Enforcing patient rights or improving care? The interference of two modes of doing good in mental health care.

Abstract

New state laws are intended to bring about formal changes. These juridical activities inevitably interfere with the content of care of substantially changing health care practice. The case is argued by means of an analysis of ethnographic material gathered in the long-stay wards of two psychiatric hospitals in the Netherlands. The question raised by the ethnography is which 'mode of doing good', juridical or caring, is relevant to daily practice. A 'mode of doing good' is defined as a pattern of ideals, procedures, routines and knowledge that is oriented towards a specific form of 'good care'. The interference of these different modes of doing good explains the impact of recent juridical changes in Dutch mental health care. The potential tensions between juridical and caring traditions are accommodated in different ways. Either juridical and caring modes resonate and gradually merge into new patterns of day-to-day practice, or there is dissonance and they remain oppositional. Rather than securing patient rights, juridical measures change daily life and work on the wards in far more complex ways.