Swiss Excellence Federal Scholar (ESKAS), Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.
Department of Humanities and Social Science, Indian Institute of Technology Madras, Chennai, India.
Health Care Anal. 2020 Sep;28(3):249-265. doi: 10.1007/s10728-020-00395-w.
This article illustrates the less-acknowledged social construction of the concept of 'incompetency' and draws attention to the moral concerns it raises in health care encounters in the south Indian city of Chennai. Based on data drawn from qualitative research, this study suggests that surgeons subjectively construct the idea of incompetency through their understanding of the perceived circumstantial characteristics of the patients and family members they serve. The findings indicate that surgeons often underestimate patients and family members' capacity based on constructed assessments, which leads to paternalistic practice. In this article, I illustrate how these assessments influence the surgeons' practices and provide the moral and practical justifications for their actions. The constructed knowledge becomes a source for drawing normative justification for surgeons' actions and, in conjunction with socially enforced power relationships, results in patients and family members to be on the receiving end of disrespectful attitudes. Based on the data analysis and by drawing on philosophical analysis, I emphasize the need to focus on 'respect for persons,' to rethink the framework of 'capacity,' and to practice respect in hospital settings.
本文阐述了“无能”概念鲜为人知的社会建构，并提请关注在印度南部城市钦奈的医疗保健中所引发的道德问题。本研究基于定性研究的数据，表明外科医生通过对所服务的患者和其家属的感知环境特征的理解，主观地构建无能的概念。研究结果表明，外科医生经常根据构建的评估而低估患者和家属的能力，从而导致家长式作风。在本文中，我举例说明了这些评估如何影响外科医生的实践，并为他们的行为提供了道德和实际的理由。构建的知识成为外科医生行为的规范性理由的来源，再加上社会强制执行的权力关系，导致患者和家属成为不尊重态度的接受者。通过数据分析，并借鉴哲学分析，我强调需要关注“尊重人”，重新思考“能力”框架，并在医院环境中实践尊重。
