Placental Social Ethics: Designing for Epistemologies of Resistance

i thank dr. vink for her impressive analysis of design and introducing me to another method in thinking about institutional organization. I also am deeply grateful for Dr. Vink’s engagement with my work on “Placental Ethics: Addressing Colonial Legacies and Imagining Culturally Safe Responses to Health Care in Hawaiʻi” (Bardwell-Jones) and responding to the call to re-envision alternative design models in guiding institutional operations that seek community engagement. Responding to this paper helped me to think further about the work I began in that article.

Dr. Vink’s project carefully reflects on her experience working with communities in Canada on behalf of hospital administration. Seeking input from differently situated communities, she reflects on moments of perplexity and resistance from the community members. Working with members from an Indigenous community, she found that dominant design models “can contribute to the reproduction of coloniality and modernity.” Working with diverse communities in Toronto, she acknowledged the “hypocrisy” of participation when dominant design models failed to acknowledge the ongoing process of local design work within the community.

It appears that dominant design within hospital administration understands care as best done by authority. Community members are reduced to data. The cognitive work is done by the experts, who are situated outside the community. There are risks that dominant design models, despite the good intentions motivating the inquiry, may perpetrate unconscious structural gaslighting. Drawing upon Elena Ruiz’s notion of settler epistemic economies that generate structural violence, Nora Berenstain identifies the nature of structural gaslighting as

forms of violence that are perpetrated by settler administrative systems and their organizing logics [which] inherently depend on what Ruíz refers to as settler epistemic economies—collections of hermeneutical resources specifically engineered to promote, uphold, and entrench colonial epistemic frameworks and forms of domination as the only possible epistemological systems and governance structures while violently foreclosing on alternative epistemologies.

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Dominant design models go beyond merely asserting hermeneutical dominance, but in so doing enact epistemic erasure. Structural gaslighting undermines autonomous community processes and prevents them from taking shape. Ultimately, the dominant design model, which assumes that the researcher knows best, stunts the necessary resistance to undermine the dominant design models.

To avoid these problems, Dr. Vink aims to transform the colonial logics involving hospital administration toward a pluralistic design model. Care, in this framework, is a community endeavor. Community members are active agents involved in all aspects of the cognitive work. The experts’ knowledge is decentralized and is positionally placed among the perspectives of the community. Within this narrow space, experts are part of the crowd and must engage with the conflicting values, the chaotic background, and the turbulence of the community. A pluralistic design model, Vink argues, encourages reflexivity or epistemic perplexity, which causes the necessary friction to unsettle one’s own assumptions about care in a hospital setting. Vink points out how individual and social frameworks may elicit epistemic perplexity. First, she discusses aesthetic friction, which aims to encourage individual self-reflection. Part of the intent of the design is to change the way caregivers relate to their patients in a hospital setting. The example of the dual tubing of the stethoscope invites the patient and the caregiver to listen to the patient’s heart together. The modified stethoscope aims to open up a space where the caregiver and the patient mutually develop epistemic perplexities, which might bridge diverse perspectives in health. The double stethoscope offers a context of play and experimentation in dialogue with differently situated others. An aesthetic disruption of this sort aims to decentralize the epistemic labor involved in understanding the patient’s health. I find this instrument interesting as it opens up a space where the patient is able to understand their bodily health more through modern medical technology, and it allows the caregiver the opportunity to learn more about the patient’s values of health through a shared experience of listening to the heartbeat of the patient at the same time.

Second, Vink acknowledges the limitations of generating the necessary friction that can take place at the individual level. For José Medina, individual...