Performing accountability?:the case of image guided radiotherapy

In medical practices accountability is often reduced down to the writing and use of protocols, guidelines and standards in order to standardize practices and hence provide a justification for these actions – what could be termed ‘audited’ accountability (Giri, 2000). In presenting examples from ethnographic field work in two cancer treatment units I will show how accountability is performed in the context of the introduction of new technology and how these performances of accountability can be considered as a means for coping with potential absences of evidence or a lack of confidence surrounding new technologies. Informed by Science and Technology Studies, I will explore the role of protocols as tools for constructing and performing accountability. I argue that, in separating the processes of ‘giving an account’ from taking responsibility, practitioners are able to work with, or ‘park’, any uncertainty relating to their duties in order to continue to practice. The collective action afforded by introducing protocols therefore can be seen as necessary to enable practitioners, who are also affected by their practices, to continue to work. This parking of uncertainty may be considered unethical or unsafe but I suggest this technique enables practitioners to protect their own role and status within the organisation, in light of the changes associated with introducing new technology. I conclude that providing accounts, in order to legitimate practices, does not necessarily equate to responsible practice and that justifications for such practices should be based upon a rationale which includes ethical responsibility beyond the legal minimum