Freedom to Care

Liberalism, Dependency Care, and Culture

Asha Bhandary

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781000227963
• Edition: 1
• Topic: Philosophy
• Subtopic: Ethics & Moral Philosophy

This book presents the first systematic account of dependency care in a liberal theory of justice. Despite the fact that receiving dependency care is necessary for human survival, the practices with which we meet society's care needs are seldom recognized for their functional role. Instead, norms about gender and race obscure and shape expectations about whose needs for care are legitimate as well as about whose caregiving labor more advantaged members of society will receive. These opaque arrangements must be made visible if we are to remedy skewed intuitions and judgements about care. Freedom to Care develops a modified form of social contract theory with which to evaluate society's caregiving arrangements. Building on work by feminist liberals and care ethicists, it reframes debates about care to move beyond gender with an inequality-tracking framework that can be employed in any culture. Because care provision has been enmeshed in the subordination of women and people of color, eliminating the invisibility of these forms of labor yields a critical liberal theory of justice with feminist and anti-racist aims.

1 The Theory of Liberal Dependency Care

The infant cries with hunger, utterly dependent on her mother to nurse. Only a few months later, she begins to exert independence, picking up peas with determination and pushing away the spoon offered by her mother.

The 20-year-old man with an autism spectrum disorder moves to a neighboring state to live next to a resource center for people with autism spectrum disabilities. As a member of an affluent family, his parents buy him a unit in an integrated condominium building next to the community center that facilitates independent living. Once there, he partakes in activities at the community center, has friends over for dinner, and takes the community center shuttle to a job. He also enacts his social class privilege when he commands, rather than asks, his nonaffiliated neighbors to help him.

The 94-year-old woman lies in a hospital bed, largely unresponsive due to the effects of a stroke. Her boyfriend of 19 years refuses to leave her side. The doctors note that her eyes sparkle when he is there. Out of respect for the value this relationship holds for their patient, the hospital staff does not enforce the rule that only family members may remain for the night.

A successful professional woman of color hires a white woman as a nanny for her newborn baby. After a seemingly smooth introductory week, the nanny quits, using vitriolic racialized language.

These vignettes span two elements of the human experience and their corresponding values, hinting, too, at the ways in which the manifestations of these needs and our responses to them are shaped by race, gender, and social class. The first element is human vulnerability, which results in dependence on others to provide dependency care. The second element is the drive toward independence and a life governed by one’s own commitments and values. Although these two sides of human existence are sometimes construed as conflicting, they are intimately linked, for to become independent, we must receive care. All human beings need to receive care as infants, as small children, and during episodes of illness. In addition, modern medicine’s ability to extend the end of life has resulted in a growing demand for hands-on elder care. Finally, persons with severe disabilities may require ongoing daily care. These periods of dependence require “dependency care,” which is intensive, hands-on care provided by another person. What differentiates dependency care from other forms of care is that the absence of dependency care rapidly results in the death of the dependent person.

Despite its universal necessity, dependency care has been absent from traditional liberal theories of justice, and the societies for which liberalism is endemic are characterized by gendered and racialized assumptions about who will tend to the needs of others, and whose needs will be attended to. This book evaluates the nature of dependency care when we evaluate this category of human activity and labor without the shroud of assumptions about, for instance, women’s natural fitness for this kind of labor. It shows how liberalism can and should take on dependency care, offers an analysis of care and care theories in relation to Rawls’s thought, and addresses questions of multicultural justice in relation to care. I argue that the receipt of care should be governed by principles of justice, and that the just provision of care will require that caregiving skills be taught to populations who do not possess them. I also provide independent arguments for the enduring value of liberalism. The outcome of these commitments is a liberal account of dependency care that places due value on caregiving skills and the role of care in human life.

Overview

Susan Moller Okin’s (1989) book Justice, Gender, and the Family provided an impactful look at the caregiving lacuna in liberal theories of justice. She argued that this oversight contributed to persistent inequalities in the distribution of labor in the home. Okin’s feminist liberal work (see also Okin 2004, 2005) was pathbreaking, and it continues to provide valuable insights. Yet, many liberal theorists continue to ignore or give only cursory attention to care in their accounts of justice. Meanwhile, many care theorists continue to juxtapose their ideas to liberalism, especially when liberalism is framed in terms of an abstract social contract. My book continues the feminist liberal lineage by addressing some shortcomings of Okin’s analysis. In doing so, I develop a form of liberal social contract theory that incorporates dependency care into a liberal egalitarian understanding of justice. By theorizing about care in a way that takes a constructive approach toward liberalism, I thereby contribute to a small, but growing, body of work by feminist liberals on duties to care. However, whereas the feminist liberal tradition has been shaped by a certain kind of family as the heterosexual and white upper-middle class family, the liberal theory that I advance begins from a different insight: that every society has a set of caregiving practices.

