This thesis is about how medical knowledge is constructed by staff for patients and their families in a Japanese 'comprehensive care' facility for the treatment of epilepsy (the JEC). The thesis sets out to explain the possible reasons for differences between the number of surgeries of epilepsy performed at the JEC and the number performed in a Canadian institute. I will argue in the thesis that the fundamental difference between the two institutes lies in cross cultural and cross institutional differences in the uses and interpretations of the polysemic phrases 'comprehensive care' and 'quality of life'. They are ideological constructs embedded in a social process of knowledge production. Uncritical acceptance of these institutional objectives has significant ideological consequences in that it (1) justifies the unequal distribution of services, (2) legitimates the treatment program's objectives, and (3) masks the social relations out of which authoritative knowledge about epilepsy at the JEC is produced.

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