This paper examines the prevalence of the ideal of “independence” in intellectual disability care in the Netherlands. It responds to a number of scholars who have interrogated this ideal through the lens of Michel Foucault’s vocabulary of governmentality. Such analyses hold that the goal of “becoming independent” subjects people with intellectual disabilities to various constraints and limitations that ensure their continued oppression. As a result, these authors contend, the commitment to the ideal of “independence” – the “ethic of autonomy” – (...) actually threatens to become an obstacle to flourishing in the group home. This paper offers an alternative analysis. It does so by drawing on a case study taken from an ethnographic study on group home life in the Netherlands. Briefly put, the disagreement stems from differing conceptualizations of moral life. Put in the vocabulary of moral anthropologist Cheryl Mattingly, the authors propose to approach the group home more from a “first-person” perspective rather than chiefly from a “third-person” perspective. They then draw on Mattingly to cast the group home as a “moral laboratory” in which the ethic of autonomy is not just reproduced but also enacted, and in which the terms of (in)dependence constantly get renegotiated in practice. What emerges is not only a new perspective on the workings of the “ethic of autonomy” in the group home, but also an argument about the possible limitations of the vocabulary of governmentality for analysing care practices. (shrink)

Dependency is fundamental to caring relationships. However, given that dependency implies asymmetry, it also brings moral problems for nursing. In nursing theory and theories of care, dependency tends to be framed as a problem of self‐determination—a tendency that is mirrored in contemporary policy and practice. This paper argues that this problem frame is too narrow. The aim of the paper is to articulate additional theoretical ‘problem frames’ for dependency and to increase our understanding of how dependency can be navigated in (...) practices of long‐term care. It does so by way of an empirical ethical analysis of how care professionals tackle the problem of dependency in group homes for people with intellectual disabilities. The paper refers to these practices of mitigating the problem of dependency as ‘dependency work’, a phrase borrowed from Eva Kittay. The analysis of dependency work suggests that for care professionals, dependency is a threefold problem: one of self‐determination, one of parity and one of self‐worth. These findings suggest that patient autonomy cannot be a full solution to the problem of dependency in long‐term care relations. But they also show that dependency as such is not a problem that can be solved, as attempts to mitigate it only serve to tighten the dependency relationship further. This is the paradox of dependency work. (shrink)

Jacobson finds two distinct meanings of “dignity” in the literature on dignity and health: intrinsic human dignity and social dignity constituted through interactions with caregivers. Especially the latter has been central in empirical health research and warrants further exploration. This article focuses on the social dignity of people marginalized by mental illness, substance abuse and comparable conditions in extramural settings. 35 studies published between 2007 and 2017 have addressed this issue, most of them identifying norms for social dignity: civilized interactions, (...) non-stigmatizing treatment, treatment as unique individuals, being taken seriously, maintaining a positive identity, experiencing independence, relating to others, and participating in daily life. We argue that these norms belong to ideal theory, whereas we agree with Robeyns and others that improving practice is better served by non-ideal theory. Towards this end, we derive from the literature four building blocks for a non-ideal theory of dignity: avoid violations of dignity rather than seeking to promote it; dignity is not a goal to be reached; it requires ongoing effort; promoting dignity is a balancing act; contradictory norms can make it impossible to realize; and dignity can be undermined by organizational and discursive constraints. (shrink)

Broad Morals and Broad Reason: Reconciling inclusive ethics with psychological realism Many of today’s problems revolve around distance and proximity. Progressives argue that a universalist, inclusive ethics requires us to bridge distances in identity, space, and time. Conservatives object that such bridging is psychologically unrealistic: people of flesh and blood can only care about whom/what is close-by. Evolutionary and psychological research seems to corroborate this sobering view. Many researchers confirm that our intuitions (‘System 1’) are groupish and short-sighted, and largely (...) deaf to the appeal of rational universalism (‘System 2’). But not all agree. We distinguish four ‘evo-progressive’ attempts to reconcile evolution and psychology with a universalist, inclusive ethics. Singer and Pinker (1), Buchanan and Powell (2), and Sunstein (3) contend that a reason-based, inclusive ethics is psychologically feasible, but that such an ethics has to be thin, solely focusing on rights and no-harm. By contrast, Haidt (4) argues that an inclusive ethics should be ‘broad’, also encompassing moral domains like sacrality, loyalty and authority. This implies for him that it cannot be reason-based. We argue that a broad form of inclusive ethics can and should be reason-based, but that this requires a rethinking of ‘reason’. We show that the evo-progressives’ conviction that a rational ethics is by definition thin, results from their theoreticistic conception of reason. But reason can also have more mimetic-embodied or mythical-narrative forms. These do allow for a broad, rational, inclusive ethics that can motivate real people to include stakeholders that are distant in identity, place, and time. (shrink)

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‘Waar blijven de intellectuelen?’ vroeg Balkenende in het najaar van 2006 . Waar blijven die maatschappelijke wetenschappers die eens in de zoveel jaar met een nieuw boek komen dat Nederland een Spiegel voorhoudt en aan het Denken zet? Een doorwrocht wetenschappelijk, maar toch uitstekend leesbaar boek dat de opiniepagina's wekenlang beheerst en ons zelfbegrip voor altijd verandert. Waar blijven de nieuwe Bram de Swaan, Trudy Dehue, Cees Schuyt, Hans Achterhuis, Christien Brinkgreve, Anton Zijderveld of Lolle Nauta? Wie gaat ons waarschuwen (...) voor de gevaren van utopieën of protoprofessionalisering of ons aansporen tot kleine deugden ? (shrink)