research – Medical and Health Humanities

June 27, 2019

Liz Newnham

Interview with Elizabeth Newnham, lecturer in Midwifery at Griffith University, Australia.

1. Where are you working at this moment?

Since January this year, I have been working as a lecturer in midwifery at Griffith University. I currently teach in the Masters in Primary Maternity Care – a postgraduate programme that implements the ‘Framework for Quality Maternal and Newborn Care’ from the Lancet series on midwifery and supports the development of maternity care leaders who can design, implement, and evaluate leading-edge primary maternity care models. Before this I was at Trinity College Dublin for two years, which was also a wonderful experience.

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

I am only at the beginning of my exploration into care ethics. During my doctoral research, which was an ethnographic study of epidural analgesia use within a hospital labour ward setting, I really started to think deeply about the idea of informed consent, an idea which is completely embedded into health care practice and based on the bioethical principle of autonomy.

What I saw in practice, in my research, and around the world within the maternity context, is that when we follow the principle of autonomy to its endpoint – when women are wanting to make decisions about their bodies, but outside of medical recommendations, then they appear neither to have autonomy nor the opportunity to give informed consent.

There are cases all over the world of women being bullied, coerced, threatened or forced into decisions about their bodies that they disagree with—this is not only unethical, it is dehumanised care. This is something I now want to explore further using a care ethical framework.

3. How did you get involved in care ethics?

As I was thinking about this problem, I came across an article by Jennifer MacLellan(( MacLellan J. 2014. Claiming an ethic of care for midwifery. Nurs Ethics, 21(7), 803–811. DOI: 10.1177/ 0969733014534878)) proposing that midwifery look to care ethics as a solution to some of these issues. This interested me, so I then read Joan Tronto’s Moral Boundaries((Tronto J. 1993. Moral boundaries: a political argument for an ethic of care. London: Routledge)) and also looked at Carol Gilligan’s In a different voice and started to explore articles on the topic. However, I was particularly drawn to the way that Tronto brought the political into care ethics.

4. How would you describe care ethics?

As a midwife who also has degree in Politics, I see care ethics as a politicised ethics. Drawing on Tronto’s care ethics argument, it is important that power relationships are made visible when we are talking about care, ethics and all things in between, such as bodily autonomy and decision-making.

There is also an emphasis on relationality—attentiveness arises between people, rather than passed from one person to another as are autonomy and consent—and on the recognition of the asymmetry of these relationships. People are not necessarily equal, especially at the time of care-giving and care-receiving, as to require care is to have some level of vulnerability.

The way that Tronto makes care central to human life is also a great shift in how we think about care. Which has traditionally been relegated to the private/female sphere, and has often been unpaid, unrecognised and undervalued, while generating wealth, goods or power has typically been hyper-valued. This is one of the most important aspects of care ethics – that care is actually central to who we are as a species and to our survival and therefore deserves attention.

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

I am still at the early stages of learning, but I suppose at this moment the most important thing has been that the concept of autonomy, so central (and for the most part unquestioned) to my teachings in midwifery, can be unpacked to reveal assumptions about individualism, agency and equality that are not apparently obvious, and which actually recreate power relationships.

6. Whom would you consider to be your most important teacher(s) and collaborators?

I am lucky to have found several brilliant and supportive teachers/mentors over the years. But, specific to ethics, I must mention Mavis Kirkham, with whom I co-authored a recent article on care ethics(( Newnham, E., & Kirkham, M. (2019). Beyond autonomy: Care ethics for midwifery and the humanization of birth. Nursing Ethics. DOI: 10.1177/0969733018819119)).

I remember reading her work as a midwifery student – the results of an ethnographic study that demonstrated how the institution could effectively come between the midwife-mother relationship. And that really struck me. It provided an explanation, and perhaps a solution, to the discord that I was feeling in practice. It is, of course, an ethical dilemma – to be in a profession that is at its foundation woman-centred and yet midwives find themselves everyday having to support the needs of the institution over the needs of the woman.

