Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-23T17:43:38.107Z Has data issue: false hasContentIssue false

Visions of utopia: markets, medicine and the National Health Service

Published online by Cambridge University Press:  02 January 2018

John Harrington*
Affiliation:
University of Liverpool

Abstract

Legislative restrictions on the sale of organs, gametes and surrogacy services are often seen as having no basis other than mere prejudice or taboo. This paper argues instead that they can be read as instances of a broader decommodification of healthcare provision established in Britain with the creation of the NHS in 1948. Restrictions on the marketisation of medicine were justified by Aneurin Bevan, the founder of the NHS, and by Richard Titmuss, one of its chief academic defenders, in distinctly utopian terms. On this vision, the NHS would function as a utopian enclave prefiguring an idealised non-capitalist future. This commonsense of post-war medicine was fatally destabilised by fiscal crisis and social critique in the 1970s. Influential commentators like Ian Kennedy developed an anti-utopian account of the real NHS and proposed legalistic and market-based reform. These reforms sought to dissolve the enclave, assimilating medical work and the NHS as a whole to broader systems of accounting and accountability. Insofar as they have been realised, they achieve a recommodification of medicine in Britain. The paper concludes by examining recent studies of the ‘new NHS’, which see in the latter-day idealisation of market processes a novel form of self-denying utopianism.

Type
Research Article
Copyright
Copyright © Society of Legal Scholars 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Bellamy, E Looking Backward 2000–1887 (Oxford: Oxford University Press, 2007) p 182.Google Scholar

2 See, respectively, Human Tissue Act 2004, s 32; Human Fertilisation and Embryology Authority Code of Practice, para 4.26; Surrogacy Arrangements Act 1985, s 2.

3 See, eg, S Wilkinson Bodies for Sale. Ethics and Exploitation in the Human Body Trade (London: Routledge, 2003).

4 See Hutchinson, AC It's All in the Game. A Non-Foundationalist Account of Law and Adjudication (Durham NC: Duke University Press, 2000) p 170.CrossRefGoogle Scholar

5 M Brazier, A Campbell and S Golombok Surrogacy. Review for Health Ministers of Current Arrangements for Payments and Regulation Cmnd 4068, 1998.

6 Respectively Surrogacy Arrangements Act 1985, ss 2 and 3.

7 Ibid, s 1A. Adoption arrangements are subject to similar control: Adoption Act 1976, s 57.

8 Human Fertilisation andEmbryology Act 1990, s 30(7).

9 See ‘Summary of recommendations’ in Brazier et.al, above n 5, pp 71–72.

10 Admittedly, there was no direct evidence of psychological harm to such children, but the potential for this demanded a precautionary approach from the state; see ibid, pp 32–33.

11 Ibid, p 35.

12 Freeman, M Does surrogacy have a future after Brazier?’ (1999) 7 Medical Law Review 1 at 5.CrossRefGoogle ScholarPubMed

13 Ibid, at 10.

14 See further Mason, JK and Laurie, GT Mason & McCall Smith's Law and Medical Ethics (Oxford: Oxford University Press, 7th edn, 2006) pp 105119.Google Scholar

15 Brazier et.al, above n 5, p 38.

16 Ibid, p 39.

17 Ibid, p 39.

18 For example, see: Van Niekerk, A and Van Zyl, L ‘Commercial surrogacy and the commodification of children: an ethical perspective’ (1995) 14 Medicine and Law 163 Google Scholar; Wilkinson, above n 3, ch 8.

19 McLachlan, HV and Swales, JK ‘Babies, child bearers and commodification: Anderson, Brazier et.al, and the political economy of commercial surrogate motherhood’ (2000) 8 Health Care Analysis 1.CrossRefGoogle Scholar

20 Ibid, at 10.

21 Thus the Review Team is charged with the ‘rhetorical ploy’ of contrasting its own ‘values and beliefs’ with the mere ‘opinions’ of its opponents: ibid, at 10.

