Achieving the indeterminate: Accomplishing degrees of certainty in life and death situations

This paper explores technology's pivotal position at the intersection of control and uncertainty. It examines two areas: Intensive Care and a Labour Ward. Building on the work of Davis (1960), it argues that certainty and uncertainty are socially constructable and reconstructable. This is actively achieved by the deployment of strategies involving particular paradigms (the biomedical model) and artefacts (medical technology). Power lies in control over knowledge and the structures and practices which sustain it, including those embedded in advanced technology. The contribution of medical technology to the achievement of certainty in Intensive Care and end-game Obstetrics (the Labour Ward) is considered. Achieved certainty in medical situations is seen as: the structured masking of uncertainty by the application of medical iconography, artefacts and techniques to create the illusion of certainty. The accomplishment of uncertainty in Obstetrics (as a precursor to technological intervention) is also explored. The accomplishment of uncertainty in medical situations is seen as associated with the structured projection of uncertainty, involving using medical discourse rooted in the medical paradigm to exaggerate the generality of risk and the probability of pathology. It is argued that the highly structured and routinised settings of ICU and the labour Ward, not only aid control by the medical profession but diminish perceptions of uncertainty.