The importance of care

作     者：van Schie, T Seedhouse, D 

作者机构：Westmere Physiotherapy Clin Auckland New Zealand Univ Auckland Dept Psychiat & Behav Sci Auckland 1 New Zealand 

出 版 物：《HEALTH CARE ANALYSIS》 (Health Care Anal.)

年 卷 期：1997年第5卷第4期

页      面：283-291页

核心收录：

学科分类：12[管理学] 1204[管理学-公共管理] 120402[管理学-社会医学与卫生事业管理(可授管理学、医学学位)] 0101[哲学-哲学] 1004[医学-公共卫生与预防医学(可授医学、理学学位)] 10[医学] 

主　　题：预算 卫生保健提供/经济学 卫生保健提供/标准 神入 伦理理论 伦理学 伦理学 医学 家庭医学/经济学 家庭医学/组织和管理 卫生保健公平提供/经济学 卫生保健公平提供/标准 卫生服务研究 模型 理论 新西兰 资源分配 社会价值 人类 

摘      要：This paper is in three parts. In Part One we briefly explain that an unsophisticated form of utilitarianism-economic rationalism (ER)-has become dominant in many health systems. Its proponents argue that one of ER s most important effects is to increase consumer choice. However, evidence from New Zealand does not support this claim. Furthermore, the logic of ER requires the construction of systems which tend to restrict individual participation. In Part Two we argue that although some have advocated an ethic of care in an attempt to counteract ER s utilitarianism, two decades of campaigning have had little influence on health policy. ER s pro-care adversaries have failed to make an impact because they have not developed a taxonomy of fare-they have not established a language compatible with, or as powerful as, ER s. In Part Three, in an attempt to raise the conceptual and practical status of caring in contemporary health systems, we distinguish four different forms of care. In opposition to those who believe the ethic of care can adequately direct health care practice, we demonstrate that care is a secondary notion. We show that in order for a carer to decide which form of care to adopt in different situations she requires a more powerful idea. We contend further that health care ought to be governed by a theory of health, and suggest that the foundations theory of health should be adopted by planners searching for a more humane alternative to ER. We conclude that ER s dominance can and must be challenged. However, only those arguments which offer detailed theoretical analyses of health care, as well as meticulously derived practical policies, have any chance of success. (C) 1997 John Wiley & Sons, Ltd.