Ethics at the 'kitchen-table conversations'; how informal care is framed in policy and practice.
Projectomschrijving
Samenvatting na afronding
In keukentafelgesprekken over een Wmo-melding kunnen zich tal van moeilijke keuzes voordoen over ondersteuning van hulpvragers die verband houden met verschillende onderliggende ethische waarden.
De overheersende waarde in de Wmo 2015 is die van het bevorderen van zelfredzaamheid. Deze waarde alleen biedt echter onvoldoende houvast bij het verhelderen, bespreken en besluiten over moeilijke keuzes over ondersteuning. Dat komt deels door de specifieke invulling die de waarde krijgt in het beleid: doe zo min mogelijk beroep op professionele hulp.
Daarnaast blijkt uit ons onderzoek dat in de praktijk van het keukentafelgesprek gespreksvoerders impliciet andere waarden meewegen, namelijk die van het respecteren van de keuzevrijheid van de cliënt en het voorkomen van schade (aan de cliënt en mantelzorger). Deze drie waarden zijnmet behulp van een literatuuronderzoek uitgewerkt tot een afwegingskader dat gespreksvoerders en anderen handvatten biedt bij het bespreken en aanpakken van moeilijke keuzes over informele en professionele ondersteuning.
Samenvatting bij start
Dit onderzoek richt zich op het zogenaamde ‘keukentafelgesprek’.
Het keukentafelgesprek is een gesprek tussen burgers en gemeente (in het kader van de Wmo), waarin samen wordt nagegaan wat een passende oplossing is voor de situatie van de burger. In het keukentafelgesprek wordt ingegaan op de behoefte van de burger, maar ook op zijn of haar eigen mogelijkheden en sociale kapitaal. In die gesprekken spelen verschillende perspectieven en waarden een rol. Zo hecht een burger mogelijk andere waarden aan informele zorg dan een mantelzorger of een ambtenaar. Het onderzoek moet leiden tot handvatten voor het omgaan met ethische dilemma’s die mogelijk een gevolg kunnen zijn van de verschillende waarden van betrokkenen. Daarbij richt dit project zich op de gesprekken met ouderen boven de 75 jaar. De uitkomsten van het onderzoek worden in wetenschappelijke publicaties maar ook in een toegankelijke video vervat.
Meer informatie
- Stappenplan: zo voorkom je ongemakken tijdens het keukentafelgesprek (Kennisplein Zorg voor Beter)
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Ethische discussies veranderen voortdurend (Mediator Special Ethiek 2017)
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‘Zelfbeschikking is méér dan zelfredzaamheid’ (Mediator oktober 2020)
Verslagen
Eindverslag
Samenvatting van de aanvraag
What is the problem? According to the new Social Support Act (Wmo2015) municipalities are required to ensure that people can stay in their homes for as long as possible. To achieve this, municipalities are supposed to look at what older persons and disabled can do for themselves and how family, friends or neighbours can help. During a so-called ‘kitchen table conversation’ a social consultant appointed by the municipality assesses a citizen’s needs for social support and domestic care. The social consultant maps out the citizen’s social capital during a kitchen table conversation. The new law has established a new formal standard of expected ‘usual care provision’. Care-needs that remain unmet by ‘usual care provision’ can be provided by volunteers and professionals paid, in part, by government subsidies through the Wmo 2015. However, the decentralisation is combined with a serious budget cut. The participation society that the Wmo2015 refers to is therefore just as much a policy ideal as an economic necessity. Why this project? The Wmo2015 is guided by moral assumptions about the roles of municipalities, citizens, their informal caregivers, and the nature of care, including ‘usual care’. However, informal care relies on ethically loaded commitments by informal caregivers. Informal caregivers and the receivers of care may not always share those moral assumptions and will act from their own value commitments. Municipalities’ social consultants have a policy-informed assignment but may simultaneously also have other roles and ethical commitments. The participants’ different ethical commitments may generate urgent tensions with the government’s yard-stick for defining ‘usual care’. Existing research predicts that the implementation of WMO undercuts (tacit and explicit) norms of reciprocity among care-givers and care-takers; that the new policy is insufficiently attentive to the role of shame and pride; and that it presupposes that most intimate, voluntary care is provided by those living together. Even so, the new policy can also be seen as a promising area of moral discovery. For, the kitchen table conversations, if properly handled, can, at the individual level, also be an occasion for the articulation of various needs, including moral ones. It can also lead to mutual recognition at the public level as well as a form of exploratory policy tinkering that will satisfy more of citizens’ care needs. What will this project add? In our project we will emphasize the opportunities for mutual understanding and recognition by generating tools (a video and an ethical alert sheet), that may help all participants to discover and articulate moral tensions during the process in order to generate better outcomes. We define better outcomes as outcomes that reflect the Wmo2015 central policy’s key concepts of tailoring, dialogue and a fitting outcome while respecting the right to self-determination and honouring as much as possible the different values ascribed to giving and receiving care and support. Our aim is to make the kitchen table participants more reflexive about their own moral aspiration and more sensitive to their interlocutors needs and roles. How is this done? The kitchen table conversations involve social consultants and citizens. At times informal caregivers will also be present. We will conduct Socratic group conversations with those who participate in kitchen table conversations. This method is useful in exploring and making explicit moral assumptions and values. To extrapolate and validate these findings we will conduct a focus group conversation with representatives and experts. An ethical policy evaluation will be performed to make the ethical norms in policy explicit. We will use the existing body of theoretical ethical knowledge to interpret and explicate our first findings and sensitise us to possible new tensions and solutions. Observations and interviews will be conducted to see in more detail how ethical tensions figure in practice and how these may currently be solved. In the final analysis the findings from all earlier activities will be used to generate a theoretical framework that leads to better outcomes. What are the project’s goals? The project has three goals: - To make explicit the moral commitments that enter into informal care from the citizen’s perspective and from the social consultant’s perspective; - To find ethical tensions and make these transparent; - To create reflexivity on these ethical tensions at the kitchen table and sensitise the various participants. This project leads to an innovative contribution to the academic debate on the ethics of care. It illustrates how the field can be applicable in a bureaucratising context. With involvement of the target group, the findings will be disseminated through an illustrative video as well as an ethical alert sheet that is available to the participants at the kitchen table conversation.