The construction of incompetency: moving beyond embedded paternalism toward the practice of respect

Abstract

This paper illustrates the less-acknowledged social construction of the concept of “incompetency” and draws attention to the moral concerns it raises in healthcare encounters in the south Indian city of Chennai. Based on in-depth interviews with 16 surgeons, drawn from qualitative research, this study reveals that surgeons subjectively construct the idea of incompetency through their understanding of the perceived circumstantial characteristics of the patients and family members. The findings largely suggest that surgeons dismiss their capacity based on constructed assessments, which leads to paternalistic practice. The findings illustrate how these assessments structure the surgeons’ practices and provide the moral and practical justifications for their actions. The constructed knowledge becomes a source for drawing normative justification for surgeons’ actions and, in conjunction with socially enforced relationships, leads patients and family members to be on the receiving end of disrespectful attitudes. By employing the ethical framework, this paper argues for physicians to pursue “respect for persons,” beyond the framework of “capacity/autonomy,” and to practice respect in hospital settings.