Abstract
The essence of caring for those in need of help consists in a certain relationality, in giving and receiving a certain relationship. The relationship as such is the protagonist of the care. It is a lifeworld relationship. What is lacking in today’s society is not so much material and technological resources, but rather the relational skills of welcoming, supporting and socially integrating people in difficulty. The care of the Other is increasingly entrusted to new technologies and impersonal welfare mechanisms, while interpersonal social relationships become increasingly weak, liquid and unavailable. The consequences are evident in the loss of social solidarity and in the degradation of the human condition. We need a social and cultural change which brings out, rather than concealing, the relational character of human needs and, correlatively, of the necessary response, which is realized only in the gift between caregivers and care receivers, that is, in the creation of a relational good between them. We still have a long way to go to understand what it means to say that caring for the Other lies in the qualities and causal properties of human and social relationships, and why it is necessary to make care services relational.
1. The topic and the approach: understanding the relational meaning of care
Caring for others, whether individuals or social groups, consists in a certain relationality, in giving and receiving a certain social relationship. The material help that is given to those in need is certainly important and often decisive for the fate of people, but taking care of the Other consists in the specific qualities and causal properties of the relationship established with the person.
It is the relationship that gives meaning and quality to care, because all requests in conditions of need are requests for embodied relationships. In the relationship, all human dimensions are present, the physical, psychological and spiritual.
Caring for the person implies giving meaning to the interpersonal relationship with the Other in order to respond to the ultimate value of life,[1] and yet this sense is formed and regenerated through the bodily relationship between people in a precise sociocultural context. C. Mora and J. Rivera, for example, presented the results of a study on how mothers with children suffering from degenerative pathologies develop a sense of care in their own bodies and through their own bodily relationship with their child, within a specific cultural context.[2]
I propose to explore this perspective, which I call relational as it is based on a social ontology, an epistemology and practical intervention methodologies that have their fulcrum in the understanding and management of interhuman and social relationality. Its fundamental assumption is that being a person is possible only in the relationship with the Other, as that which goes beyond the individual being and makes it possible.
The word ‘relationship’ is on everyone’s lips, scholars and ordinary people alike. However, ways of understanding what relationship really is differ greatly. There are those who treat the relationship as a variable factor derived from subjective states of mind, without understanding the reality and internal dynamics of relationality. There are those who try to ‘fix’ objective typologies and taxonomies of relationships that run the risk of reifying relationships. Moreover, in the last decades theories have emerged that conceive relationships as mere events, pure interactions, structureless transactions, which I call relationalist theories.
Unlike all these approaches, I propose a generalized theory of the relationship which, unlike positivists, seeks to understand the relationship in its own sui generis reality, by entering into the relationship and showing its internal dynamism, so as to be able to identify the peculiarities of every relationship, particularly in the case of new forms of disability.
The perspective I am speaking of is justified by the fact that it is social relations that ‘constitute’ the human person in her identity. In fact, people are subjects who generate relationships, but at the same time they are generated by relationships with others. Care is a relationship in this sense. We need to understand the specific qualities of the relationship between the caregiver (formal or informal) and the care receiver[3] at the same time. Here it is important to distinguish what I call “the order of relationships”[4] with respect to the order of interactions mentioned by Erving Goffman.[5] Social relations are a reality that arises from interactions (contingent events), but they have their own consistency and dynamic structure that defines the identity of the subjects in relation.
The ontological basis of this distinction lies in the fact that there are three orders of reality: the order according to substance (the substance of human persons), the order according to accident (the contingency of interaction), the order of relations (the structure of their exchanges).[6] Each of these orders of reality has its autonomy.
The originality of the relational perspective consists in the fact that it considers care not only as an expression of the commitment of individuals as such (the caregiver and the care receiver, considered for their individual qualities), nor as the result of an efficient organization of services, but above all as a way of living interpersonal relationships in situational contexts in which Ego meets an Alter in need of help. it is necessary for the fragile or disabled person to be supported by a network of people in her lifeworld.
Personal commitment of Ego and efficient organization of services are necessary but not sufficient requisites to carry out a care for the Other that qualifies as a good practice. In order for it to be such, the relationship between caregiver and cared for must have a sui generis form and content.[7]
At the basis of this perspective there is a fundamental ontological and epistemological assumption, according to which it is the relationship with the context that expresses, and at the same time constitutes, the person together with her needs. We must be able to see this when we observe the interaction between the person who is in need and the one who is called to help her. Each person defines and enters the relationship in a certain way, with a certain identity, and leaves it with another identity. Care is a relationship that changes the people involved.
For example, in the story of the good Samaritan (Lk 10, 25-37), the three protagonists (priest, Levite, Samaritan) enter the scene with their own identity, and leave with another. The priest represents the Law and therefore should identify himself with the Torah, but his identity comes out defeated and without dignity, because the priest avoids the person massacred by the thieves (“when he saw him, he crossed over to the other side”). The Levite represents the prophets, and therefore should be the bearer of a prophetic identity, but this identity disappears, because the Levite escapes the prophecy (“he saw the man beaten by brigands and passed on”). The Samaritan, on the other hand, enters with the identity of a common person and leaves as a saviour.
The encounter with the person in need, willy-nilly, never leaves one indifferent, due to the fact that the relational context of the meeting has an emerging effect on whoever is involved. The effect can be positive or negative. Since the relational context of need demands a response, it always tests the person’s ability to respond in a more or less virtuous way.
When we meet the person asking for help, we cannot remain morally immune from the experience of this relationship. The encounter with the Other in need of help is an opportunity to realize our humanity or it results in a loss of humanity. In any case, after having met the needy, the awareness emerges in ourselves that we have seized, or instead of having missed, the opportunity to generate a relational good with the Other.
2. The relationship is the foundation of care
Taking care of the Other, in the broadest sense of the term, i.e. understood not only as cure (that is, the provision of a technically qualified service), but above all as care, i.e. taking charge of the person as such, and not just of a particular need, is a relationship. Saying relationship means seeing care as the product of the reciprocal action of the caregiver and the care receiver.
Indeed, one cannot take care of the other if, first, one does not take care of the relationship with the other, and of the relationships that the other has with the world. The COVID-19 pandemic has revealed just this to us: before dealing with the disease caused by the virus with healthcare services, we had to take care of relationships as such, maintain the ‘right distance’ with others. Relationships can cause disease, as well as remedying it.
Generalizing, we can say that it is in the relationality between people in a given social context that a condition of need is generated, and it is in that context, or by changing the relational context, that the right way of solving the problem must be sought. This is valid for all conditions of need, for the poor, the sick, the lonely person, the disabled.
