Care Ethics

New Theories and Applications

Christine Koggel, Joan Orme, Christine Koggel, Joan Orme, Christine M. Koggel, Joan Orme

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9780415623308
• eBook ISBN: 9781317981497
• Topic: Medicine
• Subtopic: Health Care Delivery

The ethic of care has developed to become a body of theory that has expanded from its roots in social psychology to many other disciplines in the social sciences as well as the humanities. This work on care has informed both theory and practice by generating complex accounts of care ethics for multiple and intersecting kinds of relationships, and for a variety of domains and contexts. Its application now extends from the moral to the political realm, from personal to public relationships, from the local to the global, from feminine to feminist virtues and values, and from issues of gender to issues of power and oppression.

The developments in the theories and applications of care ethics over the past few decades make this book an appropriate and timely publication. It includes chapters by authors who are developing or expanding theories of care ethics and also by those who work on applying and extending insights from care ethics to practices and policies in personal and institutional settings. Care Ethics provides readers from different disciplines and professional groups with a substantial number of new theories and applications from both new and established authors.

This book was originally published as two special issues of Ethics and Social Welfare.

Introduction

Christine M. Koggel and Joan Orme

Introduction

When Carol Gilligan (1982) first introduced the ethic of care she did so from the discipline of psychology using empirical data that questioned Kohlberg’s (1981) negative assumptions about the moral development of women. Gilligan argued that Kohlberg’s research assumed a male model of moral reasoning and decision making, and that women were either left out of the studies all together or judged to have less ability to reason. Gilligan’s uncovering of a ‘different voice’ has had broad implications in its challenge to mainstream moral theory in the liberal tradition. In contrast to accounts of universal principles and of the significance of impartiality, individual rights, consequences, and justice in consequentialist and deontological moral theories, the ethic of care emphasizes the importance of context, interdependence, relationships, and responsibilities to concrete others. In developments that followed, some debates centred on the extent to which care ethics are feminist ethics (Held 1995; Koehn 1998) relevant predominantly to interpersonal caring relationships (Noddings 1984) and the institutions based on these. Other theorists broadened the debate to the political realm (Tronto 1993; Sevenhuijsen 1998; Robinson 1999) or explored intersections between or the possible integration of care and justice in international relations and the global context (Held 2006).

The ethic of care has developed over the past few decades to become a body of theory that has expanded from its roots in social psychology to many other disciplines in the social sciences as well as the humanities. This work on care has informed both theory and practice by generating complex accounts of care ethics for multiple and intersecting kinds of relationships and for a variety of domains and contexts. Its application now extends from the moral to the political realm, from personal to public relationships, from the local to the global, from feminine to feminist virtues and values, and from issues of gender to issues of power and oppression more generally.

These theoretical developments have led to examinations of an ethic of care that challenge contemporary theories such as the capabilities approach, cosmopolitanism, global justice, international political theory, and virtue ethics (to name a few). Often these accounts begin with a feature of an ethic of care already present in Gilligan: the idea that individuals are not the isolated and abstract entities described in traditional liberal theory, but are fundamentally relational and interdependent. Care theorists who bring this feature to the forefront highlight our embeddedness in networks of relationships that intersect at various levels of the personal and political in ways that shape people’s lives as well as the values, practices, policies, and institutions that affect them (Koggel, 1998). As it relates to political theory, this work on an ethic of care identifies the limitations of liberal accounts of the self, autonomy, justice, and equality and reconceives these concepts in relational terms (Downie and Llewellyn, 2012). The result is the envisioning of new theory, policies, and structures (Mahon and Robinson, 2011; Miller, 2011). All of these developments in theories and applications make care ethics an appropriate and timely topic for further exploration.

About this volume

The influence of care ethics is such that when the call went out for papers for a special issue of the journal Ethics and Social Welfare on Care Ethics: New Theories and Applications, the response was overwhelming. It was not just the volume of papers, but also the scope of the topics covered and the international spread. The areas covered went beyond what had been anticipated by highlighting the continuing applicability of care ethics to all aspects of human relations and organisation and involving responses both to theoretical challenges and to fast changing social circumstances. The richness of submissions led to the publication of two special issues on an ethic of care, and other papers appeared in other issues of the journal. The organising principle for the publication of the papers accepted was along the lines of those authors who worked on developing or expanding theories of care ethics and those who worked on applying and extending insights from care ethics to practices and policies in personal and institutional settings. This monograph combines the papers from the two special issues along with one other and maintains the distinction in its two parts: Part I, New Theories and Contemporary Issues and Part II, New Applications in Contemporary Contexts.

