ETHICS OF CARE

The ethics of care is a distinctive approach to moral theory that emphasizes the importance of responsibility, concern, and relationship over consequences (utilitarianism) or rules (deontologism). The concept of care is inherent to professions that care for individuals and this approach to ethics has therefore been a central part of professional ethical issues in both nursing and medical ethics, but in fact has much broader applications in relation to science and technology. "Due care" has for example, been a part of statements in engineering and has been used to include such typically technical activities as the maintenance and repair of an engineered system.

Origins and Development

As a moral theory the ethics of care originated during the 1970s and 1980s in association with challenges to the standard moral theories of utilitarianism and deontologism, primarily by women philosophers. The original work was Carol Gilligan's, conducted in the early 1970s and articulated in In a Different Voice (1982). Gilligan argued in response to the psychology of moral development formulated by Lawrence Kohlberg (1927–1987). Kohlberg himself built on the ideas of Jean Piaget (1896–1980), who did preliminary work on moral development as one facet of cognitive growth.

In his research Kohlberg posed moral dilemmas to males of various ages and compared the kinds of reasoning with which they responded. The dilemmas tended to be shorn of details about the people involved. The responses moved from self-centered thinking, emphasizing the importance of physical pleasure through thinking under the influence of peer pressure, to a moral orientation toward justice and abstract appeals to universal rights (Kohlberg 1984). Gilligan, on the basis of alternative research with both men and women, discovered a contrasting tendency, predominantly but not exclusively among women, to interpret "the moral problem as a problem of care and responsibility in relationships rather than as one of rights and rules" (p. 73). "While an ethics of justice proceeds from the premise of equality—that everyone should be treated the same—an ethic of care rests on the premise of nonviolence—that no one should be hurt" (p. 174).

Like Kohlberg, however, Gilligan sees an ethics of care emerging in three phases. In the early phase individuals care more for themselves than for others. In a middle phase care comes to emphasize concern for others over care for oneself. Finally, in its mature form the ethics of care seeks a balance between care for oneself and care for others. What nevertheless remains primary in each case is personal relationships: of others to oneself, of oneself to others, or mutually between oneself and others.

This new ethics of care was developed further by Nel Noddings (1984) in relation to education, and given a more philosophical formulation by Annette C. Baier (1985). According to Baier, Gilligan exemplifies a strong school of women philosophers that includes Iris Murdoch (1919–1999) and G. E. M. Anscombe (1919–2001), out of which have developed moral theories that stress living relationships over abstract notions of justice illustrated, for example, by the work of Immanuel Kant (1724–1804). Indeed, three decades prior to Gilligan, Anscombe had already suggested the need for a philosophical psychology as the gateway to any moral philosophy that might be adequate to issues arising in relation to science and technology.

Baier herself criticizes the rationalist individualism that rests content with establishing a minimalist set of traffic rules for social interaction as inadequate on a multitude of counts. Historically, it has failed to oppose injustices to women, the poor, and racial and religious minorities. While most human relations are between unequals, it has focused almost exclusively on relations between alleged equals. Despite the fact that many morally significant relations are not freely chosen, it has emphasized freedom of choice and rational autonomy. And although emotions are often as important as reasons, it has persistently stressed the rational control of behavior. At the same time Baier is careful to emphasize how an ethics of care complements rather than discards an ethics of justice. A good moral theory "must accommodate both the insights men have more easily than women, and those women have more easily than men" (Baier 1985, p. 56).

Applications in Biomedicine

From her empirical studies of people faced with difficult moral decisions, Gilligan identified a distinct approach—one of care, responsibility, concern, and connection, based on personal relations. This care orientation forms the basis of the ethics of care, "grounded in responsiveness to others, that dictates providing care, preventing harm and maintaining relationships" (Larrabee 1993, p. 5). It was natural that such an approach to ethics would be applied in the field of medicine, especially in nursing, where caregiving is already a defining characteristic. It is often argued that care is distorted by the dominance of scientific and technological practices in the practice of medicine.

In this regard one can note, for instance, how care has come to play an increasingly prominent role in such an influential text as Tom L. Beauchamp and James F. Childress's Principles of Biomedical Ethics. From its first edition (1979), this representative of the "Georgetown School" of bioethics emphasized a deontological "system of moral principles and rules" that highlighted four principles: autonomy (of the patient), nonmaleficence, beneficience, and justice. In neither the first nor the second edition (1983) did the ethics of care play a role. In the third edition (1989) and subsequent editions care has nevertheless been acknowledged especially in conjunction with an account of criticisms of principlism.

