Communicative action and practical discourse to empower patients in healthcare-related decision making
DOI:
https://doi.org/10.18778/0208-6107.38.04Schlagworte:
public healthcare, communicative action, discourse, Jürgen Habermas, shared decision making, relations between patients and healthcare providersAbstract
The aim of the paper is to reconsider Habermas’ discourse approach in terms of its usefulness in the realm of public healthcare where, on a microscale, intersubjective communicative situations arise between defined participants, i.e., patients and healthcare providers, patients’ family members, and further eligible contributors to patient-related decision making. A need for more “communicative interaction,” and explicative and practical discourse, is illustrated by two empirical examples of medical decision making which reveal both communicative and discursive deficits (Section I). To empower and enable the patient as a rational and autonomous speaker and discourse participant, a Habermasian emancipatory argument and ‘the power of the better argument’ is recalled (Section III). The possibility of equal communicative and discursive rights in the light of real inequalities is discussed in the context of a ‘competence gap’ between participants (Section IV). Further sections focus on the importance of informed consent on the side of the patient and the communicative competences as an important factor of healthcare system.
Literaturhinweise
Alexy, R. (1978). Theorie der juristischen Argumentation. Frankfurt am Main: Suhrkamp.
Google Scholar
Carel, H. (2011). Phenomenology and Its Application in Medicine. Theoretical Medical Bioethics, 32 (1), pp. 33–46.
Google Scholar
DOI: https://doi.org/10.1007/s11017-010-9161-x
Celikates, R. (2018). Critique as Social Practice. Lanham: Rowman & Littlefield Int.
Google Scholar
Elwyn G., Frosch D. L., and Kobrin S. (2016). Implementing Shared Decision-Making: Consider all the Consequences. Implementation Science, 11, pp. 1–12.
Google Scholar
DOI: https://doi.org/10.1186/s13012-016-0480-9
Emanuel, J. E. and Emanuel, L. L. (2004). Vier Modelle der Arzt-Patient Beziehung. In Wiesing U. (ed.), Ethik in der Medizin. Stuttgart: Reclam.
Google Scholar
Engelhardt, H. T., Jr. (1986). The Foundations of Bioethics. Oxford: Oxford University Press.
Google Scholar
Fiester, A. (2015). Neglected Ends: Clinical Ethics Consultation and the Prospects for Closure. The American Journal of Bioethics, 15 (1), pp. 29–36.
Google Scholar
DOI: https://doi.org/10.1080/15265161.2014.974770
Gillespie, A. et al. (2013). Beyond Ideal Speech Situations: Adapting to Communication Asymmetries in Health Care. Journal of Health Psychology 19 (1), pp. 72–78.
Google Scholar
DOI: https://doi.org/10.1177/1359105313500251
Granero-Molina, J. et al. (2015). Habermasian Knowledge Interests: Epistemological Implications for Health Sciences. Nursing philosophy. An International Journal for Healthcare Professionals, 16 (2), pp. 77–86.
Google Scholar
DOI: https://doi.org/10.1111/nup.12080
Greenhalgh, T., Robb N., and Scambler G. (2006). Communicative and Strategic Action in Interpreted Consultations in Primary Health Care: A Habermasian Perspective. Social Science & Medicine, 63, pp. 1170–1187.
Google Scholar
DOI: https://doi.org/10.1016/j.socscimed.2006.03.033
Habermas, J. (1970). Towards a Theory of Communicative Competence. Inquiry, 13, pp. 360–375.
Google Scholar
DOI: https://doi.org/10.1080/00201747008601597
Habermas, J. (1971). Vorbereitende Bemerkungen zu einer Theorie der kommunikativen Kompetenz. In Habermas J. and Luhmann N., Theorie der Gesellschaft oder Sozialtechnologie. Frankfurt am Main: Suhrkamp, pp. 101–114.
Google Scholar
Habermas, J. (1979). Moral Development and Ego Identity. In Habermas J., Communication and the Evolution of Society. Translated by T, McCarthy. Toronto: Beacon Press, 1979, pp. 69–94.
Google Scholar
Habermas, J. (197b). What is Universal Pragmatics. In Habermas J., Communication and the Evolution of Society. Translated by T. McCarthy. Toronto: Beacon Press, pp. 1–68.
Google Scholar
Habermas, J. (1983). Moralbewußtsein und kommunikatives Handeln. Frankfurt am Main: Suhrkamp.
Google Scholar
Habermas, J. (1984). Theory of Communicative Action. Volume 1: Reason and the Rationalization of Society. Translated by T. McCarthy. Boston: Beacon Press.
Google Scholar
Habermas, J. (1987). Theory of Communicative Action. Volume 2: Lifeworld and System: A Critique of Functionalist Reason. Translated by T. McCarthy. Boston: Beacon Press.
Google Scholar
Habermas, J. (1998). The Inclusion of the Other. Edited and translated by C. Cronin and P. de Greiff. Boston, MA: MIT Press.
Google Scholar
Habermas, J. (1990). Moral Consciousness and Communicative Action. Translated by Ch. Lenhardt. Cambridge: Polity Press.
