ABSTRACT
In the market variant of the logic of choice patients are called customers, while in the civic variant they are modelled after citizens. The first variant cannot begin to understand disease, the second wants us to control our bodies instead of nourishing them. What the two have in common is something that so far has not been made explicit. This is a specific understanding of the character of scientific knowledge, medical technologies and the tasks of professionals. Within the logic of choice scientific knowledge is taken to be a growing collection of facts that gradually increases in certainty. Professionals need to know these facts. Preferably they should also add to them. Where appropriate they should be passing them on to lay people: one of their tasks is to provide patients with information. With the relevant facts laid out, someone has to determine the value of various possible courses of action. What might be better? A pen or a pump? Tight or mild regulation? This insulin or that one? Once a decision is made, providing or implementing the chosen technique is a professional task again. But, as making the decision is a matter of balancing values, there is no particular reason why doctors or nurses should be doing this. Since treatment interferes with the life of patients, it is the values of patients that should count for most. Framed in this way, the logic seems inescapable. And it is: in the logic of choice. But not in the logic of care.
