Citizenship and the Ethics of Care

Feminist Considerations on Justice, Morality and Politics

Selma Sevenhuijsen

• Publisher: Routledge
• Year: 2003
• eBook ISBN: 9781134697236
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Care and women's emancipation have often been seen as opposed. Politicians have begun to look again at the issue of care in the context of new reforms in the welfare state, health care policies and family law. Using concrete examples taken from parental rights cases, health care education and the public health sector. Using concrete examples taken from the practice and discourse of care, those found in parental rights issues, health care education, the family and in the public health sector, Sevenhuijsen argues for revaluation of care from a feminist perspective.

1
‘HAS HEAD, HANDS, FEET AND HEART’

The context: care and politics under discussion

This morning activity supervisor Moniek van den Heuvel (23) is ‘shmoozing’ with Mrs Geurlings, who, wearing a pink dressinggown, and leans lopsidedly in her wheelchair. ‘Just among the crowd, walking down the road, those everyday things…’ sounds from the radio, which, like the lampshades, plastic roses and an old-fashioned teapot, forms part of the furnishings of the ‘shmooze’ room. Moniek van den Heuvel hums along with the tune. She goes and sits down close to Mrs Geurlings, strokes her thin white hair and holds her hand. Then she takes a marshmallow from a glass jar. ‘Ummm, we’re going to have a treat today, Mrs Geurlings’, she says, as she pops a tiny piece of marshmallow in her mouth. Mrs Geurlings starts to mumble, inaudibly, but suddenly the word ‘eat’ can quite clearly be heard. Van den Heuvel: ‘This is the first time I have ever heard her really say anything at all. That alone makes my morning worthwhile.’ Meanwhile the radio plays ‘On the wide, lonely dunes’, and Mrs Geurlings continues to chew.

This arresting description of an everyday scene in a nursing home formed the closing lines of the leading article in the Saturday supplement of the Dutch newspaper NRC Handelsblad on 5 November 1995. For the cursory reader it is probably just an everyday scene, a story that you read without really stopping to think about it. Few would be likely to read it as a ‘moral tale’, except those who are more familiar with the moral dimensions of providing care. The description of Moniek van den Heuvel contains various elements which are commonly regarded as characteristic of ‘good care’: patience, empathy, attentiveness, intimacy and, not least, the ability to draw satisfaction from fulfilling what may seem to be insignificant needs. Many readers will feel admiration for Moniek van den Heuvel’s actions, but at the same time be grateful that they are not in her shoes. The description of Mrs Geurlings also arouses ambivalent feelings: everyone would like to receive such dedicated care if they were dependent on it, but most people hope that they will never end up in such a position of dependency. The story about Mrs Geurlings evokes fear: fear of deterioration and futility, fear of the winding, grey, twilit path which leads from growing dementia finally to death. The presence of Moniek van den Heuvel provides some solace for the reader; not only solace for their own vulnerability and fear of dying, but also for their difficulty in dealing with the illness and finiteness of their own loved ones. Her caring presence also symbolizes the patience which is so difficult to achieve for those who have become drawn into our achievement-oriented culture and the often stressful labour process.

The headline of the article, ‘At the limits of care’, will be more likely to raise associations with ethical issues than the excerpt quoted. The first association will probably be the familiar question, at present frequently raised in public debate, of whether the provision of care should be limited now that medical science and medical technology can prolong life in unprecedented ways. In discussions about euthanasia and the possibility of ending the lives of severely handicapped babies this problem is discussed in terms of ‘meaningful life’. The ethical issue is usually posed as a problem of authority and rights, and as the issue of who should decide what constitutes meaningful life and on what criteria. From the article it becomes clear, however, that the journalist is referring to something else: to the limits of people’s capacity to care under difficult circumstances. This applies to the task of caring in difficult situations; situations which involve making tolerable a vulnerable and finite existence within relationships of extreme dependency, rather than the promotion of growth or recovery. The ethical aspects of the situation in the article centre then, not so much on the issue of whether physicians are authorized to end life, but on the moral burden placed on carers. The moral question, although it is not posed in terms of ethics, centres on whether care-providers can and should establish limits to their emotional involvement, intimacy and tenderness, those qualities, in fact, which are precisely what is needed in caring for old people suffering from senile dementia. The nursing home director sees the problem as a conflict between emotion and professionalism, or how carers can avoid ‘personal feelings’ getting in the way of a professional approach. However, in the rest of the article there is less emphasis on the conflict between emotion and professionalism. On the contrary, a professional attitude is presented as being a necessary requirement for learning to render feelings productive and keep them in perspective, for turning commitment into self-knowledge and for reflecting on useful caring relationships.