Google Scholar
Habermas, J. (2003). Truth and Justification. Translated by B. Fultner. Cambridge, Mass.: The MIT Press.
Google Scholar
Habermas, J. (2009). Between Naturalism and Religion: Philosophical Essays. Translated by C. Cronin. Cambridge: Polity Press.
Google Scholar
Hvidt, E A. et al. (2021). A Colonized General Practice? A Critical Habermasian Analysis of How General Practitioners Experience Defensive Medicine in Their Everyday Working. Health, 25 (2), pp. 141–158.
Google Scholar
DOI: https://doi.org/10.1177/1363459319857461
Jones, I. R. (2001). Health Care Decision Making and the Politics of Health. In Scambler G. (ed.), Habermas, Critical Theory and Health. London: Routledge, pp. 68–85.
Google Scholar
Klieme, E. et al. (2007). Zur Entwicklung nationaler Bildungsstandards. Eine Expertise. Available at http://edudoc.ch/record/33468/files/develop_standards_nat_form_d.pdf [Accessed: 29 July 2021].
Google Scholar
Kodeks Etyki Lekarskiej (2003). Available at https://nil.org.pl/dokumenty/kodeks-etyki-lekarskiej [Accessed: 29 July 2021].
Google Scholar
Langford A. T, et al. (2019). Partnerships to Improve Shared Decision Making for Patients with Hypertension – Health Equity Implications. Ethnicity & Disease, 29 (Suppl 1), pp. 97–102.
Google Scholar
DOI: https://doi.org/10.18865/ed.29.S1.97
Leanza, Y., Boive, I., and Rosenberg, E. (2013). The Patient’s Lifeworld: Building Meaningful Clinical Encounters between Patients, Physicians and Interpreters. Comm Med., 10 (1), pp. 13–25.
Google Scholar
DOI: https://doi.org/10.1558/cam.v10i1.13
Lee P. R. and Emmott C. (1978). Health-care System. In Reich W. T. (ed.), Encyclopedia of Bioethics. Vol. 2. London: Collier Macmillan Publishers, pp. 610–619.
Google Scholar
Napiwodzka K. (2021). The Shared Decision-Making Model and Practical Discourse to Foster the Appreciation of Patients’ Value Preferences in Polish Healthcare. In Schildmann, J., Buch, Ch, & Zerth, J. (eds.), Defining the Value of Medical Interventions. Normative and Empirical Challenges. Stuttgart: Verlag W. Kohlhammer, pp. 135–157.
Google Scholar
Newton-Howes G., Pickering N., and Young G. (2019). Authentic Decision-making Capacity in Hard Medical Cases. Clinical Ethics, 14 (4), pp. 173–177.
Google Scholar
DOI: https://doi.org/10.1177/1477750919876248
Program akredytacji podstawowej opieki zdrowotnej. Zestaw standardów akredytacyjnych (2011). Available at https://www.cmj.org.pl/dodatki.php?plik=5601b8718fcf959dd96d9e22921c809b [Accessed: 29 July 2021].
Google Scholar
Rodrian-Pfennig, M. (2014). Karriere und Kontext des Kompetenzbegriffs. Ein skeptischer Rekurs aus der Sicht der Hochschullehre. In Rodrian-Pfennig, M. et al. (eds.), Reflexive Lehrforschung an der Hochschule. Opladen, Berlin, Toronto: Budrich UniPress.
Google Scholar
DOI: https://doi.org/10.2307/j.ctvdf07kn
Rothman, D. J. (1991). Strangers at the Bedside: History of How Law and Bioethics Transformed Medical Decision Making. New York: Basic Books.
Google Scholar
Scambler, G. (ed.) (2001). Habermas, Critical Theory and Health. London: Routledge.
Google Scholar
Stefaniak, K. (2011). Władza i tożsamość w komunikacji lekarz-pacjent. Wrocław: ATUT.
Google Scholar
Svenaeus, F. (2003). Hermeneutics of Medicine in the Wake of Gadamer: The Issue of Phronesis. Theoretical Medicine and Bioetehics, 24 (5), pp. 407–431.
Google Scholar
DOI: https://doi.org/10.1023/B:META.0000006935.10835.b2
Swales, J. M. (2016). Reflection on the Concept of Discourse Community. ASp le Revue du GERAS^, 69, pp. 1–12.
Google Scholar
DOI: https://doi.org/10.4000/asp.4774
Szahaj, A. (ed.) (1990). Krytyka, emancypacja, dialog. Jürgen Habermas w poszukiwaniu nowego paradygmatu teorii krytycznej. Warszawa: Universitas.
Google Scholar
Walker, P. and Lovat T. (2016). Dialogic Consensus in Clinical Decision Making. Journal of Bioethical Inquiry, 13 (40), pp. 571–580.
Google Scholar
DOI: https://doi.org/10.1007/s11673-016-9743-z
Walseth, L. T., Abildsnes, E., and Schei, E. (2011). Lifestyle, Health and the Ethics of Good Living. Health Behaviour Counselling in General Practice. Patient Education and Counseling 83, pp. 180–184.
Google Scholar
DOI: https://doi.org/10.1016/j.pec.2010.05.022
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