Reading :: Doing Dignity

 Doing Dignity: Ethical Praxis and the Politics of Care

By Christa Teston

Christa Teston is well known for doing strong research in the rhetoric of health and medicine. When I found out recently that she was going to give a talk on the UT campus about her new book, I rushed out and bought it so that I could read it before hearing her talk. And of course I’m glad that I did.

Teston starts out by reviewing how the term dignity has been construed and operationalized in various milieux, starting with Cicero. It is not all positive. “For premodern thinkers, dignity was a way of demarcating an individual’s superiority or worth within a community,” she argues (pp.13-14). Working her way forward, Teston demonstrates different legacies of “dignity” that are often invoked together in modern discourse. Ultimately, she concludes, dignity is a rhetorical practice rather than an individual human property, “conditional, not intrinsic” (p.27). 

To investigate further, she examines three case studies:

• “Proning,” in which an oxygen-starved patient is laid prone (face down) to relieve lung pressure and increase oxygenation. Proning is uncomfortable, scary, and undignified. 
• Digital comments on death-with-dignity legislation being considered in two US states. Proponents and opponents of the legislation alike invoked dignity to support their points. Here, she notes that people supporting this legislation often describe what-if stories in which they take advantage of death-with-dignity to save their loved ones from crushing medical debt, and notes the counterargument that it would be better to have a medical system that does not impose such debt.
• An assistive technology clinic, in which people who need assistive technologies (e.g., motorized wheelchairs) interact with clinicians and salespeople.

In her conclusion, Teston argues that we do dignity — that is, we perform it rhetorically — and she offers one example of how this happens. “Dignity therapy” involves “the coauthoring of one’s discursive end-of-life legacy” (p.149). “Fundamentally, I see dignity therapy as a systematized practice of dignified care that uses qualitative research methods such as semi-structured interviews to do dignity” (p.150). Or — this is my characterization, based on the book and what Teston said during her presentation — we might say that dignity therapy leads a dying person to tell their own life story and therefore make sense of their life. They do dignity by describing how they lived their lives, and perhaps how they were the hero of their story.

I see an obvious connection with the second case study. Here, proponents of death-with-dignity legislation frame their arguments by asking: What if I have an expensive terminal illness? Should the law force me to stay alive, and along the way, impoverish my loved ones? Or can I have the agency to lay down my life for my family, to be the hero one last time, to do dignity through my sacrifice? One can certainly argue that this choice should never have to be made, that the US government should socialize medicine. But these commenters recognize the system in which they live, and they spin these speculative stories on the entirely reasonable premise that it won’t change. Under those conditions, they attempt to do dignity, to tell a story in which they can be a hero, just as those in dignity therapy do.

This brings me to a broader question, which I tried to ask at the end of Teston’s talk, but I flubbed. That question is: When we talk about doing dignity, does that mean that we reach (and sometimes fail to reach) an existing goal? Or is it that we do the best that we can, and at the end, we call it (characterize it as, conceptualize it as) dignity? 

Related, is there a difference between the smaller processual indignities that we must endure (e.g., proning, or talking to a med tech salesperson who doesn’t understand our life, or getting our prostate checked) and the larger concept of Dignity at the end of life (e.g., making sense of your life, looking back and being satisfied with how you lived it — and perhaps rising above the many smaller indignities you had to endure)? 

Overall, I found the book to be well researched and (even more importantly) thought-provoking. Definitely pick it up. 

Reading :: Rhetoric, Innovation, Technology

 Rhetoric, Innovation, Technology: Case Studies of Technical Communication in Technology Transfer 

By Stephen Doheny-Farina

I was surprised to see that I hadn’t reviewed this book yet — I’ve been aware of it and one of the underlying case studies, which I read as a graduate student in the 1990s. The book itself, which was published in 1992, represented a fundamental shift in 1990s technical and professional communication studies: it was both an early technical communication study at a time when such studies were rare, and an early qualitative case study of workplaces at a time when most tech comm research was and happening in classrooms. 

