ESPMH Conference Zagreb
This week, I'm having a special seminar on Autonomy, heteronomy and inequality at the Annual ESPMH Conference, this time in Zagreb.
Abstract of the seminar:
For years now,
research on inequalities in health demonstrates the importance of social
determinants in health outcomes. Contrary to that, public debates on health
offer us a picture as if the only problem left in healthcare is how to empower
individual patients so they would be able to make the right and autonomous choices
and lead a healthy lifestyle. Next to that, in many countries the pursuit of a
healthy lifestyle has or is expected to become a criterion in the allocation of
healthcare services.
One of the crucial
questions is what could be the consequences of this evolution for health care
policy for individuals and for society in general? If we consider individuals
as autonomous and regard the way they live as largely a matter of their own
free choice, would it then not be “logical” to hold patients personally
responsible for making (un)healthy life style choices, when they try to obtain
insurance or enter healthcare facilities? And if the individuals are unwilling
to change their risky behavior, could they then also be denied health care
services?
As the idea of patient
empowerment runs the risk of reducing health problems to the responsibility of
the autonomous individual, we want to take into care a broader perspective. The
myth of the independent autonomous individual taking rational decisions about
his health and lifestyle, is indeed a myth. All of us are related to an outer
world, to family and networks of friends, etc. We will call that heteronomy:
the dependency of an individual to circumstances (determinants, social context)
transcending its own choices. Heteronomy differs from paternalism. Judging from
outside on what is the best in our interest, is exactly what the paternalist
does: exercising over an individual’s choice for a particular way of living, or
punishing the individual for not having the right lifestyle or for not having
made the right choices.
Starting from the
importance of social determinants, of course, the goal of healthcare should be
to decrease heteronomy in people’s lives by offering them the chances to be
able to live their life according to the choices they personally have made. The
more we can increase autonomy, the better off we will be and the better for our
health. At the same time, we should be fully aware that this goal will never be
realized. The current ideal of the autonomous, self-monitoring patient, does
not account for most people and the reality is way more complex than
individuals making rational choices.
Consequently, more and
more patient autonomy is understood as a thick concept or as ‘relational
autonomy’ leaving the idea of fully independent beings behind. People can be
empowered to make the choices they prefer, but we should also reflect upon the
conditions how heteronomy hinders them from making the choices they want to or
healthcare expects them to do. This reflection should prevent us from stepping
back into paternalistic scenario’s, knowing what’s in the best interest for the
people and punishing them if they do not make the ‘right’ choices. Although
patient autonomy should always be our goal, the agency of autonomy never stands
on its own.
Method
In this special
seminar, we present papers on ongoing research in phenomenology, on
participation in screening programs, on health in equality and how these might
put patient autonomy under pressure. Next
to the papers, we will have a roundtable debate on autonomy and health
inequality.
Comments
Post a Comment