![]() ![]() It stood in contrast to (German) historicism, which was sensitive to the subjectivity, contingency, and unrepeatability of history ( Weber, 1922). The appearance of Galileo Galilei, the Enlightenment, and the French Revolution brought a shift toward a struggle between the ideal of progress and the Ancien Régime, or science and tradition, marking a cultural divide that would have a profound effect on the following centuries.Ī similar fundamental dichotomy is also reflected in the modernity of the late 19th century, in which the positivist vision, faithful to the 18th-century Enlightenment and rationalist tradition, searched constantly for the ordering principles of an objective and universal nature. With the advent of Christianity, the categories of worldly and otherworldly (or sacred and profane) distinguished the opposite poles around which life and social organization developed in the Middle Ages. In the pre-Socratic world, this founding tension is seen between the philosophy of Heraclitus-who conceived an unstable world in continuous evolution-and Eleatic thought, which was more interested in grasping the indivisible essence hidden behind the multifaceted phenomenal appearance of life. Simmel (1997), one of the fathers of sociology and one of the most acute thinkers in grasping the metamorphosis of social reality, argued that the variety of human behaviors and expressions of social life could be reduced in every epoch to a fundamental, historically circumscribed antinomy. Introduction: Contingency and Universalism in Modern Culture The article shows how care practices cannot disregard the specific organizational conditions in which they unfold and suggests that research should develop reflective analysis skills on what Annemarie Mol calls the logic of care, thus ceasing to treat the local dimension as a disturbing element in formal systems but, on the contrary, taking note of its impact and unavoidability in actual practice. I consider two repertoires: the interpretative (examining the production and dissemination of knowledge) and the relational (focusing on informal interactions between different professional groups and communities of practice). Following the Science and Technology Study perspective in a practice-based analysis of daily work, I show how interactions between human actors, technological artifacts and organizational apparatus in daily practices constitute repertoires of resignification through which local universality emerges, resolving the tension between medicine's universalistic aspirations and the unpredictable, situated nature of the lifeworld. Using data collected during a year of ethnographic research in an intensive care unit in Northern Italy, I discuss how the abstract indications of EBM and the formal dimension of health organizations are incorporated, through socially located interactive repertoires, in actual care trajectories. “Universalistic” premises are never merely “applied” to “local” interactive contexts but are always creatively “implicated” in them. In everyday clinical, therapeutic, and care activities, these procedures are intertwined with the multiplicity of elements that make up the lifeworld. The EBM paradigm, which is currently the most prevalent in every medical-nursing discipline, aims to standardize care procedures through the process of constant scientific literature review and the production of operational guidelines based on what epistemic communities define as the most reliable and effective results: the so-called gold standards. This tension constantly challenges the unitary, universalistic vision to which modern medicine and science aspire. In this article I discuss the irremediable tension between the universalistic dimension of contemporary medicine, represented by the paradigm of evidence-based medicine (EBM), and local daily practices in specific healthcare organizations. Department of Human and Social Sciences, Università di Bergamo, Bergamo, Italy.
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