John Owens (john.owens@kcl.ac.uk, website)
King’s College London, 2011
LINK MISSING
Abstract
This thesis provides a philosophical analysis of proposals to reform the NHS around the concept of personalisation. In part I of the thesis, I track the origins of personalisation and ask what exactly it might mean in practice. Exposing the vague terms in which personalisation is presented invites the question ‘how ought personalisation to be interpreted?’ The remainder of the thesis is concerned with providing a set of arguments which may justify an answer to this question. In part II, I consider personalisation from a clinical health perspective, paying particular attention to the potential balance between patient autonomy and professional paternalism in the context of a personalised doctor-patient relationship. I consider a possible problem personalisation may face should professionals and patients hold significantly different beliefs about the nature of health and the best course of treatment. I seek to resolve this problem by employing a conceptual framework based on Roy Bhaskar’s philosophy of critical realism to outline what I call a ‘stratified theory of health’. This framework also provides the foundation for a ‘stratified theory of well-being’ which I use to stipulate a balance between professional paternalism and patient autonomy. Part III considers personalisation from the perspective of public health. I examine the relationship between patient choice and the goals of improving health outcomes, reducing inequalities and increasing patient empowerment. Again, I use the framework provided by critical realism to suggest that if personalisation were to be interpreted in terms of increased patient choice there would be reason to be sceptical about its ability to deliver these goals. In part IV, I conclude by suggesting that there are reasons from both clinical and public health perspectives for interpreting personalisation in terms which increase care and communication in the doctor-patient relationship and which limit the introduction of greater patient choice.
Methods
Philosophical