Creating an impersonal <scp>NHS</scp>? Personalization, choice and the erosion of intimacy

Owens, John

doi:10.1111/hex.12000

Cited by 12 publications

(9 citation statements)

References 14 publications

(12 reference statements)

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“…People are increasingly expecting, and being expected, to be able to contribute positively to, and accept personal responsibility for, their own health and well-being (Waller 2005). Respect and support for personal autonomy has become a key plank of contemporary health promotion discourse and strategy and has been facilitated by a combination of measures based on enhancing public education, motivation, supporting choice and encouraging patients and the wider public to actively 'coproduce' good health outcomes for themselves (Owens 2012;Owens and Cribb 2013). Wearable technologies fit squarely within these trends as a means of informing and enabling individuals' choices and facilitating forms of direct participation in caring for their own health.…”

Section: Wearable Technologies and Enhanced Autonomy Over Healthmentioning

confidence: 99%

‘My Fitbit Thinks I Can Do Better!’ Do Health Promoting Wearable Technologies Support Personal Autonomy?

Owens

Cribb

2017

Philos. Technol.

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This paper critically examines the extent to which health promoting wearable technologies can provide people with greater autonomy over their health. These devices are frequently presented as a means of expanding the possibilities people have for making healthier decisions and living healthier lives. We accept that by collecting, monitoring, analysing and displaying biomedical data, and by helping to underpin motivation, wearable technologies can support autonomy over health. However, we argue that their contribution in this regard is limited and that-even with respect to their 'autonomy enhancing' potential-these devices may deliver costs as well as benefits. We proceed by rehearsing the distinction that can be drawn between procedural autonomy (which refers to processes of psychological deliberation) and substantiverelational autonomy (which refers to the opportunities people have for exercising potential actions). While the information provided by wearable technologies may support deliberation and decision-making, in isolation these technologies do little to provide substantive opportunities to act and achieve better health. As a consequence, wearable technologies risk generating burdens of anxiety and stigma for their users and reproducing existing health inequalities. We then reexamine the extent to which wearable technologies actually support autonomous deliberation. We argue that wearable technologies that subject their users to biomedical and consumerist epistemologies, norms and values also risk undermining processes of genuinely autonomous deliberation.

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Section: Wearable Technologies and Enhanced Autonomy Over Healthmentioning

confidence: 99%

‘My Fitbit Thinks I Can Do Better!’ Do Health Promoting Wearable Technologies Support Personal Autonomy?

Owens

Cribb

2017

Philos. Technol.

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“…When everything becomes calculable, what cannot be calculated or is difficult to calculate gets 'crowded out' (Sandel 2012). Similar concerns have been raised with regard to marketisation in healthcare, where the process has been exposed to result in erosion of intimacy and trust in the relationship between doctors and patients (Owens 2012).…”

Section: Resultsmentioning

confidence: 86%

Neoliberalism, postsocialism, disability

Mladenov

2015

Disability & Society

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This paper discusses the impact of neoliberalism on disability policy and activism. The paper highlights the neoliberalisation of postsocialist disability policy, as well as the convergence between the neoliberal critique of welfare-state paternalism and the advocacy of disabled people's movement for deinstitutionalisation and direct payments (personal assistance). The discussion is supported by examples from Bulgaria and the United Kingdom. In conclusion, the paper argues that neoliberalism confronts the disabled people's movement with two difficult tasks: to defend self-determination while criticising market-based individualism, and to defend the welfare state while criticising expert-based paternalism.

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“…In turn this is changing the nature of the relationship between healthcare professionals and patients (Mol, 2008); patients are expected to take more responsibility for their health and now even their deaths, choosing from a variety of services and treatment options. A focus on personal choice risks reducing the personal, and dignified, nature of care by eroding the intimacy of the care relationship (Owens, 2015), which is supposed to be at the heart of end-of-life care policy. Moreover, the routinized ways in which advance care planning is done risks undermining its core values by focusing on documentation rather than the person, as has happened in hospice care previously (James and Field, 1992).…”

Section: Discussionmentioning

confidence: 99%

Planning for an (un)certain future: Choice within English end-of-life care

Borgstrom

2015

Current Sociology

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Neoliberal policies are shaping the healthcare landscape by emphasising individual choice. End-of-life care is a case in point as patient choice, through advance care planning, is a key conceptual framework for motivating service development and provision. Based on qualitative ethnographic research in England, this paper describes what choice is and how it is enacted in the context of end-of-life care. Within policy, choice represents individual autonomy and is a goal to strive towards. In order to enable choice, healthcare professionals are to openly discuss dying with patients and in turn, patients are expected to express their preferences. However, by focusing on two case studies, the paper demonstrates how people struggle to articulate choice in these ways and the preferences expressed represent the complex contexts in which care is performed. Although death is certain, the possibility of control alluded to by choice rhetoric is not realised in practice.

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Creating an impersonal NHS? Personalization, choice and the erosion of intimacy

Abstract: Background Personalization -most often understood in terms of granting patients greater opportunity to participate in, and make choices about, the services they receive -has become a key principle guiding reform of the English NHS.

Cited by 12 publications

References 14 publications

‘My Fitbit Thinks I Can Do Better!’ Do Health Promoting Wearable Technologies Support Personal Autonomy?

‘My Fitbit Thinks I Can Do Better!’ Do Health Promoting Wearable Technologies Support Personal Autonomy?

Neoliberalism, postsocialism, disability

Planning for an (un)certain future: Choice within English end-of-life care

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