I am also enjoying some correspondence with Inge van Nistelrooij, and some of her colleagues at the University of Humanistic Studies, Utrecht. They have extensive experience and publications in the field of care ethics, and with whom I share a common interest of care ethics in maternity. We have begun some interesting discussions and hope to work on some projects together in the future.

I look forward to collaborating with my new colleagues in the midwifery team at Griffith University. If we consider the university (and academia) as an institution with its own power relationships, Midwifery@Griffith embodies a kind of ‘care ethics’ in the practice of a collaborative collegiality that is also founded on relationality and mutual support, is student-centred, with a transformative education philosophy and commitment to improving maternity care systems in Australia.

7. What publications do you consider the most important with regard to care ethics?

Again, I am quite new to this, but I really favour Tronto’s thesis in Moral Boundaries. I have read some of Elisabeth Conradi’s work on attentiveness within institutions and the simplicity yet importance of this in practice also strikes a chord. I look forward to exploring more publications on care ethics, both seminal and emerging.

8. Which of your own books/articles/projects should we learn from?

The most obvious would be Mavis Kirkham and my recent article on the topic of care ethics in midwifery:

Newnham E & Kirkham M. 2019. Beyond autonomy: Care ethics for midwifery and the humanization of birth, Nursing Ethics. DOI: 10.1177/0969733018819119

My PhD Thesis was published as a book in 2018 by Palgrave Macmillan and is called Towards the humanisation of birth: A study of epidural analgesia and hospital birth culture. Although not about care ethics, ethical practice and informed consent do come into it. It might also be of interest to anyone looking into hospital birth culture, midwifery practice, the experience of childbirth, maternity policy or ethnography.

Articles published from this doctoral research include:

Newnham, E, McKellar, L & Pincombe, J 2017. It’s your body, but…’ Mixed messages in childbirth education: findings from a hospital ethnography, Midwifery 55: 53–59.
Newnham, E, McKellar, L & Pincombe, J 2017. Paradox of the institution: findings from a hospital labour ward ethnography, BMC Pregnancy and Childbirth 17(1): 2-11.
Newnham E, McKellar L, Pincombe J 2016. Critical Medical Anthropology in Midwifery Research: A Framework for Ethnographic Analysis, Global Qualitative Nursing Research 3: 1–6. DOI: 10.1177/2333393616675029.
Newnham E, McKellar L & Pincombe, J 2015. Documenting risk: A comparison of policy and information pamphlets for using epidural or water in labour, Women & Birth 28(3): 221-227.
Newnham E, Pincombe J & McKellar L 2013. Access or egress? Questioning the “ethics” of ethics review for an ethnographic doctoral research study in a childbirth setting, International Journal of Doctoral Studies 8: 121 – 136.

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

I think care ethics, by Tronto’s definition, as ‘a species activity that includes everything we do to maintain, continue, and repair our ‘world’ so that we can live in it as well as possible.’ (Tronto 1993, p. 103) is actually crucial to our future survival. The emphasis on care as a practice is a message that could help with numerous current global problems, the most obvious being the environment.

10. How may care ethics contribute to society as a whole, do you think?

Care ethics provides an ethical grounding for promoting social justice. It does this by inserting an understanding and recognition of power into ethical thinking, by placing increased value on relationality, by recognising vulnerability and embodiment as central principles of existence, by emphasising the need for a dialectical ethics that moves between practice and theory, and in doing all of this, exposing the falsehood that late capitalism and neoliberalism perpetuate – that the pursuit of profit and power, status or material possessions are to be valued over humanity, care and equity.

11. Do you know of any research-based projects in local communities, institutions or on national levels, where ‘care’ is central?

I think care is talked about a lot, especially in the health sector – but is not always understood in the same way by different groups. I know of no current Australian research in which care is central – but as I hope to begin work in this area I am sure I will find out if/where these may be.

12. The aim of the consortium is to further develop care ethics internationally by creating connections between people who are involved in this interdisciplinary field, both in scientific and societal realms. Do you have any recommendations for us?

No recommendations as such. I think this consortium is a really good starting point, because connection, especially between disciplines, is needed to keep ideas growing and developing. The CERC conference would be great way to create connections and new networks, and I look forward to attending one. There is something about having dedicated time and space to discuss concepts, current research and new ideas with other interested people – an embodied relationality perhaps – that can be deeply inspiring.

