The Ethics of Care

Patrick McKearney

Department of Social Anthropology

University of Cambridge

June 2019

In her reading list, I was amazed by how elegantly Megha Amrith held in tension the multiple meanings of care and the diverse bodies of literature that intersect in the anthropology of care. I doubt I can repeat the feat. So what I want to do, instead, is try to focus in on what we might mean by the ethics of care.

The ethnographic record shows relationships of care are imagined and practised with often unimaginably diversity. And it also suggests that it is rare for them to be anything other than heavy with moral significance. Such relationships are places where the meaning of human vulnerability is weighed, contested, and borne in strikingly different ways. And they are often the means for people’s most concerted and culturally specific attempts to become (or turn someone else into) a valuable, desirable, and capable person. Their daily rhythms can be just as full of the comforting intimacies of dependence as they are pregnant with longings to transform and transcend such intense involvement.

This was certainly the case in the communal care home for adults with cognitive disabilities in the UK that I lived and worked in for my first fieldwork. In this context, carers pursue some of their deepest egalitarian values either by trying to make the people with intellectual impairments they support just as independent as anyone else, or by trying to form mutual and reciprocal relations with them in their dependence. But carers are continually thwarted by the fact that they do not know another way of keeping these individuals alive other than through an unequal relationship in which they not only perform most of the labour but also take many of the decisions.

I am fascinated by the fact that such asymmetrical dependence persists in my fieldsite despite everyone trying to make it disappear. Is there something about the way independence is imagined and valued in Britain that excludes people with disabilities (along with children, the sick, and the elderly) and makes them particularly in need of care? Are carers missing some tricks that would make relationships of dependence less hierarchical – or is their oddity, instead, that they are so committed to making dependence so egalitarian? Is this kind of care difficult because it is an unarticulated and undervalued moral practice in Euro-American societies, or because this kind of unequal dependence and vulnerable intimacy is always exposing and relationally fraught?

Engaging these questions properly and ethnographically requires resisting our temptation to rely on ready-to-hand and moralistic ways of talking about care that offer simple solutions to intractable ethical difficulties, and obvious descriptive categories that cover over the complexity of intimacy and dependence. But thankfully there is already a whole world of research out there that can help us do just that: a very unsystematic selection of which I present here …[1]

Debility and Moral Imagination in Botswana: Disability, Chronic Illness, and Aging (2005) by Julie Livingston

Livingston’s historical ethnography traces the ways in which Tswana have morally imagined what places people in need of care, and how they have distributed responsibility for actually providing it within and between kinship networks, communities, and the state. It enables us to go beyond the romantic and despairing stories we tell about the role of care in the past in order to explore how the practical realities of dependency actually played out. It contributes to a rich vein of anthropology that explores the relationship between different patterns of care and local visions of debility and personhood.

See Also:

• Jenkins, Richard. 1999. Questions of Competence: Culture, Classification and Intellectual Disability. Cambridge University Press.
• Cohen, Lawrence. 2000. No Aging in India: Alzheimer’s, The Bad Family, and Other Modern Things. Berkeley: University of California Press.
• Horden, Peregrine, and Richard Smith. 2013. Locus of Care. London: Routledge.
• Gammeltoft, Tine. 2014. Haunting Images: A Cultural Account of Selective Reproduction in Vietnam.
• Zoanni, Tyler. 2018. ‘The Possibilities of Failure: Personhood and Cognitive Disability in Urban Uganda’. The Cambridge Journal of Anthropology 36 (1): 61–79.

Love’s Labor: Essays on Women, Equality, and Dependency (1999) by Eva Kittay

Kittay’s contribution to a long feminist tradition of thinking about the ethics of care and its burdens is to focus on the asymmetrical nature of certain kinds of dependence such as that we all experience in childhood. Love’s Labor challenges liberal philosophies and polities that try to realise equality through assuming independence by drawing attention to the fact that this kind of care is premised on a disparity between givers and receivers. If we are to have justice both for those who need care and for those who give it, should we not start not with independence but with the asymmetrical forms of dependence that we all, in practice, need?

See also:

• Ehrenreich, Barbara, and Arlie Russell Hochschild, eds. 2004. Global Woman: Nannies, Maids, and Sex Workers in the New Economy. Henry Holt and Company.
• Pols, Jeannette. 2006. ‘Washing the Citizen: Washing, Cleanliness, and Citizenship in Mental Health Care’. Culture, Medicine and Psychiatry 30 (1): 77–104.
• Mol, Annemarie. 2008. The Logic of Care: Health and the Problem of Patient Choice. London: Routledge.
• Ferguson, James. 2013. ‘Declarations of Dependence: Labour, Personhood, and Welfare in Southern Africa’. Journal of the Royal Anthropological Institute 19 (2): 223–242.
• Buch, Elana D. 2018. Inequalities of Aging: Paradoxes of Independence in American Home Care.

Between Will and Thought: Individualism and Social Responsiveness in Amazonian Child-Rearing by Francesca Mezzenzana

Care is essential to keeping children alive and to teaching them how to care for others, right? Not according to the Runa of the Ecuadorian Amazon who value independence so highly that they leave their children to fend for themselves from astonishingly early ages, and think this the best way to teach them to be responsible. This paper develops a long lineage of work in the anthropology of childhood that challenges widespread assumptions about the necessity of care, and with it the characterisation of Euro-Americans as concerned solely with autonomy.

