Ducey, ArielNikoo, Shoghi W2014-05-272014-11-172014-05-272014Nikoo, S. W. (2014). Decision-making in Practice: Surgical Actionability and Consent in Pelvic Floor Medicine (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/25528http://hdl.handle.net/11023/1564In this thesis I explore how patients’ problems are made surgically actionable so that decisions regarding and consent to surgery may be produced. I employ ethnographic observations of the material and semiotic practices in which surgeons and patients are engaged. Surgical actionability arises in a cascade of practices that produce diseases such that they meet conditions of actionability. Disagreement between realities of a problem, or uncertainty regarding surgical outcomes, may produce disruptive turbulence in these cascades. Surgeons manage turbulence by shifting sites of decision onto ‘patient choice’ – if a patient decides she is bothered enough to justify the risks, surgery may go forward. However, patients’ decisions rarely take on this ‘rational’ character; instead, they appear to be non-formal and centre on issues other than risks and benefits. I question the value of ‘respect for autonomy’ and propose that policy based in care, with a focus on the particularities of disease and decision production, may serve patients better.engUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.Education--Sociology ofSociologyHealth SciencesActor-network theoryMedical sociologyAutonomyInformed consentUrogynaecologydoctoral thesis10.11575/PRISM/25528