Governing the ethical consumer: identity, choice and the primary care medical encounter

Abstract

Government policy promoting consumerism in healthcare can be seen as offering up certain preferred identities to which its citizens are encouraged to aspire. Whilst many commentators reject the notion that health services users should be conceived of as consumers, this paper outlines the relevance of the concept to our understanding of the ways in which individuals manage their health and service use. The paper examines the identity work undertaken by individuals in relation to decisions about healthcare preferences and assesses the extent to which this is compatible with the identities promoted in Government policy. We suggest that in circumstances where individuals feel both a sense of personal entitlement and a desire to be supportive of the needs of other members of the community, 'doing' ethical consumer can be fraught with discomfort and anxiety. These anxieties are exacerbated in a context where citizenship is increasingly being defined in terms of consumer identities, and making good (health) choices might be seen as distinguishing the civilised from the marginalised.

Treatment Decision Making and Its Discontents

“…Rather, it functions normatively, assigning value to autonomous decisions centered in medical evidence: the patient felt sure that her decision making, rooted as it was in her caregiving role, was "not the right way to go." The moral dimensions of individuals' actions (and inaction) in relation to health and health care has been much discussed, and will not be pursued here (but see McDonald et al, 2007;Wilson, 2001;Ziebland, 2004). However, it is worth noting that the normative quality of the treatment decision-making model may render many people's processes of coming to be on treatment as "not the right way to go.…”

When choice becomes limited: Women’s experiences of delay in labour

“…They were prepared to put their trust in them with the expectation that whatever they did would be in the best interests of both them and their babies. Indeed, while discourses of choice may be argued to offer up preferred identities to patients (McDonald et al, 2007; Mol, 2008), in this context at least the discourse around motherhood was also a powerful force – a ‘good mother’ relies on the doctor’s expertise to keep her baby safe from harm (Miller and Shriver, 2012) rather than pursuing her preference for a vaginal birth when the doctor tells her that her baby is showing signs of distress and a caesarean section is needed.…”

“…Policies emphasising choice tend to position patients in particular ways and in relation to other actors, most obviously professionals (Greener, 2009). In doing so, they can serve to offer up preferred identities for patients (McDonald et al, 2007), with choice often being argued to be based on a rational consumer model that may not always be well-suited to the healthcare context. As a result, many have argued that (at least some) choice models seem to ask rather a lot of patients, and it is not always clear that they want to take on this work (Clarke et al, 2006; Fotaki et al, 2005; Greener, 2009).…”

The drugs don't sell: DIY heart health and the over-the-counter statin experience

“…Aware that health may have limited salience in everyday life (Calnan and Williams, 1991), particularly in an area as prosaic as cholesterol management, we did not expect respondents consciously to adopt strong and coherent positions or identities in relation to health consumption. Yet in carrying out our analysis we were attuned to different moments during the interviews that were suggestive of implicit identity work (McDonald, Mead, Cheraghi-Sohi et al 2007).…”