Chamberlin, Rachel
(2018)
DEFINING THE BIOCITIZEN IN PLURALISTIC HEALTHCARE SETTINGS:
THE ROLE OF PATIENT CHOICE.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
This is the latest version of this item.
Abstract
This dissertation examines how ontologies of "personhood" are introduced and reinvented by members of healthcare systems, and how the choices of patients who opt out of public healthcare are informed by a nonconventional view of personhood in Florianópolis, Brazil. I argue that the Democratization of the Brazilian healthcare system in 1988, created a conventional vision of the "New Brazilian (bio)Citizen" that has been institutionalized by the public healthcare system and reimagined or resisted by patients who seek care outside of the system. Rather than adopting the ontology of the New Brazilian (bio)Citizen as codified in the 1988 constitution, patients have built in additional ideas about the relationship between health, the self and their rights and responsibilities as citizens of Brazil and members of humanity. As such, they can be thought of as nonconventional biocitizens who illustrate their "alternative" personhood in the choices they make as patients.
Based on twelve months of ethnographic research with an Anthroposophic Clinic and seven public health posts in Florianópolis, Brazil, and work with the Secretary of Health's Commission on Integrative Health Practices, I describe how patients who mix services or opt out of quality free public healthcare entirely, are making choices that are influenced by a vision of personhood that contrasts the "New Brazilian (bio)Citizen." I argue nonconventional biocitizens reject the biomedical personhood underpinning public healthcare, but often do not reject biomedicine itself. Nonconventional biocitizens position themselves differently in relationship to healthcare providers, and express different positions on health and the rights and responsibilities of patients and physicians compared to conventional biocitizens. These differences are important to understanding patients' choice of provider and/or treatment.
Finally, I examine the implications for incorporating personhood in considerations of patient choice. While patients who opt out of biomedical care are often cast as noncompliant, their resistance to conventional care can be viewed as a strategy to execute the responsibilities and rights that align with their understandings of their own membership as nonconventional biocitizens. Understanding how and why individuals choose providers and treatments offers a wider picture of what patients expect, need and search for in healthcare services.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
26 September 2018 |
| Date Type: |
Publication |
| Defense Date: |
19 April 2018 |
| Approval Date: |
26 September 2018 |
| Submission Date: |
9 August 2018 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
261 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
Dietrich School of Arts and Sciences > Anthropology |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
anthropososphy, anthroposophic medicine, biocitizenship, Brazil, personhood, patient choice |
| Additional Information: |
other email: rachelchamberlin@hotmail.com |
| Date Deposited: |
26 Sep 2018 21:55 |
| Last Modified: |
26 Sep 2018 21:55 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/35321 |
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