Although [principled] impartiality is a moral virtue in some contexts, it is a moral vice in others. [Principlism] ... overlooks this two-sidedness when it simply aligns good and mature moral judgment with moral distance. The care perspective is especially meaningful for roles such as parent, friend, physician, and nurse, in which contextual response, attentiveness to subtle clues, and the deepening of special relationships are likely to be more momentous morally than impartial treatment. (Beauchamp and Childress 2001, p. 372)

The authors go on to note the centrality of two themes in the ethics of care—mutual interdependence and emotional responsiveness. For the ethics of care, "many human relationships involve persons who are vulnerable, dependent, ill, and frail [and] the desirable moral response is attached attentiveness to needs, not detached respect for rights" (p. 373). The ethics of care further corrects a "cognitivist bias [in principlism] by giving the emotions a moral role" (p. 373) and encouraging attention to aspects of moral behavior that might otherwise be ignored.

In the field of nursing, in which care exercises an even more defining role than in other medical professions, the ethics of care has been accorded even more significance. Helga Kuhse's Caring: Nurses, Women, and Ethics (1997) provides a good overview in this area.

Criticisms

Beauchamp and Childress also summarize key criticisms of the ethics of care in the biomedical context. First, the ethics of care is incompletely developed as a theory. Second, one can easily imagine situations in which relatives or medical professionals are called on to override emotional responses and to abide by principles. Third, the ethics of care can be distorted by cultural expectations. Indeed, some feminist critics have argued that care is easily distorted by contemporary interests, as in cases in which the terminally ill request to be allowed to die because they do not want to continue to be a burden to those around them. Finally, still others have challenged the empirical basis for some of conclusions advanced by Gilligan and others, and questioned popular associations between the ethics of care and female experience.

More constructively, it is unnecessary to maintain an essentialist connection between the ethics of care and female experience. In fact, Gilligan herself argues that the connection may be only historical. It may just be that those who are marginalized in a rule-governed scientific and technological culture have a natural tendency to emphasize alternatives. But this possibility reinforces rather than diminishes the need to attend to the claims in ethics of care. In a culture that values competition and efficiency the ethics of care also promotes such activities as conflict resolution and dispute mediation when dealing with ethical and other conflicts.

Application to Technology and Engineering

The most salient definition and framework of care to apply to the contexts of science and technology is that of Joan C. Tronto and her colleague Berenice Fisher. Tronto and Fisher suggest that caring be viewed as "a species activity that includes everything that we do to maintain, continue and repair our world so that we can live in it as well as possible. That world includes our bodies, our selves, and our environment, all of which we seek to interweave in a complex, life-sustaining web" (Tronto 1993, p. 103).

The ethics of technology and of science needs to be a system ethics to be followed by a system of actors, doers, and stakeholders. It needs to work in the context of the science and technology enterprises, which are distinct. The justice and rights perspective gives an abstract, universalizable goal as Kohlberg, and indeed Kant before him, intended, but the praxis of science and technology calls for a guide for action in terms denoting action. This is what the ethics of care provides. Care in this sense is larger than care implied by familial and close community relationships. Care, too, is universalizable, but not abstract.

The Fisher-Tronto definition provides the actions—maintain, continue, and repair—that care demands, words closely associated with engineering, the action element of technology. This definition of care also recognizes that human existence is intricately woven into the web of the natural environment and that the ethics of care must apply to nature as well as to humans and their communities. In this perspective, care is well positioned as an ethics for a sustainable world, a prime challenge to today's technology. In her analysis of care, Tronto recalls David Hume's understanding of justice, an artificial passion, as a necessary complement to the natural passion of benevolence, which alone may not be sufficient as a moral basis in a human society. These ideas also hark back to Aristotle who sees practical deliberation as the means of achieving the ethical good and praxis as the end of ethics.

Marina Pantazidou and Indira Nair (1999), who have examined care particularly in the context of engineering, identify care as a value-guided practice, not a system of values. Care emerges in response to a need. Meeting human needs is indeed the ideal for technology. Tronto has provided a framework for practicing care that is particularly suited for application to technology and indeed to science. Tronto identifies four phases of care that parallel closely stages identified with the process of engineering design.