The issue of the active ending of life is not entirely absent from the article, however. The direct pretext for the article was the report, a month previously, that a nurse in Delfzijl had confessed to killing nine patients suffering from severe senile dementia out of a sense of pity. What is remarkable in the article is the understanding shown for the nurse in question. A social worker who is interviewed about the case lacks the customary arrogance of experts who wonder how this nurse could ever have let herself go so far. She interprets the nurse’s actions rather as a sign of her loneliness and stress, signals which should have been picked up more effectively by her team leaders. Because the journalist has chosen to write an ‘inside’ story from a nursing home, the ‘killing nurse’ incident is described in a different moral vocabulary than that used in ethical discussions about the authority to end life. While it would not have been at all difficult to depict the nurse as a ‘murderess’ (the associations with the stereotypical image of the female poisoner are obvious) and out-rightly to condemn her behaviour, the reader is asked for understanding instead; understanding for the heavy burden carried by those who care for psycho-geriatric patients and for the joys and sorrows which are inseparably linked to their daily routines. The article provides no clearly defined ethical norms. Rather than establishing fixed boundaries by means of ethical norms, it points out the difficulty of marking ‘boundaries’ at all.

Seen from this perspective the article is less arbitrary and innocent than is at first suggested. The report about the ‘killing nurse’ must, after all, have aroused consternation in many circles. ‘What guarantees can be offered for good institutional care for ourselves and our families?’ is the thought which must have occurred to many people when the report first appeared. ‘How far can we entrust ourselves to professional care?’ And, conversely: ‘How can nursing homes prevent their image of providing good care from being tarnished?’ A realistic, sympathetic story from everyday life manages to quell this unease. It presents care as complicated but also touching: joys and burdens are depicted as inseparably linked aspects of care. In the article patient love and compassion lead to respect and wonder for the fragility of human existence, even though this same love and compassion can degenerate into active killing. The boundaries are sometimes flexible, but we can guard them by ensuring that care does not have to be given in isolation, that it is embedded in a professional framework.

The fear of the ‘female poisoner’ can be transformed into understanding, if we are able to appreciate what a heavy toll patience and empathy exact on the endurance of carers. There is no mention of a legal norm; a more professional system of care is presented as offering the necessary guarantee against such a deplorable act.

Although the words ‘morality’ and ‘ethics’ are not specifically mentioned, the contents of the article point in many ways to moral questions: the question of how to deal with dependency, responsibility, vulnerability and trust; the importance, but also the fragility of intimacy and connectedness; the everrecurring problem of establishing boundaries between the self and others. This would suggest that the invisibility of the moral dimensions of care stems from the limitations of the vocabulary with which ethics is usually discussed: in the public debate ethical issues are mainly posed in terms of rights and duties, obedience and authority, and in the question of who has the competency to decide what is right and wrong, or good and bad. It is thus difficult to recognize many everyday questions as ethical issues. The protagonists in the public debate on ethical issues are lawyers, medical professionals, psychologists, theologians and moral philosophers, who rarely, if ever, mention nurses and carers, let alone marshmallow-chewing senile women and the daily moral interactions in the care of the elderly. Their judgement about the killing nurse would probably be unequivocal: punishable behaviour, which at best can be accorded some compassion if the nurse can be considered by the court as having acted from a condition of ‘unsound mind’. This, then, is the importance of the article: it establishes different moral principles than that of conviction and punishment. It does not of course condone the nurse’s actions, but it does invite the public to look more closely at the conditions under which care is provided in nursing homes and to show understanding for care-givers, for their loving, professional relationships with those for whom they care and for the heavy burden which this form of care can entail.

