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For a bureaucracy to establish a smooth data collection effort, a means must be found to detour around such higher order issues. The statistical committee discussed in chapter 4, assigned with determining the exact moment of the beginning of life by number of attempted breaths and weight of fetus or infant, cuts a Solomon-like figure against such a disputed landscape. At the same time, there is an element of reductionist absurdity herenow many breaths equals "life"? If not specified, another source of quality control for data is lost; if specified, it appears to make common sense ironic. This is an issue we will revisit as well in the discussion of nursing interventions, in chapter 7. |
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Algorithms for codification do not resolve the moral questions involved, although they may obscure them. For decades, priests, feminists, and medical ethicists on both sides have debated the question of when a human life begins. The moral questions involved in encoding such informationand the politics of certainty and of voice involvedare much more obscure. |
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Forms like the death certificate, when aggregated, form a case of what Kirk and Kutchins (1992) call "the substitution of precision for validity" (see also Star 1989b). That is, when a seemingly neutral data collection mechanism is substituted for ethical conflict about the contents of the forms, the moral debate is partially erased. One may get ever more precise knowledge, without having resolved deeper questions, and indeed, by burying those questions. |
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There is no simple pluralistic answer to how such questions may be resolved democratically or with due process. Making all knowledge retrievable, and thus re-debatable, is an appealing solution in a sense from a purely information scientific point of view. From a practical organizational viewpoint, however, this approach fails. For example, in 1927, a manual describing simultaneous causes of death listed some 8,300 terms, which represented 34 million possible combinations that might appear on the face of a death certificate. A complete user manual for filling out the certificate would involve sixty-one volumes of 1,000 pages each. This is clearly not a pragmatic choice for conducting a task that most physicians also find boring, low-status, and clinically unimportant. |
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As we know from studies of work of all sorts, people do not do the ideal job, but the doable job. When faced with too many alternatives and too much information, they satisfice (March and Simon 1958). As an indicator of this, studies of the validity of codes on death certificates repeatedly show that doctors have favorite categories; these are region- |
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