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In:Dialogues of the Clinic: Encounters across medicine and beyond
Edited by Mariaelena Bartesaghi and Shelby Forbes
[Dialogue Studies 36] 2026
► pp. 232–258

Chapter 9
Dialogue in medical care

The bright and dark side of the “patient-centered” doctrine in health care settings

 | University of Bologna
This content is being prepared for publication; it may be subject to changes.
Abstract
In the second half of the twentieth century, patient-centered care (PCC) gained ground as a dialogic practice within a new architecture of care and became the gold standard of healthcare worldwide. Adopting the analytical lenses of epistemic (in)justice and intersubjectivity, I reconstruct the history of this concept and argue that PCC and its corollaries (e.g., “patient empowerment and agency,” “shared decision making,” and “clinical empathy”) constitute a morally loaded doctrine whose raison d’être is ethical rather than clinical. Building on recent studies, I also illuminate the overlooked risks of uncritically adopting PCC: neglecting the non-agentic dimensions of “being a patient,” disregarding the dependence of effective caregiving on the caregiver’s epistemic and deontic authority, reinforcing abandonment through the rhetoric of empowerment, dismantling asymmetry-based models of care in favor of egalitarian consumer-provider relations, and tacitly aligning PCC with contemporary neoliberalism.
Article outline
  • 1.Introduction
  • 2.Dialogue and epistemic (in)justice in health care
  • 3.Intersubjectivity in healthcare: From being opened to the wor(l)d
    of the other to compassionate care
  • 4.Beyond clinical effectiveness: The moral grounds for adopting
    the patient-centered approach
  • 5.The dark sides of the patient-centered approach
    in healthcare settings: “Patient abandonment”
    and medical expertise “under siege”
  • 6.Whose knowledge, whose decision? Prescribed resilience,
    normative autonomy, and the ethics of asymmetry
  • 7.In the guise of a conclusion
  • Notes
  • References
References (125)
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