If we take a central feature of care ethics to be its attention to the specificity of contextual description and analysis, this division between theory and practice or policy may be somewhat artificial. While it is true that the papers in Part I, New Theories and Contemporary Issues, use issues and examples from real contexts and lives, they do so in order to illuminate the new theories that the individual authors attempt to articulate and develop. Some of these theorists returned to their early, substantive work that helped to develop the ethic of care in order to reflect on what was missing then, left unsaid, could be challenged, needed to be developed, given a new emphasis, or taken in new directions. An important point is that the authors’ reflections, critiques, and broadening of their early work is now being done in the light of urgent and serious issues in a global context, ones that require paying attention to and addressing the needs of distant others in morally responsible ways. In other words, the global context highlights the very features of dependence and interdependence that were central from the very beginning, when Gilligan took relationships and responding to the needs of others as central to the moral reasoning underlying an ethic of care. In this collected volume, therefore, we not only have some of the most prominent care theorists reflecting on their own previous work on an ethic of care, we also have them in dialogue with other authors in the use that each makes of the work and insights of others to develop new theories and new applications for care ethics.

New Theories and Contemporary Issues

The papers in Part I investigate the broad implications for theoretical developments of care ethics for a variety of issues and contexts. Authors explore the relevance of care ethics to current issues such as war, terrorism, gender violence, and health care; to global concerns such as international law, economic globalization, poverty, and the global economic crisis; and to inequalities in a postcolonial context. In taking such a broad perspective we are widening the definitions of welfare to that of well fare. In other words, we are moving beyond an understanding of welfare that relates only to the services provided by the state, or by organisations on behalf of the state, to one which includes all relations and interventions that contribute to the well being, health, safety and security of individuals, communities and nations. It is testimony to the impact of care ethics over the decades that the focus of attention is so broad. The papers in Part I reflect these theoretical developments and applications, some of which broaden the discussion to the global context and issues in it, some of which focus on the effects of state and global economic policies on people in a specific context, and some of which illuminate how care ethics can avoid the pitfalls of current policy and envision new policies and structures.

Part I, therefore, includes authors that work with this broad understanding of welfare to delineate new theories and applications in the political realm. Virginia Held opens the volume by asking ‘Can the Ethics of Care Handle Violence?’. She acknowledges that care ethics has been viewed as having little to offer in dealing with issues such as crime, war, terrorism, and violence against women. Held works with the two issues of violence against women and terrorism to develop an ethics of care that can acknowledge the need for law and its enforcements at the same time as it rejects law and enforcement as encompassing the whole of morality. The result is an account that can provide guidance in understanding and dealing with family violence and terrorism in ways that go beyond and may help supplant the need for justice. In the paper that follows, Fiona Robinson uses the current economic global crisis as an opportunity to challenge and rethink liberal and neo-liberal approaches that have dominated international political theory. By challenging the individualism of liberalism, Robinson uses insights of relationality, interdependence, and responsibilities to others to sketch an international political theory of care. The result is a political theory of care that is able to reveal the gendered and raced nature of caring and better address the real needs of others in a postcolonial context shaped by a global political economy. She discusses the earthquake in Haiti and its aftermath to illustrate features of an international political theory of care.

In ‘Cosmopolitan Care’, Sarah Clark Miller reflects on how care ethics can deal with another crisis that has demanded a global response: that of widespread violence in the Darfur region of Sudan and, specifically, of gender violence as a mechanism of war. She moves away from the usual focus on justifications for humanitarian intervention to sketch a cosmopolitan account of care that can do the crucial work of rebuilding the lives of women and communities affected by the devastation of gender violence by restoring and strengthening their ability to care for others. Unlike cosmopolitanism in the justice tradition, with its assumptions of individualism, universality and generality, cosmopolitan care emphasizes the importance of responding to others’ needs in ways that are contextually sensitive and culturally attuned. Miller’s call for strengthening institutions that reflect responsive and responsible care practices is given a theoretical framework in Joan Tronto’s ‘Creating Caring Institutions: Politics, Plurality, and Purpose’. Tronto extends her earlier work that brought care ethics into the realm of political theory and social policy by developing an account of what it would mean for institutions to provide good care. Accounts of institutions of care tend to model them on the family or the market, both of which are shown to fall short of providing good institutional care. Tronto uses key features of an ethic of care to delineate three elements of good care in an institutional context: the purpose of care, a recognition of power relations, and the need for pluralistic, particular tailoring of care to meet individuals’ needs. In the paper that follows, Heather Peters et al. pick up on an aspect of Tronto’s critique of a market model of care by examining how care in families and in caring institutions is affected by economic decline and the resulting government policies of cuts to these institutions and programs. They contextualize the effects of economic decline and these now popular cuts to federal and provincial funding by explaining what this means for people in northern, rural and remote communities in northern British Columbia, Canada.