Focusing on the relationship as the foundation of care does not mean diminishing the importance of people’s subjective factors, i.e. their good intentions, wills and feelings. It means understanding that these aspects are true and authentic if and to the extent that they materialize in the relationship. It means adopting a relational anthropology, passing from an individualistic personalist vision to a personalism centred on the relationship, because the person does not transcend herself in her single act (the performance), but in the relationship. In fact, in the single act the person remains herself, even if she tries to surpass herself in order to seek greater perfection. It is only in the relationship that she becomes a good Samaritan, without this meaning diminishing the importance of generosity and personal dedication.
If it is true that the relationship is the foundation of care, the problem that arises is that of situations in which relationships are problematic, have a deficit or are even rejected or distorted. How to relate to the sick person who does not want to be treated? How to relate to those who want to sleep on the street and refuse the offer of shelter?
In these cases great competence is required in knowing how to manage relationships with the person in whom we see a need while she refuses help because she identifies with her condition and does not want to change it. We should learn the ‘art of relationality’.
This art was asked of us during the Covid-19 pandemic, when interpersonal relationships were reduced or banned due to lockdowns. In these situations, unlike the previous ones, people wanted relationships, but relationships were forbidden or minimized. How do you organize a care service, which requires human relationships at all levels (micro, meso, macro), if caregivers are deprived of human interaction? And what about when the patient is entrusted to a machine?
Whatever the need and the help requested, we see that the problem of care coincides with the problem of human relationships. A surplus of relational competence is required: these are the caring relational skills. These skills can only be nurtured with more personal and relational reflexivity. To humanize the care of the Other it is necessary to know how to read relationships and know how to deal with them even ‘acting at a distance’ or by means of technologies. As far as the latter are concerned, they must be evaluated according to the relationships they favour or inhibit
3. What the COVID-19 pandemic has taught us
The pandemic has taught us many things about caring for the Other, but I will mention just a few:
(i) it showed that social relations are not accidental elements of little importance, but are entities endowed with their own and sui generis reality; this reality is demonstrated by the fact that they have a profound effect on our lives; relationships have specific causal properties;
(ii) it redefined the meaning of the disease, of care and of the modalities of care as relational problems;
(iii) it showed that if caring relationships are reduced to role relationships, this generates a dehumanization of people;
(iv) and it also made us understand that the ‘right distance’ between people is not a physical quantity, but a relational quality.
I would like to say something more about these teachings.
(i) The pandemic has been an epiphany of relationships. It revealed to us the importance of social relationships. Before the pandemic, we gave little importance to relationships, in the sense that we took them for granted. With the pandemic we have learned that relationships have their own reality, somewhat independent of the intentions of individuals, and we can no longer consider them as a reality available to us.[8] The dynamics of infections taught us that health and disease depend on our relationships. We may have good intentions in acting in a certain way, but the relationship that comes out of our actions can have different effects than we expected.
Saying that the relationship exists (in the Latin language ‘ex-sistere’ means ‘standing out’, having one’s own autonomy with respect to the terms of the relationship, therefore standing out from the people who generate the relationship) involves acknowledging that the relationship has its own order of reality, that is, its consistency. The relationship is generated by people, who are indispensable, but it doesn’t consist of people. It consists of symbolic references that become a link between people, i.e. between the caregiver, formal or informal, and the person in need. The caregiver must be able to recognize this reality, that is, he must be able to see the Other in the relationship, with the relationship, through the relationship.
(ii) The pandemic has shown us that our Western systems of organizing care are generally oriented towards individuals rather than their relationships. Our entire welfare system is geared towards people as if they were individuals, while we need social and health care services that are not geared towards the individual as such but towards the social networks (family, relatives and networks of friends) in which he lives. Social needs, from various forms of poverty to multiple dependencies, are generated by social networks that generate pathological social relations and, therefore, to respond to social problems, care services must modify the social structures from which the problematic nature of social relations derives.
(iii) The pandemic has taught us that limiting or even eliminating physical interpersonal relationships, to leave care to the formal role relationships of health care systems, produces a profound sense of dehumanization. Care implies a balance between role relationships (formal) and intersubjective relationships (informal). In any case, care requires intersubjectivity, even if not necessarily a physical attachment in the strict sense, given that it is rather a question of how to manage the care relationship even at a distance, with gestures and communications of help.
(iv) The pandemic has taught us that in an adequate culture of relationships the notion of the ‘right distance’ between people is important. This notion was understood as physical distance, which meant isolating grandparents, locking the elderly in protected social and health care structures, with disastrous consequences on generational relationships and a certain dehumanization of care. The fact is that physical distance must be distinguished from social distance. Often people do not perceive the difference. Physical distance is quantitative (N meters), while social distance is qualitative and relational. It is possible to have caring relationships on the level of social relationality without necessarily being physically in contact. Even if the imperative is to keep physical distance from others to avoid evil, it must be understood that physical distance depends on social distance, and not vice versa. If Ego is aware of the relationship and acts in the relationship, then he can take the right physical distance, otherwise the physical distance will be out of control.
4. Care is a gift to the Other and the gift is in the relationship
4.1. Be to care
The expression “be to care” refers to a conception of the nature of the human person as a relational being. Being the subject and recipient of care reveals the quality of human essence that is unique among living beings. Non-human animals also take care of their young, but they don’t do it ‘relationally’ as humans can.
We can all agree with Martin Heidegger when he states that our existence (our Dasein) is preconstituted by the fact of existing with others, that is, by coexistence (Mitdasein). His fundamental thesis is that being-with determines being-there, always and necessarily, even in the case in which the other is, in fact, neither present nor known. Feeling of being-alone, wanting to be alone or posing to be alone, is a defective way of being-with in the world.
Unfortunately, however, in Heidegger’s philosophy, the Mitdasein, as an a priori ontological structure of human existence, is somewhat formal, and anthropologically translates into indifference towards the Other.[9] It follows that the human person is described as a subject who lives a ‘loneliness without relationship’ and a ‘monological existence’, therefore incapable of a true interpersonal relationship with the Other, with a You. For Heidegger the relationship is only a vehicle of thought, nothing more.[10]
I quote Heidegger for the enormous influence he had on the entire culture of the 20th century. In fact, this vision still persists, aggravated by the use of new technologies.
