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Person-Centred Care: Putting the Organic Horse back in front of the Mechanical Cart

Stephen Tyreman


Is person centred care merely a humanitarian addition to good medical practice - considering the person’s personal needs and wishes on top of mending the body? Or is it a truly fundamental essential of good practice in the way that hygiene was in the 19th Century? Is there a compelling (rather than merely desirable) reason for being person-centred?

This chapter defends the claim that the holistic person is primal to understanding human health and healthcare. Human beings are organisms, not mechanisms, and there are fundamental differences between the two. Organisms are essentially whole at all stages of their development, whereas machines are not whole until assembled from component parts.  In addition, organisms are always in transition in response to the ever-changing environment. While these distinctions have been recognised since the ancients, medicine in the modern era has largely focused on body mechanisms for its theory and practice. Dramatic increases in knowledge and technological innovation have led to a focus on the body as a machine and a failure to consider the implications of the organism for human health.

The chapter argues that, in contrast to current thinking, a person is not constituted by the capacity of their genes and molecular mechanisms, etc., but by their unique set of experiences together with a narrative that interprets and gives meaning to them. The role of genes along with other body mechanisms is not so much to provide a blue-print for body growth and development, as a means of responding and adapting to environmental resources and challenges. It is the essence of those responses that forms the core of human experiences in all domains.


Machine-as-metaphor, meaning, mechanisms, narratives, organisms, physical-causal framework, process philosophy, uniqueness

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