June 10, 2019

Elena Cologni

Elena Cologni is an artist whose research practice has had a sustained in(ter)disciplinary approach. After a BA in Fine Art from Accademia di Belle Arti Brera in Milan, and a MA in Sculpture from Bretton Hall College, Leeds University, Cologni was awarded a scholarship for a PhD in Fine Art and Philosophy from University of the Arts, Central Saint Martins College, London, 2004 (CSM).

Where are you working at the moment?

I am based in Cambridge (UK), where I had also managed for a few years the artistic research production platform Rockfluid to work internationally, and address with an in(ter)disciplinary approach issues of memory, perception and place.

I am now bringing to conclusion the project CARE: from periphery to centre commissioned for the 250th Anniversary of Homerton College, at the University of Cambridge. This included an exhibition and site-specific installation developed in response to the history of the college, through research in the archive, and in consultation with the 250 Archive Working Group, including archivist Svetlana Paterson, historian of science Dr Melanie Keene, and educationalist and social historian Dr Peter Cunningham.

Can you tell us about your research and its relation to care ethics?

The mentioned project, draws on the College architecture (Ibberson Building, 1914), and on two key figures in its history: Maud Cloudesley Brereton (formerly Maud Horobin, lecturer and Acting Principal, 1903), and Leah Manning (student 1906-08). Both of international importance, they were concerned with health, well-being, and education, and I am specifically interested in how they engaged with care in domestic (Brereton published the book ‘The Mothers’ Companion, 1909) and international political contexts (Manning organised children’s escape from the Spanish fascist regime, 1929).

A display of items from the archive gives a snapshot of early 20th-century life in a women’s College, while focusing on practices of care in society and in students’ learning, through domestic studies, teachers training in medicine, health, and physical education, academic subjects which were considered less central than others, but more ‘appropriate’ for female students.

These themes underpin my sculptural installation designed in response to the 1914 Ibberson building (a former gymnasium), and echoed in the Queen’s Wing (housing the new gym) opening to a glass veranda, flowerbeds and lawn.

Moreover, after an exchange with care ethics’ philosopher Virginia Held, I was able to contextualise my practical work, and focus on aspects of womanhood, relationally and reciprocity at the core of the approach. This process is evidenced throughout the exhibition, including the recorded development of my thinking in a Moleskine sketchbook, and a selection of extracts from one of the publications Held shared with me informed a series of custom-made fabric labels, the steel frieze construction (Care As Support), and the steel and rope made sculptures (Relations Of Care).

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How did you get involved in care ethics?

In the current project care ethics functions as the lens through which I responded to the College archive, but I have been working in this direction even if I did not addressing it directly for some time. It naturally evolved from understanding the dialogic approach in my artistic process as a reciprocal form of caring (from the part of myself as the artist, and that of the participant), while building on educationalist, sociologist and poet Danilo Dolci, who theorised and adopted Reciprocal Maieutics (1973).

Learning about his work and talking to people who were close to him, allowed me to become aware of the impact of the reciprocal giving process involved (Cologni 2016), also typical in ecological and feminist approaches. This experience still is at the core of my creative thinking and it was embedded at the time in a series of dialogic sculptures for hands (Lo Scarto).

More recently the project Seeds of Attachment (2016/18), a specific feminist lens (discussed at New Hall Art Collection in Cambridge and Freud Museum in London), allowed me to focus on undervalued roles of care in society, as I worked with region based participants, and in particular on motherhood in collaboration with the Centre for family Research in Cambridge. This had been previously addressed through the project ‘U Verruzze’ (2013), looking at trust between mother and child and curated by Vessel.

However, in the latest work, the emphasis is on the caring role of motherhood in society in a wider sense. This, similarly to other practices of care in society, is undervalued, even if hugely contributing to our economies and welfare. The project tried to identify intersections between the theory of attachment of parent and child and place attachment, by proposing encounters on the school-run (the route from home to school), thus highlighting a sort of geography of difference of caring. This was done by using a dialogic sculpture to create a physical and conceptual new place for the encounter to happen: the intraplace.

