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UBC Theses and Dissertations

Medical citizenship and the social right to health care in Canada : a genealogy of medical education discourses Schrewe, Brett Michael


The Canada Health Act (CHA) is clear “that continued access to quality health care without financial or other barriers is critical to maintaining and improving the health and well-being of Canadians”. Failure to attend to these barriers may lead to inequitable distribution of the health care system’s intended benefits, constricting the CHA’s aspirations towards health equity, unravelling a key thread of the fabric of Canadian society, and impinging upon citizens’ abilities to enjoy their civil and political rights. As physicians are key actors in health care delivery, it is paramount to understand whether and to what degree they are formed through medical education to work for the realization of the social right to health care. Using a theoretical framework of Western citizenship, a methodological approach of Foucauldian genealogy, and methods of critical discourse analysis applied to an archive of over 120 texts, this dissertation considers what kind of physician the competency-based medical education system produces. Analysis of the discourses of medical professionalism, health advocacy, and social accountability suggests that current educational policies and practices produce medical experts primarily focused upon providing high-quality individual clinical care. While this skill set is necessary, it is insufficient to deliver on medical education’s claim that it is fundamentally anchored in meeting societal health care needs and to prepare physicians to work for the equitable distribution of the health care system’s intended benefits. In its place, this work proposes that the medical educational system shift from a focus on medical experts to medical citizens. Centring the latter subject position in medical education neither excludes the provision of high-quality clinical care nor negates the clinical activities of the former. Rather, it broadens how we think about physician competence and, in turn, considers how current medical educational practices may be re-purposed to shape physicians who inflect the social and political responsibilities of citizenship medically and put the equitable realization of the social right to health care at the centre of their professional efforts.

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