Commodification of healthcare in a private healthcare facility: ethical implications for the nurse-patient relationship
Most literature on commercialisation of healthcare reports on the effects of the continuing commodification of healthcare on the doctor-patient relationship. It suggests that the commodification of healthcare as a management practice has the potential to alter the power balance between doctor and patient, and affect the care relationship. This has resulted with the global rebranding of patients as healthcare consumers, in the process impacting on the caring value that characterises the healthcare doctor-patient relationship. In contrast, however, these concerns have not been widely investigated in relation to the nurse-patient relationship. This relationship, grounded as it is in care ethics, has the potential to be severely altered by the pressures of healthcare commodification – particularly as nurses continue to be the primary caregivers in hospital settings. Thus, the study aimed to address this by empirically identifying and exploring areas of ethical tension relating to nurse-patient relationships in a commodified healthcare environment. The objectives of the study were to offer an empirically-based care ethics discussion on nursing care in private healthcare facilities. This study plays a part in addressing the current absence of both theoretical and empirical studies that examine the impact of commodification of healthcare on the actions of nurses. The study used a qualitative, explorative and descriptive approach to thematically analyse data collected from interviews with 16 nurses working in a private healthcare facility in Johannesburg. The findings support the argument that the commodification of healthcare transforms the nature of healthcare provision resulting with the replacement of professional ethics with marketplace ethics. This is harmful to the mutual trust and respect between the nurses and their patients. Hence, it is critical to rethink the value of compassionate and humane care as an integral part of ethical nursing practice.
A research report submitted in partial fulfillment of the degree of MSc. Med (Bioethics & Health Law) Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwatersrand (Wits), Johannesburg November 2017.