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The New England Journal of Medicine


Medical professionals serve a number of “parastatal” functions, actions partly of and for the government: they sign birth certificates and death certificates, determine eligibility for disability benefits and paid sick leave, and fill other roles that intersect with the work of municipal, state, and national governments. The sociologist Pierre Bourdieu grouped these state functions into two main categories, which he called the “left hand” and the “right hand” of the state

In nations like the United States and the United Kingdom, the left hand of the state encompasses therapeutic services such as education, health care, food support, public housing, and social assistance that protect and expand life choices, providing relief to vulnerable people. The right hand of the state serves punitive functions such as justice, police, correctional, and regulatory operations that control deviance and enforce discipline. Understanding these two “hands” can help clinicians recognize and map the roles that health care professionals play when we mediate between patients and state organizations: Are we acting as an agent of a therapeutic form of governance (the left hand) or a punitive form (the right hand)?


Berlin, A, Koski-Karell, V., Page, K.R., Polk, S. (2019). The Right and Left Hands of the State – Two Patients at Risk of Deportation. New England Journal of Medicine; 381: 197-201. DOI: 10.1056/NEJMp1811607.


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