Facilitating Patients’ Hope Work Through Relationship: A Critique of the Discourse of Autonomy

Abstract

Taking a Foucauldian approach to ‘discourse’ (Foucault, 1973), this chapter explores the transformation, in the context of health care, from a previously dominant discourse of ‘paternalism’ to the present, increasingly dominant discourse of ‘autonomy’. The discourse of autonomy is focused on communication and information giving, especially as it pertains to ‘bad news’. According to Foucault, ‘discourse’ can be conceptualised as a system (or systems) of thought composed of ideas, attitudes, courses of action, beliefs and practices that systematically construct the subjects of the worlds of which they speak. Their role can be defined as one of legitimation and power with an emphasis on the construction of ‘truth’, how that truth is maintained and the power relations they carry within them. Indeed the concept of power is omnipresent and can both produce and constrain ‘truth’. As Salmon and Hall (2003) have argued, ‘new’ discourses do not necessarily displace previous ones; they may coexist and even become intertwined, but at the same time ‘new’ discourses may be responses to tricky and problematic earlier ones. The function of the discourse that pertains to the one we name the discourse of autonomy can only be understood by addressing its history, and the way it may combine and contrast to a ‘new’ one (Salmon and Hall, 2003).