Ethic of Care

by Mark Hughes, MD, MA

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    00:00 Our third approach to thinking about ethics is going to be the Ethic of Care.

    00:06 So, the first thing to point out is this is really just a matter of the focus or the lens that we use to look at a situation.

    00:15 And it could be said that the ethic of care is consonant with other ethical theories.

    00:20 So, you could look at a situation through the lens of principalism but you can also look at it through the ethic of care.

    00:26 So it doesn't mean that they're in opposition, it's just a different way of looking at the same situation.

    00:33 The ethic of care grew out of thoughts with regard to developmental psychology.

    00:37 So how does one achieve moral maturity and there are different ways that philosophers have thought about this over the years.

    00:45 And the ethic of care is a tradition that goes back thousands of years, but really gained residence just in the past half century.

    00:55 And what it really focuses on is the idea of relationships and relatedness.

    00:59 So, a saying that people are connected to each other.

    01:03 That interconnection then generates some obligations or feeling of responsibility for other people because we're in relationship with them.

    01:13 And unlike some other traditional philosophical approaches where reasoning was everything, you know, the rational mindset is how you would deliberate and come to decisions.

    01:26 In the ethic of care, it's felt that emotions are important.

    01:30 How we feel, how we react to another person's, whether it's suffering or situation, those emotions are important and should not be disregarded.

    01:43 So ethic of care, again, different lens, different focus, different viewpoint is saying emotions matter.

    01:50 And if you think for yourself of we use care in a lot of different ways.

    01:56 So I tell another person I care for you or I care about you.

    02:01 We talked about taking care of another person.

    02:04 We talked about giving care.

    02:06 So, care is an element in our language that shows our connection to each other, various ways that we use it and demonstrate that to another person.

    02:20 So even though I said doing, you are not going to say that they're in opposition, the ethic care and principle so I just want to do a compare and contrast between these 2 approaches since we've talked so much about principalism.

    02:32 So again, if we're thinking about a lens and how we're focusing, the locus for principalism is the self, you know, respect for autonomy and the person being self-determining, making their own decisions whereas in the ethic of care, the locus is relationships.

    02:48 So not to mention the individual person, but the person in relationship with others.

    02:54 The fear, when we're thinking about you know what's at stake, in principalism we think about oppression, you know, that idea of other people are out to get me, I got to defend myself and you know the liberty interest would say I don't want to be oppressed by other people.

    03:13 Whereas if you're thinking about the ethic of care and being in relationship with other people, really the main fear is being abandoned, losing those relationships.

    03:23 The goal is going to be a little different.

    03:25 So, in principalism, again the reasoning, the having order and getting rules and you know deontology following those rules and that there's an equality everyone, you know, gets an equal share.

    03:38 Whereas the goal for the ethic of care is security.

    03:42 So, feeling secure and safe in your relationships.

    03:48 When we think about judgment for principalism, think about the scales of justice.

    03:54 You know, justice is blind, wearing a blindfold and being impartial in how you're rendering judgments.

    04:01 Whereas in the ethic of care, if we're thinking about relationships and people being connected, really it's all about partiality.

    04:09 Knowing the other person and knowing their connection to them, that is going to matter in how you come to reach your judgment, how you make a decision.

    04:19 Very much for a social justice, we think about partiality rather than impartiality when we think about like retributive justice.

    04:28 For the self, for the person, the individual, you know in principalism it's sort of an atom, you know atomistic, 1 unto itself.

    04:42 Whereas, the self in the ethic of care is in relationship.

    04:47 It's more like a molecule rather than an atom.

    04:50 You know, you're connected to that other person.

    04:55 When you're thinking about maturity, you know, so when you've achieved moral maturity, that developmental process that we go from childhood into adulthood and being able to make decisions and perform actions, when we talk about principalism, again we were thinking about respect for autonomy, the autonomous individual making their own decisions.

    05:17 Whereas in the ethic of care, it's all about interdependence.

    05:22 We're all connected to each other, we're all dependent on each other.

    05:25 So being mature is actually recognizing you're not in it by yourself, you've got others to think about.

    05:33 And those others, you know, in principalism it's the abstract others.

    05:36 It's just people out there in the world.

    05:38 It's me and my atomistic self, my individual self against the world and the others are just abstract.

    05:46 Whereas in the ethic of care, each person has their own identity. They're individuated.

    05:52 They matter because they have their own personhood and we're connected to them.

    05:59 And showing respect for other people, you know, so in principalism it's about what we call negative rights, so not being oppressed by the other person, the non-interference, the non-maleficence idea.

    06:11 Whereas respecting others in the ethic of care is about responsibility.

    06:15 So, if I'm in, you know, the paradigm relationship would be like the family relationship.

    06:20 Do I feel responsible for these other people in my family? And acknowledging that they have needs, I have needs, we're interdependent and therefore we're going to respect each other by taking care of each other.

    06:33 So let me talk about a case just to try to bring this to light.

    06:36 Imagine you're taking care of middle-aged woman who has just had a cardiac arrest.

    06:42 She has lack of oxygen to her brain and she goes in to a persistent vegetative state so she is no longer going to be able to communicate with those around her.

    06:54 If you look at this case through the lens of principalism, you'd start with well "Did she ever have an advanced directive that would sort of state what she would want or not want if she were in a persistent vegetative state?" We'd turn to somebody to make decisions for her.

    07:12 Is there someone to represent her interest or surrogate decision maker, perhaps a family member, that would make decisions.

    07:19 And then we'd ask them, you know, through an informed consent process, you know "What should we do to take care of your loved one? Are there risks and benefits of whatever treatment we're proposing? If it's a life-sustaining treatment like mechanical ventilation, we have to keep her alive through this artificial means.

    07:37 Is that something that she would want or not want? That's sort of how principalism would approach this.

    07:42 Whereas, if you think about it through the ethic of care and you use that lens, you're really going to think about who was this woman? What's her story? What's her life story, you know? Who are her family members? What are the relationships they have with her? How can we assist, perhaps it's her adult children that need to make this decision? They are also going through this, you know, devastating lost.

    08:08 Their mother will no longer be the same person that she was.

    08:12 We think about the relationships they have.

    08:14 We think about her more in terms of a family unit rather than just the individual person and then trying to come to a decision about how we're going to take care of her in the future.

    08:25 It might include, you know, making those decisions for mechanical ventilation or it might be choosing to withdraw any life-sustaining treatment.

    08:33 Again, it's just the lens that we used to think about the case and how we focus it.

    About the Lecture

    The lecture Ethic of Care by Mark Hughes, MD, MA is from the course Introduction to Clinical Ethics.

    Included Quiz Questions

    1. An idea that moral action depends upon relationships and relatedness
    2. An idea that moral action depends upon reasoning
    3. An idea that moral action depends upon being unemotional
    4. An idea that moral action depends upon protecting oneself against oppression
    5. An idea that moral action depends upon being impartial
    1. The locus of principlism is the self and the locus of the ethic of care is a relationship.
    2. The locus of principlism is the family and the locus of the ethic of care is a relationship.
    3. The locus of principlism is the family and the locus of the ethic of care is the self.
    4. The locus of principlism is the family and the locus of the ethic of care is a religious denomination.
    5. Self is the locus for both principlism and care.
    1. Security in relationships
    2. Authority
    3. Noninterference
    4. Power
    5. Status
    1. Understanding the story of the patient and their relationships with family and other individuals
    2. Knowing who the surrogate decision maker is for them when they do not have the capacity
    3. Knowing whether they have an advance directive
    4. Knowing whether they have health insurance
    5. Knowing whether they have worked in healthcare

    Author of lecture Ethic of Care

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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