In this book, Doheny-Farina describes three case studies: a “high-tech venture” (i.e., a software development company) producing a business plan, a new medical device supported by instructional documentation, and two product design teams attempting to design for users. In other words, he really had his finger on the pulse of the 80s and early 90s, during which technologies were rapidly commercialized and seemingly no one knew how to shape them or design them for actual users. (I remember these times well!)

Of the three case studies, the one that is most immediately applicable to what I’m doing, and the one that caused me to pick up the book, is the first one. As Doheny-Farina begins Chapter 2: 

In January 1982, the United States was deep into a recession, but a small group of what the popular press commonly calls whiz kids were starting an enterprise in the same spirit as the legendary start-ups that fueled Silicon Valley and the Massachusetts Miracle. They were graduate and undergraduate students from a highly respected northeastern university, and they were going to exploit the pending microcomputer revolution, creating a dynamic, high-tech company out of a class project. (p.31)

If you were trying to get rich, this would be a great time to do it. The IBM PC was released in 1981, using an operating system supplied by Microsoft. It, and other personal computers, spread rapidly into both businesses and homes. The technology seemed to provide endless functionalities — mass-market business applications, niche technical applications, games, and quirky hobbyist applications. Riding on this wave, many hobbyists and students jumped into marketing and selling their own software. 

So did “Microware,” the company that is the focus of this case study. (Side note: This is not Microware, the Des Moines-based software company for which I interned in the mid-1990s.) As mentioned above, Microware emerged from a student project in which an enterprising management student (Bill) arranged for an independent study at his university. The independent study was focused on developing a software company, specifically on creating a business plan. Bill was 20. In writing the plan, he organized other students who could develop software, mainly structured around their own interests: games, graphics, and specialty software oriented to the medical market. Doheny-Farina quotes Bill as saying: “Without a product, without money, without furniture, without machines, the business plan is it. That’s your whole case for existence” (p.48).

Let’s take a second to shed a tear for Bill and the students he pulled into this company. It would be a few decades before Steve Blank articulated a case against such business plans. Lean Startup — which is the process we currently teach young entrepreneurs-in-training — was developed as an alternative to an initial business plan, since at the very early stages of a startup, entrepreneurs must investigate many questions before they can confidently put their (and others’) time and money into a startup. What is their offering? Who needs that offering, and do they need it enough to actually pay for it? What problem will that offering solve for them? What competition do you face? What business model will you establish? And on and on. Blank argues that a startup is a temporary organization in search of a hypothesis — a hypothesis that must be validated through lots of feedback loops with lots of stakeholders. So a business plan, which presumes the hypothesis and builds long-term plans based on them, should come at the very end of this process rather than at the beginning.

Since Lean Startup is upfront about the fact that this work is all guesswork, searching for an answer that will work, it drives entrepreneurs to ask those questions, seek answers, and pivot when the answers aren’t positive. It builds in flexibility as an ethos. But back in 1981, Bill had just one way to make a “case for existence” for his startup: The business plan. And since the business plan’s function is to provide answers and certainty, this put Bill in a position that did not serve him well. He had to act certain when he couldn’t be. Doheny-Farina says this more pithily: “External promotion often involved deception” (p.45).

Microware’s executives, who were almost all 22 in 1983, knew how to write programs individually. Bill knew how to promote them, first to a local attorney who was interested in supporting local high-tech companies, then to other investors and a bank. Yet, tragically, no one seemed interested in long-term product strategy. Bill’s business plans (there were two) tended to focus on what he considered to be sexy applications, but internally, people tended to focus on passion projects such as games. The company pursued three different, unintegrated types of software production (different types of products required different types of production). Due to frictions in the group — especially Bill’s tendency to promise things that were not technically feasible — the rest of the leadership team insisted on collaborating with him on writing the new business plan. They also thought seriously about firing him. Instead, they kept him and had him pull together the parts they wrote (which he often ended up watering down). 

I think you can imagine how this story ends. It’s a tragedy — a well-told tragedy that Doheny-Farina supports well with his ethnographic research. If, like me, you’re interested in case studies of entrepreneurship, definitely pick it up.