The Dispositions of Things : the non-human dimension of power and ethics in patient-centred medicine

This paper explores power relations between clinicians, patients and families as clinicians engage in patient-centred ethical work. Specifically, we draw on Actor-Network Theory to interrogate the role of non-human elements in distributing power relations within clinical settings as clinicians attempt to manage the expectations of patients and families. Using the activities of a multidisciplinary team providing deep brain stimulation to children with severe movement disorders as an example, we illustrate how a patient-centred tool is implicated in establishing relations that constitute four modes of power: power over, power to, power storage, and power/discretion. We argue that understanding the role of non-human elements in structuring power relations can guide and inform bioethical discussions on the suitability of patient-centred approaches in clinical settings.