On the contrary, the Christian vision indicates in coexistence, in being-with-and-for-the-other, the reality of a relationship – original and generative – between human beings which is ‘given’, that is, has a giving character. Life is received as a gift and must be reciprocated as a gift. Reciprocity is the essence of human relationality. This reality, seen in the light of the Trinitarian conception of being as intrinsically relational, has enormous consequences on the level of secular daily life. It implies that people cannot live without interdependence and mutual exchange. However, relationships that implement interdependence and exchange can have very different qualities.
Care is the relationship that most corresponds to the original and generative sense of being together in the world, since the exchange that takes place between the caregiver and the assisted has its essential and specific quality in the fact that the relationship is given and received regardless of any other consideration and motivation other than meeting the Other and being with him. Such is the gift, an expression of pure original reciprocity as a symbolic exchange between human beings who recognize themselves as such.
What is care? It is an opening to the Other as the bearer of a need that first of all asks for acceptance, recognition, involvement.
Certainly, as Heidegger says, “caring is a way of being with the other that does not respond to the logic of duty but finds a generative reason in feeling needed by the other; a need is felt in the other who calls us into the field in the first person”.[11] For him, however, care has its being in the inclinations, projects, illusions of individuals, and therefore has neither a relational meaning nor a relational structure. The relationship is supposed to exist because of temporality.[12]
In the Christian vision, instead, the response to the need of the Other is human to the extent that it reflects the structure of a social relationship which, by nature, binds, connects, the co-existing. It is activated in need and is mobilized by subjective moral sentiments, but it has its own reality because it consists in the common origin and destiny of the fraternity. The ontological relationship of fraternity goes far beyond the fact that, faced with the needy, the person feels the moral need for a response, as Heidegger says. Fraternity is what substantiates and articulates moral responsibility by attributing to it a non-subjective meaning (contrary to the idea, supported by Emmanuel Lévinas, that personal ethics of duties towards the Other comes first and replaces the ontological reality of fraternity as a relation).
4.2. Care must overcome the fear of otherness
At the core of what makes humans, and their behaviour, social, is the interplay between self and other. Who is the Other we are talking about in terms of care? I use the word ‘Other’ to indicate someone who presents himself to us in a condition of weakness, disadvantage, fragility, poverty, marginalization and therefore puts us in front of an otherness – that is, a difference/diversity – which can raise feelings of anxiety, sometimes even fear, and which nevertheless asks for recognition, acceptance and taking charge. In the interaction between the Self and the Other, the identity of both and their inner conversation are brought into play.
Taking care of the Other therefore means facing an otherness in a double sense: first, because it is a question of overcoming the border, sometimes the wall, which divides us, and the fear that the Other can arouse; and then it is a question of validating and also thanking the Other for an identity different from ours.
Lack of recognition can lead to serious repercussions and consequences, which translate, on an individual level, into a reduced way of being, into feelings of exclusion, and, on a social and political level, into tensions and conflicts. For this reason, the care relationship refers, willingly or unwillingly, to power relationships.[13]
If I maintain that giving the relationship is the first act of recognition of the Other, I am stating that taking care of the Other implies on the part of the caregiver the renunciation of the exercise of a power that is necessarily assigned to him by the asymmetrical position and dependency in which the latter is found. While care implies the adoption of a relationship of subsidiarity towards the Other.
What is at stake is the real presence of the Other. It is not the presence of someone who plays a social role, but that of an Other person who is unique, who is here, hic et nunc, with his history and his needs and desires, and cannot be ‘labelled’, it cannot be traced back to some conceptual or spiritual category, nor can it be stigmatized. It must be seen with/through/for the relationship, i.e. with a relational gaze.
The reconstruction of the identity of the suffering person, in need of help, ill, or simply in difficulty, is true if it is also the reconstruction of the identity of the carer. This happens because, if otherness is experienced as an encounter, if it is a true relationship (i.e. reciprocal action), it always involves a certain reciprocity, even if it is asymmetrical. In relating to Alter, Ego experiences Alter’s action on himself, and this forces Ego to relate to himself again in his inner conversation. He must re-act on himself in order to be in relationship – i.e. reciprocate – with Alter.
Even before the relationship brings something with it, in terms of performance, it is the spirit of the gift that animates the relationship. Spirit is signified in how one relates to another. It has rightly been said that taking care of the Other means “enlarging the heart”. How does the heart expand? It is not an operation that the person can do by herself staying in her own intimacy, because the heart expands with relationships, that is, by opening up to the relationship with the Other. This openness feeds on subjective feelings, but becomes a real relational reality only when it translates into living a we-relationship between caregiver and care receiver that involves their life contexts.
5. Understanding relationships and knowing how to manage them
5.1. Three ways to read relationships
If the world of social relationships, as the pandemic has taught us, has its own existence, i.e. it ‘exists outside’ of the people who generate them, then we ask ourselves: what are social relationships? How can we understand and manage them? And what is the relationality that characterizes taking care of those in difficulty?
When we speak of a social relationship, we must think of it neither as a projection of the ego nor as the product of social structures. I propose to read it according to three semantic modalities (refero, religo, emergent effect).[14]
(i) The relationship is above all a symbolic reference. This meaning of relationship comes from the Latin refero, which means to refer something (a need) to someone (the person in difficulty). Relating to an Other means taking the Other as a symbolic reference that identifies him in a certain way, for his specific need. In one respect, the image of the Other is a cultural construction. The caring relationship is a particular form of otherness in which the Other is symbolized for the need it presents. If he is a poor man, what poverty does he suffer from? It takes expertise to answer this question.
(ii) Beyond the psychological-symbolic aspect, the relationship presents itself as a social bond. In referring to each other, the one who gives help and the one who receives it interact and thus generate a connection that, in some way, binds them (religo). This bond is partly due to the roles they occupy (for example doctor-patient), which depend on the context of the social structure in which they find themselves, and partly it is their creation as a stabilization of mutual expectations. For example, the relationship of helping the blind person who has to cross the street creates a bond that is different from offering accommodation to a homeless person within a voluntary organization for some time. In the first case, the bond is contingent and tenuous, while in the second case the bond is stronger because it is formed within an organized structure.
(iii) The relational paradigm, however, goes further. It indicates an aspect that is difficult to grasp, but is the most decisive for managing the effects of the helping relationship on the people involved and their surroundings. In short, it is the fact that the reciprocal reference and the bond, combined together and repeated for a certain period of time, generate an emergent effect with its own reality and causal powers with respect to those of the caregiver and the care receiver. These causal powers influence both the giver and the receiver of help, as well as the people close to them. For example, a relationship of trust is created which has different effects depending on whether the needy person perceives it as conditioned or unconditional, regardless of the caregiver’s intentions. The emerging effect can have a more ephemeral impact or a stronger and more stable one, depending on the number of interactions and on the characteristics of the context. In any case, the emergent relationship has externalities, which can be positive or negative.
