My dissertation is foremost a critique of traditional normative approaches to health care ethics. I argue that many health care ethicists presuppose an idealized conceptual schema where moral values, justifications, or principles are the primary driving force in health care practices and thus should be the primary focus for normative consideration. On the contrary, social and economic structures shape and constrain health care practices and in many instances undermine or preclude attempts to alter practices by altering moral justifications or normative stances. In my dissertation I argue that accounting for the functions of economic and social structures in health care helps reveal the ways that individual concepts, moral dilemmas, or actions are mediated by their relations to those structures. Examining social practices and the actual functions of profit-driven health care production is necessary for health care ethics because those social functions help constitute moral concepts and practices. Marxian social theory contributes to addressing this problem in that it accounts for the role of social relations in determining conceptual categories and related practices. By accounting for the social relations and economic practices that produce health care, health care ethicists can theorize from a better starting point and offer better normative argument for social change.The first chapter details and defends my overall methodology and critique of what I call "idealized moral frameworks" in health care ethics, arguing that an explanatory model of social relational structures is a necessary contextual grounding for stronger, more informed moral and political theorizing. The chapter grapples with the role of symbolic discourse in influencing social, political, and economic changes to deeply rooted structures. The chapter also situates my project amid existing literature.The second chapter analyzes the concept of the commodity as it relates to health care ethics. I argue that health care functions as a commodity in the United States in that it is subject to the value form through ideational and actual exchange. Further, health care fits the commodity form in that it functions as a vehicle for the production of surplus value and profit-despite the fact that the earnest motivating ethos of individual practitioners and regulators is likely health promotion. In the third chapter I turn to medical labor and its relation to profit production. Health care ethicists tend to depict physicians and medical practitioners in a largely separate sphere from ordinary economic, market, or commercial relations. Yet such depictions interfere with understanding medical labor as a part of the totality of processes that reproduce the material conditions of society, which is to say capitalist economic production. I explicate Marx's account of labor and value-production in order to explain how capitalist production creates value and surplus value by manipulating labor power, time, and wages. In the fourth and final chapter, I offer more explicit directions for translating my project into normative health care ethics. I utilize Marx's ethical politics in dissolving the tensions between ethical and critical analytic frames in theory by focusing attention on the task of health care ethics: effecting change in health care praxis. I offer a concept of social pathologies of health care, which emerges from my project, and lends normative and epistemic motivation to ethical politics aimed at transforming and de-alienating health care practices, institutions, and structures.
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