What Justice, What Autonomy? The Ethical Constraints Upon Personalisation

This article considers the ethical dimensions of attempts to ‘personalise’ health and social care services in the UK. Personalisation is identified as closely related to efforts to introduce elements of neoliberal marketisation into public service provision, particularly through the introduction of consumer choice for services users. We consider two areas of ethical concern surrounding personalisation: its contribution to social justice agendas and the enhancement of service users’ autonomy. While personalisation in general, and consumer choice in particular, has been presented as positively contributing to both social justice and autonomy, we critically revaluate these claims. We draw on the work of Nancy Fraser and relational theories of autonomy to highlight the ethical complexities of personalisation and the potentially negative effects that the extension of consumer choice may have on promoting social justice and supporting substantive forms of autonomy. We suggest that understanding and negotiating these complexities imposes ethical constraints on the ways in which, and extent to which, health and social care services can be defensibly personalised.