1. Attentiveness, or "caring about," is the phase of recognizing the correct need and realizing care is necessary. This is parallel to the need identification stage in design.
2. Responsibility, or "taking care of," is the phase that involves "assuming responsibility for the identified need and determining how to respond to it" (Tronto 1993, p. 106 ). This is parallel to the conceptualization phase of design.
3. Competence, or "caregiving," is the phase in which the need is met with the expertise needed. This is parallel to the actual design and production.
4. Responsiveness, or "care receiving," is the phase in which "the object of care will respond to the care it receives" (Tronto 1993, p. 107). This is parallel to the acceptance (or rejection) of the designed product.

Total care requires an attuned caregiver, who through commitment, learning, and experience has an understanding of the process as well as the competence and skills and watches the response of the one cared for. Tronto introduces a fifth component to complete the process. She calls this the Integrity of Care, requiring "that the four moral elements of care be integrated into an appropriate whole."

Figure 1 is the representation of this process by Pantazidou and Nair with the Integrity of Care as a prism that focuses the four care components to a socially and technically responsible technological product. Carrying the prism analogy forward, a technology that has no room for any error will require extremely fine tuning of the four angles of the phases of care to yield a sharp focus. One may argue that in general an ethics of care applied to a technology will say that such a technology poses high risk and may be best avoided. Where such precision is not required, there may be more tolerance of how the phases come together. In some cases, a single focused solution may not be possible or it might not be critical. Then, a range of perhaps suboptimal solutions—a smeared focus—may be sufficient or even necessary for pragmatic reasons.

Figure 2 shows how the ethics of care and the description of the engineering design process compare.

Care in Science

Science in general is not as easily mapped into such a scheme unless it is science done expressly for the purpose of answering a technology-derived question or problem. In this case, Figure 1 applies directly, because the science is done in response to a need.

In the case of science in general, the ethics of care can provide some ethical tests attuned to each phase.

1. Attentiveness: Is the science being done in response to a perceived need? Or, are needs being scientifically assessed so that a given technology is likely to be the best response? As human needs are perceived, are scientific resources being directed toward those?
2. Responsibility: What is the science that determines if a technological process or product is the answer to the need? Does new scientific knowledge direct action toward the appropriate human need?
3. Competence: This is perhaps the one phase toward the accomplishment of which the current scientific ethic is almost solely directed.
4. Responsiveness: The science of the consequence of a technology is a requisite. This would include predictive science. Hans Jonas (1984) has suggested that one imperative of human technological power is that "knowledge (science) must be commensurate with the causal scale of our action ... that predictive knowledge falls behind the technical knowledge that nourishes our power to act, itself assumes ethical importance" (p. 8).

This last corollary is perhaps the most important result that the ethics of care can yield in the case of science—that science to reduce the uncertainty of human technological actions take on importance in the scientific enterprise.

Care in Engineering

"Reasonable standard of care" has been common parlance in product specifications separate from the consideration of any ethical standard. Product liability issues assess whether "due care" was taken. Thus care has become an inherent notion in technological products spurred over time by legal demands. A working definition of the standard of care for engineering, set by legal precedent, has been proposed by Joshua B. Kardon (2002) as "That level or quality of service ordinarily provided by other normally competent practitioners of good standing in that field ... under the same circumstances." While proposed as an ethic for the engineer to follow, this standard does not fully address all the elements of the ethics of care.

Moreover, challenged by the requirements of sustainability, technological planning has begun to consider system characteristics such as environmental impacts of a product life cycle in the design of a product or a process. With technology intertwining with everyday lives in intricate ways, interface design of all sorts of technology has become important. Industrial ecology, green design, green chemistry, and humane design are some of the trends that illustrate the ethics of care at work (Graedel and Allenby 2003; Collins Internet article).

A systematic application of the ethics of care to science and technology is yet to be done and may indeed benefit practice. Such an analysis and a synthesis of standards of the practice of science and technology with the ethics of care may yield a framework that is realistic enough for the handling of the complexity of technological and scientific progress. The ethics of care may aid in this by responding to Jonas's condition of the sustainability of humanity as a technological imperative, Manfred Stanley's call for placing human dignity on par with species survival (1978), and Anthony Weston's observation that tough ethical problems be treated as problematic situations and not as puzzles (1992).

INDIRA NAIR

SEE ALSO Anscombe, G. E. M.;Bioethics.

