The trouble with personhood and person‐centred care

Abstract

The phrase 'person-centred care' (PCC) reminds us that the fundamental philosophical goal of caring for people is to uphold or promote their personhood.However, such an idea has translated into promoting individualist notions of autonomy, empowerment and personal responsibility in the context of consumerism and neoliberalism, which is problematic both conceptually and practically. From a conceptual standpoint, it ignores the fact that humans are social, historical and biographical beings, and instead assumes an essentialist or idealized concept of personhood in which a person is viewed as an individual static object. From a practical standpoint, the application of such a concept of personhood can lead to neglect of a person's fundamental care needs and exacerbate the problems of social inequity, in particular for older people and people with dementia. Therefore, we argue that our understanding of PCC must instead be based on a dynamic concept of personhood that integrates the relevant social, relational, temporal and biographical dimensions. We propose that the correct concept of personhood in PCC is one in which persons are understood as socially embedded, relational and temporally extended subjects rather than merely individual, autonomous, asocial and atemporal objects. We then present a reconceptualization of the fundamental philosophical goal of PCC as promoting selfhood rather than personhood. Such a reconceptualization avoids the problems that beset the concept of personhood and its application in PCC, while also providing a philosophical foundation for the growing body of empirical literature that emphasizes the psychosocial, relational, subjective and biographical dimensions of PCC.

What does person‐centred care mean, if you weren't considered a person anyway: An engagement with person‐centred care and Black, queer, feminist, and posthuman approaches

“…Earlier we have highlighted the angles of PCC that we find problematic. In some ways this aligns with a recent critique of PCC (Tieu et al, 2022); however, the authors' analyses are based in humanism. We believe that there is a lot of potential in using the posthuman lens to critique PCC and to speculate what posthuman care might look like.…”

“…This perspective includes the patient in their care while acknowledging that many other things contribute to what is possible in care. In some ways, this understanding of care could align with descriptions of PCC (McCormack & McCance, 2010), especially when the concept of personhood is interrogated (Tieu et al, 2022). However, a critical posthuman approach to care demands further contextualization, situating the person and their care providers within their materiality of being human and more-than-human.…”

“…Lambert et al (1997) have critiqued PCC as reductive, leading to the model of PCC that describes more holistic care. Tieu et al (2022) emphasize how PCC produces a reductive relationship between patients and nurses, creating “a relationship that is antipaternalistic whereby the care provider is not an active participant in the care relationship and whereby the responsibility to make decisions about care rests primarily on the care recipient” (Tieu et al, 2022, p.4).…”

“…Many organizations and institutions focus on the individual attributes of patients to facilitate high-quality PCC (Fotaki, 2015). In part, this establishes care as a service industry in which the individual becomes the customer who is imbued with choice as to how they purchase their healthcare (Tieu et al, 2022). Patients' and nurses' ability to make these personal choices orientates all responsibility for those choices towards the person making them.…”

“…Other critiques of PCC have also discussed problematic neoliberal productions of the human in healthcare (Greco, 2009; Millenson, 2017; Tieu et al, 2022). We argue that although PCC might not be directly built on neoliberalism, we have to acknowledge that the neoliberal shift in which the individual is centred in relation to the welfare state moved towards individual responsibility, creating a rich soil that made PCC congruent and conducive with neoliberalism.…”