Abstract
As essentially social beings, we humans are fragile and dependent on what is outside ourselves—others, institutions and sustained and sustainable environments—. Vulnerability acquires for us a social role (not a mere contingency or a subjective disposition) and hence the positive social obligations arise to minimize instability and its differential distribution, to demand basic support (food, shelter, work, healthcare, education, mobility, expression) and to reduce avoidable damage. We are a social species, with reciprocal links (rights and duties), built on the interdependence; not a group of solitary individuals whose mutual obligations are limited to not invading other people’s space. Care-related obligations by the (social) state come into play here, as in the case of healthcare systems. These can be characterized as “due cares” (due actions) because the action is an expected event within a social context of values and guidelines. In that context, the omission that causes or enables harm, as in exclusion from healthcare, qualifies as an “undue inaction”. In the criminal legal sense, the idea of “nonfeasance” refers to bringing about a result by not avoiding it, by violating a special duty, which equates with its causation—the prototypical example is the crime of failing to assist. Here the question not only of intentional omission but of neglect and abandonment comes into play. One example is the exclusion from healthcare and drugs of wide sectors of the Spanish population, not only undocumented migrants but also poor and unemployed people. The State is shamelessly neglecting important segments of the population, and causing harm—especially to the most vulnerable—by an ethically reprehensible omission of care. This case illustrates the need for defining what we have called “a public ethics of care” combining public ethics obligations with the responsibilities of care—since the ethics of care shapes government.
The place of other (autrui) is the true perspective point in politics as well as moral, and the precept of Jesus Christ, to put oneself in the place of other, serves not only the end of which our master spoke, namely morality, but that of politics as well.
LEIBNIZ, La place d’autrui, 1679 (A VI, 3, 903–904).
This work has been sponsored by the Spanish Ministry of Economy and Competitiveness through its research project KONTUZ! (FFI2014-53926-R): www.kontuz.weebly.com; INBOTS (EU-H2020 grant agreement 780073); and EXTEND (EU-H2020 grant agreement 779982).
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Notes
- 1.
It should be notice that sometimes there has been a rutinary, non-reflective, and indeed incoherent use of concepts like “vulnerable groups”. This concept could lead to stigmatization and stereotype of some populations.
- 2.
Empathy and responsibility are the main features of the ethics of care. The discovery of mirror neurons shows that empathy is a fundamental human capacity that we are born with but which must be strenghtened through a nurturant upbringing or it will decay. But, as Lakoff stands, caring is not just feeling empathy; it is taking responsibility, acting powerfully and courageously. You have to be strong to care, and to act on that care with success; you should be responsible about care (Lakoff 2009, p. 47).
- 3.
This idea of “extended self” belongs to philosphers as Ortega y Gasset or Heidegger.
- 4.
“Throughout our lives, all of us go through varying degrees of dependence and independence, of autonomy and vulnerability. A political order that presumes only independence and autonomy as the nature of human life thereby misses a great deal of human experience, and must somehow hide this point elsewhere”. (Tronto 1993, p. 135).
- 5.
Outsourcing care work creates a “global care chain” (Hochschild and Ehrenreich 2003).
- 6.
“New forms of capitalism try to insert care into the market, and increasing areas of activities that used to be in the public sphere are being privatized. Modern analysis has led to the emergence of a kind of neoliberal governance in respect of care through the extension of the market into social and personal spheres.” (Brugère 2011, p. 73).
- 7.
Julian Tudor Hart espoused the “inverse care law”: As much more care is needed, less care received, and moreover in a market oriented health system.
- 8.
I’m aware of the difficulties on the role of causation by omission. About this topic, see the research project “Causal responsibility of perpetration through nonfeasance: An ethico-juridical inquiry into undue inaction” (www.kontuz.weebly.com). We seek to determine the causal responsibility of nonfeasance and the problems posed thus by undue inaction. To this end, we will combine a social action approach to action with a materialistic conception of causality, a factualist ontology that introduces nonexistence or negative facts, and a gradualist theory that will accommodate degrees of causation, degrees of social expectation, and of ethical-legal responsibility, all in line with the earlier work done by this research group and with the introduction by cognitive scientists and psychologists of moral categories such as “enabling” harm (Hanna 2015).
