Neoliberal Rationality: A Primary Impetus for Reification and Derecognition of the Patient in Nursing Care.

Abstract

In this article, I discuss the implications of the neoliberal transformations on healthcare that are justified under the aegis of economic efficiency. Drawing on the work of German critical philosopher Axel Honneth, I present a critical-social and philosophical perspective that reinterprets these transformations as pathological consequences with devastating impacts on how we understand what human beings and social relations are. I argue that in a neoliberal context, nursing care becomes a form of reification defined as 'forgetfulness of recognition' of the human identity of the patient which contradicts the assumed ethical foundations of nursing. The article provides a detailed account on how neoliberal rationality that governs nursing performance promotes an objective and a 'neutral stance' of care that neglects emotional engagement and deals with the patient as an object or a thing which violates all dimensions of patient recognition. I also emphasize that neoliberalism must rather be understood as a specific form of governmentality that goes beyond mere economization and structures a specific way of understanding people in the healthcare context. Neoliberal rationality, as conceptualized in this article, not only considers human being as homo economicus, where decisions are based on economic ideals, but also neutralizes relationships and disseminates an 'objective' and purely scientific stance in caring interactions. This leads to the detachment of nurses and reification of patients. Thus, nursing care is reduced to an instrumental rationality that focuses on technical care, which diminishes any possibility for nurses to engage with patients and understand their unique phenomenological world necessary for coping and recognition. Finally, nurses are urged to raise their voices against neoliberal rationality that programs their ideas of what 'good care' is. A critical emancipatory mode of thinking provides an opportunity to challenge neoliberal rationality and revitalize nursing agency to resist the devastating transformations taking place in health care.