Abstract
Jacobson (Social Science & Medicine 64:292–302, 2007) finds two distinct meanings of “dignity” in the literature on dignity and health: (1) intrinsic human dignity and (2) 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 (Social Theory and Practice 34:341–362, 2008) 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: (1) avoid violations of dignity rather than seeking to promote it; (2) dignity is not a goal to be reached; it requires ongoing effort; (3) promoting dignity is a balancing act; contradictory norms can make it impossible to realize; and (4) dignity can be undermined by organizational and discursive constraints.
Highlights
Concerns about dignity have been central in healthcare policies and research over the past decade, in the realm of public health (Winter and Winter 2018)
This article contributes to a non-ideal theory of dignity in public healthcare through an interpretative review of the empirical literature on the dignity of marginalized people as they receive treatment or support
Building on Leget’s claim that social dignity rests on “relational practices” (Leget 2013), we inductively examine which relational practices are deemed in the empirical literature to promote social dignity
Summary
Concerns about dignity have been central in healthcare policies and research over the past decade, in the realm of public health (Winter and Winter 2018). Health and dignity often intertwine because the experience of dignity is contingent on both how people view themselves and on how others see them (Leget 2013; Mann 2006). Ill health itself can undermine dignity by reducing control over one’s body, emotions and mental faculties, while the Despite the salience of dignity for people marginalized by their health or social status, dignity in public healthcare has received much less scholarly attention than in other areas such as end of life care (Chochinov 2002; Chochinov et al 2005) or intramural care (Gallagher et al 2008; Kane and De Vries 2017; Šaňáková and Čáp 2018). This article contributes to a non-ideal theory of dignity in public healthcare through an interpretative review of the empirical literature on the dignity of marginalized people as they receive treatment or support. We draw on meta-ethnography aimed at theory building (Dixon-Woods et al 2006; cf. Brookfield et al 2019; Flemming and McInnes 2012)
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