An ethic proposes a way of being and acting in given contexts in order to achieve one’s own good and the good of others. Full human fulfillment always requires shared rules as well as virtues of character and habits to develop.
Every person has a dimension of fragility and vulnerability. Around this fundamental dimension has developed, in the last decades, what has been called ethics of care.
The philosopher Joan Tronto defines those ethics in the following way: “The characteristic activity of the human species which includes all that we do in order to maintain, perpetuate and repair our world so that we can live there as well as possible…. What we seek to connect in a support network for life.” (Moral boundaries: a political argument for an ethic of care).
This ethical approach is based first of all on the attention to details of people’s lives and their specific needs, in order to support them with adapted rather than systematic responses. The ethics of care aim to give the act of support a personal dimension and not just a technical one (for example, giving medicines). To do this, an ethic of care grounds itself on the personality and the story of the patient’s life in order to rebuild the self-esteem, the sense of existence and the capacities of the person which have been deconstructed through illness and suffering.
In this perspective, fragility is an opportunity to live one’s life in an authentic way, to be reconciled with the different aspects of one’s life. It can be the moment of an important speech about one’s own life and of one’s relatives. Autonomy, in this context, is the ability to build a meaningful narrative of life with this vulnerability (Paul Ricoeur).
Attention, responsibility, competence and responsiveness are the grammar of the ethics of care.
Care has four dimensions, according to the philosopher Joan Tronto.
1) to care about: care requires first and foremost attention to people and their needs. We here need to recognize the other as an equal who might need our help.
2) to take care: to help someone requires that we take on his or her fragile condition, that we accept responsibility for his or her well-being.
3) to give care: it is the actual work of caregiving, which consists in doing certain acts to relieve, help or entertain. This work requires special skills that can be developed over time or through adequate training.
4) receiving care: the success of the care relationship depends on the capacity of response of the beneficiary. We must help the other to welcome the care and in order to put him or her at ease. It is also the moment of the exchange, where the caregiver evolves personally thanks to this relation.
1) Support: This is the moment when an alliance between the caregiver and the caretaker must be formed. This alliance begins by listening to the patient, paying particular attention to the singularity of his situation. In concert, the caregiver and the patient determines the purpose of the care that will be conferred. The aim is to create a relationship of trust and a “therapeutic narration” (why, how, for what purpose, according to what motivation?) that will contribute to the effectiveness of the treatment.
2) Diagnosis: It is the moment of the scientific action where the diagnosis is elaborated using measures and technical tools. Trust is established, the patient is better able to let himself be examined in all the complexity of his situation, and to calmly accept the diagnosis and its consequences. This step is also that of the formulation of relevant rules governing the treatment and the care relationship (ethical aspect).
3) Therapeutic act: At this stage is conferred the care adapted to the singularity of the project of care of the patient. The aim is to restore the patient’s capacity of being and to rebuild his identity through physical care and psychological support. It is the moment when the rules and the framework of care must be supplemented by a constant deliberation on the adequate means to reach the goal. Benevolence must always accompany technical expertise.
Benaroyo, Lazare et al., La philosophie du soin, Paris : Presses Universitaires de France, 2010.
Mattingly, Cheryl, « The Concept of Therapeutic “Emplotment” », Social Science and Medicine, no 38, 1994.
Tronto, Joan. Moral Boundaries: a political argument for an ethic of care, New York, Routledge, 1993.
Ricœur, Paul, « Les trois niveaux du jugement médical », Esprit, no 227, 1996, p. 21-33.