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The logics of choice and care in transition
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This talk examines how the requirement to offer choice to service users influences one particular transition across the lifespan, the transition into adult services for those with a long-term condition. Choice is considered to be both the outworking of enlightenment philosophy’s focus on autonomy, and an expression of neoliberal politics where services are shaped primarily by market forces. Theorists drawing on both Virtue Ethics and the Ethic of Care have proposed alternative approaches embedded within the assumption that interdependence is more important than independence, in particular Mol’s (2008) analysis of the logics of choice and care as they affect the way people with diabetes and their health professionals work together. While such constructionist perspectives on interdependence are gaining adherents, they have had little effect upon policy. This article examines accounts of the way parents, staff, and young people with relatively severe intellectual disabilities experienced and responded to the choice agenda as the latter left school. We draw on 3 cases from a longitudinal cohort study of 28 young people with complex intellectual disabilities including intractable epilepsy, selected in order to facilitate consideration of a broad range of issues. We conclude that acting out of a single value such as choice is unlikely to meet the needs of people who face complex situations. Acceptable outcomes may be more likely to emerge from a hermeneutic process which involves navigating backwards and forwards between the logics of choice and of care, with a view not to one position trumping the other but to their integration. Implications of this conclusion for services for people with ID, and possibly for those facing other long-term conditions, are explored.
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