Medicalization and its discontents (original) (raw)
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Public Health or Clinical Ethics: Thinking beyond Borders
Ethics & International Affairs, 2002
Most work in medical ethics across the last twenty-five years has centered on the ethics of clinical medicine. Even work on health and justice has, in the main, been concerned with the just distribution of (access to) clinical care for individual patients. By contrast, the ethics of public health has been widely neglected. This neglect is surprising, given that public health interventions are often the most effective (and most cost-effective) means of improving health in rich and poor societies alike.In this essay I explore two sources of contemporary neglect of public health ethics. One source of neglect is that contemporary medical ethics has been preoccupied—in my view damagingly preoccupied—with the autonomy of individual patients. Yet individual autonomy can hardly be a guiding ethical principle for public health measures, since many of them must be uniform and compulsory if they are to be effective. A second source of neglect is that contemporary political philosophy has been ...
Medicalization and social justice
Social Justice Research, 1987
Most social justice critiques of medical care focus upon the allocation of extant, but scarce, resources. In contrast to that focus, this article explores the preallocative arena o f factors which shape the supply and availability of medical care. We identify four such factors: (1) medicalization-the tendency to regard as biologically caused various human problems which were in earlier eras ignored or attributed to other causes; (2) social inclusion-the bringing of economically deprived and socially marginal groups into participation in the medical care system; (3) biomedical transcendence-the elevation of biomedically derived concepts of human function into a social and personal world view; and (4) health absolutism-the ideology which holds individuals accountable for their own health and which, contrary to the thrust of the other factors, deemphasizes access and social equity for professionally provided medical care. While these forces all enhance the place of health as a social value, it is by no means certain that they will lead to a society which is more medically just. The article concludes with an appeal for critical analysis of the processes which shape both the medical care system and the broad social concern with medical care.
Rethinking Medical Ethics: A View From Below
Developing World Bioethics, 2004
In this paper, we argue that lack of access to the fruits of modern medicine and the science that informs it is an important and neglected topic within bioethics and medical ethics. This is especially clear to those working in what are now termed 'resource-poor settings'-to those working, in plain language, among populations living in dire poverty. We draw on our experience with infectious diseases in some of the poorest communities in the world to interrogate the central imperatives of bioethics and medical ethics. AIDS, tuberculosis, and malaria are the three leading infectious killers of adults in the world today. Because each disease is treatable with already available therapies, the lack of access to medical care is widely perceived in heavily disease-burdened areas as constituting an ethical and moral dilemma. In settings in which research on these diseases are conducted but there is little in the way of therapy, there is much talk of first world diagnostics and third world therapeutics. Here we call for the 'resocialising' of ethics. To resocialise medical ethics will involve using the socialising disciplines to contextualise fully ethical dilemmas in settings of poverty and, a related gambit, the systematic participation of the destitute sick. Clinical research across steep gradients also needs to be linked with the interventions that are demanded by the poor and otherwise marginalised. We conclude that medical ethics must grapple more persistently with the growing problem posed by the yawning 'outcome gap' between rich and poor. I INTRODUCTION Bioethics and medical ethics are necessarily a contentious enterprise. These fields have the potential to embrace not only empiric research, but also philosophical commentary, informed opinion,
Societies
This article seeks to capture variations and tensions in the relationships between the health–illness–medicine complex and society. It presents several theoretical reconstructions, established theses and arguments are reassessed and criticized, known perspectives are realigned according to a new theorizing narrative, and some new notions are proposed. In the first part, we argue that relations between the medical complex and society are neither formal–abstract nor historically necessary. In the second part, we take the concept of medicalization and the development of medicalization critique as an important example of the difficult coalescence between health and society, but also as an alternative to guide the treatment of these relationships. Returning to the medicalization studies, we suggest a new synthesis, reconceptualizing it as a set of modalities, including medical imperialism. In the third part, we endorse replacing a profession-based approach to medicalization with a knowle...
The political abuse of medicine and the challenge of opposing it
Social Science & Medicine, 1987
A fundamental aim of medicine is to protect and promote health. The practice of medicine has, however, been used to promote political aims which may be detrimental to health. The article attempts to isolate the ways in which political abuses may interfere with good medical practice: by allowing health policies to be influenced by undemocratic political considerations; by using health services to reward or punish political supporters or opponents; by direct medical involvement in political acts which contradict accepted medical ethics; and by the support which conventional medical practises give to perpetuating inequalities in health and social services. Each of these is examined with the use of a number of examples. The ways in which medical personnel have opposed the political abuse of medicine is explored by a brief review of the opposition of Chilean doctors to torture, the involvement of South African doctors in opposing the abuse of health services in perpetuating apartheid, and the growing medical movement in opposition to nuclear war. Some comments concerning the monitoring of a multitude of medical disciplines which are open to political abuse are made. The purpose of the paper is primarily to stimulate debate around this important issue and it does not attempt to provide a comprehensive review of the political abuse of medicine.
The Political Economy of Health and Medicine
Monthly Review, 1988
Crisis, Health and Medicine is a collection of Vicente Navarro's essays developing the thesis that the crisis of medicine is inseparable from the recurring crisis of capitalism. Crisis in medicine has been described as the continued rapid escalation of costs in the face oflittle or no improvement in health for the nation or the world. In the United States nearly 11 percent of the gross national product is devoted to medical care and yet much of the care available is inappropriatedependent on high technology, hospital-based, and fragmented by specialization. Fully one quarter of the U.S. population is uninsured or underinsured. And despite evidence that the health of any nation is historically more dependent on social factors-primarily the standard of living associated with class-than on specialized medical intervention, the concentration of capital into high-cost and "hightech" medical care continues. Do policy makers and professionals allocate resources in this manner because they cannot read the evidence, or haven't been apprised of the public health studies? Does some conspiratorial plan exist in which those who profit from medicine conspire to keep the population sick or keep them demanding more expensive medical care, or to exclude various groups from care? Navarro argues that this is not the case. As he puts it, "the bourgeoisie does not lie ... nor does Roberta Lessor teaches sociology at Chapman College and social and behavioral medicine in the Primary Care Program at the University of California, Irvine. Howard Waitzkin teaches internal medicine and social sciences at U.C. Irvine.
Social Science & Medicine, 1998
ÐThis paper addresses issues of public health and access to care for the urban poor in the context of current U.S. urban, economic and industrial policy. The pathologies that threaten``inner city'' neighborhoods are the result of decades of political neglect, economic exploitation and resource withdrawal, which themselves stem directly from public and corporate sector strategies to facilitate capital accumulation and consolidation. The resulting conditions of uneven development between wealthy and impoverished local sectors mirror similar relationships between First and Third World countries. These same patterns are re¯ected and reproduced in the health care``industry'' itself, where growing corporate dominance has developed alongside a concomitant reduction in support for public sector and community-based care. These trends create and exacerbate conditions that place poor and minority populations at risk. Community development and political empowerment, as well as the overall corporate hegemony that increasingly characterizes the political economy of the U.S.A., are essential public health considerations that must be included in any meaningful health policy or health care reform proposals.