{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:19:50Z","timestamp":1792783190676,"version":"4.5.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National Yang Ming Chiao Tung University","id":[{"id":"https:\/\/ror.org\/00se2k293","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Med Health Care and Philos"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Patient-centered care (PCC) is widely endorsed in contemporary medicine, yet philosophical analyses often approach it through concept-first approaches that define patienthood in advance\u2014typically in terms of autonomy, holistic personhood, or rational agency\u2014and then assess clinical practice by reference to these ideals. This paper argues that such an approach can obscure how patienthood is configured in practice. We develop a tool-first approach that treats cognitive, communicative, and material tools as analytically primary for understanding how patients are individuated in clinical reasoning. The argument is grounded in an ethnographic case study conducted in a specialized cancer hospital, focusing on outpatient clinics in medical oncology, colorectal surgery, and palliative care. Rather than treating ethnography as descriptive background, we use it to identify tools-in-use that structure what becomes salient, actionable, and patient-relevant in situated encounters. Across these settings, distinct configurations of tools generate systematically different modes of patienthood. In oncology, staging systems and expectation management configure patients as therapeutic trajectories oriented toward uncertain futures. In surgery, anatomical diagrams and probabilistic framings individuate patients as operative bodies embedded in structured decision spaces. In palliative care, symptom scales, narrative practices, and informational scaffolding configure patients as experiential subjects and epistemic agents. We analyze these differences as instances of structural plurality: patterned, tool-mediated modes of patient individuation that are internally coherent yet irreducible to a single model. On this account, ethical ideals commonly associated with PCC\u2014such as autonomy, shared decision-making, and informed consent\u2014can be understood less as prior normative standards applied to practice, and more as contingent achievements that depend on how tools structure salience, understanding, and possibilities for agency in clinical contexts.<\/jats:p>","DOI":"10.1007\/s11019-026-10359-x","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T08:38:42Z","timestamp":1778488722000},"page":"747-760","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tool-mediated patienthood: structural plurality in oncology, surgery, and palliative care"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2788-8420","authenticated-orcid":false,"given":"Karen","family":"Yan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Jung","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Ying","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong Alison","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"issue":"December","key":"10359_CR1","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.shpsa.2016.08.003","volume":"60","author":"Rachel A Ankeny","year":"2016","unstructured":"Ankeny, Rachel A., Sabina Leonelli. 2016. Repertoires: a post-kuhnian perspective on scientific change and collaborative research. Studies in History and Philosophy of Science Part A 60:18\u201328. https:\/\/doi.org\/10.1016\/j.shpsa.2016.08.003","journal-title":"Studies in History and Philosophy of Science Part A"},{"key":"10359_CR2","doi-asserted-by":"crossref","unstructured":"Ankeny, Rachel A., Sabina Leonelli. 2020. Model Organisms. MIT Press.","DOI":"10.1017\/9781108593014"},{"issue":"11","key":"10359_CR3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1080\/15265161.2019.1665402","volume":"19","author":"Tom Beauchamp","year":"2019","unstructured":"Beauchamp, Tom, James Childress. 2019. Principles of Biomedical Ethics: Marking Its Fortieth Anniversary. The American Journal of Bioethics: AJOB 19(11):9\u201312. https:\/\/doi.org\/10.1080\/15265161.2019.1665402","journal-title":"The American Journal of Bioethics: AJOB"},{"key":"10359_CR4","doi-asserted-by":"publisher","unstructured":"Berwick, Donald M. 2009. What \u2018patient-centered\u2019 should mean: confessions of an extremist. Health Affairs 28 (Supplement 1): w555\u201365. https:\/\/doi.org\/10.1377\/hlthaff.28.4.w555","DOI":"10.1377\/hlthaff.28.4.w555"},{"key":"10359_CR5","doi-asserted-by":"crossref","unstructured":"Bueno, Ot\u00e1vio, Ruey-lin Chen, Melinda Bonnie, and Fagan. eds. 2018. Individuation, process, and scientific practices. Oxford University Press.","DOI":"10.1093\/oso\/9780190636814.003.0001"},{"key":"10359_CR6","doi-asserted-by":"crossref","unstructured":"Carel, Havi. 2016. Phenomenology of Illness. Oxford University Press.","DOI":"10.1093\/acprof:oso\/9780199669653.001.0001"},{"issue":"11","key":"10359_CR7","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1056\/NEJM198203183061104","volume":"306","author":"EJ Cassel","year":"1982","unstructured":"Cassel, E. J. 1982. The nature of suffering and the goals of medicine. 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Any use of generative AI in this manuscript adheres to ethical guidelines for use and acknowledgement of generative AI in academic research. The lead author was responsible for the writing, conceptual framing, and philosophical analysis. The second and third authors contributed to data collection and analysis, while the fourth author assisted with participant recruitment and securing IRB approval. All contributions have been reviewed for accuracy, and each author takes responsibility for the integrity of their respective work.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}]}}