Department Citizenship and Humanisation of the Public Sector, University of Humanistic Studies, P.O. Box 797, 3500 AT, Utrecht, The Netherlands.
Med Health Care Philos. 2021 Mar;24(1):85-97. doi: 10.1007/s11019-020-09987-8. Epub 2020 Oct 27.
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.
雅各布森（《社会科学与医学》64:292-302, 2007）在关于尊严和健康的文献中发现了“尊严”的两个截然不同的含义：（1）内在的人类尊严和（2）通过与护理人员的互动构成的社会尊严。后者尤其在实证健康研究中占据核心地位，值得进一步探讨。本文关注的是处于社会边缘地位的精神病患者、药物滥用者和类似条件者的社会尊严。2007 年至 2017 年间发表的 35 项研究探讨了这一问题，其中大多数确定了社会尊严的规范：文明互动、非污名化对待、将患者视为独特个体、认真对待患者、保持积极的身份认同、体验独立、与他人建立关系、参与日常生活。我们认为这些规范属于理想理论，而我们同意罗比尼斯（《社会理论与实践》34:341-362, 2008）和其他人的观点，即改善实践最好采用非理想理论。为此，我们从文献中得出了尊严的非理想理论的四个基石：（1）避免侵犯尊严，而不是寻求促进尊严；（2）尊严不是一个要达到的目标，它需要持续的努力；（3）促进尊严是一种平衡行为；相互矛盾的规范可能使其无法实现；（4）尊严可能会受到组织和话语限制的破坏。
