(Un)disciplined Patients, (Un)controlled Medical Authority?

Abstract

Starting at the end of the 1940s, the so-called “democratic transformation of healthcare” was not limited to the expansion of beneficiaries and making care provided in the system free of charge. It also sought to define the new roles of those who run (physicians) and use (patients) the system. To enforce the implementation of new norms, medical ethics committees were set up, and in many respects, these new structures were integrated into the system of social courts and were tasked mainly with the protection patients’ rights during investigations into complaints against doctors. This article aims to address the following question: What role did the functioning of these medical ethics committees play in healthcare operations organized along socialist principles, considering their involvement in both politics and healthcare? Additionally, what forms of governmentality can be inferred from the ways these committees functioned within the framework of socialist healthcare? To answer these questions, I examine patients’ complaints received by the medical ethics committees, as the core objective of socialist healthcare was to provide quality healthcare and educate individuals about utilizing the socialist healthcare system. My hypothesis is that while the committees exhibited organizational and operational characteristics aligned with the basic institutions of socialist democracy, their ultimate goal was to educate individuals in accordance with the principles of the socialist system. However, the committees’ decisions were influenced by the degrees of autonomy granted to them and existing practices for supervising medical activity prior to the establishment of the state-socialist system. Consequently, they functioned not as guardians of the socialist state’s biopolitics but rather as autonomous bodies of medical advocacy. Although patients used various strategies of argumentation to justify the incompatibility of their grievances with socialist healthcare, doctors did not primarily assess the seriousness of the problems based on patient complaints. Institutional constraints and specific professional practices, which also played a role in medical activities, had a more significant impact on the decision-making process.