Activity: Talk or presentation › Lecture and oral contribution
Dignity has come to play an increasing role in healthcare discourses, and has also become a healthcare policy-issue (Nordenfelt, 2009). For example, in 2011, both Sweden and Norway included the aim of digni-fied care services in their social service and health legislation. In Denmark, the 2016 national budget in-cluded a ‘dignity billion’ to promote dignity in care services for older people. Furthermore, all municipali-ties must develop a local ‘dignity policy’, and questions of dignity figure prominently in several national reform initiatives aiming to promote user-centred care practices.
This paper explores how dignity is articulated and pursued in two current initiatives to promote user-centred care in Danish care services for older people, and what implications this has for the work practices of care workers. Based on two ethnographic studies of respectively ‘reablement’ practices, and the use of ‘welfare technologies’, I will show how these attempts to create dignified, user-centred services trans-form care interactions between care recipients and formal care workers, and especially what has been termed the ‘bodywork’ of care (see Twigg, Wolkowitz, Cohen, & Nettleton, 2011).
In these initiatives dignity is articulated as closely related to older people’s increasing autonomy and inde-pendence of formal care – in Dahl’s (2005) words ‘a different form of retrenchment’. Bodily care is seen as a transgression of the care recipient’s bodily autonomy, and as related to the loss of bodily control of ‘the fourth age’ (Gilleard & Higgs, 2011), thus representing a threat to dignity in the form of autonomy. These articulations of (un)dignified care influence care practices in the sense that the bodywork of care becomes more distanced and ‘hands off’, and care workers withdraw from care recipients’ private spheres. These practices rely on increasing care recipients’ abilities to perform self-care (perhaps with guidance or relying on informal care from relatives), and on technological automation of care tasks (e.g. toileting).
However, these articulations of dignity do not stand alone. When care practices are closely examined dignity is also pursued as a question of cooperation and equality between care workers and care recipi-ents, as a question of de-objectification, as promotion of enjoyment and quality of life. In the studied care practices, care is thus ambivalently positioned as both a potential transgression and threat to dignity, and as a prerequisite for achieving it.