The Logic of Care
Health and the Problem of Patient Choice
New York: Routledge 2008
Summary written by – Laurie Denyer Willis –
Mol, in the early pages of this book, recounts a panel discussion she is invited to chair on patient choice and autonomy. The discussants – ethicists and psychiatrists – are presented with the case of a patient on a psychiatric ward who does not want to get out of bed. The panellists are asked, “are you going to allow him to stay in bed or not?” Different panellists give different answers, reflecting on whether a choice might harm, whether a patient is ‘capable’ of making their own choices, and whether individual choice might hinder the value of communal living in psychiatric care. One doctor, however, gives an altogether different answer, pointing away from questions of autonomy and choice, and instead towards the need for patient care, saying:
“On a ward with enough staff, I’d send a nurse to sit next to the patient’s bed and ask him why he does not want to get up. Maybe his wife is not coming for a visit that afternoon. Maybe he feels awful and fears he will never be released from hospital. Take time for him, let him talk. Someone who does not want to get up…needs care”
Mol argues that the dominant logic currently surrounding disease and patient treatment is that of a ‘Logic of Choice’, and that this undermines what she terms a ‘Logic of Care’. For Mol, worrying solely about ‘patient choice’ is often a form of neglect. A fascination with ‘choice’ often occurs at the expense of care. ‘Individual choice’ is an idealized part of Western medical systems, but what does an attention to ‘choice’ obstruct? For Mol, ‘patient choice’ is often at odds with ‘good care’.
The idea of championing ‘patient choice’ in modern health care services is meant to disrupt top-down approaches to health care that tend to silence patients and make them subservient and passive recipients. What Mol demonstrates is that ‘choice’ has not corrected this hierarchal relationship, but has instead complicated health care systems ability to work alongside patients to manage the complexities and intricacies of their disease. Based on long-term ethnographic research with people suffering from diabetes, and fused with real clinical examples, Mol carefully details the ways that a logic of choice has upended health systems, while arguing for a relational logic of care that is oriented to the everyday lives of those living with disease.View Publication >
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