The moral significance of capturing micro-inequities in hospital settings

This paper illustrates and reflects on subtle micro-level events and practices that sustain and reproduce unequal relationships in healthcare encounters, and draws attention to their moral significance in two hospitals in the south Indian city of Chennai. Based on observational data and in-depth interviews with 16 surgeons, 11 nurses, and 36 patients and their family members between February 2016 and July 2017, it reveals how both victims and perpetrators normalize instances of micro-inequities, often failing to recognize or acknowledge them. The findings illustrate how the prevalence of micro-inequities varies between different medical institutions, and suggest that while subtle in nature, their effect raises concerns regarding dignity and respect for patients and family members. Drawing on existing philosophical analyses of micro-inequities, the study concludes that their production in hospital settings creates an institutional ethos that disdains and marginalizes patients and their family members. Further, it negatively influences the patient/family-doctor relationship and functions as a barrier to reflective patient-centered care.