STEM disciplines are the dominant culture in K-12 education. With its study of organs and diseases that afflict patients’ bodies, Western evidence-based medicine is seen and understood in the modern cultural paradigm as a science and as the practice in which a subject, the doctor, acts on an object; the patient’s body—a dominant culture in the patient’s journey. However, with the continually evolving high-technological and medical knowledge, life-saving therapeutic options are life-changing. They can range from changes in the diet, requiring structural and cultural changes in family life, to changes related to the experiences of learning to live tethered to a machine that is partly inside and partly outside one’s body or with somebody else’s heart. In this article, we show how competing needs to personalize care for the patient as a person forcefully emerge in response to evidence-based medicine’s global cultural dominance. We highlight two fundamental issues emerging in decision-making processes: (1) Framing evidence-based knowledge, uncertainties of the course of the disease and options, and (2) working with different, equally important, and often at odds conceptions of time in the care for the Other. Through the longitudinal analysis of moment-to-moment interactions in high-tech medicine encounters of a patient, his family, and the team caring for them, we show how framing and different conceptions of time emerge as issues, are profoundly interconnected, and are addressed by participants to care for a patient confronting existential decisions.

STEM 学科是 K-12 教育的主导文化。通过对影响患者身体的器官和疾病的研究，西方循证医学在现代文化范式中被视为一门科学，并被理解为主体（医生）作用于对象的实践；病人的身体——病人旅程中的主导文化。然而，随着高科技和医学知识的不断发展，挽救生命的治疗选择正在改变生活。它们的范围可以从饮食上的变化，需要家庭生活中的结构和文化变化，到与学习生活相关的变化，这些变化与部分在身体内部，部分在身体外部或与他人心脏相连的机器相连。在本文中，我们展示了作为一个人为响应循证医学的全球文化主导地位而强有力地出现时，如何为患者提供个性化护理的竞争需求。我们强调决策过程中出现的两个基本问题：(1)构建基于证据的知识、疾病过程和选择的不确定性，以及 (2)在照顾他人时使用不同的、同等重要且经常不一致的时间概念。通过对病人、他的家人和照顾他们的团队在高科技医疗遭遇中瞬间互动的纵向分析，我们展示了框架和不同的时间概念是如何作为问题出现的，它们之间有着深刻的相互联系，并且由参与者解决，以照顾面临生存决定的患者。