Читать книгу Becoming a Reflective Practitioner - Группа авторов - Страница 83

Utilitarianism is based on the idea of ‘the greatest good’ whereby the needs of the individual are in tension with the needs of society as a whole due to finite resources. Hence the healthcare practitioner is always concerned with managing resources to the best effect. It involves establishing priorities and pitching the need of the individual against the needs of many.

This inevitably creates tension between the person’s autonomy (the right to make decisions about their healthcare) and utilitarianism. It becomes an issue of justice and goodness. Gilligan (1982) argues that women and men have different criteria to judge ‘moral goodness’. Men tend towards that the highest moral claim is justice (utilitarianism) based on the utilitarian ethic, whereas women tend towards the highest moral claim of caring and responsibility that is essentially respecting the person’s autonomy. Gilligan suggests that within a patriarchal culture, the masculine ethic is deemed a higher level of ethical development, that the needs of society as a whole is morally greater than the needs of the individuals within that society because of finite resources. The reader will appreciate the way this tension is played out in everyday life, reflected in the media, about the way decisions are made about healthcare – what is funded and what is not, as supported by NICE. As such, the person’s right to make decisions about their healthcare is constrained by resources available as determined by others with greater authority. Hence the practitioner will reflect on how utilitarianism affects the ability to give patient‐centred care due to finite resources. This, in turn, impacts on number of staff available, how priorities are made, how much time can be spent with one patient, what equipment is available and staff development. It behoves the practitioner to become political to assert necessary resources to create an environment where her vision can be realised. This is very difficult for the individual practitioner and requires community action or wider society action no longer tolerating poor care. The NHS is a constant political battleground. In the 2019 election, the Conservatives promised 50 000 more nurses and 23 billion pounds.