The limits of primary care
The limits of primary care

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The limits of primary care

3: Testing the limits

Choosing Jim and Marianne as the central case study in the course was a deliberate strategy to enable you to consider conflicts at the very heart of health and social care:

  • the rights of the individual versus the rights of the community

  • the nature of community for people who have no settled abode

  • dilemmas about apportioning limited resources.

Following their story is a way of testing the limits of health and social care services, and exploring where community obligation should stop.

There are considerable moral and ethical issues involved in the debates around this case study. Do citizens have unlimited calls on health service resources, or are there limits to what services and facilities people could or should expect from the state? Do people whose problems may be considered to be ‘self-inflicted’ have the same rights and access to resources as other people? We will be reconsidering such questions at various points in the course.

Key points

  • An approach that seeks to find the person behind the label is an antidote to their being seen simply as a collection of ‘problems’. It may also make a practitioner's task more complex.

  • Heavy drug users test the limits of community services.

  • Practitioners and planners are faced with moral dilemmas that are not susceptible to hard and fast rules.

  • When children are involved, the welfare of the adult patient or client is not the sole consideration.


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