To understand what an emergent effect is, an example may be useful. One often wonders why a couple of good parents, who individually are excellent people, can have problematic and deviant children, for example drug addicts, bullies, or with some mental pathology. The reason is that children don’t learn so much from the caring relationship that the father and mother give them individually, even if they are good people; they learn from their relationship as a couple. If the children are problematic, most likely the cause must be sought in the parents’ couple relationship, which was not working well, was not very mature or lacking as a relationship. This is why I tell parents: if you want to understand your children, look at your relationship! The relationship is an emergent effect that arises from you, but goes beyond you.
Two things should never be forgotten. The first is that the child’s personal identity resides in the relationship between those who generated it. What generates are not two individuals as such, but their relationship. This is the point to understand: what qualifies the generation of a child as human is the male-female structure and the intersubjective quality of this relationship.[15] The second thing is that, as the saying goes, “there are loves that kill”. The teaching is clear: it is not enough to love; we need to see what relationship results from our feelings.
5.2. Managing relationships
On the basis of the previous considerations, we can say that good management of the helping relationship involves: (i) seeing it as the product of reciprocal actions between Ego and Alter; (ii) avoiding labelling or stigmatizing the person in difficulty; (iii) accepting a bond that can only continue on the basis of mutual trust and recognition; (iv) reflecting on the emerging effect, to evaluate and modify it from time to time.
Each action has its own goals, its own means to achieve the goals, its regulatory rules and its own basic value attributed to the action itself.[16] The social relationship is also made up of these elements which, however, are not supplied by one or the other subject, but rather result from a particular relational combination of the elements sustained by individual actions. The relationship between Ego and Alter intertwines in a complex (cum plexus) the ends, the means, the norms, the values of both according to different relational modalities that must be understood on a case-by-case, situation-by-situation basis.[17]
In the example of two good parents with problematic children, they should ask themselves how their goals-means-rules-values combine in configuring their couple relationship, which is both conjugal and parental. Likewise, the caregiver should ask himself how his goals-means-rules-values combine with those of the care receiver if the two are to achieve a good helping relationship.
Based on these considerations, taking care of the Other is certainly not just making a benevolently symbolic gesture or giving alms to someone, but it involves knowing how to read and manage a social context in which relationships are the protagonists. Even when the help consists in advice, the advice should be the result of a relational analysis of the problem.
6. Care is a relational service that creates relational goods
6.1. Care as a relational service
The aid given to people in difficulty can be divided into relational and non-relational services. The former require a relational commitment between people, such as, for example, the education of children, support for a disabled person, assistance to non-self-sufficient elderly people, the rehabilitation of drug addicted and deviant children and young people in general, the help to the homeless person on the street, or to the immigrant in difficulty. Non-relational services, on the other hand, are those given without the need for a relational involvement with the recipient on the part of the provider of the benefit (for example, bonuses and economic benefits given administratively by public or private bodies, or help entrusted to a machine, such as a robot).
Humanizing care means giving priority to relational services over non-relational ones, because authentic and solid social inclusion requires not only material benefits, but above all the construction of a social fabric. As Stefano Cobello[18] writes, “inclusion is a right, is a must of being part of any culturally evolute society and it mainly means to pay attention to everyone in every context of the life in the same way. But more than that, inclusion cannot exist without everyone’s awareness of all the human life phases and the capability to look deeply into the human needs of relationship and the common need to be accepted and beloved”.
Well, care in the proper sense is a relational service which maximizes its purpose when it manages to create relational goods between the caregiver and the care receiver.
What are relational goods? They are goods that consist in those relationships that make it possible to meet people’s needs that cannot be satisfied in another way, i.e. with other types of relationships.[19] Caring for the Other, from a social point of view, consists precisely in creating a relational good between caregiver and care receiver.
For example, the need for companionship that a lonely person has can only be satisfied by creating a relational network with her. The relational good is not a sort of material service given by other subjects to the person alone, but can only consist in a certain relationship created and enjoyed together with her.
In fact, relational goods come into existence only if they are produced and enjoyed together by two or more people, for example by giving and receiving trust, cooperation, and reciprocity, which feed sharing and a sense of communion. Let’s think about health. The pandemic has taught us that health is the product of good relationships. People are healthy to the extent that they can enjoy the good relationships (relational goods) that they themselves generate and enjoy with other people who are significant to them. This applies to all forms of care.
Strictly speaking, relational goods have an immaterial character (they are intangible goods) and emerge from subjects reflexively oriented towards producing and enjoying together a good that they could not obtain otherwise. Relational goods are therefore goods common to a network of people who produce them, and therefore are neither public goods nor private goods, but goods shared by the people who form the network. These goods are regenerated the more they are used, and can have positive externalities on the surrounding community, as they create a cohesive and supportive social fabric.
6.2. When does care create relational goods?
Care creates relational goods when those who take care of the Other learn to be ‘relational subjects’,[20] that is, they operate with a ‘relational gaze’, they know how to see others through relationships, they look at others with relationships and in relationships.
This means that, in the care relationship, while the caregiver pursues the good of the Other, at the same time he pursues the good for himself. Indeed, the reconstruction of the identity of the needy or ill person is also the reconstruction of the identity of the caregiver. This happens because in every relationship there is always a reciprocal effect on the inner reflexivity of the people: in relating to Alter, Ego experiences Alter’s action on himself, and this forces Ego to relate again with himself (he must re-act on himself to be in relation – i.e. reciprocate – with Alter).
Care that is oriented towards generating relational goods has an educational and creative value. In the helping relationship there is a pedagogical dimension because the request for help, if experienced as a relationship, teaches us to help others but also ourselves. Caring for others also means caring for yourself. When the caregiver wants to reconstitute the identity of the person to be assisted, at the same time, if he does it well, he also reconstructs his own identity and this happens because in every relationship there is reciprocity between the operator and the person in need. In Learning from My Daughter, Eva Feder Kittay[21] claims that living with a daughter who has multiple and significant disabilities, including cognitive disabilities, has been utterly transformative for thinking about her training, career and research as a philosopher.
In encounters with Others it is necessary to be ethically generous, and to know how to be surprised by them. We must be prepared for the challenge of our preconceived ideas about them – those that fix, categorize and constrain their identity. Such encounters are self-transformative because being surprised allows us to rethink and question our taken-for-granted worldview.