22 For an overview, see Barthes, R The Semiotic Challenge (Berkeley: University of California Press, 1994 Google Scholar) ch 1.

23 Goodrich, P Reading the Law. A Critical Introduction to Legal Method and Techniques (Oxford: Blackwell, 1986) pp 171172.Google Scholar

24 Perelman, CH The Realm of Rhetoric (Notre Dame IN: University of Notre Dame Press, 1982) p 21.Google Scholar

25 Goodrich, above n 23, p 178.

26 Harrington, JA ‘Law's faith in medicine’ (2009) 10 Medical Law International 357.Google Scholar

27 Brazier et.al, above n 5, p 39.

28 Brazier, M Regulating the reproduction business?’ (1999) 7 Medical Law Review 166 CrossRefGoogle ScholarPubMed at 191.

29 McLachlan and Swales, above n 19, at 10.

30 Significantly they query the failure to include an economist in the Review Team: ibid, at 14.

31 Ibid, at 17.

32 For an overview, see Berridge, V Health and Society in Britain since 1939 (Cambridge: Cambridge University Press, 1999).CrossRefGoogle Scholar

33 See Jessop, B The Future of the Capitalist State (Cambridge: Polity, 2002).Google Scholar

34 For example, see Gray, J Black Mass. Apocalyptic Religion and the Death of Utopia (London: Penguin, 2008).Google Scholar

35 On the idea that ‘the NHS was a bottomless pit into which any amount of money could be poured without satisfying the demand for healthcare’, see Timmins, N The Five Giants. A Biography of the Welfare State (London, Harper Collins, 2nd edn, 2001) p 260.Google Scholar

36 See Levitas, R ‘Looking for the blue: the necessity of utopia’ (2007) 12 Journal of Political Ideologies 289 CrossRefGoogle Scholar at 300–301.

37 See Levitas, R The Concept of Utopia (Cambridge: Polity, 1990) p 178.Google Scholar

38 Jameson, F Archaeologies of the Future. The Desire Called Utopia and Other Science Fictions (London: Verso, 2005) p 16.Google Scholar

39 Kumar, K Utopianism (Buckingham: Open University Press, 1991) p 65.Google Scholar

40 See Polanyi, K The Great Transformation. The Political and Economic Origins of Our Time (Boston: Beacon Press, 2001) pp 174182.Google Scholar

41 Harvey, D Spaces of Hope (Edinburgh: Edinburgh University Press, 2000) p 160.Google Scholar

42 Ibid, p 160.

43 Ibid, p 160.

44 See Levitas, above n 37, pp 6–7.

45 Jameson, F, from ‘The seeds of time’ in Hardt, M and Weeks, K (eds) The Jameson Reader (Oxford: Blackwell, 2000) p 385.Google Scholar

46 Ibid, p 385.

47 See Levitas, above n 36, at 291.

48 Jameson, above n 38, p 4.

49 Sir William Beveridge Social Insurance and Allied Services Cmnd 6404, 1942.

50 This insight on style is drawn from Timmins, above n 35, p 23. Bunyan's millenial vision was a staple of radical political culture in England up until the early twentieth century, see Thompson, EP The Making of the English Working Class (London: Penguin, 1980) p 34.Google Scholar

51 Beveridge has been accurately described as a ‘non-socialist collectivist’, indicating the broad faith in planning at the time; see Rintala, M Creating the National Health Service. Aneurin Bevan and the Medical Lords (London: Frank Cass, 2003) p 16.Google Scholar

52 Timmins, above n 35, p 24.

53 For an overview, see Webster, C The National Health Service. A Political History (Oxford: Oxford University Press, 2002) pp 1230.Google Scholar

54 Carey, J Introduction’ in Carey, J (ed) The Faber Book of Utopias (London: Faber, 1999) p xiii.Google Scholar

55 Bevan, A In Place of Fear (London: Quartet Books, 1990) p 106.Google Scholar

56 Quoted in M Foot Aneurin Bevan – A Biography vol 1: 1897–1945 (London: MacGibbon & Kee, 1962) p 105.

57 Ibid, p 105.

58 Bevan, above n 55, p 99.

59 Rintala, above n 51, p 51.

60 Bevan, above n 55, p 112.

61 Titmuss, RM The Gift Relationship. From Human Blood to Social Policy (New York: New Books, 1997).Google Scholar

62 For example, see Rapport, FL and Maggs, CJ ‘Titmuss and the gift relationship: altruism revisited’ (2002) 40 Journal of Advanced Nursing 495 CrossRefGoogle Scholar; ; .

