The ethics of everyday practice in primary medical care: responding to social health inequities

Some see doctors as bound by a notion of care that is blind to a patient's social position, while others respond to this issue through invoking notions of justice and human rights where access to care is a prime focus. Both care and justice orientations however conceal important tensions linked to the presence of bioethical principles underpinning these. Other normative ethical theories like deontology, virtue ethics and utilitarianism do not provide adequate guidance on the problem of social health inequities either.This paper explores if Bauman's notion of "forms of togetherness" provides the basis of a relational ethical theory that can help to develop a response to social health inequities of relevance to individual physicians. This theory goes beyond silence on the influence of social position of health and avoids amoral regulatory approaches to monitoring equity of care provision.The socially patterned nature of disease and illness is now a commonplace understanding of health [1]. Social disadvantage and vulnerability, differences in income, occupational group and status, quality of housing and level of education are not just distal and remote influences on the health of a community. The impact of such influences is felt by individuals, real patients who present in clinical practice. Each of us takes our place in the inequitable social gradient of health, embodying a lifetime of socially patterned resources, choices and relationships that create health and illness. The unequal lives of patients and the health effects of social disadvantage are thus a daily reality of medical care. The family physician particularly cannot avoid the effects of social disadvantage in their ongoing relationship with their patients. How to respond to these inequities is challenging and there is a lack of adequate ethical guidance on the matter.Primary care occupies a unique place in the effort to understand how physicians might respond to this issue as it is so closely linked to th