Medicalization and social justice (original) (raw)
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Medicalization and its discontents
Social Science & Medicine, 1987
This paper raises the question of the ethically proper balance in health care policy between the medical-clinical-high technology model of health service and the grass-roots, community based or traditional models of care. Paradoxical imblances between the two approaches are traced to political, economic or prestige factors. Case studies examined include the hospitalization of non-contagious leprosy patients while protecting the anonymity of AIDS-infected prostitutes, medical resistance to the adoption of a clinical role by Community Cancer Centers, and the continued preference in some quarters for elaborate (and often delayed) hospital treatment for such problems as infant diarrhea, despite the availability of much simpler solutions, as in the case of the widely successful oral rehydration therapy.
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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...
Social medicalization (II): Biomedical limits and p roposals for primary care clinic
Social medicalization diminishes or even destroys the population's autonomy regarding disease and healthcare and generates an endless demand on health services. It consists on an important challenge the SUS (Unified Health System). This article discusses the limits of biomedical knowledge and practices in relation to their contribution to the promotion of users' autonomy and proposes some guidelines for handling these limits. It comes to the conclusion that intervention technologies, biomedical knowledge and its cognitive procedures contribute very little to patients' autonomy. The article suggests a shift of the biomedical knowledge's meanings, focused on the healing function of health professionals. This shift should be regarded as a mission to rebuild autonomy, prevent and heal the lived sicknesses, beside the ones that are diagnosed. It defends a reorganization of primary care biomedical clinic's values and goals, such as the diagnosis' relativity, the end of disease and risk ontology, the end of the control obsession, the fight against biomedical dogmatism, and giving priority to therapeutics.
The Political Ethics of Health
Les ateliers de l'éthique, 2010
This paper seeks to provide an overview of some of the main areas of debate that have emerged in recent years at the interface between theories of justice and health care. First, the paper considers various positions as to what the index of justice with respect to health ought to be. It warns on practical and principled grounds against conceptual inflation of the notion of "health" as it appears in theories of distributive justice. Second, it considers how various standards according to which goods ought to be distributed in a just society apply to debates within health care.
Just Health (Care): Social Justice, Health and the Common Good
Zeitschrift für Wirtschafts- und Unternehmensethik 13.1 (2012): 31-49.
The answer to the question of how to deal with the widening gap between the growing costs of health (care) and necessarily limited health (care) resources in a just fashion, heavily depends on what we take the term ‘just’, to signify. This article is meant to offer a perspective on the topic of just health (care) which takes the idea of justice as virtue seriously by embedding it in the context of its original explication, namely an onto-teleological philosophy which takes (social) justice to be about claim-rights (as well as their corresponding duties) and the common good. This article is, however, not meant to provide ready-made answers or a discussion of the arguments featuring in the contemporary debate about health (care) prioritisation and/or rationing. It rather takes up the cudgels on behalf of the concept of the common good and reminds us of the fact that if we want to talk about (social) justice and just health (care) we cannot do so without also talking about the common good.
The Limits of Social Justice as an Aspect of Medical Professionalism
Journal of Medicine and Philosophy, 2013
Contemporary accounts of medical ethics and professionalism emphasize the importance of social justice as an ideal for physicians. This ideal is often specified as a commitment to attaining the universal availability of some level of health care, if not of other elements of a "decent minimum" standard of living. I observe that physicians, in general, have not accepted the importance of social justice for professional ethics, and I further argue that social justice does not belong among professional norms. Social justice is a norm of civic rather than professional life; professional groups may demand that their members conform to the requirements of citizenship but ought not to require civic virtues such as social justice. Nor should any such requirements foreclose reasonable disagreement as to the content of civic norms, as requiring adherence to common specifications of social justice would do. Demands for any given form of social justice among physicians are unlikely to bear fruit as medical education is powerless to produce this virtue.
Medicalization and epistemic injustice
Medicine, Healthcare, and Philosophy, 2014
Many critics of medicalization (the process by which phenomena become candidates for medical definition, explanation and treatment) express concern that the process privileges individualised, biologically-grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice – a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect the ways in which medicalization may not obscure, but rather illuminate, individuals’ experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers.
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