Jürgen Habermas: politics and morality in health and medicine

Abstract

German critical theorist, Jurgen Habermas, is generally known for offering a rather dense and abstract theory of modern capitalist society. There continue to be moves however to apply his concepts in ways that relate to concrete issues in empirical research. A promising branch of this ‘applied turn’ has put Habermas’s ideas to use in research on health and medicine. Here, his concepts have led to critical engagement with issues of medicalization and medical expertise, doctorpatient interactions and clinical practice, and collective action around health in the public sphere (see Scambler, 2001). This work has shown that Habermasian theory can be a valuable asset inresearch on health and medicine. This is because his concepts of ‘system’, ‘lifeworld’ and ‘colonization’ focus attention on issues of a political and moral nature and raise questions of real concern, like: ‘does the doctor know best?’; ‘how far should patients be involved in their treatment?’; and ‘how should knowledge about the causes, treatment and prevention of illness be constructed?’ The political issues raised relate to power and democratic practices, whilst moral debates centre on how to ensure recognition and human dignity in medical settings. In fact, raising these kinds of issues confirms the relevance of Habermas’stheory of modern society for health today. In many ways he is able to prefigure current conflicts between expert and lay approaches to health, and the moral controversies that arise therein. The evidence for this comes largely from looking at the collective struggles of health movements in the public sphere. It is social movements, after all, that politicize and remoralize health issues. The struggles of health-related ‘new social movements’ in particular suggest that the concerns raised by Habermas continue to be a source of both moral debate and political mobilization. I suggest here, therefore, that Habermas has been used to good effect tounderstand conflicts surrounding the growing power of medical expertise in everyday life, and the collective struggles of social movements to ‘reclaim’ health. A key part of Habermas’s argument, however, is the (related) growth of the state and the market into areas of everyday life, but there have been relatively few attempts to look at this process in relation to health (with some rejecting its relevance, Fredriksen, 2003). I argue here that this is a symptom of the conceptual problems that belie Habermas’s distinction between ‘system’ and ‘lifeworld’ moregenerally. I suggest that there is a need to rethink ‘system’ and ‘lifeworld’ in order to apply Habermas’s theory to conflicts surrounding the state, market and health. It is in the context of public health services, I contend, that the battle lines between everyday communicative practices on the one hand, and money and power on the other, are drawn and fought over today. The chapter proceeds as follows: first I outline Habermas’s concepts of ‘life-world’ and ‘system’ and the conflict between them, pointing to the way in which he prefigures a set of moral and political concerns relevant to health and medicine. Second, I look at how these conflicts play out in the collective struggles of health social movements. In the latter part of the chapter, I present a conceptual critique of ‘system/lifeworld’ in order to consider colonization and resistance in public health services today.