The elementary forms of care: an empirical approach to ethics in a South African Hospital. 2008

Didier Fassin
Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux, Centre National de la Recherche Scientifique, Ecole des Hautes Etudes en Sciences Sociales, Université Paris 13 - 96 Boulevard Raspail, 75 006 Paris, France. dfassin@ehess.fr

Ethics is generally seen as the application of universal and intangible principles. Empirical studies then consist in verifying the degree of adequacy of practices to the norms. Here, conversely, ethics is considered as everyday practice: professionals, whether nurses or doctors, act within routines and under constraints, and later give an account of their action. Fieldwork was conducted during one year in the emergency and admission wards of a large South African hospital. It was based on interviews and observation and included feedback meetings for health professionals and focus group discussions with inhabitants of the neighbouring township. Ten elementary forms of care were identified in terms of patients' expectations. Five concerned the person as patient: ailment, problem, pain, agitation, life. Five concerned the patient as person: recognition, sovereignty, respect, privacy, interest. Discrepancies between claimed norms and actual practices were justified by health professionals in terms of workload, lack of resources and social deviance of patients. Ethnography suggests a more complex interpretation: on the one hand, technique-oriented professional ethos and efficiency-oriented organizational imperative are consequences of both historical territorial segregation and present resource inequalities. On the other hand, the lack of social recognition felt by nurses and doctors is in turn reflected in their moral evaluation of patients, which goes beyond concepts of values and worthiness. Although inscribed in the specific context of post-apartheid South Africa, the present description and analysis of practices has a broader scope as it proposes a way of approaching the elementary forms of care.

UI MeSH Term Description Entries
D007407 Interviews as Topic Works about conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes works about school admission or job interviews. Group Interviews,Interviewers,Interviews, Telephone,Oral History as Topic,Group Interview,Interview, Group,Interview, Telephone,Interviewer,Interviews, Group,Telephone Interview,Telephone Interviews
D004995 Ethics, Professional The principles of proper conduct concerning the rights and duties of the professional, relations with patients or consumers and fellow practitioners, as well as actions of the professional and interpersonal relations with patient or consumer families. (From Stedman, 25th ed) Professional Ethics,Ethic, Professional,Professional Ethic
D005791 Patient Care The services rendered by members of the health profession and non-professionals under their supervision. Informal care,Care, Patient,Informal cares,care, Informal,cares, Informal
D006760 Hospitalization The confinement of a patient in a hospital. Hospitalizations
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000884 Anthropology, Cultural Study of social phenomena which characterize the learned, shared, and transmitted social activities of particular ethnic groups with focus on the causes, consequences, and complexities of human social and cultural variability. Ethnography,Cultural Anthropology,Material Culture,Culture, Material,Ethnographies,Material Cultures
D001291 Attitude of Health Personnel Attitudes of personnel toward their patients, other professionals, toward the medical care system, etc. Staff Attitude,Attitude, Staff,Attitudes, Staff,Health Personnel Attitude,Health Personnel Attitudes,Staff Attitudes
D013019 South Africa A republic in southern Africa, the southernmost part of Africa. It has three capitals: Pretoria (administrative), Cape Town (legislative), and Bloemfontein (judicial). Officially the Republic of South Africa since 1960, it was called the Union of South Africa 1910-1960. Republic of South Africa,Union of South Africa
D017144 Focus Groups A method of data collection and a QUALITATIVE RESEARCH tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. Focus Group,Group, Focus,Groups, Focus
D054625 Healthcare Disparities Differences in access to or availability of medical facilities and services. Disparities, Healthcare,Health Care Disparities,Health Care Inequalities,Healthcare Disparity,Healthcare Inequalities,Disparities, Health Care,Disparity, Health Care,Disparity, Healthcare,Health Care Disparity,Health Care Inequality,Healthcare Inequality,Inequalities, Health Care,Inequalities, Healthcare,Inequality, Health Care,Inequality, Healthcare

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