This chapter examines how precarity affects the experiences of low skilled dirty workers – a group characterised by stigma and devaluation. Utilising Axel Honneth’s ideas of mutual recognition and the normative significance of work for identity, we explore how precarious working conditions affect self-understanding at the intersection of class and gender. Drawing on ethnographic data from street cleaners and refuse workers across four London boroughs, our findings demonstrate lack of secure employment has resulted in experiences of self-doubt and diminished sense of self-worth. Additionally, our findings highlight how secure employment and the ability to provide for one’s family is imperative to these workers, due to the heavy reliance on working class masculinity norms for affirming identity. Thus, we argue the centrality of work for a positive sense of self remains classed and gendered. We also show how the increasingly precarious nature of work is perpetuating feelings of vulnerability and therefore undermining opportunities for class solidarity through collective action in the face of moral injury for working class men.

We have seen in Chapter 9 that we have many avenues to improve medication safety in anesthesia and the perioperative period, with considerable evidence and expert consensus to support them. However, human nature, just as it leads to errors, also often drives resistance to implementing safety interventions. Complicating our efforts to improve safety are safety paradoxes that, although would seem to improve safety, actually may work against safety. Achieving improved patient safety requires a deep understanding of not just how things go wrong when error-prone human beings work within complex systems but also why changes that would have a high probability of reducing the risk of errors are so often resisted. Needed changes can be resisted by individual physicians and by entire leadership of a large healthcare system. We return to the concept of violations, and emphasize that failure to hold violators accountable will effectively undermine safety efforts. Finally, an effort to understand why we do not change is absolutely imperative, as our continued refusal to change to safer methods continues to imperil our patients.