Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8312-8326
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8312
Grounded theory qualitative approach from Foucault's ethical perspective: Deconstruction of patient self-determination in the clinical setting
Jesús Molina-Mula
Jesús Molina-Mula, Nursing and Physiotherapy Department, University of Balearics Island, Palma 07122, Illes Balears, Spain
Author contributions: Molina-Mula J contributed to Conceptualisation, writing original draft preparation, review and editing, visualisation, supervision, and funding acquisition. The author has read and agreed to the published version of the manuscript.
Supported by the Advanced Research Chair in the College of Nurses of the Balearic Islands, No. IB3389.
Conflict-of-interest statement: The author do not present any conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jesús Molina-Mula, MSc, PhD, RN, Academic Research, Assistant Lecturer, Nursing and Physiotherapy Department, University of Balearics Island, Valldemossa Km 7,5, Palma 07122, Illes Balears, Spain.
Received: February 3, 2021
Peer-review started: February 3, 2021
First decision: April 25, 2021
Revised: April 30, 2021
Accepted: August 27, 2021
Article in press: August 27, 2021
Published online: October 6, 2021

This paper aims to explain the construction of the autonomous subject from Foucault's ethical perspective for the qualitative analysis of interprofessional relationships, patient-professional relationships, and moral ethics critique. Foucault tried to break loose from the self, which is merely the result of a biopolitical subjectivation and constituted an interpersonal level. From this, different elements involved in the decision-making capacity of patients in a clinical setting were analysed. Firstly, the context in which decision-making occurs has been explained, distinguishing between traditional practices involved in self-care and the more modern conceptions that make certain possible transformations. Secondly, an attempt is made to explain the formation of the medicalisation of society using the transformations of what Foucault called "techniques of the self". Finally, the ethical framework for a subject's "self-creation", insisting more on the exercises of self-subjectivation, reinforcing the ethics of the self by itself, the "care of the self", has been explained. The role of the patient is understood as an autonomous subject to the extent that the clinical institution and the professionals involved comprehend how the patient’s autonomy in the clinical environment is constituted. All these elements could generate grounded theory on the qualitative methodology of this phenomenon. The current ethical model based on universal principles is not useful to provide a capacity for patients decision-making, relegating to the background their opinions and beliefs. Consequently, a new ethical perspective emerges that aims to return the patient to the fundamental axis of attention.

Keywords: Decision making, Personal autonomy, Foucault, Principle-based Ethics, Bioethics, Qualitative methodology, Grounded theory

Core Tip: The current model of decision-making for patients in the clinical setting has major limitations. A new perspective using the concepts of Foucault's ethics from grounded theory allows to analyse the phenomenon and propose changes. From a critique of principlist ethics, this study attempts to configure elements of analysis to build a new theory on how professionals should act to achieve real self-determination of patients in decision-making.