I did not plan to write about COVID-19. There have been so many texts at this point on the different trails of destruction the pandemic will leave behind, and how it will change things forever. But then again, looking back in history, writers will probably be right. So, maybe I can at least use COVID-19 as a reminder about how other, less brutal events, work to change the ideas and practices of healthcare?
While out on a walk the other day, I was listening to show ‘The Philosophical Room’ that is airing on Swedish public radio. Being an arena for popular philosophical discussion and debate, they were touching on the subject of COVID-19. More particularly, the two invited philosophers were talking about a conflict of values that the pandemic could pose in Swedish healthcare. The main topic of the discussion was how to prioritise different patients due to the outbreak of COVID-19.
I am the first to admit that my use of COVID-19 as an example is a bit over the top. Having said that, I believe that COVID-19 really is a timely example on how the ideas and practices of healthcare are rearticulated – however often by less dramatic events. In Sweden and other countries, there are policies about what healthcare should be to individuals as well as society as a whole. Swedish healthcare, is guided by three pivotal principles on ethics.
Just like the philosophers on the show described to listeners, these are applied to assure the equality between different groups in society; aged, classed, gendered, etc. More specifically, all individual (Swedish) subjects are given equal value through these principles and thus, all patients have the legal right to get good care. What the guests on the radio show added though, was that due to the potential influx of patients because of COVID-19, what healthcare is and should be to subjects, might have to be renegotiated. Should younger people be cared for on the expense of elders? Or should doctors, based on utilitarian ideas, be saved instead of other groups that in the context of the pandemic, appear to be less important for society?
In the last decades, there has been a general move towards personalisation, individualisation and marketisation in western healthcare. Nordic welfare states like Sweden are no exceptions. However, when listening to the radio show, the forecasts of COVID-19’s effects, we are presented with a different discourse on healthcare. In the shows’ discussion, the philosophical underpinnings of healthcare were moved from an individualistic understanding of health and care, to a more collective approach – making care, health and ultimately death, more of a communal effort.
This ideological probing is not only evident among professional philosophers on radio shows, but also in media more generally. Both Swedish and Australian news media have regular pieces on how healthcare should be managed in times of COVID-19, often with collective calls to ‘flatten the curve!’ and sometimes with nationalistic under tones.
That phenomena like healthcare are renegotiated is not a new idea. It is a basic theoretical tenet in social constructivist ontologies that cultural phenomena are continually rearticulated, but also that the social is inherently political. What healthcare ‘is’, and correspondingly, how it is enacted in policy, organisations, among professionals and patients, varies depending on ideological, historical and material conditions. What COVID-19 can help remind us, and what I hope will help make my use of the pandemic as an example seem more sensible, is the constructed and ideological character of healthcare.
More importantly though, given the potential consequences for elders and non-doctors, the pandemic could also help restate what we know from other ideological turns, like personalisation, individualisation and marketisation – that they tend to have very tangible effects for everyday users. So while COVID-19 might change things forever, it is still important to peruse less dramatic renegotiations, and explore how they affect different groups in healthcare.
Jens Lindberg is a Research Fellow at the Department of Social Work, Umeå University, Sweden. His research interests are welfare organisations, sexual violence and digitalisation. He is a visiting researcher at the Vitalities Lab. However, due to the massive bush fires in south east Australia followed by the global outbreak of COVID-19, his research visit has turned into a year of self-isolation.