“Learning to take care also means to foster and create new connections to solve problems in society.”

ELENA cOLOGNI

How would you describe care ethics?

Care ethics allows us to step out of the dominant social, political and cultural system of understanding society and relations, and look at the peripheral (not the central) instead: the circular (not the linear) thinking, the quiet (not the loud) voices in society as strengths (not weaknesses). Care Ethics teaches and trains us not to get tempted to compete by adopting the same strategies, which have damaged our society and environment, but try different avenues instead.

Learning to take care also means to foster and create new connections to solve problems in society, something at the core of some non-western countries’ ethos (eg. Ubuntu). Essentially care ethics has listening at its core, as much as most dialogic approaches including Dolci’s, and a lot can come from practicing it.

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

As an artist and academic, I have referred to phenomenology the most since early on (1999-2004), while also understanding the participants’ and audience’s reception of my work through aspects of psychology, and considering lived experience as central to my work. Care ethics showed me how to position my subjectivity, within this tradition.

Virginia Held for example states that “Experience is central to feminist thought, but what is meant by experience is not mere empirical observation, as so much of the history of modern philosophy and as analytic philosophy tend to construe it. Feminist experience is what art and literature as well as science deal with. It is the lived experience of feeling as well as thinking, of performing actions as well as receiving impressions, and of being aware of our connections with other persons as well as of our own sensations.” (2006)

Whom would you consider to be your most important teacher(s) and collaborators?

My interest in how care can be embedded in art evolved from considering its perceptual and psychological component since my early studies in Italy, which led to include specific strategies for enhancing social awareness and engagement. This was inspired by artists from the 60s and 70s, whose approaches impact society to this day in different ways. These are, including: the psychology informed approaches by Bruce Nauman, and Grazia Varisco (Varisco taught me at Brera Academy in Milan); the sociology related one by Dan Graham; the active participation and empathy in Lydia Clark’s, and the social actions and positioning by Artists Placement Group (APG) and Steven Willats.

In addition, I partially owe my unconventional research journey to experimental film maker and great mind Malcolm Le Grice, who was the director of studies of my PhD at Central Saint Martins in London from 1998. Generally, in my projects, my collaborators are carefully chosen and approached to take part in the initial investigation and research and/or in aspects of the creative process as participants.

What publications do you consider the most important with regard to care ethics?

I can mention the references which are useful for me to consider a very small portion of this wide area of study, and specifically to do with care in relation to women’s position in society, dialogic strategies and ecology. I would mention Nel Noddings’ developed idea of care as a feminine ethic, drawing conceptually from a maternal perspective (Caring: A Feminine Approach To Ethics And Moral Education, Berkeley: University Of California Press, 1986), and understanding caring relationships to be basic to human existence and consciousness. Also, Annette Baier underscores trust, as a basic relation between particular persons, and as the fundamental concept of morality (Trust and Anti-trust, Ethics 96: 231-60, 1986).

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Virginia Held wrote numerous publications on care ethics, in which she construes care as the most basic moral value, and describes feminist ethics as committed to actual experience, and lived methodologies. One of the most recent books is Ethics of Care, Personal Political and Global (New York, NY: Oxford University Press, 2006). Held argues that rights based moral theories presume a background of social connection, and that care ethics can help to create communities that promote healthy social relations. In this context, I argue that art can be a powerful dialogic tool.

Which of your own books/articles/projects should we learn from?

My artistic approach has developed through steps of a personal journey, each of which investigates different aspects of the same unsettled condition of a human being in search for home. However, in the body of work since 2014 the subject matter has become more specific and so has my awareness of the impact of my participatory strategies.

For example, the project Lo scarto, a workshop based project also including 40 sculptures for hand and drawings, developed in Sicily, where Danilo Dolci worked, a process of visualization of the role of listening in dialogue (Unesco and European Funding, 2015), allowed for a non-verbal dialogic strategy to emerge therein. This is discussed in the book chapter Cologni, E. (2016) ‘A Dialogic Approach For The Artist As An Interface In An Intercultural Society’. In Burnard, Mackinlay, Powell, The Routledge International Handbook of Intercultural Arts Research New York, London: ROUTLEDGE.