63 Abel-Smith, B and Titmuss, K (eds) The Philosophy of Welfare. Selected Writings of Richard M Titmuss (London: Allen & Unwin, 1987) p 191.Google Scholar

64 Titmuss, above n 61, p 306; see also Archard, D ‘Selling yourself: Titmuss's argument against a market in blood’ (2002) 6 Journal of Ethics 87 CrossRefGoogle Scholar at 90.

65 Kynaston, D Austerity Britain 1945–51 (London: Bloomsbury, 2007) p 543.Google Scholar

66 Jameson, above n 38, p 18.

67 Abel-Smith and Timuss, above n 63, p 269.

68 Ibid, p 269.

69 Ibid, p 275.

70 Ibid, p 270.

71 Ibid, p 270.

72 Ibid, p 274.

73 For further discussion, see Titmuss, above n 61, p 311.

74 Abel-Smith and Timuss, above n 63, p 273.

75 Ibid, p 274.

76 Klinck, D ‘This other Eden”. Lord Denning's pastoral vision’ (1994) 14 Oxford Journal of Legal Studies 25.CrossRefGoogle Scholar

77 Ibid, at 45.

78 See Tonsor, SJ ‘The conservative element in American liberalism’ (1973) 35 Review of Politics 489.CrossRefGoogle Scholar

79 For a philosophical perspective on this ‘alliance’, see Jacob, JM Doctors and Rules. A Sociology of Professional Values (London: Routledge, 1988) pp 181184.Google Scholar

80 Lawrence, C Medicine in the Making of Modern Britain 1700–1920 (London: Routledge, 1994) pp 7677.CrossRefGoogle Scholar

81 Williams, R Culture and Society 1780–1950 (Harmondsworth: Pelican, 1962) pp 2324.Google Scholar

82 ‘The genius of poetry must work out its own salvation in a man. It cannot be matured by law and precept. That which is creative must create itself’: J Keats ‘Letters’, quoted in ibid, p 61.

83 Marx, K Economic and Philosophic Manuscripts of 1844 (London: Lawrence and Wishart, 1970) pp 106119.Google Scholar

84 PB Shelley ‘A defence of poetry’, quoted in Williams, above n 81, p 59.

85 Ibid, pp 23–24.

86 Bellamy, above n 1; see W Morris ‘Bellamy's “Looking Backward”’ Commonweal 21 June 1889, available at http://www.marxists.org/archive/morris/works/1889/backward.htm.

87 Morris, W Useful work versus useless toil’ in Morton, AL (ed) Political Writings of William Morris (London: Lawrence and Wishart, 1973) pp 86108 Google Scholar at p 87.

88 W Morris ‘Art and socialism’ in ibid, pp 109–133 at p 129.

89 Morris, W News from Nowhere (Oxford: Oxford University Press, 2003) pp 3940.Google Scholar

90 It is the ‘change which makes all the others possible’: ibid, p 79.

91 Ibid, p 83.

92 Ibid, p 84.

93 See D Leopold ‘Introduction’ in ibid, p xvii. This reference to male workers is deliberate. Morris envisaged a continuing, if much more highly valued role for women as homemakers: see ibid, pp 51–53.

94 Morris, above n 88, p 118.

95 On Bevan's formation as a socialist and a trade union organiser, see Campbell, J Nye Bevan and the Mirage of British Socialism (London: Richard Cohen Books, 1997)Google Scholar ch 2.

