Dignity and Health

Nora Jacobson

Description

In these hard times of global financial peril and growing social inequality, injuries to dignity are pervasive. "Indignity has many faces," one man told Nora Jacobson as she conducted interviews for this book. Its expressions range from rudeness, indifference, and condescension to objectification, discrimination, and exploitation. Yet dignity can also be promoted. Another man described it as "common respect," suggesting dignity's ordinariness, and the ways we can create and share it through practices like courtesy, leveling, and contribution.


Dignity and Health examines the processes and structures of dignity violation and promotion, traces their consequences for individual and collective health, and uses the model developed to imagine how we might reform our systems of health and social care.


With its focus on the dignity experiences of those often excluded from the mainstream--people who are poor, or homeless, or dealing with mental health problems--as well as on vulnerabilities like age or sickness or unemployment that threaten to make us all feel "less than," Dignity and Health recognizes dignity as a moral matter embedded in the choices we make every day.

Sujets

• Health Care Delivery
• Human Rights
• Medical
• Médecine
• Health

Informations

• Publié par: Vanderbilt University Press
• Date de parution: 15 septembre 2012
• Nombre de lectures: 0
• EAN13: 9780826518637
• Langue: English

Extrait

DIGNITY AND HEALTH
DIGNITY and HEALTH
Nora Jacobson
Vanderbilt University Press
NASHVILLE
2012 by Nora Jacobson
Published by Vanderbilt University Press
Nashville, Tennessee 37235
All rights reserved
First printing 2012
This book is printed on acid-free paper.
Manufactured in the United States of America
Library of Congress Cataloging-in-Publication Data on file
LC control number 2012003426
Dewey class number 174.2-dc23
ISBN 978-0-8265-1861-3 (cloth)
ISBN 978-0-8265-1862-0 (paperback)
ISBN 978-0-8265-1863-7 (e-book)
CONTENTS
Acknowledgments
Introduction: A Conceptual, Practical, and Moral Inquiry
1. Dignity Violation: A Universe of Human Suffering
2. The Structures That Deny Dignity
3. An Epidemiology of Damage
4. Dignity Promotion: The Ordinary Language of Respect
5. The Demands of Dignity
References
Index
ACKNOWLEDGMENTS
It has been a privilege to have had time over the last seven years to think and to write about dignity. I greatly appreciate the research funding I received from the Social Sciences and Humanities Research Council of Canada and the sabbatical support provided by the Mary Beck Professional Development Fund at the Centre for Addiction and Mental Health in Toronto. I thank Paula Goering for facilitating a leave I took during the first eight months of 2010 to write this book. I am lucky to have shared this undertaking with a number of talented students: Michael Chan gathered literature right at the beginning. Diego Silva wrote a paper with me close to the end. Andrew Koch made important contributions to the design and conduct of interviews and to the early stages of analysis. Vanessa Oliver, whose engagement was the most sustained, extending over a period of several years, was an indispensable partner throughout the project s data collection, initial analysis, and early dissemination phases. I hope Michael, Diego, Andrew, and Vanessa find some of their own intellectual enthusiasm and their compassion reflected in these pages. I am grateful to the people who assisted with study recruitment-for example, the agency managers who allowed us to post flyers or to use their spaces to conduct interviews. Many researchers and scholars have asked important questions or offered me good opportunities, and in these ways spurred me to do more careful and comprehensive work. I am thinking especially of Vanessa Johnston and Claire Hooker in Australia and Janecke Thesen and Kirsti Malterud in Norway. I thank all the people who attended conference presentations or seminars or my talks to service providers. I m sure their observations and questions taught me more than I ever conveyed to them.
I have also valued the contributions of family, friends, and colleagues. I would like to single out for special acknowledgment my mother, Dolly Jacobson, who saw from the beginning just how compelling a topic dignity is; Suzanne Ross, who listened so attentively to a synopsis of this book during a long, snowy training run we took in February 2010, and continued to ask about it even after race day; and Dale Butterill, whose question during an early presentation of my work in progress helped open up a whole new area for analysis. My association with Carrie Clark and the other members of the dignity working group at the Centre for Addiction and Mental Health showed me some of the ways in which my conceptual thinking might begin to be made practical. For their work during the publication process, I thank Michael Ames and his staff at Vanderbilt University Press, including managing editor Ed Huddleston, freelance copy editor and indexer Peg Duthie, design and production manager Dariel Mayer, and the two anonymous reviewers whose comments did much to improve my presentation of the material in this book. Finally, I would know very little about dignity without the generosity of the men and women who agreed to speak about it. This book will have been successful if it goes some way toward portraying the resonant complexity of dignity in their lives.
INTRODUCTION
A CONCEPTUAL, PRACTICAL, AND MORAL INQUIRY
