Patients and agents – or why we need a different narrative: a philosophical analysis

Walach, Harald and Loughlin, Michael ORCID: (2018) Patients and agents – or why we need a different narrative: a philosophical analysis. Philosophy, Ethics and Humanities in Medicine, 13 (13).

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Background: The success of medicine in the treatment of patients brings with it new challenges. More people live on to suffer from functional, chronic or multifactorial diseases, and this has led to calls for more complex analyses of the causal determinants of health and illness.
Methods:Philosophical analysis of background assumptions of the current paradigmatic model.
Results:While these factors do not require a radical paradigm shift, they do give us cause to develop a new narrative, to add to existing narratives that frame our thinking about medical care. In this paper we argue that the increased focus on lifestyle and shared decision making requires a new narrative of agency,to supplement the narrative of“the patient”. This narrative is conceptually linked to the developing philosophy of person-centred care.
Conclusions:If patients are seen also as“agents”this will result in a substantial shift in practical decisions: The development and adoption of this narrative will help practitioners work with patients to their mutual benefit, harnessing the patients’motivation, shifting the focus from treatment to prevention and preventing unnecessary and harmful treatments that can come out of our preoccupation with the patient narrative. It will also help to shift research efforts, conceptual and empirical, from “treating” and “battling”diseases and their purported mechanisms to understanding complex contributing factors and their interplay.

Item Type: Article
Identifier: 10.1186/s13010-018-0068-x
Additional Information: © H. Walach and M. Loughlin. 2018 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Keywords: Agency, Causation, Context, Complexity, Lifestyle, Multifactoral diseases, Narratives, Patients, Person-centred, Philosophy of medicine
Subjects: Medicine and health
Related URLs:
Depositing User: Michael Loughlin
Date Deposited: 18 Oct 2018 15:12
Last Modified: 06 Feb 2024 15:58


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