Social dignity for marginalized people in public healthcare: an interpretive review and building blocks for a non-ideal
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Social dignity for marginalized people in public healthcare: an interpretive review and building blocks for a non‑ideal theory Jante Schmidt1 · Margo Trappenburg1 · Evelien Tonkens1 Accepted: 21 October 2020 © The Author(s) 2020
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. Keywords Social dignity · Public healthcare · Marginalized populations · Interpretive literature review · Non-ideal theory
Introduction Concerns about dignity have been central in healthcare policies and research over the past decade, specifically in the realm of public health (Winter and Winter 2018). Mann already argued in 1997 that public health would benefit from analyses of the “burdens on dignity which constitute the societal roots of health problems” (2006/1997, p. 1940). 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). When people are socially marginalized due to for example illness, substance abuse, poverty or homelessness, they are especially vulnerable to violations of their dignity. Ill health itself can undermine dignity by reducing control over one’s body, emotions and mental faculties, while the * Jante Schmidt [email protected] 1
Department Citizenship and Humanisation of the Public Sector, University of Humanistic Studies, P.O. Box 797, 3500 AT Utrecht, The Netherlands
requirements of treatment may restrict one’s freedom (Jones 2015). Marginalization is also often accompanied by social stigma which negatively affects both mental and physical health (Link and Phelan 2006). Despite the salie
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