Democracy and dilemmas of self‐determination

Abstract

Results from analyses of interactions in ‘user‐centred’ meetings within the Swedish rehabilitation sector are reported. Transcripts of team meetings are used to discern situations in which dilemmas of self‐determination versus paternalism may possibly need to be treated when the ‘user’ with impairment is to exercise his/her social citizenship. The analyses illustrate how the liberal ideal of self‐determination makes certain demands on the ‘user’. These demands are categorised as ‘physical presence’, ‘interpretable voice’, ‘purposeful voice’, ‘sincere voice’ and ‘realisable voice’. It is argued that dilemmas of self‐determination are impossible to avoid completely. To deal with the complexity of implementing self‐determination, it is important to try to adjust the preparations and the organisation of the meetings, increase user control of services provided, combine individualised support with collective and political action, and allow expressions of different models of democracy. The possibility of appreciating interdependence and justifying paternalistic actions also needs to be acknowledged.