There has been, in recent years, an increasing emphasis on ‘choice’ for service users within long-term care policies in England and Japan. In both the two countries, ‘choice’ reflects ideological divergence in policy at a societal level. In England, an emphasis on choice is evident in ‘personalisation’ agendas which aim to increase choice and control through financial resources. In Japan, this emphasis on choice is seen in the ‘socialisation of care’, which embodies an attempt to increase the support systems of formal care services, with the intention of improving care for older people, and reducing social pressure on the family to provide care for older relatives. Considering these national contexts, as well as the local contexts of Bristol in England and Kyoto in Japan, my research explores how older people are exercising (and not exercising) choice in care practice. (See whole article from here: Ageing and Society, 36 (6) July 2016.)
Choice is widely understood as ‘rational decision-making’, which is based on the assumption of detached, self-interested individuals in an abstract context. In this paradigm, ‘exercising of choice’ is seen in terms of a particular ‘moment’, as a ‘fixed’ entity of material selection. However, empirical data from care practice in both England and Japan has highlighted the ‘relational decision-making’ of older people, acknowledging differing human relationality and the interdependency of fluid care processes in the two countries. (See more details from here)
In my research, I develop relations-based knowledge, reflecting the ethics of care perspective. One of the main findings of the research has been the importance of the ‘psychological aspects of choice’ through offering a relational understanding of the concept – an overlooked area of significant importance in dealing with choice in the care context, and highlighting a gap between current policy debates and research findings.
Using comparative methodology, I analyse empirical data from England and Japan through the theoretical frameworks of the (Western) feminist ethics of care, and Confucian care ethics, which enshrine Western and Eastern traditional moral values and reasoning. As relations-based moral theories, both the ethics of care and Confucian ethics provide critique of impartiality and rationality as the superior paradigms of moral reasoning. As such, they can be understood as posing a challenge to the neoliberal model of welfare service development. The comparative approach offers the advantages of developing insights into different cultural, political and moral concerns and types of human relationality in England and Japan, highlighting Western and Eastern contrasts. (For a detailed theoretical comparison between the ethics of care and Confucian ethics, see from here: Ethics and Social Welfare, 8 (4): 350-63.)
In international comparisons, a nation or country has generally been regarded as the unit of analysis. In existing cross-national comparative research on long-term care, there has been little emphasis on considering the views and experiences of older people themselves. Comparative researchers have tended to pay attention to developing discussions at the international level; however, it is crucially important to ensure that the experience, values and priorities of older people themselves, affected as they are by policy and practice, are adequately taken into consideration. In the light of this, my approach is layered and in-depth, taking into account the micro-dimension of older people’s choice in their everyday lives, as well as, policy, and cultural and historical dimensions at the macro-level. In doing so, I also look at the perspectives of a range of key players in the field of long-term care, including policy makers, care providers, social workers/care managers, and representatives of citizens’ groups and academics, in order to understand the various meanings of choice from different standpoints, and to reveal gaps in the understanding of choice between actors involved in the system.
‘Choice’ is widely understood according to neoliberal values, underpinned by market rationality. These values have become increasingly dominant, and are often uncritically applied within policies in general, and long-term care policies in particular. The understanding of ‘choice’ in this paradigm assumes ‘active’ policy-making, providers and user participation. However, it can easily ignore frail and isolated older people. Addressing the above points, my research offers conceptual and methodological advances, reflecting the ‘care’ paradigm in producing relations-based knowledge, underpinned by the ethics of care perspective, and supported by a critical awareness of prevailing neoliberalism in long-term care for older people.