reflection – Medical and Health Humanities

Christa Schnabl is an Associate Professor at the Institute of Social at the University of Vienna, and currently the Vice Rector of the University of Vienna.

1. Where are you working at this moment?

I am Associate Professor at the Institute for Social Ethics of the Catholic Faculty of Theology in Vienna. From 2007 until 2011 I am also appointed as vice-president of the University of Vienna (Austria) and therefore I am on leave from my educational and research work.

2. Can you tell us about your research and its relation to the ethics of care?

As a social ethicist I am mainly interested in anchoring socioethically the impulses that emerge in an ethics of care. I therefore focus on the activities and demands from a societal perspective, rather than on the immediate and personal relation of care. Put differently, I am interested less in the inner perspective of caring, and more in the outer perspective on care and the social responsibility to care.

3. How did you get involved into the ethics of care?

It was gender ethics that led me to care ethics. I learned to recognize care as a key concept for the further development of modern societies, because in it many areas of life come together. The questions of care unite questions of family policy, social policy, health care policy, gender policy and economic policy. This recognition only arose later on, after first having held care as a peripheral theme….

4. How would you define ethics of care?

That is difficult, because I do not consider myself a care ethicist in the first place. I consider care a central topic area of ethics. However, I want to stress that the ethical principle of care should be connected to the principle of justice, and not be elaborated as a separate, special ethic. An ethic of care that puts questions of care and caring central, should in my view be more broadly orientated.

5. What is the most important thing you learned from the ethics of care?

I have learned to see the implications of drawing into the ethical reflection those themes that are invisible within the public sphere. Ethics is not a construction of reflective thoughts in itself, but must always reflect upon everyday fields of reference. For human experience does lead to different plausibilities, which effect both the reflection and the special sensitivity for themes that emerge. Moreover, the naturalness of ethical systems is questioned.

6. Whom do you consider to be your most important teacher(s) in this area?

To me certain theoritical lines have been more important than any specific teacher. For instance, there is a theoretical line of individual ethical questions as well as a line of political ethics, and theoretics can be divided accordingly. Thus, Eva Feder Kittay, Herta Nagl-Docekal, Herlinde Pauer-Studer, but also Axel Honneth and Emmanuel Levinas focus upon care and the individual, and on the other hand Joan Tronto, Selma Sevenhuijsen, Susan Moller Okin have their focal point upon the political and ethical aspects of care.

7. What works in the ethics of care do you see as the most important?

It is widely acknowledged that Carol Gilligan’s „In A Different Voice“ , which appeared in the early eighties, is the initial igniter of the entire care ethics debate. Her theoretical impulses have started different philosophical and ethical debates and further developments.

8. Which of your own books/articles should we read?

My book „Gerecht sorgen. Grundlagen einer sozialethischen Fürsorge“ is my most exhaustive work on the connection of the debates of care and justice, considered from a social-ethical point of view. A publication list with German articles can be found on:

9. What are important issues for the ethics of care in the future?

The question of how care can be implemented within social theory and societal considerations is a real challenge. How can the care area be politically embedded? What models and possibilities are being given, that may help changing the recognition and distribution of care work?

10. Our ambition is to promote ethics of care nationally and internationally. Do you have any recommendations or wishes?

My wish would be, that a platform or network is established, which is not only accessible for researchers and the academic world, but also integrates people who are politically and practically involved. That would be a step towards „politicizing“ the subject.

Linus Vanlaere is Coordinator Ethics of the Elder (Coördinator Ouderenethiek) for the Groepering van Voorzieningen voor Ouderenzorg (GVO) and scientific fellow worker at the Centrum voor Biomedische Ethiek en Recht of the Katholieke Universiteit Leuven, where he researches the care ethical aspects of the care for the elderly. At the same time he is scientific fellow worker at the care ethical lab, sTimul.be. Vanlaere is a religious scholar, theologist and promoted in the field of care ethics.

1. Where are your working at this moment?

In my work as clinical ethicist in a group of seven nursing homes for elderly, I try to enhance the ability of professionals to engage in ethical reflection on their practice. sTimul, a ‘care-ethics lab’ is crucial here. In sTimul, the context of elderly care is simulated, with student nurses giving care for two days, including a night, to experienced caregivers who are, for this period, in the role of elderly patients. This simulation aims to foster ethical reflection for both parties. Through the simulation, the veteran caregivers experience how dignity is at stake in daily care situations and in communication. The experience of being helpless or dependent and deprived of privacy offers caregivers incentives to reflect ethically on their own caring practices.