A wide range of practices respond to the problem: how will our society meet its needs for care? Taken together, caregiving practices, norms, and structuring principles constitute the caregiving arrangement for that society. Caregiving practices include marital practices, gendered arrangements, extended families, nuclear families, professionalized care, state-funded care, birth-order assignments of responsibility, and racially assigned expectations of ease and difficulty in one’s life. The society-wide caregiving arrangements include direct lines of care as well as ancillary components that make these arrangements stable and self-sustaining, such as the illegal status of immigrants acting as care workers. The arrangements include norms and principles that assign caregiving responsibility to individuals based on not only their relationship with the dependent person, but also their gender, race, ethnicity, caste, or class. Among these practices, norms, and principles, only a few are explicitly recognized as sources of care in cultural narratives. Instead, quite often, caregiving occurs in social practices that subordinate a set of people and thereby make it possible to discount their contributions. For example, when undocumented workers care for the children of affluent families, care of the children may be credited to the family, rather than to the worker, whose social contribution thereby remains invisible.

It is a matter of philosophical importance that the caregiving arrangement for a society evades public recognition because the invisibility of caregiving arrangements corresponds to a dearth of conceptual tools and theoretical frameworks with which to identify and evaluate systems of care. This book argues that a society’s implicit arrangement to secure care must be made visible within the purview of justice, evaluated, and then redesigned. I offer a way to evaluate the arrangement as a whole, revising the core apparatus of contract theory to yield criteria that a society’s caregiving arrangement must meet to count as just. I also contribute to the project of designing just, and good, caregiving practices within which care could take place, where actual practices of care will be embedded in culture and meaning and will be intertwined with a variety of other aims, such as meaningful human relationships.

Across a variety of cultures, women are designated as the main caregivers, both within and beyond families. This functional designation becomes combined with the label “caring person,” which implies a social expectation to care about, and for, other people. Despite shared gendered trends across societies, the meanings attached to caregiving vary across, and within, different societies. Practices of care are encoded in cultural norms and narratives, and these narratives are influenced by the particularities of history. For instance, the history of slavery in the United States means that black women who are caregivers for white women act in a context that is racially and historically charged. In societies with extended-family systems, such as some societies of South Asia, younger family members who do not provide hands-on care may be seen as withholding care, failing to meet a particular responsibility, and not affectively caring about the elders.

In everyday usage, the term care has multiple meanings. It describes a good person, as when we say that someone is a caring person. It also connotes deeply affective relationships that can be reciprocal—as in friendship—or involve asymmetrical vulnerability and responsibility, as in the parent-child relationship. “Care” standardly includes an attitude of caring about a particular other person as the particular person they are, and it brings with it a certain amount of empathy. When we amplify this sense of care with “deeply,” it can transform into love. Finally, Harry Frankfurt employed the phrase “what we care about” to discuss the contours of the self, agency, and value.¹ In this book, I bracket these associations with the term “care” to focus on what we may call “material caregiving,” which is the labor of caregiving, not caring in the affective sense (Brake 2017, 136).²

To further fix ideas about this category of labor, I pay special (but not exclusive) attention to the subcategory of material caregiving that is directed at utter dependents, which I call dependency care. Eva Feder Kittay calls a related form of work “dependency work,” which she characterizes as different from many other forms of labor because it necessarily requiring affective caring, sustained effort, and the prioritization of the needs of the dependent.³ Unlike Kittay’s “dependency work,” though, what I call dependency care does not necessarily include affective connections. Instead, I use the term dependency care to mean the hands-on labor without which a person would not survive, such as feeding a baby, helping a paraplegic person with toileting, and assisting a person with mental disabilities to obtain food and live safely. What these activities share is the relative immediacy of the harm that the vulnerable person will experience when the dependency care is absent. For instance, in the paradigm case of dependency care for a baby, the baby will not survive long in the absence of positive actions by a caregiver.