Dignity exists in a state of some peril. It can be taken away. Men and women can be deprived of their dignity. The verbs people used when they spoke to us about dignity indicate that these threats come in many different forms. Dignity may be challenged or compromised or offended. It can be upset or undermined. It can be stolen, crushed, punctured, eroded, stripped, assaulted, or snuffed out. In some circumstances, it may be given away. People may posture, putting on a dignified face to hide a felt lack of dignity. Yet dignity is also malleable in positive ways. It can be achieved (from within) and cultivated or fostered (from without). Individuals or groups may act and interact in ways that dignify themselves and others.
Dignity is a human characteristic equated with real worth as a human being and the value of being a person. Dignity is the positive feelings I have for myself, self-respect, self-esteem, pride, and confidence and self-assurance. One has dignity naturally. Dignity is inborn, inherent in everyone, and something that everybody has inside of them. However, dignity also is something fluid : it exists in levels or stages, serving as an ever-shifting indicator of your place in the world.
The word dignified refers to the outward manifestations of this human characteristic. Dignity is demonstrated in poise - the way somebody carries their self, their speech. One woman I interviewed described an image of the person as a whole being . . . standing upright and, and intact. A man offered Audrey Hepburn as the picture of dignity: The way that she conducted herself-she was graceful, she was humble. Others saw dignity demonstrated in behavior, or manners and courtesy, and in behavioral control-a kind of stoicism in the face of suffering, and self-reliance under arduous conditions. In evaluating their own dignity and that of other people, the men and women we spoke with emphasized standards and values. To be dignified is to follow the same rules as everyone else, but also to act in accordance with your morals and what you stand for.
Dignity is not a commodity that can be purchased, we were told repeatedly, yet people were acutely aware of the ways in which their material possessions and physical appearance-visual cues like cleanliness, good teeth, upright posture, and neat clothing-figured in the dignity calculus of others who were assessing them. They also often seemed to look to the state of their own possessions and appearance as indicative of deserving dignity or of having failed to earn it.
In another sense, dignity is an attribute of action-doing something with dignity. The men and women we interviewed described the ways in which individuals may live (or die) with dignity. They spoke of being treated with dignity and treating others with dignity. At its root, they suggested, such treatment is about acting and interacting in ways that respect the worth and humanness of both the self and the other. One man called this common respect, hinting at not only the presumed ordinariness of dignity but also the ways in which dignity is necessarily something shared, created, and held in common.
Robert Fuller, who writes about rank and its discontents, including the myriad insults and injuries to dignity found in the hierarchical institutions that dominate contemporary society, has described the enthusiastic and heartfelt response of readers to his work, noting an iceberg of indignation out there of which we re seeing only the tip (2006, 4). Indeed, concerns about dignity (and indignity) run deep for most of us, and dignity talk is ubiquitous in our cultural conversations.
For example, dignity is prominent in the posted mission statement of Toronto s public transit agency. (Ironically, as it turns out, because in the stories we heard, Toronto s subways and streetcars were prime settings for dignity violation.) It is featured in CBC radio discussions of public policy prescriptions for aging at home. Dignity is highlighted in advertisements for services as diverse as cremation and veterinary care and also in solicitations for charitable donations. The concept dominates the appeals of social movements. The 2011 popular uprising in Egypt was dubbed the Dignity Revolution. European Union member states use dignity in their discussions of remedying social exclusion; there, the term appears to be a catchall synonym for the rights and privileges of citizenship: voice, recognition, participation, and dignified living. During the recent economic collapse, the president of the New York Public Library told the BBC about the many men and women who dressed in business attire and came to spend the day in the library s reading room. It was, he said, a dignified way of dealing with their unemployment (BBC World Service 2009).
Art copies life. Ben Kingsley s character in the 2003 film House of Sand and Fog is an Iranian migr and retired high-ranking military officer who dresses in an immaculate suit and tie each day before leaving an apartment he cannot afford to travel to his dirty job on a road construction crew. In the German novel The Reader (Schlink 1998), the narrator realizes that his former lover, on trial for her actions as a concentration camp guard, is illiterate. Her failure to properly defend herself at the trial, the circumstances of her employment as a guard, even some of her crimes-all can be traced to her attempts to maintain her dignity by concealing her inability to read and write. Dignity is the major theme of Kazuo Ishiguro s The Remains of the Day (1989), an exquisite portrait of the English butler Stevens as he looks back over the years of his life in service. Stevens contemplates dignity as