During the ethical reflection at the end of the second day, we try to help them to attain a heightened moral sensitivity to the vulnerabilities, values and responsibilities in their work; to make explicit norms and values that guide their actions in practice, and to evaluate this via their new experiences. Students, who take up the role of caregivers in the ‘care-ethics lab’, are stimulated to reflect ethically on their practices. The feedback they receive from their “patients” enables them to rehearse interactions and to be guided in their reflection in a ‘safe’ environment. More empirical research is needed to verify the effects of this ethical learning programme on the ethical reflection and ethical practice of caregivers in the care of older people.

2. Can you tell us about your research and its relation to the ethics of care?

My PhD concerned a philosophical-ethical research to care as concept. This started with the phenomenon ‘care’ in the life of humans. Care as moral value is the point of departure of the ethics of care, so I tried to map the different perspectives on the concept of care in the work of different care ethicists. I also make a link between the viewpoints of the Louvain tradition of personalism and a few basic principles of care ethics.

At the moment, I am involved in an empirical research to the effects of our ‘simulation learning in ethics’ on the veteran caregivers who are the ‘patients’ for two days. With this research, we want to verify the effects of this ethical learning programme on the ethical reflection and ethical practice of caregivers in the care for older people. The research can give us a more adequate view to the value of ethical reflection for the ethical attitude of caregivers. This research also possibly brings us to a better understanding of the ethical concepts used in care ethics.

3. How did you get involved into the ethics of care?

I studied theology at the Katholieke Universiteit of Leuven, where the course of ‘Feminist Studies’ brought me in contact with the work of Carol Gilligan and Joan Tronto. I finished my Master studies with a research paper about a care-ethical view on suicide. Chris Gastmans, at that time assistant professor at the Center of Biomedical Ethics and Law, evaluated this paper and invited me to work on a research project about the concept of care. He gave me the opportunity within this project to elaborate a care-ethical view on suicide in the elderly. By this project I got involved into the ethics of care, but also into the ethics of care into the perspective of elderly care.

4. How would you define ethics of care?

I think I am defined by the ethics of care more then I can define ethics of care. Crucial in defining ethics of care is the contextual and relational sensitivity; the fact that the care ethics perspective starts from the context wherein care takes place.

5. What is the most important thing you learned from the ethics of care?

The most important thing that I learned from the ethics of care is that it is impossible to ‘do ethics’ in a detached, abstract, academic way. To stand in “the mud” of the caring practices, to know the context of care, to reveal and to reflect on your own intuitions and emotions and these of the other people involved, all this are very important insights of the ethics of care.

6. Whom do you consider to be your most important teacher(s) in this area?

Referring to my answers above, I would say that the caregivers on the one hand, and the care-receivers (the elderly) at the other hand, are both my most important teachers. They can learn me a lot about care and care ethics, because they experience daily what it is to give and/or to receive care, what ‘good’ care is, what ‘reciprocity’ in care means and how important it is in a view on good care…

7. What works in the ethics of care do you see as the most important?

I must say that novels have learned me the most about care ethics. Novels as ‘Slow Man’ (Coetzee) or ‘Everyman’ (Roth) for example, stimulated my thinking about some fundamental concepts of the ethics of care and made these concepts very clear to me through the narratives of ‘real life experiences’. In this way, novels help me to sharpen my ethical reasoning more then some academic works. But of course, ‘Moral Bounderies’ is important to me; Tronto’s view on care as a moral value and as a basis for the political achievement of a good society is crucial for care ethics. The work of Stan Van Hooft, and more especially his older book ‘Caring’ – where he starts from ‘deep caring’ as ontological structure – is also very important to me.

8. Which of your own books/articles should we read?

Maybe the stories of people about care that I will write down somewhere in the future. Meanwhile I would refer to ‘Cirkels van zorg’ (Cercles of care), where Chris Gastmans and I applied a care ethics perspective on elderly care.

9. What are important issues for the ethics of care in the future?

The issue of the place of care as moral value in a normative perspective seems the most important issue for me. There is still a great deal of confusion and uncertainty surrounding the notion of care. One of the focal points of critics is the normativity of care. To what extent does care have an obligatory character? Only when the objective normative basis of care is sufficiently clarified, care practices can be evaluated and optimised from an ethical perspective. For this issue, I refer to our article in ‘Bijdragen. International Journal in Philosophy and Theology’ 69 (4), 443-469.

10. It is our ambition to promote ethics of care nationally and internationally. Do you have any recommendations or wishes?

Of course I refer to our care-ethics lab sTimul as a creative and innovative tool in facilitating and promoting ethics of care. It is my dream to set up an international network of ‘care-ethics lab’ in ethics education…