While the site responsive art project Lived Dialectics, Movement and Rest at Museums Quartier in Vienna, was informed by walks (sic) and research on place attachment in dialogue with US based environmental psychologist David Seamon (discussed at the Leonardo Laser series of talks at Central Saint Martins College University of the Arts London and Westminster University, in 2016, and the Leonardo 50th Conference, 2017, Bologna, Italy, published as Cologni, E. (2018) ‘LOCATING ONESELF’, in The New and History – art*science 2017/Leonardo 50 Proceedings. Capucci and Cipolletta (Eds), Noema Media and Publishing – ISBN 978-88-909189-7-1). This project informed the development of Seeds of Attachment, which, together with my ongoing relevant research will be included in a book.

What are important issues for care ethics in the future?

My interest is now in a possible link between ecofeminism and care ethics (Held) through practices of care. I am trying to embed the adoption of dialogic (inherently interdisciplinary) strategies in the creation of the work, a form of socially engage art practice. These include responding to the spatial (Linda McDowell), social (Henry Lefebvre), and cultural dimension of a place, as well as engaging with specific communities and collaborators therein to create situated (Donna Haraway) and embodied knowledge (Luce Irigaray). My projects often develop through collaborating, and thus becoming part, of interdisciplinary contexts.

For example, the current project was developed in collaboration with the College 250 Archive Working Group and involved subjects like science, education and architecture. However, in my practice, consistent concerns with ecofeminism and place are informed by ongoing conversations with Professor Susan Buckingham (feminist geographer, Cambridge, UK), whereas the artistic strategies with curator Gabi Scardi (Milan, Italy, International Development Fund British Council/Arts Council England, 2018/19), and in reference to historical artists like Mierle Laderman Ukeles (Maintenance Art Works 1969–1980).

How may care ethics contribute to society as a whole, do you think?

I am interested in the fact that it takes us to look at things from a different angle, consider our actions and experience, to then realize how we can contribute to society. More specifically sharing through art, strategies and concerns I have as a mother myself was quite natural, and this will hopefully lead to make people more aware of how they can contribute themselves to society in the everyday. Joan Tronto and Berenice Fisher have defined ‘‘taking care of’’ as an activity that includes ‘‘everything that we do to maintain, continue, and repair our ‘world’ so that we can live in it as well as possible” (1990), and this is so relevant now and must be implemented at a social and environmental levels.

Do you know of any research-based projects in local communities, institutions or on national levels, where ‘care’ is central?

I have been in touch with different contexts relevant to my art work and research in the UK and beyond, including conducting ongoing dialogue with Ecofeminist Laura Cima (Italy, see my A-N Bursary blog 2018), and the Moleskine Foundation, whose social and pedagogic work through art takes place internationally including Africa. I am always interested in gathering more information about associations and organisations specifically in the context of artistic practice and care, and these include for example: the research centres CAMeO, at the University of Leicester (UK), or the projects Laboratory for Aesthetics and Ecology (Denmark), and Pier Projects (UK).

However, there are many wonderful socially engaged projects, institutions, artists and curators I have been following out there, whose remit is to impact society, and whose approach resonates with care ethics, even if in a wider sense, in terms of supporting social cohesion, denouncing and acting on climate change, address geopolitical issues, support inclusive gender policies, and intercultural dialogue. These are, including: VISIBLE Project (Belgium/Italy), Museum MIMA (UK), Arte Útil by artist Tania Bruguera, curatorial platforms PUBLICS (Finland), Arts Catalyst (UK), Vessel, and Connecting Cultures (Italy), to mention just a few.

