Conflictos éticos y acciones de resistencialos profesionales de atención primaria de Mallorca frente a los recortes en el Sistema Público de Salud

Abstract

In the context of the current economic crisis, and from a neoliberal approach, the Government of Spain enacted the Royal Decree (RD) 16/2012 claiming it would improve the efficiency of the national health care system. Consequently, undocumented migrants were excluded from healthcare, and pharmaceutical co-payment was introduced for the entire population. This situation created new ethical conflicts among primary healthcare professionals by regulating their actions in daily practice according to new principles. To explore this phenomenon, Michel Foucault’s theoretical framework was used in this research, especially concepts such as resistance and power. The specific objectives were to: (1) explore the perceptions of primary health care professionals in Mallorca regarding changes in the health system resulting from neoliberal policies and the implementation of RD 16/2012; (2) describe the ethical conflicts facing professionals due to cutbacks in the healthcare system and the implementation of RD 16/2012; (3) analyze the actions professionals take in these situations, exploring the factors that facilitate and/or hinder such actions; and finally, (4) analyze whether there are differences in discourse, conflicts, and actions between doctors and nurses. This study presents a critical discourse analysis of the content of the transcripts of two semi-structured sequential interviews with 13 primary healthcare professionals in Mallorca, doctors and nurses, during 2014. The results were divided into four categories: (1) perception of context; (2) ethical conflicts arising from cutbacks; (3) normalization and resistance actions; and (4) similarities and differences in professional discourse by profession. RD 16/2012 produced health exclusion, creating new conflicts among professionals, whose reaction involved struggle, disobedience and resistance against the norm, clandestinely caring for excluded groups and developing solutions to mitigate the impact of what is considered a form of state racism. Thus, resistance can be postulated as a new ethical competency for health professionals. In addition, the implications of Michel Foucault's ethics of self-care were explored for healthcare, management, education, and research implications.