A key site of meaning making for the praxis of Evidence Based Healthcare (EBHC) is consciousness itself, that is, how the human being forms her conscious beliefs to make sense of herself and the world and to make healthcare decisions. Specifically, the question posed in this chapter is: can the individual patient ever be a whole person and a really ‘free’ decision-maker independent of the capitalist structure and its social relations?
This chapter uses Karl Marx’s analyses of alienation and commodity fetishism to illustrate that consciousness, in the form of beliefs, is shaped by the social relations of capitalism itself, and taken for granted cultural norms.
Under capitalism, the individual and her desire is shown to be susceptible, and vulnerable, to: a) normative cultural beliefs (for example, early diagnosis by screening is a good thing regardless of its harms); b) an excessive desire for health technology (screening tests are a desirable thing); and c) harm caused by anticipatory care because the meaning of harm is made non-conscious.
I describe how, through anticipatory care, both the raw material of the body and the consciousness of care-labour are put to work. The subject embodied by the care-labourer, her body and mind, is subjectivised, that is, both oppressed to become an object of labour, and at the same time makes sense of her self and her labour through this objectivisation.