Images

Maud Cloudesley Brereton, The Mother’s Companion (1909), detail from Contents page. Published when Brereton was a mother of five children. She had been honoured by the French Academy for her work in promoting public health. Sir Lauder Brunton, a leading medical practitioner with an international reputation, and a founder of the National League for Physical Education contributed a Preface. Published by Mills and Boon, best known for their popular literature and practical handbooks.
Display of selected items from the College archive on Maud Brereton and Leah Manning.
Indoor Gymnastics (1944/5). Photograph of scenes from Homerton’s past, showing students participating in gymnastics classes. Learning about health and moving the body was an important part of historical curricula.
Installation view in the Ibberson Gymnasium, Homerton College, University of Cambridge. The arrangement of the display was inspired by archival photographs of the room, whose architectural design was punctuated by wooden panels corresponding to the areas in between the curved windows. On view are reproductions of the original items kept in the College Archive, as well as selected sport equipment. The newly produced rope sculptures refer back to the time when the space was used as a gym since it was built in 1914.
Relations of Care, Elena Cologni (2018, pair of mobile sculptures, steel rods, jute ropes, 2.5 x 2.5 x 2 metres each).
Care Proximities, Elena Cologni, installation view in front of the Ibberson Building, Homerton College, University of Cambridge (2018, installation including two sculptures and drawing on college lawn: wood + lawn marking paint, 20x100x0.5 meters)
Care Proximities, Elena Cologni, installation view in the college lawn.
Installation view including: Mother’s Tools, Elena Cologni (2018, 1 in a composition of 4: wood, steel, custom-made fabric labels, printing tools from the artist’s mother’s embroidery kit, 20cmx20cm each); and Care Notes, Elena Cologni (2018, graphite prints, graphite pencil, laser print on paper, Moleskine Japanese album, with inserts of fabric designs from the Architectural Review Magazine, June 1936, 21cm x 120 cm).
Mother’s Tools, detail from installation
Portion of display with content from the College archive, including contents of a needlework box (1861-2). Bought for 12s 6d, this box belonged to Emma Hunter, a student at Homerton College in the early 1860s. Dressmaking was an important skill for students in their adult lives, and in preparing a younger generation of girls at school for home-making and motherhood.
Care Is Relational, and Care Instructions, Elena Cologni (2018, 2 from series of woven labels, the first of which is inspired by Virginia Held’s writings, and the latter by Maud Brereton’s revolutionary position at the time, that domestic labour should be paid)
Copyright Ó Elena Cologni, Homerton College, University of Cambridge and Moleskine Foundation

Selected References

Cologni, E. (2016) Dialogic Approach For The Artist As An Interface In An Intercultural Society. In Burnard, Mackinlay, Powell, The Routledge International Handbook of Intercultural Arts Research New York, London: Routledge.
Cologni, E. (2018) Locating oneself, in The New and History – art*science 2017/Leonardo 50 Proceedings. Capucci and Copolletta (Eds), Noema Media and Publishing (ISBN 978-88-909189-7-1)
Held, V. (2006) Justice and Care: Essential Readings in Feminist Ethics Boulder, CO: Westview Press, 101-115.
Held, V. (1993) Feminist Morality: Transforming Culture, Society, and Politics. Chicago, IL: University of Chicago Press.
Held, V. (2006) Ethics of Care, Personal Political and Global. New York, NY: Oxford University Press.
Held, V. (2018) Care Ethics and the Social Contract, unpublished lecture, Oxford.
Noddings, N. (1982) Caring: A Feminine Approach to Ethics and Moral Education. Berkeley: University of CA Press.
Fisher, B. and Joan C. Tronto (1990). Toward a Feminist Theory of Care. In Circles of Care: Work and Identity in Women’s Lives, edited by Emily K. Abel and Margaret K. Nelson. State University of New York Press.
Tronto, J. (1994) Moral Boundaries: A Political Argument for an Ethic of Care. New York, NY: Routledge.

Acknowledgements

The discussed project ‘CARE: from periphery to centre‘ was developed with contributions from University College London Library; Cambridge University Library; The Harlow Art Trust: Gibberd Gallery, Harlow. The project was part of Cambridge Festival of Ideas 2018, was commissioned by Homerton College of the University of Cambridge for the 250th Anniversary Celebrations, and kindly supported by the Moleskine Foundation.
www.elenacologni.com

Copyright Elena Cologni, Homerton College, University of Cambridge and Moleskine Foundation

Text: Ayla van der Boor

August 23, 2018

Medical versus care ethics

As a former medical student – but not a doctor – studying the field of care ethics, I was always interested in bringing these two worlds together. Whereas the dominant (bio)medical ethics in healthcare revolves around four principles – beneficence, non-maleficence, respect for autonomy, and justice – care ethics questions whether morality can be derived from abstract principles and suggests it rather emerges from relational practices. As a medical student I wasn’t even aware of an, or any, alternative brand of ethics. Was it just me or was my lack of knowledge a consequence of medical education and the profession I was briefly acquainted with?