Although harm from its absence is a clear marker of dependency care, the definition of dependency care I employ does not specify necessary and sufficient conditions, because dependency care is entwined with the organization of a range of other activities and many features of the practice are likely to change as caregiving arrangements become transparent. For example, when a surgeon performs emergency heart surgery, they give the utterly dependent person a form of care required for the latter’s survival. But because medical care is highly visible, it differs from the forms of caregiving traditionally called women’s labor. Medical care is systematized, evaluated, and quantified, and it is a form of work that is embedded in high status practices. Consequently, medical care by physicians is an example of socially visible care that is often provided to a dependent person, whereas the subject of this book is dependency care as it has been shaped by opacity in the system of social cooperation.

The costs of securing care are obscured by systems of socialization and subordination that produce a reliable population of caregivers. Although the subgroup corresponding to the population serving as caregivers varies in different societies, feminist scholarship yields an exhaustive analysis of how social norms, tropes, and legal and workplace institutions maintain the subordination of girls and women (Meyers 1987, 2002). These social norms and practices are inextricable from the social aim of securing a population of caregivers for society. Correspondingly, most societies have existed with coercion and effective unfreedom for women and other groups. Because caregiving arrangements are the skeleton for every social form, the lack of transparency about caregiving arrangements causes skewed intuitions about hardship, entitlements, and the nature of a just society. Existing caregiving arrangements are imprinted on social forms and cultural constructions, thereby influencing the intuitions that have dominated liberal theory.

I offer several remedies to the problem of skewed intuitions about care. First, I advance the arrow of care map as a new way of conceptualizing caregiving practices and arrangements that track the care that is given and received (see chapter 3). Second, I argue that a Rawlsian form of hypothetical acceptability supplies valuable critical distance (more on this in the section on Rawlsian liberalism below). And, third, I acknowledge that theorists who specify principles of justice always draw on our understandings of the world, where these understandings (see Walker 2007) include a sense of what counts as a disadvantage, and the perception of some experiences as hardships rather than others. To improve the context in which philosophers form our judgments, I defend teaching autonomy skills in the real world as an enduring condition for any society that strives to be just. The latter two conditions come together into a new form of constructivism that I call two-level contract theory, which requires an evaluation of the principles of justice that people would choose when they do not know where they will be in the resultant distributive arrangement (the first level), where that thought experiment is performed by a real person in a particular historical context whose intuitions and insights will be informed by what they know and what people around them value and articulate, so that autonomy skills for real people is another necessary condition that is located at the second level of the neo-Rawlsian contract device. I use the abbreviated term liberal dependency care as shorthand for the overarching theory of the book, which is a form of critical liberalism that incorporates dependency care into its foundations. Moreover, because the oppression that has characterized the invisibility of care in the real world overlaps with characteristics of other forms of oppression, I suggest, but do not defend the claim, that two-level contract theory is a core modification for any Rawlsian contract theory aiming to address the manifestations of oppression.

Liberal dependency care holds, with Rawls, that an arrangement is fair if the hypothetical agents of construction in the original position would agree to it. The two-level contract theory includes the outcome of an assessment of hypothetical acceptability from the contract device presented in chapter 2, where these assessments should be informed by a society in which real people possess autonomy skills. The process of arriving at principles and adjusting intuitions may be one that extends into perpetuity, given the currently existing pockets of invisibility and subordinating narratives surrounding the aptness of women as caregivers.

Liberal dependency care’s conclusions about the appropriate level of responsibility and other-directedness in a society structured in accordance with the principles of the theory may strike many existing real-world deliberators as “unduly burdensome” despite reflecting the real costs of society’s care needs. Consequently, theorists of justice need to have knowledge of the extreme demands of other-directed attention and action that are required to care for another person.

In the society that is just according to liberal dependency care, everyone will have competency in autonomy skills. Everyone will also possess basic competency in the caregiving skills of attentiveness and responsiveness. In addition, because caregiving will not be highly concentrated in any one group, some amount of caregiving will play a role in nearly every person’s life. Some people will also specialize in caregiving, and it will be recognized as a domain in which innovation and excellence can be attained. People will not be disadvantaged because of being caregivers.

Because we will each receive the care we need to survive, the children who are currently disadvantaged in that respect should receive far more care than they do now, and people who currently receive care as a byproduct of social privilege may receive less care. However, beyond teaching caregiving and autonomy skills through public edu...

Table of contents

• Cover
• Half Title
• Series
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• Preface
• 1 The Theory of Liberal Dependency Care
• Part I Theory
• Part II Practices, Principles, and Change
• References
• Index