Public health, medicine and the ideal of self-governance: Conflicts in the modern culture of health and well-being

This dissertation explores how modern public health and medicine define and organize the participation of citizens and patients in the context of the relations of care in which they are involved. It pursues four detailed case studies focusing on the Canadian province of Ontario that show the specific ways in which contemporary public health and medical authorities construct the roles of citizens and patients in fighting threats and disease and in pursuing health and well-being. The first two cases center on recent traffic safety initiatives that seek to keep drivers from speeding and driving while impaired. They show the legal, moral and technical mechanisms through which regulators in the field strive to promote self-control and moderation in the drivers' relation to speed and alcohol. The third and fourth cases look at the regulation of the doctor-patient relation and focus on two different mechanisms through which the medical profession seeks to empower patients to become more involved in decisions affecting their care: the doctrine of informed consent, which gives patients the legal right to refuse treatment, and the market model of medicine, which treats the patient as a consumer of medical services. Taken together, these cases bring to view the grey zone in the modern culture of health and well-being. While public health and medical authorities strongly emphasize the need for citizens and patients to direct their own behavior in relation to questions of health and illness, they enforce self-governance by means of methods that fail to engage the one thing that makes true autonomy possible: the ethical capacities for judgment and self-reflection.