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Discursive constructions of social responsibility Dharamsi, Shafik

Abstract

There is a widespread concern that the dental health care system in North America sustains an inequitable opportunity for accessing care. In response, the term social responsibility appeared in the dental literature, but it is not clear how it is understood and enacted, particularly within the context of a growing desire to enhance access to oral-health care through an affordable, equitable and practical system of delivery. Using an interpretive ethnographic approach, and the analytical and critical techniques of discourse analysis, I studied how 34 participants, comprising dental educators, dentists in private practice, and those in leadership and governance of dentistry, spoke about and accounted for social responsibility in relation to their sense of how the dental health care system operates or should operate and why they see and do things in one way and not another. Competing professional, social, economic, and political views unveiled the moral and practical explanations the participants used to justify their position on social responsibility in dentistry. My findings reveal four competing discursive constructions of social responsibility in dentistry, situated within discursive spaces intersected by individual and collective notions of social responsibility on the one hand, and the acceptance and challenge of the status quo on the other. Each space occupies a range of accounts to explain, rationalize and justify particular viewpoints on social responsibility. The responsibility to treat pain, regardless of compensation, was a social responsibility that was held sacrosanct, and considered a widely accepted code among dentists generally and within dentistry in particular. It provided an agreed upon discursive space in talking and thinking about social responsibility. Problems emerged when particular discursive constructions of social responsibility took on a sense of what was considered so 'natural' and conclusive so as to be unassailable from any other position. There is an obvious tension between competing discourses and the associated constraints and challenges of accepted and dominant norms within dentistry, and the participants' sense of their rights and responsibilities.

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