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This thesis sets out to examine the place of patient choice in English health care, primarily within the National Health Service and in relationship to English law with regard to (a) informed consents and information and risk disclosure, and (b) confidentiality and privacy in relation to the access to and management of patient information. The analysis in underpinned with a limited review of the associations between choice and respect for individual autonomy. Health policy rhetoric has been laden with references to pro-patient choice in recent years and yet this research re-affirms that in law (still) it is the negative patient choice that carries weight in matters of consent to treatment. There is (still) no place for real demand. Similarly, in individual medical information access and management there is no sanction for demand, even negative patient choice is bounded. In both aspects of health care the ‘choices’ are (rightly) limited and can hardly constitute choice as the consumer-patient might see it. What the three papers contribute is the recognition that restrictions in patient choice are necessary; to be supported and for some individuals should be even more fettered than that of the general public in the interest of that general public. The papers examine the language of choice and find it lacking in transparency, with the reality dissociated from patient engagement, information dissemination and shared decision making; so compromising trust. If the health care system is to genuinely respect the individual autonomy of the capable adult and not utilise choice language as covert method of policy implementation, the language of what is on offer and why, the reasons for information acquisition and use and why, needs to be part of the patient-practitioner discussion as well as clarified in policy.

The work that is submitted here for the degree of PhD by publication comprises one book, one book chapter, and fourteen papers published in peer-reviewed journals. Many arise from qualitative research projects on which I was the appointed researcher. I am sole author on five of the publications, lead author on seven, and joint author on four. The publications span the years 1998-2007. They are included in full, and are examined, using Foucault's notion of 'governmentality', in an overview. The projects were designed and conducted during a particular era in history (characterised as 'risk society' or Yeflexive modernity'), dominated by a particular political ideology (characterised as 'neo-liberal'), and all examined aspects of public service delivery and use. Using Foucault's notion of governmentality, this body of research is concerned with questions of how we govern, and how we are governed, and with the relation between the government of ourselves, the government of others, and the government of the state. Foucault suggests that it is only through the analysis of various micro-sites that practices of power or governmentality might be identified. The research collected here represents a study of governmentality in the 'micro-sites' of welfare, (in this case, the provision and use of social security benefits); health care (the delivery and 'consumption' of NHS Direct, an innovative health care service); and education (in particular, the management of change in Higher Education, and the production of university learning, teaching and research).