The Fallacy of Person-Centred Care: Deconstructing the Discourse to Reimagine Practice.

Abstract

Person-centred care dominates today's sociopolitical landscape, influencing the approach and conduct of healthcare institutions, organisations and practices. It seeks to elevate and transcend former biomedical models by centralising a person's needs, preferences and values in the care process. Positioned as the 'gold standard' approach, person-centred care has become a central attribute in shaping professional identities and public discourse, influencing the ethos, attitudes and behaviours of healthcare professionals. Despite its dogmatic prominence in policy and professional discourse, there are entrenched bureaucratic structures, organisational barriers and conflicting agendas that impede professional efforts to uphold patient agency and autonomy; this has resulted in inconsistencies in its understanding and implementation. Furthermore, the framework itself fails to empower healthcare professionals to challenge practice when it is felt that person-centred principles are compromised, rendering it little more than a rhetorical device used to promote self-interest, enhance professional status and power. Given this fallacy, this critique contends that person-centred care is effectively 'dead'; its demise regrettably orchestrated at the hands of those entrusted to deliver it. In line with a Derridean deconstructive approach, we also provocatively question whether the very concept was ever 'alive' to begin with and whose interest it ultimately served. While its demise may signal time for a paradigmatic shift, it also presents an opportunity to reimagine healthcare practice in a manner that aligns with a more authentic approach. Inspired by Nietzsche's concept of the Übermensch ('Over-man'), we propose a vision of the 'Über-professional', whose 'Will to Power' transcends institutional constraints and conventional practices. By embracing authenticity, the Über-professional model offers both opportunity and 'permission' for adoptees to recognise and resist practices when these conflict with the provision of care. It therefore empowers them to ensure that all voices are heard, preferences are respected and the interests of patients are fully represented in all care decisions.