Paper short abstract:

This paper explores how the theoretical irreducibility of care is limited in UK general practice medicine by economic concerns and acts of clinical prioritisation, and highlights the role of ‘trust’ in ensuring that the limits of care appear advantageous rather than arbitrary.

Paper long abstract:

The irreducibility of 'care' has been celebrated in recent years as scholars have tried to explain what makes 'the logic of care' uniquely resistant to the pervasive influences of neoliberal governmentality. It is argued that care is not a product but a process, the guiding values of which cannot be reduced because they are located in the perennially incomplete lives of patients (Mol 2008). Care appears in contemporary work as a harmonious process - 'a matter of various hands working together… towards a result' (2008: 21). What is absent from this work is any sense of how the theoretical irreducibility of care is limited in practice by economic concerns and acts of clinical prioritisation. As a result, the current model of care is incapable of explaining why debates about healthcare are populated with stories of contestation and mistrust.

The paper analyses the work of several Manchester-based general medical practitioners. It shows how the irreducibility of care was carefully made to appear finite via notions about what was not in the best interests of the patient, as well as via clinical priorities and ideas about risk and resource distribution. The paper argues that care could only be achieved through acts of truncation and cutting but - because these acts involved complex moral, financial and clinical assemblages - limiting care was often prone to contestation. The paper explores the role of trust (in the motivations of patient or doctor) as pivotal in ensuring the limits of care mutually appeared advantageous rather than arbitrary.