Table 1

An outline of the logic of choice and the logic of care3

Logic of choiceLogic of care
PatientsPatients are considered as customers who choose a care product of their liking. Patients are approached as people who know what they want and who govern themselvesPatients are seen as actively involved in a care process. Central in this process is what patients need. Patients have to attend and take care of the unpredictabilities of their bodies
Healthcare professionalsProfessionals present neutral facts to patients to enable them to make a choice that aligns with their own values. They should be knowledgeable, accurate and skilful and properly implement the interventions for which their patients optProfessionals continuously ‘tinker’ with bodies, technologies, knowledge and people. Facts and values intertwine; establishing facts and figuring out what to do go hand in hand. The various activities of those involved should be well attuned to each other
Their relationship is seen as…A transaction between separate individuals who form a collective because they happen to meet each other in the consultation room. Decision making is weighing the relevant facts and arguments and offers individual autonomy and responsibilityInteraction between interdependent individuals, who always belong to multiple collectives (family, work, school). Making choices is a practical task, emerging from daily reality. Professionals and patients jointly act and act again to make life with disease bearable