Document Type


Publication Date


Publication Citation

43 Journal of Law, Medicine & Ethics 293 (2015)


This paper rejects the dichotomy between patient and consumer roles and focuses instead on how attributes of each are meaningful to those seeking health care. Arguing that health care is already commodified, it suggests that both medicine and the market offer strategies for handling commodification. The important questions are how we understand these attributes and their role in care relationships, and which attributes we should encourage. The medical profession and patient role have long accommodated commodification, using fiduciary roles, flat fees and opaque pricing to distance payment and pricing from care provision. In contrast, the market and consumer role emphasize choice and consumer agency, arms' length transactions, and exchange for value. To avoid the dehumanization of the commodification critique, health care can be restructured to combine elements of both patient and consumer choice models.

In Part I, this essay defines the roles of patient and consumer, and then describes how they are ultimately less important than the attributes of which they are comprised. In Part II, it describes theories of commodification and consumption in reproductive contexts and their negative and positive consequences, from compliance and coercion to resistance and creativity. It also examines whether ART and abortion are "markets," when, and with what effects. In Part III, this essay explores how the attributes which comprise the patient/consumer roles can be incorporated into health care reform, and the implications that various health care reform models would have for ART and abortion.