Defense Date

11-10-2022

Graduation Date

Fall 12-16-2022

Availability

One-year Embargo

Submission Type

dissertation

Degree Name

PhD

Department

Health Care Ethics

School

McAnulty College and Graduate School of Liberal Arts

Committee Chair

Joris Gielen

Committee Member

Gerard Magill

Committee Member

Peter Osuji

Keywords

Ethics, Person-centred Healthcare, Care, Capabilities, Context-specific Judgment, Health Justice

Abstract

Medical ethicists debate whether “one-approach-fits-all” is specifically a problem for disease-oriented paradigms. In developed countries, health systems have adopted limited person-centred care (PCC) paradigms, most of which focus only on patient autonomy. However, these models neither adequately respond to a nexus of relevant aspects, including patients’ vulnerability, needs, and capabilities, nor provide adequate justification that PCC is related to social justice. The central question of this dissertation is: how does a PCC framework that is based on the capabilities approach justify a shift in the current health system toward PCC so that health systems can address health injustices in a multicultural world?

Drawing on recent work that challenges the autonomy-focused models of PCC and work that argues that health systems should reject problem-oriented paradigms, I explore the moral connection between care, capabilities, and context-specific judgements within clinical settings. I argue that, when based on the capabilities approach, PCC demonstrates that the health system ought to transition away from problem-solving or disease-centred approaches in order to minimize person-specific, health injustices. To support this argument, I examine the roles of context, care, and capabilities in the ethics of PCC and analyse cases that involve patients’ and clinical research subjects’ specific vulnerabilities. Then, I develop an original account—the 3C (Care, Capabilities, Context) approach—that provides an explanation of how PCC could reduce the number of health injustices. I adopt Miranda Fricker’s conceptualisation that one’s relational epistemic contribution is a central human capability and Amartya Sen’s notion of realization-focused justice to analyse instances of reproductive injustice. Having identified injustices in the clinical experiences of patients who belong to socially or epistemically marginalized communities, I conclude that epistemic reciprocity requires that the medical team acknowledge patients’ lived experiences to ensure patients’ epistemic contribution and mitigate inequalities within clinical relationships. Focusing on distributive equality of resources only does not respond to epistemic injustice in clinical relationships. A capabilities approach to PCC requires a paradigm shift that would not only consider patient experience holistically but also minimizes health injustices in clinical and clinical research settings.

Language

English

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