In short, the newspaper article invites ‘judging with care’ in more than one sense.¹ The audience is addressed in terms of those of its mental attitudes which indicate caringness: empathy, practical knowledge and compassion. This appeal to careful judgement at the same time brings care as a form of human agency within the arena of judgement. It makes it possible to consider care as an element of human existence. An obvious legal judgement on the nurse’s actions is, even if only for a moment, suspended. Our attention is drawn away from the courtroom and directed instead towards the dayroom of the nursing home, which is conjured up for us by the familiar image of the teapot, lampshade and plastic roses. Thus, care enters into the story in two senses, as an attitude and as a form of action. Judging with care points then also to the necessity of viewing care as a form of social agency, which at the same time can inspire careful judgement. The importance of this double meaning of ‘judging with care’ is, however, broader, and this brings me to a third meaning of this phrase. To understand its wider importance we need to place the scene in the nursing home in a broader context of time and place. I am referring here to the public debate in which the newspaper readers are involved at this historical juncture, as citizens in a democratic political system in which the content and meaning of ‘care’ and ‘justice’ are continually under discussion, particularly in the context of the restructuring of the welfare state and the revision of the legal system. The nursing home can be seen as a microcosm of a wider political community, in which, as citizens, we are continually invited to pass political judgements on the quality of public and private care provision and many different aspects of human social existence.

But this is exactly where the problem lies, however: which normative vocabularies do we have at our disposal for judging with and about care in political contexts? We have become used to conceiving of citizenship issues in the terminology of enforceable authority, rights and duties, the language which seems pre-eminently designed for the expression of our manifestation in the public sphere. The problem of ‘judging with care’ lies not only in the fact that political judgement mainly proceeds in terms of rights and justice, but also in the cognitive attitudes that are supposed to guide judgements in these terms.

Judgements in the public sphere are usually associated with distance and impartiality, and with the ability to transcend the individual point of view in order to reach a ‘general viewpoint’. The virtues associated with care, such as compassion, attentiveness, empathy and attention to detail, in contrast, are depicted as belonging to a different sphere, that of interpersonal and private relationships. The modern ideal of citizenship demands that citizens free themselves from dependencies and loyalties in their political judgement in order to arrive at free and autonomous choices. As the American political theorist Joan Tronto has so aptly put it, modern political theory locates care both ‘above and below’ politics (Tronto 1995b).

Feminism and care: an uneasy relationship

This problem seems even more complex when we consider care as a political issue from the perspective of modern feminism. Feminism, in the form in which it arose at the end of the 1960s, can quite clearly be seen as a rebellion against a supposedly ‘female’ nature of care and the associated subordination of women to men.² Feminists demanded public space and made it abundantly clear that they no longer wished to be tied to a ‘woman’s destiny’, to the life which their mothers before them had led. Caring was depicted as dull, monotonous and traditional, and thus as an obstacle to self-fulfilment; it could certainly not provide an identity for modern women in search of independence. By defining care as domestic labour feminists made it clear that necessary care could just as well be provided on a professional basis and that it was high time that men finally fulfilled their duties in that respect.

For politically engaged women of my generation, political alliance with liberal socialism seemed obvious; of all the political movements, it offered the clearest promise of emancipation, through its proposed combination of the liberal freedom rights and strong public services. This also meant that feminism could quite easily associate itself with the political idiom of modern citizenship: the language of freedom and equality, redistribution, autonomy and individualism. The vocabulary of rights thus seemed a logical normative partner for feminism. The paradoxical fact that this also led to an appeal for strong government was less easily recognized. In fact, it was compatible with the feminist objective of calling on official authorities to convince the public that ‘sexual difference’ should be abolished. It also tied in with the general feminist idea that the personal was political, which in turn implied that politics had the ‘right’, and in many respects even an obligation, to interfere in all aspects of human existence.