96 For an overview, see Timmins, above n 35, pp 102–109.

97 Kumar, K Utopia and Anti-Utopia in Modern Times (Oxford: Basil Blackwell, 1987) p 99.Google Scholar

98 Ibid, p 100.

99 Harvey, above n 41, p 182.

100 Kumar, above n 97, p 100.

101 Timmins, above n 35, pp 328–341.

102 For an evaluation of Kennedy's role in creating British medical law, see Veitch, K The Jurisdiction of Medical Law (Aldershot: Ashgate, 2007) pp 825.Google Scholar

103 See Miola, J Medical Ethics and Medical Law. A Symbiotic Relationship (Oxford: Hart, 2007) pp 4046.Google Scholar

104 Kennedy, I The Unmasking of Medicine (London: Granada, 1983) p 48.Google Scholar

105 Ibid, p 48.

106 This part of the lectures relies heavily on the ‘medicalisation of life’ thesis developed by commentators such as Ivan Illich and Thomas Szasz; see ibid, pp 14 and 132.

107 Ibid, p 12.

108 Ibid, p 12.

109 Ibid, p 8.

110 Ibid, pp 13 and 22.

111 ‘Man has no more agonising anxiety than to find someone to whom he can hand over with all speed the gift of freedom with which he was born’: Dostoevsky, F The Brothers Karamazov (Harmondsworth: Penguin, 1958) p 298.Google Scholar

112 Kennedy, above n 104, p 28.

113 Boltanski, L and Chiapello, E The New Spirit of Capitalism (London: Verso, 2007) p 18.Google Scholar

114 Kennedy, above n 104, p 25.

115 Ibid, p 28.

116 Ibid, p 28.

117 For example, see Kennedy, I Treat me Right. Essays in Medical Law and Ethics (Oxford: Clarendon, 1988).Google Scholar

118 Kennedy, above n 104, pp 158, 119–120.

119 Ibid, p 154.

120 Ibid, p 152.

121 On this dimension of rhetoric, see Wander, P ‘The third persona: an ideological turn in rhetorical theory’ (1984) 35 Central States Speech Journal 197.CrossRefGoogle Scholar

122 Kennedy, above n 104, p 102.

123 Ibid, p 124.

124 Ibid, p 125.

125 See Montgomery, J ‘Law and the demoralisation of medicine’ (2006) 26 Legal Studies 185 CrossRefGoogle Scholar at 206.

126 Kennedy, above n 104, p 85.

127 For details, see ibid, pp 128–130, 179–180.

128 Ibid, p 121.

129 Pashukanis, EB Law and Marxism. A General Theory (London: Pluto, 1978).Google Scholar

130 CJ Arthur ‘Editor's introduction’ in ibid, p 13.

131 On the transition between these modes of production, see K Marx, Capital. A Critique of Political Economy vol. 3 (London, Penguin, 1981) 440–455.

132 Marx, K Capital. A Critique of Political Economy vol 1 (London: Penguin, 1976) p 178.Google Scholar

133 Marx, K Grundrisse. Foundations of the Critique of Political Economy (Harmondsworth: Pelican, 1973) p 163.Google Scholar

134 ‘This formal equality of distinct and different individuals is in exact homology with the equalisation of qualitatively different commodities in commodity exchange’: Miéville, C Between Equal Rights. A Marxist Theory of International Law (London: Pluto, 2005) p 88.Google Scholar

135 Pashukanis, above n 129, p 115.

136 Ibid, p 85.

137 For an insightful critique in this regard, see Jacob, above n 79, pp 165–172.

138 Leys, C Market-Driven Politics. Neo-Liberal Democracy and the Public Interest (London: Verso, 2001) p 189.Google Scholar

139 See Davies, M Medical Self-Regulation. Crisis and Change (Aldershot: Ashgate, 2007) pp 123-ff.Google Scholar

140 For an introductory discussion, see Davies, A ‘Don't trust me I'm a doctor – medical regulation and the 1999 Nhs reforms’ (2000) 20 Oxford Journal of Legal Studies 437.CrossRefGoogle Scholar

