How Experts Draw Boundaries

Abstract

Categorical distinctions such as healthy/sick or dead/alive serve to provide orientation and to facilitate decision-making in medicine. This is a major issue in the theory of reflexive modernisation. Recently, new scientific insights within genetics have increasingly prompted the re-drawing of such boundaries. Taking the example of prenatal testing, with particular reference to late term abortion, I investigate the governing rationalities of experts' boundary politics. It will be shown that boundary drawing is structured with reference to society's guiding principles and notions of normality. In those problematic cases where the medical frame is unable to deliver sufficient interpretative power, this reference to societal value orientations turns out to be functional for maintaining the experts' professional authority. In the case of prenatally diagnosable disabilities, for example, experts often do not know how to deal with such diagnoses. This ambiguity is for the most part understood as (cognitive) uncertainty amenable to more research, rather than interpreted as non-knowledge with reference to the level of social action which results from the interpretative failure of biomedical frames. Thus, the interpretation of non-knowledge appears to become unambiguous, which undermines any pending politicisation of non-knowledge. The alignment with society's guiding principles turns out to be functional for maintaining the claim to be able to provide adequate and relevant information and terms for decision-making processes; in other words, for maintaining professional authority. On the basis of the observation that experts have to deal with uncertainty and non-knowledge, the article asks in conclusion whether this could point to the possible emergence of a reflexive type of expert.