An ethical critique of person-centred healthcare

Abstract

This paper explores the counterfactual aspects of Person-Centred Healthcare (PCH). PCH as promoted appears to have self-evident value as an expression of humanism in medical care, but this can be deceptive. Despite its rhetorical appeal, there is limited evidence that it improves either the experience or outcomes of healthcare. More problematically, it is commonly overlooked that the philosophical assumptions upon which PCH rests carry with them other, more malign ideologies and healthcare movements such as preference-driven healthcare, extreme libertarianism and consumerism. This – as distinct from promoting humanism - has the effect of creating perverse clinical incentives that are driven by patient preferences, while simultaneously constraining these same patients’ autonomy within an economically rationalised neoliberal system of healthcare. It also works against consideration of social interests and the values privileged by communities. None of this is an argument against promoting humanism in medicine and taking seriously patients’ lived experiences; rather it is a call for a more critical approach to the bioethics of PCH - one aware of the economics and politics of healthcare.