141 See Iliffe, S From General Practice to Primary Care. The Industrialisation of Family Medicine (Oxford: Oxford University Press, 2008).CrossRefGoogle ScholarPubMed

142 Quoted in Davies, above n 139, pp 299 and 305.

143 Ibid, p 320.

144 AM Pollock NHS plc. The Privatisation of Our Health Care (London: Verso, 2004) pp 201–202.

145 Ibid, pp 73–75.

146 Ibid, p 66.

147 Aldred, R ‘Nhs Lift and the new shape of neo-liberal welfare’ (2008) 95 Capital and Class 31.CrossRefGoogle Scholar

148 For example, see Heller, T Branson sees primary care as Virgin territory’ (2008) 71 Health Matters 14.Google Scholar

149 Department of Health Building on the Best. Choice, Responsiveness and Equity in the NHS Cmnd 6079, 2003, pp 23 and 63.

150 Ibid, p 12.

151 Ibid, p 13.

152 Ibid, pp 16–19.

153 Appleby, J, Harrison, A and Devlin, N What is the Real Cost of More Patient Choice? (London: King's Fund, 2003) p 36.Google Scholar

154 Timmins, N ‘A time for change in the British Nhs: an interview with Alan Milburn’ (2002) 21 Health Affairs 129 CrossRefGoogle Scholar at 130.

155 Department of Health, above n 149, p 48.

156 A Milburn Diversity and Choice within the NHS. Speech to the NHS Confederation 24 May 2002, available at http://www.dh.gov.uk/en/News/Speeches/Speecheslist/DH_4000764; D Blunkett ‘Time to slash NHS red tape The Sun 8 July 2008.

157 Walker, D ‘Vision of the future’ (2005) 51 Public Eye 8 Google Scholar at 9.

158 Reid, J Increasing aspiration and improving life chances’ in Fabian Commission on Life Chances Life Chances. What Does the Public Really Think about Poverty (London: Fabian Society, 2005) pp 3539.Google Scholar

159 Timmins, above n 154, at 133.

160 A Milburn Speech to the Fabian Society New Year Conference 17 January 2005, available at http://www.guardian.co.uk/politics/2005/jan/17/thinktanks.uk.

161 J Reid Choice Speech to the New Health Network 16 July 2003, available at http://www.dh.gov.uk/en/News/Speeches/Speecheslist/DH_4071487.

162 Timmins, above n 154, at 133.

163 See Kumar, above n 39, p 62.

164 Jameson, above n 38, p 16.

165 Ibid, p 16.

166 On the crisis and its resolution, see Glyn, A Capitalism Unleashed. Finance, Globalisation and Welfare (Oxford: Oxford University Press, 2007).CrossRefGoogle Scholar

167 Bauman, Z ‘Utopia with no topos’ (2003) 16 History of the Human Sciences 11 CrossRefGoogle Scholar at 14.

168 Ibid, at 16.

169 Jameson, above n 38, p 20.

170 Bauman, above n 167, at 16.

171 Ibid, at 22; emphasis removed.

172 Ibid, at 2.

173 Levitas, above n 36, at 298.

174 Harvey, above n 41, p 175.

175 Ibid, p 175.

176 Milburn, above n 160.

177 Reid, above n 158, pp 35–39.

178 Appleby at al, above n 153, p 14.

179 Boltanski and Chiapello, above n 113.

180 Ibid, pp 36–40.

181 Ibid, p 424.

182 Ibid, p 443.

183 Pollock, above n 144, p 29.

184 Ibid, p 112.

185 Jameson, F Postmodernism or the Cultural Logic of Late Capitalism (London: Verso, 1991) p 2.Google Scholar

186 Pollock, above n 144, p 113.

187 Aldred, above n 147, at 40–42.

188 Veitch, above n 102, p 42.

189 I Sinclair ‘All change. This train is cancelled’ London Review of Books 13 May 1999.