Research Scholar, Department of Humanities and Social Sciences, Indian Institute of Technology Madras, Chennai-600036, India.
Soc Sci Med. 2018 Jul;209:136-144. doi: 10.1016/j.socscimed.2018.05.036. Epub 2018 May 19.
This paper illustrates and reflects on subtle micro-level events and practices that sustain and reproduce unequal relationships in healthcare encounters, and draws attention to their moral significance in two hospitals in the south Indian city of Chennai. Based on observational data and in-depth interviews with 16 surgeons, 11 nurses, and 36 patients and their family members between February 2016 and July 2017, it reveals how both victims and perpetrators normalize instances of micro-inequities, often failing to recognize or acknowledge them. The findings illustrate how the prevalence of micro-inequities varies between different medical institutions, and suggest that while subtle in nature, their effect raises concerns regarding dignity and respect for patients and family members. Drawing on existing philosophical analyses of micro-inequities, the study concludes that their production in hospital settings creates an institutional ethos that disdains and marginalizes patients and their family members. Further, it negatively influences the patient/family-doctor relationship and functions as a barrier to reflective patient-centered care.
本文阐述并反思了在医疗保健遭遇中维持和再现不平等关系的微妙微观事件和实践，并关注了它们在印度钦奈市两家医院的道德意义。本研究基于 2016 年 2 月至 2017 年 7 月期间对 16 名外科医生、11 名护士和 36 名患者及其家属进行的观察数据和深入访谈，揭示了受害者和肇事者如何使微不平等现象正常化，往往无法认识或承认这些现象。研究结果表明，微不平等现象的普遍程度在不同医疗机构之间存在差异，并表明，尽管性质微妙，但它们的影响引发了对患者和患者家属尊严和尊重的关注。本研究借鉴了现有关于微不平等现象的哲学分析，得出结论认为，这些现象在医院环境中的产生营造了一种蔑视和边缘化患者及其家属的机构风气。此外，它还对医患关系产生负面影响，并成为反思性以患者为中心的护理的障碍。
