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Dependency and Domination: Disability and Caretaking

Given both the social nature of human beings and facts about human development and basic needs, it is inevitable that human beings will stand in dependency relations. Furthermore, the way in which social relations are organized structures the forms of dependency present in a society and the ways in which persons’ needs are met. Social relations in which persons depend on others can lead to social hierarchy, relationships of domination and subordination, rather than relationships of equality between persons and citizens. Given social hierarchies, those who are subordinated can be made dependent or more dependent given social roles and social practices. Genuine social equality requires structuring social and political practices and institutions so that relationships of unjust domination and subordination do not result from human dependency. That is, while dependency relations of various sorts will be part of any society, dependency relations should not create or derive from domination and subordination. Certain kinds of dependency relations are not compatible with justice as they are due solely to relationships of domination and subordination that deny persons status as equal moral person or as equal citizens. Other types of dependency relations are only just in social conditions that protect against social hierarchies that deny these statuses. Here we aim to extend Rousseau’s insights to the case of some persons with impairments and illnesses and to caretakers of others. These cases involve dependency and domination, though they are not the sorts of cases Rousseau had in mind.

Our analysis extends and differs from Rousseau’s in some important ways. First, we draw on Rousseau’s insights concerning the need for recognition respect and the way in which social arrangements can create and sustain dependency. However, regarding social institutions, Rousseau’s critique culminates in explaining how economic arrangements and private property create conditions in which some persons are unjustly dependent on others; thus, economic arrangements occupy a primary place in his view. Our concern with social institutions and practices and their relation to dependency and domination will have a broader focus.

Second, Rousseau conceptualizes subordination as being subjected to the will of another. There is an important historical context to his formulation of subordination, yet it is too narrow. While subjection to the will of another captures an important form of subordination, social subordination - as a form of inequality - extends beyond being subjected to another’s will.24 One important form of social subordination concerns the ways in which persons as members of groups can be subjected to various forms of social power, and this power is not always a direct function of some other will. The recognition that some persons are subordinated on the basis of group membership is not part of Rousseau’s critique with any depth. He does recognize the poor as a social class that is subordinated vis-a-vis the rich, but he does not theorize social groups, and their status, beyond that. Subordinated groups are subjected to forms of power that are not always the product of intentions or wills (Young 1990). Indeed, social norms, practices, and institutions play a crucial role in the construction of social groups and social identities, and, sometimes, these norms, practices, and institutions can embody, cause, and sustain social hierarchies among persons.

Third, we think it is important to recognize two ways in which unjust subordination manifests in social life. We understand the relationship of domination and subordination to be a status hierarchy in which those in the dominant position have greater power and authority than those in the subordinate position. The fact of status hierarchies is sometimes unjust, and when status hierarchies are based on group membership, they are almost always so. For example, status hierarchies based on race are always unjust, and, so, the manifestation of that status hierarchy itself is unjust. As we note in the introduction, we leave open the possibility that some forms of domination are not unjust. So, for example, it may be that teachers and students as well as supervisors and employees can be helpfully understood to occupy status hierarchies in which teachers and supervisors justly have more power and authority with regard to certain matters than students and employees. However, under just conditions, those hierarchies do not concern or affect persons’ status as equal moral persons or equal citizens. Rather, the status inequality concerns power and authority in a particular context in which the individuals occupy certain social roles. A full theory of unjust subordination is beyond our aims here; however, we draw on the rich insights of feminist theorists, critical race theorists,25 and others to note that group-based hierarchies based on sex or gender or sexuality or race or religion are, historically, primary instances of such subordination.

Unjust subordination also manifests in material inequalities among persons (although we note that material inequalities can prompt the construction of status hierarchies, too) (Dworkin and MacKinnon 1988, 39). Such inequalities can include a lack of access to or possession of material goods or power, marginalization from important social practices and institutions, exploitation, cultural exclusion and imperialism, and violence.26 While the distinction between these two ways in which subordination manifests itself is conceptually useful, they are intimately connected.

With these distinctions in mind, we show that (1) some persons with impairments and illnesses and (2) caretakers of others are often in dependency relations that are unjust subordination. These arguments draw on Rousseau’s key insight that social arrangements, and not difference per se, produce dependencies that can result in unjust subordination.