How does caring for others come about and take place? First of all, it consists in giving attention to the Other. Because of its tension towards the other, attention is the first form of care, an ethical gesture.
Here it is necessary to understand that there are two ways of approaching another person: (i) thinking of her in front of me: in this case, the Other speaks to me about herself, and nothing more; (ii) thinking of her in relation to me: in this case, the Other tells me something more, she also talks about me, and points to a third reality, that is, the relationship between us as a third party included, in which lies the reality of caring.
To enter this second order of approaching the Other, it is necessary to implement various attitudes. First of all, receptivity, that is, letting the other question me, making room for the other, also accepting a certain form of active passivity; it is a question of adopting a non-intrusive, discreet presence that knows how to wait, of one who offers himself rather than wanting to force the Other
Then, a listening attitude aimed at understanding the experience that the Other activates to place himself in the world. Here an attitude of reflexivity, of sensitivity, is appropriate, because taking care is always emotionally connoted.
This way of relating manifests itself as responsiveness, that is, knowing how to respond adequately to the calls that come from the other, being prompt. Then, a cognitive and emotional availability is appropriate, i.e. placing one’s understanding and processing skills at the disposal of the Other, as well as one’s ability to express emotions in the relationship with him.
In this way the caregiver realizes an emotionally dense thinking or, in other words, an intelligent feeling, i.e. creates the conditions for the emergence of empathy which, as Edith Stein[22] says, overcomes the split between rationality and emotion.
It is important to distinguish between care as an object of personal reflexivity and care as an object of relational reflexivity.[23] Both forms of reflexivity are important, and must be present together, but they must be distinguished in order to take the right distance in being next to the Other.
Personal reflexivity is what every agent has within himself, in his own inner conversation, for example, when he thinks: “What should I do?” “How can I make the most of this performance?” Relational reflexivity is the one directed towards the outside, it is the reflexivity operated on the relationship, when the caregiver asks himself: “Is this relationship suitable for the Other?”, “What does the Other expect from me?” Personal reflexivity follows ethics in the first person; relational reflexivity follows ethics in the second person.
It is necessary to transform emotions (passions, states of mind) into reflexive feelings, that is, aware, mature dispositions.[24] To carry out this transformation it is necessary to realize that taking care of the Other and taking care of the relationship with the Other are not the same thing. For instance, if Albert is married to Lucy, it is one thing for him to take care of Lucy’s person and another thing for him to take care of their marriage, even more so if there are children (and the same is true for Lucy toward Albert). In the case of a disabled person, taking care of her body and/or her psyche, as the medical model does, does not necessarily imply that the helping relationship is appropriate. The disabled person needs a human relationship as much as she needs physical care.
The ‘care relationship’ should not be considered as a sequence of individual acts, but as taking care of the relationship, because it is in the relationship that we find health or illness, and well-being in general.[25]
6.3. The structure of action oriented towards the care of the Other
We can outline in a synthetic way the structure of the action oriented towards the care of the Other as in Figure 1.
Taking care of the Other begins with an unconditional motivation of benevolence, i.e. the gift of the relationship, which presupposes overcoming aporophobia (aversion and negative judgment on the needy)[26] and recognizing the relationship existing between the Self and the Other as constitutive of the Self and the Other.
It continues with the exercise of personal virtues, such as empathy, attention, recognition and acceptance of the Other, implemented by reflecting on the relationship with the Other.
It generates a relationship of care for the Other as a reflexive relationship between the caregiver and the care receiver that includes the needy person in a network of relationships through cordial reciprocity[27] that produces relational goods rather than relational evils.
7. The case of health and socio-medical services
The idea that the health of a person or a social group like a family consists in having healthy social relationships is often cited, but poorly understood and practiced. Affirming that the achievement and maintenance of a state of health requires good social relationality is very important to indicate the limits of the definition of health that has been proposed by the WHO, which reads as follows: “health is a complete sense of individual psycho-physical well-being”. This definition forgets the relational dimensions of health and its care.[28]
On the other hand, we can cite two models that help us understand the meaning of the perspective I am proposing.
(I) The CARe model[29] bases the care relationship on four principles: connecting, understanding, ensuring, strengthening the relationship between caregiver and care receiver. The core of this model lies in understanding care as a dialogue that gives space to the subjectivity of the person in difficulty, reassuring her about the situation and promoting the continuity of the relationship that gives trust with a plan centred on enhancing the abilities of the sick or otherwise needy person. In order not to lengthen this text, I summarize it in Table 1. The reference is to the professional caregiver, but in many respects it also applies to the informal one.
(II) The ‘relational care’ services model defines disability or frailty as a relational fact generated by relationships and which must be addressed with services based on relationships.[30] The relationality of the service is a quality necessary to maintain the perspective of the whole, in the sense that care is understood here as taking charge of the person in the complex of her human condition, and therefore in the complex of the relationships she has in her lifeworld (Lebenswelt). I summarize this model in Table 2.
The ‘relational care’ service is characterized by practicing care as a lifeworld relationship that goes beyond institutionalized and formal social roles. Compared to traditional medicine, this model introduces subjectivity (both of the doctor and of the patient, the caregiver and the care receiver) in the definition of the disability or disease and of the cure/care as determining factors for carrying out the healing/caring relationship. Health is pursued through healthy and meaningful relationships with others and with the world. The characteristics of the person in need are not considered deviations, but differential qualities that require a specific thematization. Pathology should be thought of as an existential experience.
In this model, medicine is considered as an instrumental subsystem in relation to the more general system of care which aims at the social integration of those suffering from the most varied pathologies. In this more general system, medicine has the role of resource and means that must operate alongside and together with the social context of relational aid to the patient. From a cultural point of view, the health service refers to the ethics of care, which legitimizes the concrete objective of the practices that must be pursued in order to achieve a state of health.
The relational approach does not ask the doctor to be an expert in social relationships. It only asks him to take into account, collaborating with other services (hospital, territorial, home, pharmaceutical or other), the fact that his action is part of a system of relationships of which he must be aware.
The relational care service model opts for the integration of technical medicine, health ethics and good practices to help the sufferer to achieve the objective of a health condition which is obviously procedural, dynamic and multidimensional (physical-organic, psychological, social, spiritual).
The two models just mentioned (I, II) have received confirmation of their validity in many field investigations. In particular, I would like to recall the research by Gavin, Evans and McAlister[31] on the importance of considering the healing context, its relational constitution and the ways of providing services in an environment oriented towards a holistic, i.e. comprehensive, medicine. The survey highlighted the importance of the environment in which the treatment takes place, as the elements that compose it (human beings, objects, ideas) create environmental ‘vibrations’ (vibes) which make it possible to search for new care relationships. A place of care, with its ‘relational vibrations’, can offer better health opportunities than other environments.
