Many health services repeatedly generate examples of staff treating patients dismissively, or with disdain, or behaving with arrogance or aloofness in ways that position people who use health services as subordinates or supplicants. These behaviours are particularly problematic and prevalent in the treatment of already socially disadvantaged groups. However, they are rarely tackled in healthcare improvement initiatives and hardly feature in discussions of equality in healthcare, which tend to focus on distributive patterns of health and of access to healthcare.
In this paper we suggest that socio-relational accounts of equality have as-yet untapped potential for normative analyses of healthcare, and particularly of the cluster of (often micro-) communicative behaviours associated with disrespect and superiority/subordination. Socio-relational equality focuses on how people view each other and relate to each other as equals. It can help illuminate that and why a discourse of equality that focuses exclusively on distributions of goods between patients goes awry in healthcare improvement contexts as it effectively aligns with Professor Henry Higgins from George Bernard Shaw’s Pygmalion as he tells Eliza "The question is not whether I treat you rudely, but whether you ever heard me treat anyone else better”.
There are clearly questions to be addressed about the application of socio-relational equality in professional healthcare contexts, but we will suggest it has significant generative potential for recognising and understanding the ethical relevance of healthcare relationships and ideas about person-centred care, including in the contexts of broader socio-cultural forms of disadvantage and discrimination.