The way in which social norms construct relations of inequality, understood as domination and subordination, can be illustrated by comparing models for understanding disability. In the 1970s, the medical model of disability was widely accepted by members of the medical community and the public, and this model was reflected in law and policy in various ways. According to the medical model, (1) an individual with a disability is not able to function at the level of the species norm in a given environment because of some persistent biological property of the individual, and (2) when it is possible, this should be corrected or prevented. On this view, persons with impairments and illnesses were disadvantaged because of their biological differences from others. Although this model is still influential, many disability scholars and activists rejected it in the 1970s and 1980s as part of the civil rights movement for persons with disabilities.27 Two concerns important for subordination, as we have characterized it, follow from this model. First, the model itself relies on assumptions and characterizations that rank persons in a hierarchy. The assumption that someone with a disability has a property that is to be corrected and prevented, as a deviation (an inferior property), functions to rank persons with disabilities (difference) as inferior. Such “inferiority,” as it were, is a product of the ranking itself, not a product of differences in properties. Second, in application, both in medical and other contexts, this model can serve as a basis for denying persons equal power and status and other goods. For example, if persons with disabilities are viewed as inferior, practices that marginalize or exclude persons with impairments and illnesses may be viewed as fitting and not unjust. Such practices may themselves make persons with impairments and illnesses dependent on others.

Given the critiques of the medical model of disability, an alternative understanding of disability emerged: the social model.28 The social model of disability posits that (1) an individual with a disability has an atypical persistent biological property that, due to discriminatory social practices and institutions, results in impaired functioning, and (2) when possible and reasonable, discriminatory social practices and institutions should be reformed and inclusive accommodations for persons with atypical properties should be constructed. The social model makes important advances over the medical model, as we discuss in the following, but we do not think that the social model of disability or any model that reduces disability to a single dimension is plausible. A mixed model of disability sensitive to the relationship between the biological properties of persons and social institutions and practices is needed.

Importantly, however, those who defended the social model pointed to discriminatory institutions and practices in society as producing exclusion, marginalization, and dependency for some persons with impairments and illnesses. For example, when firms in the labor market are not required to make reasonable accommodations for persons with impairments, persons requiring such accommodations may be marginalized from some fields or excluded from the labor market altogether. Such marginalization and exclusion, while distinct from dependency and sources of injustice in their own right, can result in persons with impairments being dependent on others - such as family members or fellow citizens through government assistance - for the resources they need to meet some of their needs. Dependency in this context is not the result of difference. It is the result of social norms, arrangements, and institutions that organize social, political, and cultural life.

Also, consider other features of the social world that, depending upon their arrangement, can lead to subordination and dependency for persons with impairments. For example, when public transportation systems, places of public accommodation (such as parks, restaurants, stores, recreational areas, hotels, etc.), and places for education and employment are not accessible to persons who use wheelchairs, these persons are excluded or marginalized from important spheres of social life. They are denied opportunities and access to goods that others enjoy. And, they are made dependent on others. This exclusion, marginalization, and dependency make them subordinates; that is, it makes them second-class citizens who are not entitled to the same opportunities and access to goods as others. Their exclusion from public transportation, places of public accommodation, and sites of education and employment subordinates them; it unjustly positions them as subordinates in a social hierarchy. Their subordination also manifests in material inequalities, as they are denied access to goods, and in their dependency on others for access to many goods. Further, their subordination by exclusion, marginalization, and dependency results in others engaging with them in demeaning and paternalistic ways. For example, others fail to make eye contact with them, ask other adults about their needs and interests, and talk and interact with them as if they are children (using abridged and simplified language and paternalistic gestures). Such treatment is a denial of recognition respect from others. Persons with disabilities are not given proper standing and authority as equal moral persons and equal citizens when they are denied the opportunity to express their needs and interests and when others are assumed to have standing and authority over their interests and experiences.29

Among the lessons of our discussion here is that differences as such do not justify inequality understood as subordination. Indeed, those who benefit from social hierarchy may follow social norms and participate in social practices and institutions that further create or maintain differences. Indeed, Catharine MacKinnon emphasizes that central to understanding women’s subordination is that social hierarchy is responsible for creating many of the differences between men and women we observe (1989). As she holds, when inequality is viewed as only (the result of) difference, it is usually in the context of profound injustice.

Rousseau thought that the fundamental cause of inequality had to do with the relationship between dependency and domination and subordination, but he also thought that some dependency is simply part of social life given the human condition. He is clearly right about both. The dependency relationships that are part of any society depend, in part, on the social structure, and the conditions of all dependency relationships in a society are a matter of how society is arranged. And, so, Rousseau offers us the incredible power to see that while those who are dependent on others in the narrow sense (i.e., rely on others for self-care activities) are often thought of as a special case or unique problem for theories of justice, we are all in dependency relationships and our dependency on others varies in degree and in kind and changes over time. Dependency is not a special problem for justice but fundamental to properly appreciating the problem of justice itself.

