Logic Of Care Health And The Problem Of Patient Choice

**Shortlisted for the BSA Sociology of Health and Illness Book Prize 2010** What is good care? In this innovative and compelling book, Annemarie Mol argues that good care has little to do with 'patient choice' and, therefore, creating more opportunities for patient choice will not improve health care. Although it is possible to treat people who seek professional help as customers or citizens, Mol argues that this undermines ways of thinking and acting crucial to health care. Illustrating the discussion with examples from diabetes clinics and diabetes self care, the book presents the 'logic of care' in a step by step contrast with the 'logic of choice'. She concludes that good care is not a matter of making well argued individual choices but is something that grows out of collaborative and continuing attempts to attune knowledge and technologies to diseased bodies and complex lives. Mol does not criticise the practices she encountered in her field work as messy or ad hoc, but makes explicit what it is that motivates them: an intriguing combination of adaptability and perseverance. The Logic of Care: Health and the problem of patient choice is crucial reading for all those interested in the theory and practice of care, including sociologists, anthropologists and health care professionals. It will also speak to policymakers and become a valuable source of inspiration for patient activists.

A sweeping history explores why people living in resource-poor areas lack access to basic health care after billions of dollars have been invested in international-health assistance. Over the past century, hundreds of billions of dollars have been invested in programs aimed at improving health on a global scale. Given the enormous scale and complexity of these lifesaving operations, why do millions of people in low-income countries continue to live without access to basic health services, sanitation, or clean water? And why are deadly diseases like Ebola able to spread so quickly among populations? In A History of Global Health, Randall M. Packard argues that global-health initiatives have saved millions of lives but have had limited impact on the overall health of people living in underdeveloped areas, where health-care workers are poorly paid, infrastructure and basic supplies such as disposable gloves, syringes, and bandages are lacking, and little effort has been made to address the underlying social and economic determinants of ill health. Global-health campaigns have relied on the application of biomedical technologies—vaccines, insecticide-treated nets, vitamin A capsules—to attack specific health problems but have failed to invest in building lasting infrastructure for managing the ongoing health problems of local populations. Designed to be read and taught, the book offers a critical historical view, providing historians, policy makers, researchers, program managers, and students with an essential new perspective on the formation and implementation of global-health policies and practices.

Western medicine is widely thought of as a coherent and unified field in which beliefs, definitions, and judgments are shared. This book debunks this myth with an interdisciplinary and intercultural collection of essays that reveals the significantly varied ways practitioners of "conventional" Western medicine handle bodies, study test results, configure statistics, and converse with patients.

The philosophy of medicine has become a vibrant and complex intellectual landscape, and Care and Cure is the first extended attempt to map it. In pursuing the interdependent aims of caring and curing, medicine relies on concepts, theories, inferences, and policies that are often complicated and controversial. Bringing much-needed clarity to the interplay of these diverse problems, Jacob Stegenga describes the core philosophical controversies underlying medicine in this unrivaled introduction to the field. The fourteen chapters in Care and Cure present and discuss conceptual, metaphysical, epistemological, and political questions that arise in medicine, buttressed with lively illustrative examples ranging from debates over the true nature of disease to the effectiveness of medical interventions and homeopathy. Poised to be the standard sourcebook for anyone seeking a comprehensive overview of the canonical concepts, current state, and cutting edge of this vital field, this concise introduction will be an indispensable resource for students and scholars of medicine and philosophy.

Rhetorics of choice have dominated the biosocial discourses surrounding BRCA risk for decades, telling women at genetic risk for breast and ovarian cancers that they are free to choose how (and whether) to deal with their risk. Critics argue that women at genetic risk are, in fact, not free to choose but rather are forced to make particular choices. In Being at Genetic Risk, Kelly Pender argues for a change in the conversation around genetic risk that focuses less on choice and more on care. Being at Genetic Risk offers a new set of conceptual starting points for understanding what is at stake with a BRCA diagnosis and what the focus on choice obstructs from view. Through a praxiographic reading of the medical practices associated with BRCA risk, Pender’s analysis shows that genetic risk is not just something BRCA+ women know, but also something that they do. It is through this doing that genetic cancer risk becomes a reality in their lives, one that we can explain but not one that we can explain away. Well researched and thoughtfully argued, Being at Genetic Risk will be welcomed by scholars of rhetoric and communication, particularly those who work in the rhetoric of science, technology, and medicine, as well as scholars in allied fields who study the social, ethical, and political implications of genetic medicine. Pender’s insight will also be of interest to organizations that advocate for those at genetic risk of breast and ovarian cancers.

In what way is »care« a matter of »tinkering«? Rather than presenting care as a (preferably »warm«) relation between human beings, the various contributions to the volume give the material world (usually cast as »cold«) a prominent place in their analysis. Thus, this book does not continue to oppose care and technology, but contributes to rethinking both in such a way that they can be analysed together. Technology is not cast as a functional tool, easy to control - it is shifting, changing, surprising and adaptable. In care practices all »things« are (and have to be) tinkered with persistently. Knowledge is fluid, too. Rather than a set of general rules, the knowledges (in the plural) relevant to care practices are as adaptable and in need of adaptation as the technologies, the bodies, the people, and the daily lives involved.

"An extraordinarily rich, provocative, and engaging conversation; one that invites--in fact demands--our participation." - Don Brenneis, University of California, Santa Cruz