Proefschrift

57 2 RISK AND THE POLITICS OF BOUNDARY WORK facts, ‘the contests over power which give rise to differences of opinion about risks’ (Douglas, 1990, p. 9) are hidden. For Douglas, this is ‘the central issue’ (Douglas, 1990, p. 10). She explains that differences of opinion about risk do not depend on facts, because, ‘[…] risk is not only the probability of an event but also the probable magnitude of its outcome and everything depends on the value that is set on the outcome [emphasis added]. The evaluation is a political, aesthetic, and moral matter’ (Douglas, 1990, p. 10). Several researchers have argued that the empirical evidence about risk in MNC that is often used to inform policy is not objective, but interpreted through the lens of one’s beliefs and interests (see, for example, Dencker, Smith, McCann, & Begley, 2017; de Vries, Paruchuri, Lorenz, & Vedam, 2013; Healy, Humphreys, & Kennedy, 2016b; Lane, 2015; Roome, Hartz, Tracy, & Welsh, 2016). Studies have also shown that use of medical interventions in MNC is associated with provider attitude rather than evidence, resulting in undesired practice variation and negatively affecting care outcomes (Klein et al., 2009; Offerhaus et al., 2015; Rivo et al., 2018; White VanGompel, Main, Tancredi, & Melnikow, 2018). The use of the ‘decision trap’ by SGKL’s chair was an effort to eliminate the influence of interests in the decision process. The consensus achieved within the SGKL can be understood as the result of the chair’s successful creation of an inclusive narrative, focusing on shared recognition of, and esteem for, scientific evidence. By encouraging participants to see their disagreements as disagreements about facts, the chair effectively masked the beliefs and interests behind what was, in fact, a political dispute. It is no surprise then that the SGKL was unable to secure approval for its recommendations from the professional association of obstetricians, which, in the end, hindered the acceptance and implementation of the proposed reforms (Casparie & de Vries Robbé, 1989; Riteco & Hingstman, 1991). Because the negotiations did not address the underlying ideas and values, the SGKL was unable to reach a lasting agreement. The different ‘schools of thought’ did allow for transprofessional coalitions, but those alliances could not overcome the polarisation caused by the very existence of those schools. Moving from polarization toward collaboration The ‘conservative’ and ‘progressive’ schools in obstetrics still exist in the Netherlands (Scherjon, 2014; Van Dillen, Hallensleber, Kleiverda, van der Post, & Scherjon, 2016). Moreover, as the risk discourse has become more prominent in MNC throughout the twentieth and into the twenty-first century, the historically ‘conservative’ profession of Dutch midwives has itself become increasingly divided (Abraham– van der Mark, 1996, Chapter 7; Koninklijke Nederlandse Organisate van Verloskundigen, 1987). As Perdok et al. (2014) have shown, in contemporary boundary work in Dutch MNC, it is midwives working in the hospital ―and not obstetricians ―who oppose handing tasks over to primary care midwives. Nevertheless, the current dispute in Dutch MNC is perceived as a ‘fight between midwives and obstetricians’ (Effting, 2016). Through this polarised medics versus midwives, and natural versus interventive frame (Coxon, Scamell, & Alaszewski, 2012, p. 506; Feinmann, 2016; Roome et al., 2016), professional groups in MNC tend to negatively stereotype each other, resulting in a climate of mistrust whereby each group anticipates conflict, reinforced by existing prejudices. These antagonisms can become ‘viral’ (Downe, Finlayson, & Fleming, 2010, p. 251), presenting major challenges for safe practice and healthcare reform which both require collaborative working (Downe et al., 2010; Reiger & Lane, 2009). Health, Risk & Society 19

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