“[Foucault’s] concept of technologies of self reveals that individuals participate in the policing process by monitoring their own behaviour… The power operating in technologies of self is not based in force but “in the exercise of self upon self by which one tries to work out, to transform one’s self and to attain a certain mode of being.””
Coors, E. Marilyn. “A Foucauldian Foray into the New Genetics.” Journal of Medical Humanities, 24.3/4 (Winter 2003): 221. Print.
This quote supports my position that patients’ so-called ‘autonomy’ is actually a self-absorbed manifestation of institutional healthcare’s agenda of efficiency. We have become perfect patients – obsessing over our own bodies, allowing our very DNA to become ticking time bombs that can turn on us at any minute.
Just a week to go! Here’s today’s version of my thesis:
- Institutional healthcare can be understood as a power regime, overseeing its own priorities of normalization and efficiency.
- These priorities have become unconsciously adopted by patients (suggesting a rather sophisticated power regime).
- Therefore, informed consent is a compromised notion as there is little autonomy or free will of the patient.
- If clinical bioethics practice wishes to help redistribute this power (rather than reinforce institutional healthcare’s power), it must assert itself as an independent practice.
I am confused. Are you saying that if clinical bioethicists want there to be a different power play between the healthcare institution and the patient, the bioethics practice should not be hired and paid by the institution itself? Jennifer, are you saying a bioethics practice may in fact be biased by the fact that the members have mortgages and children to feed? Or influenced by other pressures that do not directly pertain to the matter at hand? But wouldn’t such influences be unethical?
As for Foucault, my French is not so good, and I am only familiar with his History of Sexuality which does not seem to apply to this discussion. Nor does anything I learned from reading Foucault’s Pendulum, but I did have a wonderful conversation with the author of that novel one afternoon in a men’s room …
Single Dad, that’s exactly what I’m saying. I am half expecting to be run out of town.
That sounds fascinating. I’ve met with bioethicists who say the docs in charge of ICUs etc are the ones in power and they feel very ineffectual. Have you heard of any examples where a hospital uses an independent bioethics group?
Hi Louise – no, I haven’t heard of an independent clinical ethics practice the way I am imagining. Bioethicists are accountable to the hospital, which of course sets up a compromise from the very beginning. Many would not perceive their roles to be in conflict but I would argue otherwise. By ‘independent’ I mean, free to speak without fear of reprisal, and to have an overseeing body that can protect and defend its members. Bioethicists are simply employees at the moment, and subject to all the inherent terms and conditions that come with an employment contract. I can imagine a different kind of engagement, where the bioethicist has full autonomy and agency – can speak freely and critically, is accountable to a bioethics body or academy rather than the hospital, delivers opinions and reports ethical wrongdoings. Hey I can dream :)
You should share your ideas with Franco Carnevale at McGill/Montreal Children’s Hospital — ethicist, nurse and psychologist