Abstract

Empowerment is a widely used term in healthcare literature, policy and practice, but its meaning is often inconsistent and increasingly framed as an individual outcome linked to self-management, responsibility, and compliance. However, such framings risk oversimplifying empowerment and reinforcing neoliberal and paternalistic assumptions that place responsibility on individuals while overlooking wider relational, systemic, and contextual influences. Drawing on findings from constructivist grounded theory research with people affected by advanced liver disease, carers, and healthcare professionals, I propose that empowerment is not a fixed state or something that can be delivered by professionals, but rather a dynamic, relational process that exists on a continuum and frequently co-exists with disempowerment. Rather than being an outcome to be achieved, empowerment is enacted through everyday actions, relationships, resistance, and navigation of constraint across patients, carers, and professionals. The paper proposes a reconceptualisation of empowerment as relational, contextual, and co-produced, with implications for moving away from notions of empowerment as professional intervention or individual achievement.