An additional and important concern arises when appropriate weight and consideration are given to other facts of human dependency. This has been a central concern of many feminists in their discussions of dependency and justice. Namely, all persons at certain times in life and some persons throughout their life need material caretaking of various kinds and of varying degrees from others. Moreover, the work of providing material care to others is socially necessary work. Under current conditions, women perform much of that work, and much of it is not recognized as work, nor is it sufficiently remunerated, if it is at all. Thus, we now consider the ways in which caretakers, as providers of socially necessary work, are often made into dependents themselves.

This sense of dependency is layered: persons who require material care are dependent upon others, and those who provide care can be placed into unjust dependency relations in light of the social arrangements in which caretaking occurs. Of special concern is that the labor market is structured such that most jobs assume that workers are not the primary caretakers of one or more individuals. That is, most labor market jobs are not designed in recognition of the fact that a worker may be the person primarily responsible for making sure that, for example, a minor is adequately supervised, fed, clothed, and put to bed; receives routine and unexpected medical attention; receives care when sick; receives developmental or occupational therapy; gets to and from school; does her homework; and so on. Nor are labor markets structured to respond to the fact that workers might be primarily responsible for helping others, too, including a sibling with a profound cognitive impairment, a spouse or partner with a chronic illness, or an aging parent with various health problems.

A problematic feature of the labor market is that most participants lack either paid leave, sufficient paid leave, or sufficient flexibility in their jobs to care for others. Many labor market participants are expected to be available to work late at the request of a superior, even if given no notice, or as workload demands to meet deadlines. Moreover, traveling and relocation are simply the expectation of many jobs, are necessary for building a career in one’s field, or are required as the demand for skills in a specific locale changes. Given the expense of paid care, some persons who are responsible for caring for others, especially women given gender norms, reduce their labor market commitment; take less demanding, more flexible positions; or leave the labor market altogether.

Again, the design and assumptions that structure employment conditions and opportunities are not responsive to the fact that the work of providing material care to others is both common and socially necessary. Moreover, state-sponsored forms of assistance to reconcile, or ameliorate, the structural conditions of the labor market are not sufficient to prevent the exclusion and marginalization of those who are primarily responsible for providing care to others. As a result, many persons who are responsible for providing care to others become dependent on a partner or spouse for meeting their financial needs and the needs of those for whom they care. Caretakers may also be dependent upon their partners and spouses for social opportunities and community as well as opportunities for time for self-care or self-development, and a range of other important goods. Due in part to their financial dependency, caretakers also have a bargaining disadvantage in their relationship with the individual on whom they financially rely (Okin 1989; Sen 1990; Cudd 2006). They often defer to the person on whom they financially depend when it comes to various household decisions, and in the worst cases, they tolerate emotional and physical abuse, adultery, and demeaning spending allowances.

The situation is, in fact, much more complicated as, again, gendered social norms operating in the background culture suggest, for example, that good women are caring and sensitive to others’ emotional and physical needs and are responsible for caring for others. Good men, by contrast, excel at rational, disinterested bargaining and provide for their families.

The dependency of caretakers can constitute and lead to unjust forms of subordination. Such subordination may take the form of being subject to the will of the dominant partner, as Rousseau understands it. It can also constitute and lead to the broader understanding of subordination we have advanced. Insofar as the work of caring for others is not properly recognized as work, as caretakers are marginalized from significant aspects of the labor market as well as disadvantaged in their ability to participate in civil society and the political sphere, and as this results in their dependency, they are second-class citizens. This is a practice of subordination, a ranking of caregivers as inferior citizens, and it is a denial of recognition respect. Of course, just as not all of the injustices faced by persons with impairments and illnesses are matters of domination by dependency, so, too, not all of the injustices faced by caretakers are a matter of dependency. The fact that caretakers are excluded or marginalized in the labor market because they perform the socially necessary work of caring for others is itself an injustice. That many caretakers become financially dependent on others because they take low-paying, flexible jobs, take part-time jobs, or take leave from the labor market is a fact of our social condition, and this dependency results in subordination.

Justice requires that such institutions be restructured such that subordinating dependency is eliminated. We cannot offer a full account of the institutional change that is necessary; we rather simply aim to point out that institutional design and the way that institutions function together is a matter of basic justice.

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