The commonly occurring metaphors and models of the doctor–patient relationship can be divided into three clusters, depending on what distribution of power they represent: in the paternalist cluster, power resides with the physician; in the consumer model, power resides with the patient; in the partnership model, power is distributed equally between doctor and patient. Often, this tripartite division is accepted as an exhaustive typology of doctor–patient relationships. The main objective of this paper is to challenge this idea by introducing a (...) fourth possibility and distribution of power, namely, the distribution in which power resides with neither doctor nor patient. This equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”—is the point of departure for a qualitatively new doctor–patient relationship, which is best described in terms ofsolidaritybetweencomrades. This paper specifies the characteristics of this specific type of solidarity and illustrates it with a case study of how Swedish doctors and patients interrelate in the sickness certification practice. (shrink)

Ethical consumer discourse is organized around the idea that shopping, and particularly food shopping, is a way to create progressive social change. A key component of this discourse is the “citizen-consumer” hybrid, found in both activist and academic writing on ethical consumption. The hybrid concept implies a social practice – “voting with your dollar” – that can satisfy competing ideologies of consumerism (an idea rooted in individual self-interest) and citizenship (an ideal rooted in collective responsibility to a social and ecological (...) commons). While a hopeful sign, this hybrid concept needs to be theoretically unpacked, and empirically explored. This article has two purposes. First, it is a theory-building project that unpacks the citizen-consumer concept, and investigates underlying ideological tensions and contradictions. The second purpose of the paper is to relate theory to an empirical case-study of the citizen-consumer in practice. Using the case-study of Whole Foods Market (WFM), a corporation frequently touted as an ethical market actor, I ask: (1) how does WFM frame the citizen-consumer hybrid, and (2) what ideological tensions between consumer and citizen ideals are present in the framing? Are both ideals coexisting and balanced in the citizen-consumer hybrid, or is this construct used to disguise underlying ideological inconsistencies? Rather than meeting the requirements of consumerism and citizenship equally, the case of WFM suggests that the citizen-consumer hybrid provides superficial attention to citizenship goals in order to serve three consumerist interests better: consumer choice, status distinction, and ecological cornucopianism. I argue that a true “citizen-consumer” hybrid is not only difficult to achieve, but may be internally inconsistent in a growth-oriented corporate setting. (shrink)

This article proceeds from the assumption that the transition to socialism must take account of individuals as they are, not as they might be. The emphasis on the individual appears to be inconsistent with the marxian basis of socialist thought. Attempts to resolve this inconsistency have led marxists to concentrate on cultural and psychological explanations of people within capitalist society. We criticise these attempts, and argue for a view of the individual in society which recognises personal autonomy yet acknowledges the (...) role of structural forces in social change. Given this model, we then ask if there is any indication of individual changes within contemporary capitalism which promote the transition to socialism. In contrast to the pessimistic interpretations which dominate the literature, we argue that the present psychological and cultural states of individuals within capitalism can engender socialist change. (shrink)