8. Help through technology: the case of the use of robots
We are all fascinated by the use of robots in caring for people, starting with supporting children in difficulty, the disabled, and the elderly who are not self-sufficient. The robot replaces the human body of the caregiver, and more and more tasks of various kinds are entrusted to it, from social to healthcare. One wonders then: is the robot always useful for taking care of people?
The research conducted so far gives a fairly clear answer. The robot is a machine which, as such, can provide important assistance in terms of functional performance, but has the limitation of not being able to replace the human relationship, which once again reveals itself as a reality in itself.
Let us take the case of caring for the non-self-sufficient elderly. Empirical research confronts us with the fact that the elderly have an ambivalent relationship with the robot.[32] On the one hand, the non-self-sufficient elderly says: “yes, the robot helps me a lot, it reminds me when I have to take my medicine, it helps me make coffee, it helps me get up, go to rest and so on”. On the other hand, she says: “but I don’t feel treated like a human person”. The fact is that the elderly entrusted to the robot feel diminished in their dignity, because the robot does not give them that relationship which is human and only human. The human is in relationality. And such must be the care, of the elderly in particular.
The robot seems to be a friend of the person, but it is not a friend, it is still a machine.[33] We must avoid the mistake of thinking that the relationship between humans and robots is not fundamentally different from the relationship between humans. Many do not understand this difference. The perception that social relationships are all the same indicates that our culture of relationships is highly incomplete. The relationships between humans are different from those between robots and humans, simply because the robot follows the instructions of the algorithms, those that are given to it and those that it can build itself, but it cannot relate as humans do. Those who use the robot to take care of people must be able to distinguish what these different relationships can produce. The diversity of relationships lies in their quality and the effects they generate. We have to pay attention to these different realities.
I think it is possible to generalize these considerations to all technologies, from ICT to AI, which are only an instrumental mediation, however useful. Their problem is that they cannot replace human relationality.
9. How to rethink the formal-informal organization of care
9.1. Three ways of observing caring relationships
In current practices, care relationships are observed according to different methodological approaches that we can summarize as follows:
(i) approaches centred on the individual (methodological individualism): caring relationships are seen as an expression of the inner feelings and motivations of individuals (psychology of compassion, psychological flexibility, acceptance of the other, commitment to the other, etc.); relationships are seen as individual decisions that arise from individuals’ inner conversation; but one individual’s compassion for another, however important, does not make a true relationship;[34]
(ii) approaches centred on the social system (methodological holism): care relationships are explained starting from the social structure in which people live; it is thought that there is a system, social or cultural or economic, in any case of power, which conditions possible relationships, even those of service to others;
(iii) approaches centred on relationships as such (relational methodology): although care relationships depend on individual agents and are conditioned by social and cultural structures, they must be considered in themselves, as a good that goes beyond the intentions of individuals and organizational constraints; we can only manage them if we see them with the ‘relational gaze’, that is, focusing on the relationships themselves to understand their causal qualities and properties, modifying them so as to prevent them from generating pathologies and instead favour a healthy and just social relationality.
Examples are multiplying that confirm the validity of the relational perspective. Take, for example, the issue of medical care for patients who have a different cultural and ethnic background. Several researchers[35] have found that strategies that manage cultural differences by focusing on individual patient characteristics are much less effective than those that focus on patient-caregiver relationships. It is highlighted that a large part of the quality of cancer care depends on the ability to activate relationships that do not offend the dignity of the culturally ‘foreign’ patient, that do not eliminate their cultural differences and that, however, at the same time are not indifferent to cultural differences.
Intervention according to a relational methodology has better healing effects than the others because it combines formal and informal help. This is true not only at an interpersonal level, but also and above all at the level of service systems. For this reason, the methodology that works by enhancing the networks of relationships capable of generating relational well-being is called community welfare. Its guiding principles are as follows:
- community welfare is achieved by a plurality of actors through social governance, which is a form of coordination that enhances horizontal networks, minimizing political government (use of vertical power);
- caregivers are trained in relational social work,[36] which adopts a methodology based on network analysis;
- welfare is designed and evaluated together by those who offer and those who receive help, i.e. it is co-designed and implemented together by all the actors in the community;
- the well-being of the community is pursued by creating and regenerating social capital, i.e. relationships of trust, cooperation and reciprocity, starting from the primary networks and enhancing the processes of co-production of services.
Co-producing services means that the offer and choice of the service is made jointly by the caregiver and the beneficiary. Both share decisions about how the service should be done. Co-production makes people participate in the process.[37]
9.2. Care as an action of organizational systems
To humanize care, from a social point of view, in a relational key, my proposal is to define care and care services as an ODG (relational observation-diagnosis-guidance) system, that is, as a system that organizes interventions to create community welfare on the basis of three steps: relational observation, relational diagnosis and relational guidance. What does ODG mean? Briefly, it means the following.
(O) The observation of the need to be addressed must be relational, which implies that the problem we are facing must be defined as a problem of relationships. Poverty, social exclusion, multiple forms of malaise and existential crises, and even illnesses, are consequences of a particular social network that generates the problem as a relational configuration characterized by deficits, structural holes, inability to see and manage good and just relationships.
(D) The diagnosis must be relational, that is, it consists in knowing how to distinguish the relationships that lead to health and well-being from those that do not.
(G) The guide for solving the problem must be relational, in the sense that the practical intervention consists in modifying the relational network so that people are capable of generating relational goods rather than relational evils. The basic idea is that, if the need is generated by defective relationships, the solution lies in evaluating these relationships and changing the network of relationships that produces the need.
Through the methodology of the ODG system, we can create wellbeing of a community nature.[38] It is important that the actors, both social and health, see in the community the privileged environment for creating a humanizing welfare. Community welfare is the set of policy actions and network interventions that are capable of bringing together public institutions, businesses, organized civil society and families who create a ‘network welfare’ to the extent that they produce a social fabric that is communal because, belonging to the network, it is a source of well-being shared among all participants.
Thus, a community is created which is a We-relationality, that is, “a relationality of us”. The community is a We which does not mean having the same ideas or the same tastes and preferences, but it means sharing a relationship in which each person is herself, together with the others.
