A critical consideration of systemic moral catastrophe in modern health care systems: a big idea from an Arendtian perspective

In chairing the public inquiry into the recent events at the Mid Staffordshire NHS Foundation Trust, Robert Francis QC detailed what he referred to as the ‘appalling’ levels of care provided by multiple health care agencies and professionals, an absence of compassionate care that contributed to many ‘needless deaths’ and that was symptomatic of ‘a culture of complacency’ that focused on doing the system’s business, not that of the patients. However, while there has been subsequent incredulity at, and widespread condemnation of, the ‘morally reprehensible’ activities of health care professionals, there has been an absence of critical considerations in the health care literature that attempt to understand how so many practitioners came to carry out, contribute to or be complicit in such widespread and morally reprehensible activities. In an attempt to begin to address this apparent omission, and to stimulate further critical consideration in the literature, this paper will draw upon the work of Hannah Arendt, one of the most influential thinkers of the late twentieth century. In particular, it will propose that Arendt’s work can be productively employed to critically reflect upon how widespread participation in morally reprehensible activities can occur in modern health care systems - such as that exemplified by the events at the Mid-Staffordshire NHS Foundation Trust - as well as enabling the providers of professional health care education to begin to consider how they may contribute to the prevention of such widespread, systemic moral catastrophes in the future.