Person-centred care: navigating ethical tensions and uncertainties
The idea that health professionals should respect patients as persons, including by being mindful of their autonomy, is widely accepted and taken as commonplace. But experiences of healthcare, perhaps particularly for long-term conditions, often indicate shortfalls in this domain. These shortfalls have not been readily alleviated by interventions that exhort and train health professionals to become more ‘person-centred’ by adopting particular processes, for example of shared decision-making or patient-led goal-setting.
In this talk I advocate more serious consideration of the challenges of respecting patients as persons, and of how commitments to person-centred care can come into conflict with ideas about good clinical practice that are deeply embedded in many healthcare systems. I illustrate how a series of empirical research activities and knowledge exchange events with health professionals: prompted our research team to ask questions about the purposes of healthcare for people with long-term conditions; illuminated neglected ethical tensions and uncertainties in health professionals’ efforts to respect and enable patients; informed the development of a normative argument for adopting a broad view of the purpose of healthcare and for recognizing the need to support health professionals to navigate the ethical challenges that will inevitably arise in pursuit of that purpose; and facilitated recognition of important considerations for practical efforts to foster more deeply respectful or person-centred care.
Vikki Entwistle has recently taken up the position of Professor and Director of the Centre for Biomedical Ethics at the National University of Singapore.
Vikki’s research is highly interdisciplinary and collaborative. She draws particularly on social sciences and philosophy, and works with clinicians and patient-advocates as well as academic colleagues to develop practically useful thinking about how healthcare policy and practice can contribute to human flourishing. Vikki is currently particularly interested in the ethical tensions that arise in the pursuit of healthcare that is good in multiple senses at once.
Vikki’s interests in ethics developed in the context of applied health services research. In the mid-1990s while working to develop information to help patients and health professionals consider the effectiveness of different healthcare options, she saw a need for judgements of effectiveness to better reflect patients’ perspectives. She then started to raise and tackle questions about patients’ involvement in both treatment decision-making and research agenda setting. Several of her studies of patients’ perspectives illuminated important shortfalls in the prevailing choice-dominated discourse on patient involvement. A turn to feminist writing on relational theorising about autonomy, and a capabilities approach to thinking about quality of life, facilitated the development of more robust conceptions of notions of ‘shared decision-making’, ‘support for self-management’ and communication about screening (among others).
Together with Professor Alan Cribb (King’s College London), Vikki has recently secured a Wellcome Trust collaborative award to investigate what applied philosophy and ethics can offer to quality improvement work in healthcare.