10. In order to humanise care, a relational bioethics is required
Taking care of the Other always implies an ethical dimension. Bioethics, born between the 1960s and 1970s in the Anglo-Saxon context, remains a mixture of biology and individual-oriented ethics. Current bioethics is called to become relational because human life is relationality, and therefore bioethics training consists in thinking and acting on human life as a social relationship. When we talk about care, the reference model is often the purely medical-healthcare one, centred on the individual, while what we need is a relational model of integral ecology.
Assistance to people with disabilities is a paradigmatic field of the need for an ethically sensitive relational approach, because the problem of the autonomy of the disabled person cannot be solved by focusing directly on her individual abilities, but by creating an appropriate relational context that supports her abilities.[39]
The ethics of care (or care ethics), as a cluster of normative ethical theories that were developed by some feminist and environmentalist currents of thought since the 1980s, can and should be conjugated with virtue ethics. It is necessary that bioethical training and the ethics of care become training in thinking and acting according to virtuous relationships, since, in taking care of the Other, it is life itself as a virtuous relationship with others and with the world that is called into request. Only such a “relational view” can guarantee an ethics of care that is human rather than dehumanizing.
In short, the ethics of care cannot ignore that life is human insofar as it is a reciprocal action – endowed with meaning – of subject-persons, and it is not a laboratory alchemy.
Otherwise, bioethics becomes just a set of procedural and functional rules which, devoid of motivation and profound intentional meaning, end up fuelling the business of a market whose commodifying effects we already know. Effects that are still relatively contained compared to the devastating effects and the risks of alienation of the human being that appear as possible on the horizon of the future.
A model of care service provision as a pure performance (merchandise, commodity) is inadequate in the face of moral dilemmas and the need to be able to build and rebuild human lives and valid relationships in the context of the pain we feel towards the fragile and in distress, of the sorrow towards the sufferer, and of the unpredictability of life’s events.
What today’s society lacks are not so much material and technological resources, but rather the relational skills of welcoming, supporting and socially integrating people in difficulty.
The care of the Other is increasingly entrusted to new technologies and impersonal welfare mechanisms, while interpersonal social relationships become increasingly weak, liquid and unavailable. People are unable to care for others. Human relationships are replaced by technological means. The consequences are evident in the loss of social solidarity and in human deterioration. Situations of need due to the marginalization of disabled and frail people are spreading. Disabilities in the strict sense represent 16 percent of the world population, but the fragilities that are due to some deficit or pathology, in particular psychological ones, are at least three times as much.
We need a social change, first of all cultural, which brings out, rather than concealing, the relational character of human need and, correlatively, of the necessary response, which is realized only in the gift between the giver and the receiver, that is, in the creation of a relational good.
In an intrinsically risky society, the Other to take care of concerns increasingly large portions of the population, because everyone is potentially subject to falling into conditions of need. For this reason, it is necessary to spread a culture that recognizes and encourages caring relationships as an ultimate concern and a merit good of society as a whole, and not just of specific ad hoc organizations, if it wants to be a society with a human dimension. In fact, it is essentially in caring for the Other that the human is expressed, implemented and shared.
11. Conclusions
I have tried to explain why care is not only, after all, a question of good feelings and intentions on the part of individuals, or a question of technical efficiency in the ability of service systems to function well, but it is a social issue of relational responsibility, which must be evaluated and examined for its humanizing qualities. The relationship as such is the protagonist of care.
It is social relationships that make people and what they do human. Relationships are a reality in themselves and it is necessary to know how to deal with them (even remotely) to enhance people and generate relational goods. The good will of people and institutions is necessary, but not sufficient, because it is necessary to grow in the ability to read and manage relationships, their quality, and their effects, in order to take care of the Other in a truly human way.
We still have a long way to go to understand what it means to say that caring for the Other lies in the qualities and causal properties of human and social relationships, and why it is necessary to make all the components of caring relational, i.e. people’s actions, the organization of services and the social context that can favour or inhibit care as a relational good.
It is not a question of appealing to an abstract concept of ‘universal brotherhood’, but to a fraternity[40] experienced as a vital relationship in the world of daily life. Brotherhood is a universalistic concept that indicates the sharing of symbols referring to equality and solidarity among human beings. Most of the time it is expressed in a vague adherence to abstract values, such as perpetual peace or the total abolition of social differences, which are, of course, important objectives but which often turn out to be only illusory dreams. In order for fraternity to become an operational reality, it must go beyond a generic symbolic inspiration. It implies a concrete relationship of mutual care between people, starting with the closest to the most distant, even strangers. It is in concrete fraternity that care generates relational goods. This is the message. However, let us remember that there is something more important than fraternity, which is friendship as God understands it.
Frankl, Viktor. 2009. El hombre en busca de sentido último. Ciudad de México: Paidós.
[2] “It is not enough to take alternatives from what Berger and Luckman called ‘repositories of meaning’ contained in the social structure. As for the embodiment, it is understood the way of experiencing the body, whether it is one’s own or another’s, and through it make the meanings created from reality corporeal”; “It is observed that the sense is rebuilt through sociocultural discourses that could be related to religious beliefs; motherhood and care are processes within women’s bodies” (Mora, Carolina, and Jesús, Rivera. 2019. La reconstrucción del sentido en madres de niños con una enfermedad degenerativa. Estudios sociológicos 35(111): 757-783).
[3] The terms caregiver and care receiver are generally used to refer to people who care for the elderly and disabled, or in any case individuals in precarious health conditions, in particular their family members. This is how the WHO defines them and also many resolutions of the European Union and of various countries. However, I will use these terms in a more general sense, including people who help strangers, whether the help is given on a voluntary and spontaneous basis or within professional organisations. It is interesting to note that we do not have a specific term to indicate these figures in general, whatever the context of daily life, and not just for social and health problems. Generally, we speak of the ‘good Samaritan’ or ‘volunteer’.
[4] Donati, Pierpaolo. 2011. Relational Sociology. A New Paradigm for the Social Sciences. London: Routledge.
[5] Goffman, Erving. 1967. Interaction Ritual, Garden City: Doubleday.
[6] Donati, Pierpaolo. 2023. Alterità. Sul confine fra l’Io e l’Altro. Rome: Città Nuova.
[7] Ferrucci, Fabio. 2004. La disabilità come relazione sociale. Gli approcci sociologici tra natura e cultura. Soveria Mannelli: Rubbettino.
[8] Donati, Pierpaolo. 2022. The pandemic: An epiphany of relations and opportunities for transcendence. Church, Communication and Culture 7(1): 23-57.
[9] Cicchese, Gennaro. 1999. I percorsi dell’altro. Antropologia e storia. Rome: Città Nuova, pp. 171-173.