- 9.
You can find a deep study on this topic in Triviño et al. (2016).
- 10.
(…) as the caregiver has the responsibility to care for the dependent, the larger society has an obligation to attend to the well-being of the caregiver. Only so can the caregiver fulfill responsibilities to the dependent without being subject to an exploitation some have called ‘compulsory altruism’ (Kittay 1999, p. 133).
References
Baier, A. (1988). The need for more than justice. Canadian Journal of Philosophy, 13. (M. Hanen & K. Nielsen (Eds.), pp. 41–56).
Bello, G. (2011). Emigración y ética. Humanizar y deshumanizar. Madrid: Plaza y Valdés.
Brugère, F. (2011). L’éthique du “care”. París: Presses Universitaires de France – PUF.
Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health (Final report). Geneva: WHO.
Fisher, B., & Tronto, J. C. (1990). Toward a feminist theory of caring. In E. K. Abel & M. Nelson (Eds.), Circles of care. Albany: SUNY Press.
Foucault, M. (1986). The history of sexuality. Vol. 3: The care of the self. New York: Vintage.
Fraser, N. (2016, Fall). Capitalism’s crisis of care. Dissent. Accessed November 23, 2017, from https://www.dissentmagazine.org/article/nancy-fraser-interview-capitalism-crisis-of-care
Gilligan, C. (1982). In a different voice: Psychological theory and women’s development. Cambridge, MA: Harvard University Press.
Hanna, J. (2015). Enabling harm, doing harm, and undoing one’s own behavior. Ethics, 126(1), 68–90.
Hochschild, A. R., & Ehrenreich, B. (Eds.). (2003). Global woman: Nannies, maids, and sex workers in the new economy. New York: Metropolitan Books.
Kittay, E. F. (1999). Love’s labor: Essays on women, equality, and dependency. New York: Routledge.
Lakoff, G. (2009). The political mind: A cognitive scientist’s guide to your brain and its politics. New York: Penguin.
Mackenzie, C., & Stojlar, N. (Eds.). (2000). Relational autonomy: Feminist perspective on autonomy, agency, and the social self. Oxford: Oxford University Press.
Martinsen, E. H. (2014). Caring in medicine: From a gentleman’s care to a more sophisticated sense of human interdependence. In G. Olthuis et al. (Eds.), Moral boundaries redrawn. The significance of Joan Tronto’s argument for political theory, professional ethics, and care as practice. Leuven: Peeters Publishers.
Nuffield Council of Bioethics. (2011). Solidarity: Reflections on an emerging concept in bioethics. Accessed January 14, 2018, from http://nuffieldbioethics.org/project/solidarity
Plumwood, V. (2002). Environmental culture: The ecological crisis of reason. New York: Routledge.
Puyol, À. (2017). El derecho a la fraternidad. Madrid: Los Libros de la Catarata.
Schrecker, T., & Bambra, C. (2015). How politics makes us sick. Neoliberal epidemics. New York: Palgrave Macmillan.
Triviño, R., Rodríguez-Arias, D., & Ausín, T. (2016). Exclusion from healthcare in Spain: The responsibility for omission of due care. In H. P. Gaisbauer et al. (Eds.), Ethical issues in poverty alleviation. Dordrecht: Springer.
Tronto, J. C. (1993). Moral boundaries: A political argument for an ethic of care. New York: Routledge.
Tronto, J. C. (2013). Caring democracy: Markets, equality and justice. New York: University Press.
Venkatapuram, S. (2011). Health justice: An argument from the capabilities approach. New York: Polity Press.
Young, I. M. (2011). Responsibility for justice. Oxford: Oxford University Press.
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Ausín, T. (2019). The Public Dimension of Care: Towards a Public Ethics of Care. In: Vallverdú, J., Puyol, A., Estany, A. (eds) Philosophical and Methodological Debates in Public Health. Springer, Cham. https://doi.org/10.1007/978-3-030-28626-2_10
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