Power, Identity, and Liminality in an American Hospital

Abstract

Losing the sense of oneself is no trivial matter regardless of the reasons. But when these reasons have to do with the doubly-marginalizing circumstances of serious physical illness and subsequent hospitalization, the loss can be devastating in ways that extend beyond the patient’s release. Because the hierarchical practices and juridical moral theories that govern physician-patient hospital relationships in the United States largely disregard such losses by paying insufficient attention to power differentials and to the unique dilemmas presented by individual cases, patient care calls for better, nonideal approaches to the well-being of this vulnerable population. Specifically, the medical and administrative norms that pervade patient care both harm and alienate those subject to their power by damaging whatever sense of personal identity that an otherwise seriously ill patient might still have. By stripping away not only patient self-trust and voice, but also any semblance of agency itself, the current normative models of hospital care mark those already burdened by illness as mere bodies—not as morally equal participants in the pursuit of healing. Moving toward any semblance of change requires a fundamental re-assessment of the relationship between the patient and the institutional arrangements and priorities. For such a reevaluation to take place, nothing less than an institutional shift toward nonideal, narratively-grounded approaches to the overall well-being of the patient is required. Only then might the status of the patient as a person begin to matter as an essential part of meaningful practices of hospital care.