London School of Hygiene & Tropical Medicine

Hosted by LSHTM, KCL and UCL 

This talk will examine the dynamic between justification and practice in medicine, drawing upon the recent history of pelvic floor surgery. The controversy around the widespread adoption of transvaginally-implanted synthetic mesh for the surgical treatment of pelvic floor disorders has destabilized pelvic floor surgeons’ existing justifications for their practices, their feelings of worth, and their sense of how they know what is right. Drawing upon extensive qualitative data, The talk will show how the profession is therefore reconfiguring its forms of ethicality and justification, focusing on the challenge of creating forms of justification that can shape practice in ways that might prevent or mitigate future events like the adoption of transvaginal mesh. This analysis therefore calls attention to the necessity and importance of justification for these surgeons and for social scientific understanding of how these surgeons know and act.

The talk is based upon ongoing qualitative research, funded by the University of Calgary and CIHR, for which Ariel and a team of researchers and students from health services research, surgery, and bioethics have interviewed dozens of surgeon and stakeholders in pelvic floor surgery, carried out fieldwork at a pelvic floor clinic (observing 80 surgical consultations), coded and analyzed authoritative medical documents on the use of synthetic mesh in the pelvic floor, and observed twelve major medical meetings related to pelvic floor surgery in Europe and North America.

Ariel is an Associate Professor in the Department of Sociology, University of Calgary (Canada), and author of the book Never Good Enough: Health Care Workers and the False Promise of Job Training (Cornell 2009). Her work centres on issues of responsibility, care, and emotions in the institutions and practices of health care and medicine. Her first published paper on surgery in pelvic floor medicine, co-authored with Shoghi Nikoo, was published in SHI in January 2018, “Formats of Responsibility: Elective Surgery in the Era of Evidence-Based Medicine.”