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Understanding Health Inequalities and JusticeBridging Perspectives for New Conversations$
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Mara Buchbinder, Michele Rivkin-Fish, and Rebecca Walker

Print publication date: 2016

Print ISBN-13: 9781469630359

Published to North Carolina Scholarship Online: May 2017

DOI: 10.5149/northcarolina/9781469630359.001.0001

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The Liberal Autonomous Subject and the Question of Health Inequalities

The Liberal Autonomous Subject and the Question of Health Inequalities

(p.112) 4 The Liberal Autonomous Subject and the Question of Health Inequalities
Understanding Health Inequalities and Justice

Eva Feder Kittay

University of North Carolina Press

The bioethical principle of respect for patient autonomy represents an advance over the paternalism that earlier pervaded medical practice. Yet the normative set of assumptions that accompany the autonomy principle has its own difficulties. The notion of autonomy makes assumptions about capability and capacity that are often belied when patients are in need of medical care. Patients who can compensate for their diminished autonomy tend to have more material and social resources at their disposal. The author argues that the assumption that the recipient of health care is an autonomous subject effectively skews the distribution of health resources in favor of those who are most likely to fit that norm and who, when they have diminished capacities, have their autonomy “supported” through periods of medical need. The assumption of patient autonomy thus illuminates one way in which socioeconomic inequalities result in health disparities. Analyzing a study of three heart attack victims belonging to three different socioeconomic classes, the author concludes that a better model of medical care should anticipate the needs of a patient or the patient’s home caregiver, identify what this patient needs to meet her medical needs, and promote ways for patients to make life choices most conducive to health.

Keywords:   Autonomy, Caregiving, Health inequalities, Socioeconomic inequalities

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