As a result, in those first years the figure of Moniek van den Heuvel would have been difficult to recognize as an example for feminist judgement. Even though feminism had also adopted the slogan ‘We want to be strong without losing our tenderness’ as one of its mottos, her patience and satisfaction with such insignificant details could hardly serve as an example for feminist political judgement, which remained imbued with the normativity of power, militance, justice, autonomy and liberation. The image of the conscientious carer belonged more to the political idiom of the Dutch Christian Democrats, for whom, in the 1980s, she was the symbol of the ‘caring society’. This certainly did not provide an attractive image for feminists. The ideal of the caring society was accompanied by public pleas for an ethical revival, traditional family values, the naturalness of the heterosexual order and a revival of care as the willingness to make sacrifices. This meant that not only care but also morality seemed tainted to feminists. Together they symbolized normalization and paternalism, the antithesis of the ideals of freedom and self-determination.

Nevertheless, care remained an urgent question for feminists. In the practice of daily life the problem of care presented itself in countless different ways: from the care needed by children, friends and elderly parents, to women’s own need for care and the way in which the health service treated women’s complaints. In fact, feminist women were actively involved in the issue of care in many different ways: within private relationships, the health service and women’s care organizations, as well as in political contexts. Here they struggled for the redistribution of paid labour and care, and new forms of valuation for what increasingly came to be called ‘care labour’. The moral dimensions of care, however, remained controversial, not least because care as a political concept remained the property of the Christian Democrats. The media have always been happy to see themselves as the guardians of these divisions between political parties. Thus ‘caring has a Christian Democrat feel to it’, wrote Pauline Sinnema in Dutch newspaper Het Parool at the presentation of the National Care Plan by Jeanne de Bruijn in 1993, ‘while the professor is actually a member of the Labour Party’. According to the journalist, De Bruijn should have called the plan ‘National Work Plan’ instead. The message is clear: care doesn’t belong in a progressive person’s framework. Progressives should either stick to the language of labour or join another party.

In this short introduction I have tried to convey the complex political relations within which the essays brought together in this collection have come into being over the past years. Since 1975 I have been actively involved in what, in retrospect, could be interpreted as a search for an appropriate vocabulary for making care into a political issue from a feminist perspective, and in so doing to think what we do’, as Hannah Arendt has described the task laid out for political theory. My first approach started from the relation between domestic labour and the welfare state, and I tried to link care to Marxism, the dominant political vocabulary for left-wing feminists in the 1970s (Sevenhuijsen 1978). This approach enabled feminist theorists to raise a number of important themes. It became possible to describe care as‘labour’, thus freeing it from its self-evidence. This also meant focusing more attention on the relation between family and state, propelled by the idea that throughout history there have been repeated shifts between what women do at home and what the state organizes in the form of public services. The relation between paid and unpaid labour is still an important issue. In this vein, feminists have managed to develop an original perspective on the restructuring of the welfare state, a debate which remains as relevant today as ever.

In political theory the overtures between feminism and Marxism did not last long, however. In retrospect, feminism played an important role in the downfall of Marxism as a political theory. The Marxist idiom distorted the complex experiences of intimate life, which feminists wanted to bring out into the open and the reduction of care and gender identity to ‘labour’ soon became problematic. This became clear definitively when subjects related to sexuality and motherhood began to occupy more space in women’s studies, and when psychology and culture, as well as language and history, became subjects of feminist research. It also became clear that there are many ways in which ‘gender’ does not correspond to ‘class’ as a political factor, so that comparisons with class, from which feminism derived its legitimacy within Marxism, soon came adrift (Withuis 1990, 1995). And...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• 1 ‘Has head, hands, feet and heart’
• 2 The morality of feminism
• 3 Paradoxes of gender: ethical and epistemological perspectives on care in feminist political theory
• 4 Care and justice in the public debate on child custody
• 5 Feminist ethics and public health-care policies: a case-study on the netherlands
• Notes
• Bibliography
• Index