Organizations, Medicine and Dying

From a sociological point of view, organizations are especially interesting, because they have to deal with unresolvable contradicting and conflicting 'logics'. What differentiates how death and dying are dealt with in modern societies from traditional forms is that dying occurs increasingly in specialized organizational settings. Specialized palliative care physicians and nurses, as well as social workers, pastoral care workers or volunteers provide care to a patient. In my research, I am interested in the different professional identities that emerge in the specific actor constellations, which characterize hospice units and palliative care wards.

Even more interesting than dying in inpatient units is the professional organization of dying at home. Phyisicians and nurses are confronted not only with a patient, but also with his or her environment, which means most of the time with their relatives. Family members appear not only as guests, but are in fact pivotal for the provision of care at home. In this case, Palliative Care Teams do what they can do best: They organize the family in order to allow the patient to stay at home.

Thanatosociology – Involvement through Detachment

Even though sociologists thought about the problem of death and dying in modernity for quite some time already (for example Emile Durkheim), a somewhat distinct sociological discourse did not emerge before the 1960s with the publications of Glaser/Strauss or Sudnow. From there on, the sociological discourse seems to follow two typical patterns.

First, sociologists found themselves to be in the position of participants, which was closely tied to the hospice movement, from which sociologists gained legitimization. This position as a player in the game persists until today. Second, drawing upon the first position, sociology constructed a position of observation, that distanced itself from the hospice movement by deconstructing their ideals and normative views. This position justifies itself as being a decidedly scientific one by explicitly not being part of the game while observing others playing.

Today, we are witnessing the advent of a third position, that forms a middle ground between the first two and that consists of a discourse which we could describe with Norbert Elias as a form of "Involvement through Detachment" – and this is precisely the position that I would want to assume for my research.

Material Presentification & Digitalization

Organizations, through division of labour, not only offer different possibilities to encounter different professional perspectives, but they also offer different media to create variability in the duration and intensity of these encounters. Palliative Care Teams for example visit their patients at home, call them regularly via telephone and stay in touch with their patients and relatives through various objects that they position strategically at the patients home. These objects represent the palliative care team, thus creating material presentifications.

Current research shows that this includes "digital presentifications" such as eHealth or mHealth applications, enabling for example more continuous symptom control, amelioration of psychological distress or simplification of organizational tasks. Future research will have to focus on how digitalization solves the problem of creating a 'extended presence', that transcends and even obliterates the need for physical co-presence of professionals, which is, especially in outpatient settings and contrary to popular beliefs, frequently more of a problem than a solution.

Symmetry and Asymmetry in ANT

In my masters thesis, I looked at Actor-Network-Theory through the lens of symmetry and asymmetry. Bruno Latours earlier and more recent works were the focus of my work, as he was one of the main protagonists of ANT. In my deconstructive reading, Latours thinking appears to be driven by a continuous interplay between symmetries and asymmetries. He repeatedly finds himself in a world (modernity) full of asymmetries (in politics, science) in which he tries to find possibilities for symmetrization (reassembling the social).

This does certainly not mean, that he advocates some kind of equality between objects and subjects or human and non-human actors, but he is constantly trying to raise sensibilities for situations, in which these different kinds of actors can be included and where they appear for themselves as equals while remaining different.