pragmatist ideals are fundamental to shoulder care. Our findings call for an approach to clinical decision-making in research and policy that considers the everyday concerns of patients and clinicians as they seek to navigate highly uncertain terrains.
Longitudinal birth cohort studies are an under-examined context for considering the dynamics of healthism. This article presents a comparative perspective from the 'Biosocial Lives of Birth Cohorts' study, which takes birth cohorts as an ethnographic object of knowledge-making, social practice and participation in the Netherlands, Brazil, Portugal and the United Kingdom. Drawing from ethnographic research with participants and professionals involved in cohort data collection, we examine how, in the routine monitoring and measuring of bodies and lives in cohort studies, 'healthism', as an individualised form of moral self-responsibility for health, is entangled with medicalisation. Healthism is also at stake in the way that individual cohort test results are communicated and received. Yet the relational dynamics of cohort studies, which encompass but also exceed the scope of healthism, are also shaped by the precarity of public health infrastructures and closely entangled with the motivational desire of cohort participants, as birth cohorts can act as a stopgap for public health failures. In this way, we demonstrate how birth cohorts are an important context for considering the politics of health and how medicalisation is entangled with healthism in cohort data collection, even as this unfolds in tension with efforts to collectively intervene in public health.
Amid the ongoing opioid crisis, U.S. health systems have extended prescription monitoring interfaces with proprietary reports that provide clinicians with algorithmic risk scores to guide opioid decisions. However, little is known about how such tools shape clinical encounters, professional authority and accountability in everyday care. This article examines the case of NarxCare, a widely adopted risk-scoring system, through a multi-sited ethnographic study combining clinician interviews, interface walkthroughs, documentary analysis and clinic observation. We find that NarxCare operates through multiple opacities, presenting scores as authoritative yet unexaminable. It produces an amalgamated risk by collapsing diverse concerns-overdose, liability and societal harm-into a single number. Through its logic of contagion, physicians themselves become risk subjects, their reputations and careers tethered to the scores of patients they treat. These dynamics illustrate how this algorithmic automation recasts prescribers as governable agents of the opioid crisis; however, by unsettling established epistemic cultures of safety, it fails to completely enrol them as actuarial enforcers. In practice, clinicians respond by refusing, anticipating, or domesticating the scores, but cannot evade them fully. NarxCare thus reconfigures rather than resolves opioid risk, a dynamic with significant implications as algorithmic infrastructures expand across healthcare and scoring enters new domains.