[10] “Thinking accomplishes the relation of Being to the essence of man. It does not make or cause the relation. Thinking brings this relation to Being solely as something handed over to it from Being” (Heidegger, Martin. 1977. Letter on humanism. In Basic Writings, ed. David Farrell Krell. New York: Harper & Row, p. 193).
[11] Heidegger, Letter on Humanism, p. 193.
[12] In a commentary footnote to the text of M. Heidegger (Letter on humanism, cit., pp. 199-200), the editor writes: “In the final chapter of division one of Being and Time, Heidegger defines ‘care’ as the Being of Dasein. It is a name for the structural whole of existence in all its modes and for the broadest and most basic possibilities of discovery and disclosure of self and world. Most poignantly experienced in the phenomenon of anxiety – which is not fear of anything at hand but awareness of my being-in-the-world as such – ‘care’ describes the sundry ways I get involved in the issue of my birth, life, and death, whether by my projects, inclinations, insights, or illusions. ‘Care’ is the all-inclusive name for my concern for other people, preoccupations with things, and awareness of my proper Being. It expresses the movement of my life out of a past, into a future, through the present. In section 65 the ontological meaning of the Being of care proves to be temporality”.
[13] Amer, Amena, and Sandra, Obradovic. 2022. Recognising recognition: Self-other dynamics in everyday encounters and experiences. Journal for the Theory of Social Behaviour 52(4): 550-562.
[14] On the terms ‘refero’ and ‘religo’ and their way of working which creates the actual relationship, see: Donati, Pierpaolo. 2013. Sociologia della relazione. Bologna: il Mulino.
[15] Donati, Pierpaolo. 2021. Engendrar un Hijo.¿Qué hace humana la generatividad? Madrid: Didaskalos.
[16] I am referring to the AGIL relational scheme that I have elaborated and applied in empirical research: see Donati, Pierpaolo. 2021. Transcending Modernity with Relational Thinking. London: Routledge.
[17] This is the relationship as a result of interactions between ‘fractals’, a topic explained in Donati, Pierpaolo. 2021. Lo sguardo relazionale. Saggio sul punto cieco delle scienze sociali. Milano: Meltemi, pp. 149-165.
[18] Cobello, Stefano. 2023. Inclusive education for children with disabilities in the relational perspective. Verona: Delmiglio editore.
[19] Donati, Pierpaolo. 2019. Discovering the Relational Goods: Their Nature, Genesis and Effects. International Review of Sociology 29(2): 238-259.
[20] Donati, Pierpaolo, and Margaret Archer, 2015. The Relational Subject, Cambridge: CUP.
[21] Kittay, Eva Feder (2019). In Learning from My Daughter: The Value and Care of Disabled Minds. Oxford: Oxford University Press.
[22] Masera, Giuliana. 2007. L’empatia in Edith Stein: la giusta distanza per essere accanto all’altro. I luoghi della cura 5(3): 27-29.
[23] Donati, Pierpaolo. 2011. Sociologia della riflessività. Bologna: Il Mulino.
[24] Masini, Vincenzo. 2009. Dalle emozioni ai sentimenti. Manuale di artigianato educativo e di counselling relazionale. Lucca: Edizioni Prepos.
[25] White, Sarah. 2017. Relational wellbeing: re-centring the politics of happiness, policy and the self. Policy & Politics 45(2): 121-136.
[26] The word “aporophobia” is a neologism coined by the philosopher Adela Cortina in 1995 to refer to the “rejection, aversion, fear and contempt towards the poor, the indigent who, at least in appearance, cannot give anything in return” (the term aporophobia is formed from the Greek word á-poros, ‘without resources or poor’, and fobos, ‘fear or apprehension’: cf. Cortina, Adela. 2017. Aporofobia, el rechazo al pobre. Un desafío para la democracia. Barcelona: Paidós Ibérica).
[27] Calvo, Patrici. 2022. Reciprocidad en Adam Smith: la cordialidad como mecanismo de inclusión económica. Revista de filosofía (Chile) 79: 25-37.
[28] Donati, Pierpaolo (ed.). 1983. La sociologia sanitaria. Dalla sociologia della medicina alla sociologia della salute. Milano: FrancoAngeli.
[29] Wilken, Jean Pierre. 2021.The CARe model. The relationship as the heart of good care. Relational Social Work 5(1): 34-47.
[30] Donati, Pierpaolo (ed.). 1994. Manual de sociologia de la salud. Madrid: Ediciones Diaz de Santos.
[31] Gavin, Andrews, Joshua Evans, and Seraphina McAlister. 2013. Creating the right therapy vibe: Relational performances in holistic medicine. Social Science & Medicine 83: 99-109.
[32] Sharkey, Amanda. 2014. Robots and human dignity: A consideration of the effects of robot care on the dignity of older people. Ethics and Information Technology 16(1): 63-75.
[33] Sharkey, Amanda. 2020. Can we program or train robots to be good? Ethics and Information Technology 22: 283-295.
[34] This is my critical observation to those who simply treat disability with compassion. The disabled person needs a relationship of empowerment and not just good feelings. However, it is true that compassion can enhance the intimacy and emotionality of the disabled individual, filling the void that approaches excessively centred on the macrosociological causes of disability leave uncovered (cf. Clément, Michèle. 2018. Sociologie, souffrance et compassion. Cahiers de recherche sociologique 65: 47-69).
[35] Broom, Alex, Rhiannon Parker, and Stephanie Raymond. 2020. The (Co)Production of Difference in the Care of Patients with Cancer from Migrant Backgrounds. Qualitative Health Research 30(11): 1619-1631.
[36] Folgheraiter, Fabio, and Maria Luisa Raineri. 2017. The principles and key ideas of Relational Social Work. Relational Social Work 1(1): 12-18.
[37] Pestoff, Victor. 2018. Co-production and Public Service Management. Citizenship, Governance and Public Service Management. London: Routledge.
[38] Folgheraiter, Fabio, and Pierpaolo Donati. 1991. Community care. Teoria e pratica del lavoro sociale di rete. Trento: Edizioni Centro Studi Erickson.
[39] Ho, Anita. 2008. The Individualist Model of Autonomy and the Challenge of Disability. Bioethical Inquiry 5: 193-207.
[40] While “universal brotherhood” (in Italian ‘fratellanza’) is an immanent concept that affirms that people belong to the same species or a certain community of destiny, fraternity (in Italian ‘fraternità’) is a transcendent concept that is based on the recognition of the common fatherhood of God.