See Also:

• Ochs, Elinor, and Bambi B. Schieffelin. 1984. ‘Language Acquisition and Socialization: Three Developmental Stories and Their Implications’. In Culture Theory: Essays on Mind, Self and Emotion, edited by Richard A Shweder and Robert A LeVine. Cambridge: Cambridge University Press.
• Briggs, Jean L. 1999. Inuit Morality Play: The Emotional Education of a Three-Year-Old. New Haven; London: Yale University Press.
• Ochs, Elinor, and Carolina Izquierdo. 2009. ‘Responsibility in Childhood: Three Developmental Trajectories’. Ethos 37 (4): 391–413.
• Lancy, David F. 2014. The Anthropology of Childhood: Cherubs, Chattel, Changelings. Cambridge University Press.
• Otto, Hiltrud, and Heidi Keller. 2018. Different Faces of Attachment: Cultural Variations on a Universal Human Need. Cambridge: Cambridge university press.

Serenity: Violence, Inequality, and Recovery on the Edge of Mexico City (2015) by Angela Garcia

If you are addicted to drugs in Mexico City your relatives might pay for you to be kidnapped, confined, and tortured. Morally abhorrent surely… or might it actually be a form of care? Along with a range of challenging work in the anthropology of care, this article forces us to think more deeply about the intimate connections between care and what we typically treat as its opposites: paternalism, distance, and even violence.

See Also:

• Pols, Jeannette, and Ingunn Moser. ‘Cold Technologies versus Warm Care? On Affective and Social Relations with and through Care Technologies’. ALTER-European Journal of Disability Research/Revue Européenne de Recherche Sur Le Handicap 3 (2): 159–178.
• Brown, Hannah. 2010. ‘If We Sympathise with Them, They’ll Relax’. Fear/Respect and Medical Care in a Kenyan Hospital. Med Antropol 22: 125–42.
• Livingston, Julie. 2012. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Duke University Press.
• Garcia, Angela. 2014. ‘The Promise: On the Morality of the Marginal and the Illicit’. Ethos 42 (1): 51–64.

Bad Souls: Madness and Responsibility in Modern Greece (2012) by Elizabeth Anne Davis

This book leads us deep into the most intimate and intractable complications of caring relationships conducted in the shadow of the competing ideals of state intervention and contraction, biopolitics and liberalism, dependence and freedom. Its attention simultaneously to the subjectivity of care recipients and the ethical dilemmas of those who support them alerts us to the range and depth of aspirations we bring to care, as well as to the way they so often go tragically awry when actual people and relationships exceed the ethical categories with which we apprehend them.

See Also:

• Lester, Rebecca J. 2009. ‘Brokering Authenticity: Borderline Personality Disorder and the Ethics of Care in an American Eating Disorder Clinic’. Current Anthropology 50 (3): 281–302.
• Brodwin, Paul. 2013. Everyday Ethics: Voices from the Front Line of Community Psychiatry. Berkeley: University of California Press.
• Mattingly, Cheryl. 2014. Moral Laboratories: Family Peril and the Struggle for a Good Life. Berkeley: University of California Press.
• Kuan, Teresa. 2015. Love’s Uncertainty: The Politics and Ethics of Child Rearing in Contemporary China. University of California Press.
• Driessen, Annelieke. 2018. ‘Sociomaterial Will-Work: Aligning Daily Wanting in Dutch Dementia Care’. In Care in Healthcare, 111–133. Springer.

Loneliness and Its Opposite: Sex, Disability, and the Ethics of Engagement (2015) by Don Kulick and Jens Rydström

Care is nice. And care can stop you from doing all the things in life you’d like to. Particularly if you have a significant disability and you want to have sex. This book invites us to face – with Danish sex-workers, parents, and professional carers – the challenge of transforming care from something that denies erotic encounters into something that enables them. How, for instance, can someone support a couple with disabilities to have sex without turning it into a threesome? At stake in these kind of questions is whether we can imagine a kind of care that opens rather than forecloses the exciting and exposing possibilities of adulthood – and whether there might not be more to life than care.

See Also:

• Edgerton, Robert B. 1993. The Cloak of Competence. Berkeley: University of California Press.
• Ingstad, Benedicte, and Susan Reynolds Whyte, eds. 1995. Disability and Culture. University of California Press.
• Buch, Elana D. 2014. ‘Troubling Gifts of Care: Vulnerable Persons and Threatening Exchanges in Chicago’s Home Care Industry’. Medical Anthropology Quarterly 28 (4): 599–615.
• Myers, Neely Laurenzo. 2015. Recovery’s Edge: An Ethnography of Mental Health Care and Moral Agency. Nashville, Tennessee: Vanderbilt University press.
• Davis, Donna Z., and Tom Boellstorff. 2016. ‘Compulsive Creativity: Virtual Worlds, Disability, and Digital Capital’. International Journal of Communication 10 (0): 23.

[1] This bibliography is, in no small part, the result of reading some works in the anthropology of care over a long period of time with such perceptive scholars as Zuzanna Marciniak Nuqui, Tessa Morgan, and Giulia Sciolli.