The difficult patient

The ‘difficult patient’: why we need to reframe vulnerability in healthcare

Traditional liberal accounts of autonomy equate vulnerability with a diminishment in one’s autonomy. While this model of vulnerability suggests an increased susceptibility to harm, it may also grant access to specialised services which minimise the potential for harm and support self-determination. However, focusing on an individual’s capability as the measure for autonomy fails to recognise the broader structural inequalities one may face. Specifically, the equation of diminished autonomy with vulnerability raises problems within healthcare such as denial of healthcare, negative clinician views, and under-resourced treatment. In application, I show the effects of this on individuals with Borderline Personality Disorder. In response, I offer a solution via feminist relational accounts of autonomy which posit vulnerability as an asymmetrical relationship between individuals and the social and institutional networks they need for self-determination. Through this model, BPD’s vulnerability status is reaffirmed due to the structural stigmas they face from diagnosis to seeking treatment, thus removing the “difficult-patient” status.

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