The final two papers in Part I further expand the ethic of care in its academic and theoretical scope and also in its application to personal, public and political relationships. Focusing on gratitude, Amy Mullin identifies the particularities and vulnerabilities of care-givers and care-recipients and explores how these are shaped by social hierarchies and public institutions. She argues that a feminist ethics of care can usefully employ gratitude as a way to draw out morally significant aspects of care and highlight the importance not only of responding to specific needs but also of attending to the capacities of recipients of care. Alessandro Pratesi uses care ethics as a lens through which to examine the sociological aspects of care that can result in emotional and psychological exhaustion at the same time as it can be gratifying, rewarding and empowering. By situating an analysis in her study of the daily activities of caregivers, Pratesi uses care as a strategic site through which to understand the interactional mechanisms and explore the emotional dynamics of caregivers. These emotional and relational dynamics become a recurring theme in the papers that follow in Part II.

New Applications in Contemporary Contexts

While feminist accounts of theory and connections with care ethics in domains that were primarily and obviously relational continue, there is clear acknowledgement of the political impact and implications of the conditions in which care is provided (Williams, 2001) and of the relevance of care ethics to policy, analysis, and activism. Those conditions include contexts of paid and unpaid labour in caring domains. Yet in terms of the practice of care (in professions such as nursing and social work) there was initially surprisingly little attention to the implications of an ethic of care: practitioners who provided care assumed they understood care and deemed it an uncontested concept (Orme, 2002) and have only begun to explore the complexities in the last decade (Parton, 2003). In looking at new applications of an ethic of care, our particular interest in getting historical and contemporary examples or case studies of care ethics in social work, community work, and related social and health professions came to fruition. This was true as well in having authors explore the implications of both the ongoing need for a critical analysis of any policy initiative from the perspective of the ethic of care and the interconnections among relationships in more detail. Some of the work in this area of case studies and applications of care ethics to policy analysis and implementation is the focus of and reflected in the papers included in Part II of this volume, New Applications in Contemporary Contexts.

Part II, therefore, follows on Part I by building on the theoretical explorations of care ethics, but it does so in the context of examining their application in different areas of health and social care and in various domains and contexts. The first three papers provide a link between the political theory, agendas and policy, and the practice implications of caring. They also place a greater emphasis on the application of the ethic of care in domains that reflect the more traditional understanding of welfare. In the United Kingdom, the policy of personalisation has developed as a response to the activism of service user groups; that is to those who require the intervention of care services to facilitate daily living. This policy has been heralded as a means of granting more autonomy, but is highly contested. Critiques provided by Liz Lloyd argue that it has failed to incorporate the political and personal implications of care ethics. Lloyd focuses on how such policies construct individuals who are recipients of services. She uses the example of how the policy impacts on older people to argue that it fails to address interdependence, relationships, and responsibilities to concrete others, which are both fundamental to and a consequence of the application of the ethic of care.

The papers by Kirstein Rummery and Marian Barnes continue Lloyd’s discussions of personalisation. Rummery recognises it as a global policy development and provides a comparative analysis of its introduction across Europe and the U.S. Her conclusions that personalisation is an ‘under governed commodification of care’ that leaves both carers and cared-for vulnerable, disempowered, and exploited are echoed by Barnes. Barnes explores the relationship between personalisation and care ethics by using analytic tools developed by care ethicists. Specifically, she uses Selma Sevenhuijsen’s ‘Trace’ analysis to trace the normative frameworks in key policy documents and thereby unpack and challenge the assumptions underpinning the policy and practice formulations in England.

The four papers that follow move from theory through policy to practice by examining relations between caregivers and care-recipients and exploring answers to questions about what care demands in relationships of inequality and dependency as these are manifested in particular domains and contexts. Nicki Ward focuses on learning disabilities in the context of caring relations. In keeping with the relational approaches embedded in the ethic of care, she uses personal narrative to contextualise the experiences of people with learning disabilities. In exploring caring in unequal relations, she not only reprises many of the themes in the preceding papers, she also challenges binaries that make people dependent or independent. This leads her to argue for citizenship and social justice for people with learning disabilities. In the paper that follows, Laura Steckley and Mark Smith discuss unequal relationships in the context of child care practice in which caring is associated frequently with protection. They explore the implications of an ethic of care for residential child care, where care, protection and control are often interwoven - and confused. They argue that public care needs to move beyond its current instrumental focus to articulate a broader ontological purpose, informed by what is required to promote children’s growth and flourishing. Staying in the area of child care but moving the focus from care in (and by) public institutions Andrew Pithouse and Alyson Rees look at relations of adults and children in foster care and the private setting of the home. They explore the tensions between foster care as an institution that has adopted a highly regulatory approach and foster care in the home that requires daily and ordinary practices that are relational, constitutive, and contextual. They argue that an analysis of the taken-for-granted and ordinary aspects of domestic life such as food, the body, and touch can...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Citation Information
• 1. Introduction
• Part I: New Theories and Contemporary Issues
• Part II: New Applications in Contemporary Contexts
• Index