Brown, Jenna; (2023) Performance Care and the Ethics of Rehabilitating Elite Singers: A Policy Analysis. Presented at: International Symposium of Performance Science, Warsaw, Poland.

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Abstract

Background: Singing voice rehabilitation specialists (SVRS) are advanced singing teachers trained to work with injured voices. Standing at the intersection between clinical practice and pedagogy they draw on strategies from a range of disciplines. This multi-skill training is necessitated by the complex biopsychosocial character of many voice disorders, however as a result of navigating transdisciplinary practice they regularly meet ethical challenges. Critiques of the SVRS role call for practitioners to 'stay in their lane' and challenge the notion that singing teachers should be involved in voice rehabilitation as part of a clinical team. However, best practice in treating singers calls for practitioners to have detailed awareness of performance and pedagogy. Many clinicians do not have this. SVRS can bridge this gap, providing the services that patients and clients report needing and valuing. / Aims: This paper aims to explore the ethics of SVRS transdisciplinary practice through a document analysis of current policy documents available for the role. The analysis is completed using pragmatic feminist post-structuralism, which seeks to offer a critical paradigm examining hierarchical dichotomies through direct challenge of traditional patriarchal structures as they are evidenced in text. This paradigm has been chosen as it mirrors the structural context of current medical and pedagogical systems within which the SVRS operate. A critical literature review examines the relationship between traditional and feminist ethical theories and their potential impact on practice. Themes have been extracted from the literature to create a feminist post-structural analysis framework, facilitating exploration of the foundations of three policy documents currently available to SVRS practitioners. / Main Contribution: Findings indicate an incongruence between policy and practice. They show that current policy is weighted towards traditional ethics that values masculine ideals of rational autonomy. These ideas are seen to be at odds with the espoused values and practices of SVRS organisations, which seek to prioritise patients as experts by experience through a biopsychosocial model of care. It is suggested that adopting the guiding principles of feminist ethics for singing voice rehabilitation would present a radical shift in policy, but perhaps a closer alignment to existing practice. This study proposes that embracing a feminist ethic of relational, embodied care would contribute to the creation of policies that are better able to address the holistic needs of patients. / Implications: The current textual alignment of SVRS policy with rational, universal autonomy risks diminishing the importance of embodiment, relationship and context in rehabilitation practice. Embracing a paradigmatic shift towards feminist ethical values has two main implication in relation performance care. 1. It may help to address the legitimacy challenges levelled at SVRS practitioners by reconceptualising practitioner expertise outside of hierarchical, elitist healthcare structures. Thereby allowing patients access to rehabilitation practitioners with a breadth and depth of expertise in their performance specialism. 2. It would rebalance the relationship between practitioner and patient, allowing patients to be respected as experts by experience and valued contributors to diagnosis, treatment and recovery plans, which has been proven to improve clinical outcomes.

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