What would/could personal assistance look like in a mutual aid society?

I've been meaning to blog about this for a long time, but have been prompted into finally posting by the discussion involving Anarchafemme, Foibey and myself in the comment thread on this post at Anarchafemme's blog, which was getting quite a considerable distance from the original post topic, so to avoid derailing it any further, i thought i'd better at least make a start on the topic here. There's no way that this post is ever going to cover all of my thoughts here, but it's a start...

Background first: for almost a year now, i have been working as a PA (Personal Assistant) for a fellow disability rights activist with a physical impairment. There have been, and still are, various ongoing tensions within that working relationship, but those aren't (directly) the subject of this post, and it's still, by a long, long way, the best job (in terms of waged work) that i've ever had. In many ways, it's arguably the best possible job for an anti-capitalist - it doesn't benefit any oppressive corporation or state agency, it's effectively using money from the welfare state to sustain activism, and it (genuinely and directly, unlike so many other jobs in government departments or charities/NGOs that claim to do so) empowers and liberates oppressed people. It's also a job which does not require any particular educational or professional qualifications, and in which having experienced barriers to more "mainstream" employment is arguably actually an advantage (because members of oppressed/discriminated-against groups who tend to have such barriers are more likely to get the point that this job is about enabling and liberating, not controlling, patronising or "care-taking").

The paradigm of disabled people directly employing PAs, however, while being a major part of the Independent Living movement (a movement that i would argue is possibly the only minority liberation movement that is inherently both libertarian and socialist - but that's something i'll have to save for a future post) is one that is rooted in hierarchical and capitalist social structures of wage-work and the employer/employee relationship. Is there a contradiction here?

The employer/employee model of personal assistance comes from the concept developed by the disabled people's movement of "independent living" as not meaning "doing everything for oneself", but "having choice and control over one's own life" - a concept which, IMO, is the only concept of "independent living" which makes any sense in any modern context, as no human being in any present-day society (and possibly at any time in human history) is entirely self-reliant, but we are all interdependent on one another. This means, then, that being physically (or otherwise) impaired does not in itself prevent a person from being "independent", but it is social structures and policies that prevent people with personal assistance needs from having control over when and how they recieve that assistance that do prevent them from having "independence" in the choice-and-control sense (for one of many excellent articles on that topic, see "What's So Great About Independence?" by Sally French here).

This is libertarian in that it puts the freedom of choice of the disabled person over what happens to their own body and in their own life as the highest priority, and socialist in that paying for it is seen as the whole of society's, not just the individual's, responsibility - but where does it fit in with the anarchist/anti-capitalist/libertarian-socialist critique of the whole concept of wage work and employer/employee relationships?

Generally speaking, the anarchist vision of a world based on equality and mutual aid is one without any hierarchical relationships between (adult, at least) human beings - but the relationship between a disabled employer and hir PA is inherently hierarchical, and it's hard to see how it could not be without compromising the disabled person's autonomy. For anarcho-communists (which i would loosely speaking consider myself... although some anarcho-communists might disagree, and i generally prefer "anarchist without adjectives") at least, Utopia also doesn't have such a thing as money (as all production of goods is for need rather than for profit or exchange-value, and everything is shared freely) - but this also raises issues in relation to PA work, because of the issue of motivation...

In a "free" or "autonomous" society, in most anarchist visions, the motivation for any kind of work is either that the person doing the work enjoys doing it, or that the work needs to be done - in contrast to the "heteronomous" work that dominates existing capitalist society - work that is done not out of either need or desire to do the work itself, but because of a secondary motivation, namely the payment for doing that work - thus, people work in factories producing goods that they neither consume nor want to consume, or in administrative jobs that would have no purpose at all in a free society, because they need the money, leading to alienation (which is not seen exactly the same way in an anarchist as in a Marxist critique of capitalism... but, for now, close enough).

In PA work, however, the heteronomous nature of the work is arguably a good thing, because the fact that PAs' motivation for working is financial need creates a relationship that is co-dependent rather than one-way dependent - the PA needs hir job for the income as much as the disabled person needs the PA to get hir embodied needs met. This, however, only works in a capitalist wage-work system - in a moneyless anarcho-communist society (such as Anarres in Ursula le Guin's The Disposessed), where the motive for work is its necessity of the work itself rather than financial gain, I think there would be a significant risk of the PA/employer dynamic that currently liberates disabled people by giving them choice and control would be lost - it would be easy to fall back into a patronising "do-gooder" dynamic, where only the disabled person needs the personal assistance, meaning that the PA would be acting purely altruistically or as a "favour" to the disabled person. For many disabled people, that would be unacceptably like the paternalistic charity model, with disabled people expected to be the passive and grateful recipients of altruistically given "care", rather than in charge of their own assistance, which, in the currently existing model of PA work, their position of authority and financial power as employers allows them to be.

It could be hoped that in an anarchist society, with an explicit ideological commitment to opposing all forms of "power-over", the power of providers of assistance over dependent disabled people would be recognised as such and a paradigm based on rights and solidarity could be created to try to overcome that - but it still makes me feel slightly uneasy, because i strongly suspect it's inherent in human nature for those providing necessary assistance to others to feel that they should get some sort of "reward" in return, whether money or the praiseworthy status of "do-gooder" and the gratitude and subservience on the part of the recipient that comes with it... and also, even in anarchist circles, i have known too many people who have accepted paternalistic attitudes to disabled people all too easily (including several "anarchists" who have worked as "carers" in institutions, apparently without having the slightest idea of their jobs as being those of oppressors).

(This is, to an extent, also about intersectionality, and the fact that the disability rights movement has, at least in the UK, existed fairly separately from other new social movements and wider critiques of the statist/capitalist system, while the wider anarchist/anti-* activist movements have almost entirely failed to address disability issues...)

This post is not so much laying out any answers as asking questions and inviting debate - so i'd be particularly interested in replies from anyone who has any ideas about this (especially, in fact, from PA users). Does a model of personal assistance that is liberatory for disabled people only work within a capitalist wage-work system (where work is defined as "heteronomous production of exchange-values", as Andre Gorz says in Farewell to the Working Class), or can it transcend that system? Can disabled people with personal assistance needs be assisted effectively without depriving someone (either the disabled person or the PA) of autonomy? (Or should the employer/employee relationship between disabled person and PA be seen as "depriving" the PA of autonomy? Perhaps it could instead be seen as a form of consensual power exchange, similar to that found in some BDSM sexual relationships?) Is there a "3rd way" possible here, that is neither paternalist nor capitalist?

If we are to have a fully "joined-up" anti-oppression politics, these questions need to be addressed, regardless of whether they can be decisively answered. Anyone up for tackling them?