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Medicine and the Ethics of Care
  1. J Harbison

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    Edited by D F Cates and P Lauritzen. Georgetown University Press, 2001, £55.00 (hb), £40.75 (pb), pp 323. 0-87840-824-X

    This is a collection of essays that aims to “clarify and extend” the influence of feminist thinking and in particular the potential contribution of an ethic of care to medical practice. The essays are informed by a feminist perspective: however, the contributors are drawn from the fields of theology, philosophy, ethics, and psychology; rather than from schools of feminism, and the discussion certainly ranges beyond feminist preoccupations. Including a practising physician’s reflection on the ethics of care might have provided a useful perspective, although chapter 2 does offer an insight into a nursing perspective.

    The introductory chapter would be excellent for a person who has read little on care ethics, and it is written with clarity and precision. The ground of care ethics is covered; Cates locates this ethic in relation to traditional and contemporary ethics, pointing out salient elements. Crucially, she delineates how contributions from a variety of disciplines can shed light on moral understandings.

    The book consists of 10 chapters organised in three parts. Each of these corresponds to a major theme of care ethics: community, emotion, and narrative respectively. The three chapters in section one focus on the relationship between care and justice. Reeder claims these as related virtues; Andolsen discusses the attraction of an ethic of care for nurses; Gudorf offers a case study. This is a depressing account of inadequacies of care that makes for powerful and uncomfortable reading. Failure to meet the needs of the patient described is attributed to adherence by doctors to traditional ethical principles but can more easily be understood as adherence to technical principles. It is arguable that true adherence to ethical principles would tend to limit the deficiencies described. This chapter also seems to imply that an ethic of care deals more successfully with bureaucratic institutions. Both Andelson and Gudorf, however, point out difficulties for individual practitioners in signing up to any moral stances when working in bureaucracies. Andolsen is particularly concerned with the longstanding concerns that nurses have had with this problem. (The book being an American text, this problem is located in an American context; nevertheless the accounts of care resonate with clinical experience in the UK). This section also points out the limitations of “patient as customer” ideology in meeting moral claims. There is also an interesting argument that those adhering to care ethics can more appropriately deliver justice.

    In part 2, Vacek argues for the importance of emotion in morality, and in medicine in particular, in order to provide adequate health care. In the following chapter Callahan discusses the psychological understanding of the nature and function of the emotions: in so doing she attempts to demonstrate that caring is essential for adherence to ethical principles. For her, both care and justice involve reason and emotion. This section also concludes with a case study (Cates) that is about the nature of informed consent in women’s decisions to undergo abortion. This illustrates the different perspective of a care ethic: discussion is not couched in terms of rights and obligations and use of hypothetical examples, but in terms of compassion, respect, and understanding and is located in women’s real life experiences.

    In part 3, Connors and Franke explore narratives of care from a theological perspective; reading this suggested to me the possibility that the reason why medical and nursing professions have responded differently to the ethics of care is that if “care” is interpreted as something which is given when “cure” is no longer possible, it is not the province of the physician. Camenish provides a narrative of personal care that reveals the need for more than technical care, and Zoloth in the third chapter deals with the embodiment of care: specifically the caring for the dead body within the Jewish tradition. The last chapter (Smith) on “rhetorical-spatial transactions” is somewhat dense and I suspect would be difficult to understand for a reader unfamiliar with either theology or philosophy.

    Overall, this is a worthwhile text for health care professionals with an interest in ethics, both for those unfamiliar with the ethics of care and those who already have an understanding of it. The book is expensive, but it would be a useful text for a professional library.

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