BIBLIOGRAPHY

Anscombe, G. E. M. (1958). "Modern Moral Philosophy." Philosophy 33: 1–19. Calls for an adequate philosophy of psychology before attempting moral philosophy.

Baier, Annette C. (1985). "What Do Women Want in a Moral Theory?" Nous 19(1): 53–63. Reprinted in the author's Moral Prejudices: Essays on Ethics (Cambridge, MA: Harvard University Press, 1994).

Beauchamp, Tom L., and James F. Childress. (2001). Principles of Biomedical Ethics, 5th edition. New York: Oxford University Press. First edition, 1979; 2nd edition, 1983; 3rd edition, 1989; 4th edition, 1994. Standard text in the field of biomedical ethics.

Dieter, George E. (1991). Engineering Design: A Materials and Processing Approach, 2nd edition. Boston: McGraw-Hill. Standard text in engineering design.

Flanagan, Owen. (1991). Varieties of Moral Personality. Cambridge, MA: Harvard University Press. An exploration of the relationship between psychology and ethics, arguing for constructing ethical theory and theory of moral development from an understanding of cognitive psychology.

Gilligan, Carol. (1982). In a Different Voice: Psychological Theory and Women's Development. Cambridge, MA: Harvard University Press. A classic work that set forth the care perspective in moral reasoning.

Gilligan, Carol; Janie Victoria Ward; and Jill McLean Taylor, eds. (1988). Mapping the Moral Domain. Cambridge, MA: Harvard University Graduate School of Education. Collection of essays discussing research and research strategies for exploring care and justice perspectives in diverse populations.

Graedel, Thomas E., and Braden R. Allenby. (2003). Industrial Ecology, 2nd edition. Upper Saddle River, NJ: Prentice Hall. First textbook covering the emerging field of industrial ecology.

Jonas, Hans. (1984). The Imperative of Responsibility: In Search of an Ethics for the Technological Age. Chicago: University of Chicago Press. Jonas, a pioneer of bioethics, explores constraints that technology should follow in order to be able to preserve life on the planet.

Kohlberg, Lawrence. (1971). "From Is to Ought." In Cognitive Development and Epistemology, ed. Theodore Mischel. New York: Academic Press.

Kohlberg, Lawrence. (1981). Essays on Moral Development, Vol. 1: The Philosophy of Moral Development. San Francisco: Harper and Row.

Kohlberg, Lawrence. (1984). Essays on Moral Development, Vol. 2: The Psychology of Moral Development. San Francisco: Harper and Row. Standard works on moral psychology by pioneer Lawrence Kohlberg.

Kuhse, Helga. (1997). Caring: Nurses, Women, and Ethics. Malden, MA: Blackwell.

Larrabee, Mary Jeanne, ed. (1993). An Ethic of Care. New York: Routledge. Collection of essays concerned with the ethics of care over a decade following Gilligan's first work.

Noddings, Nel. (1984). Caring: A Feminine Approach to Ethics and Moral Education. Berkeley and Los Angeles: University of California Press. 2nd edition, 2003. Applies the care ethic to education.

Pantazidou, Marina, and Indira Nair. (1999). "Ethic of Care: Guiding Principles for Engineering Teaching and Practice." Journal of Engineering Education 88(2): 205–212. First paper on applying care ethics to engineering.

Stanley, Manfred. (1978). The Technological Conscience. New York: Free Press. A sociologist's call for an ethic of technology that values human dignity above species survival.

Tronto, Joan C. (1993). Moral Boundaries: A Political Argument for an Ethic of Care. New York: Routledge. Presents care as a central and sustaining activity of human life; examines the moral boundaries set by the politics of power in devaluing care professions.

Weston, Anthony. (1992). Toward Better Problems: New Perspectives on Abortion, Animal Rights, the Environment, and Justice. Philadelphia: Temple University Press. An application of the philosophy of pragmatism acknowledging the context and the multiplicity of values in ethical problems.

INTERNET RESOURCES

Collins, Terrence. "Ethics." Institute for Green Oxidation Chemistry, Carnegie Mellon University. Available from http://www.chem.cmu.edu/groups/collins/ethics/. Discusses the responsibility of chemists to promote sustainability.

Kardon, Joshua B. (2002). "The Structural Engineer's Standard of Care." Online Ethics Center for Engineering and Science, Case Western Reserve University. Available from http://onlineethics.org/cases/kardon.html. Points out the role care plays in the practice of engineering.