Patients' participation in decision-making in the medical field:'projectification' of patients in a neoliberal framed healthcare system

摘要

This article focuses on patients’ participation in decision-making in meetings with healthcare professionals in a healthcare system which appeared to be governed in a neoliberal manner. Drawing on two constructed empirical cases, this article analyses and discusses the clinical practice around decision-making meetings and the consequences for the healthcare professionals and the patients within a Foucauldian perspective. Patients’ participation in decision-making can be seen as an offshoot of respect for patient autonomy which means that every patient is free to decide for themselves what is going to happen in his life. Both professionals and patients have an underlying, tacit preconception that every medical treatment is better than no treatment. Patients do not always want to be a ‘customer’ in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to the some parts of the decision-making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal frame and medical logic. The decision-making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient. A ’projectification’ of the patient occurs, whereby the patient becomes responsible for his choices in treatment and care and the professionals support him with knowledge, preferences, and alternative views, out of which he must make his own choices, and the responsibility for those choices now and in the future. At the same time there is a tendency towards de-professionalisation. In that light, participation of patients in decision-making can be regarded as tacit governmentality strategies that shape the location of responsibility between individual and society, and independent patients and healthcare professionals, despite the basically desirable, appropriate and necessary idea of involving patients in their own situations from a humanistic perspective.