My years as a medical student had left me with a negative stance towards medical education and health care practice in general, without actually being able to explain why. My negative feelings were corroborated by several (non-)scientific sources describing harm in the medical encounter. In 2011, Elin Martinsen ((Martinsen, E. (2011). Harm in the absence of care: Towards a medical ethics that cares. Nursing Ethics, 18(2), pp.174-183.)) attributed this harm to the dominant ethics in healthcare.

She pleads to include “care as a core concept in medical ethical terminology” because of “the harm to which patients may be exposed owing to a lack of care in the clinical encounter,” specifically between doctors and patients. She leaves the didactical challenges arising from such a venture open for further enquiry. This left me with a chance to tackle both my personal questions and fill a scientific gap.

The informal and hidden curriculum of medical education

In this paper, medical education in the Netherlands is investigated through a “care-ethical lens”. This means exploring the possibility of enriching medical education with care-ethical insights, while at the same time discovering possible challenges emerging from such an undertaking. We present an overview of what is written on medical education, we describe care-ethical theories and what implementing these theories into medical education would imply, and we consider the accounts of several authors on the subject of care ethics and medical education.[pullquote]Master Care Ethics and Policy, University of Humanistic Studies.[/pullquote]

Personally, I have learnt most from further investigating medical education. Several authors offer alarming insights into its unintended, educational effects. Besides a formal curriculum or the explicated learning objectives, an informal and a hidden curriculum are also described. The informal curriculum is about the interpersonal level of teaching and learning between teacher and student. The hidden curriculum is also about learning objectives, but, as its name suggests, hidden, unintentional, and implicit.

What is so alarming about this, is that these curricula can lead to the erosion of expectations, ideals, and personal traits in students. Several examples of erosion have been described, such as the loss of idealism, adopting a ritualized professional identity, emotional neutralization, change of ethical integrity, tolerance of abuse, and acceptance of hierarchy. Students become hidebound, focused on facts, emotionally detached, cynical, arrogant, and irritable. Important to note here is that erosion doesn’t occur in every medical student nor does it always happen to the same extent.

Enriching medical education

What do these hidden, unintentional, and implicit effects of medical education imply for the possibility of enriching medical education with care-ethical insights? By connecting the collected bodies of knowledge on both medical education and care ethics, possible challenges are identified which can be narrowed down to two: didactical and non-didactical. These challenges might be overcome through focusing more deeply on the clinical phases of training and creating awareness of the medical morality and all that is implicit among healthcare practitioners.

With care ethics, we are dealing with a different way of thinking, one that deviates from what is currently dominant within the medical field, as I quickly realized leaving that field. We should not underestimate the possible resistance to a paradigm shift.

Eva van Reenen, MA Care Ethics

Van Reenen, E. & Van Nistelrooij, A.A.M. (2017). A spoonful of care ethics: the challenges of enriching medical education. Nursing Ethics. doi: 10.1177/0969733017747956

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April 3, 2018

Top Education certificate for Dutch Master Care Ethics and Policy

The Dutch accreditation organization for higher education (NVAO) awarded the master program Care Ethics and Policy of the University of Humanistic Studies the certificate ‘Top Education University 2018’.

Top Education

The master Care Ethics and Policy, at the University for Humanistic Studies in Utrecht, The Netherlands, is unique in the world. Chair professor dr. Carlo Leget and his team are very pleased with this award, that is an expression of appreciation by their students, as the award is chosen by students themselves through an independent, national survey.
Leget:

“It shows that this unique program is aligned with what our students want to learn. Nowadays, students search for both theoretical depth as the possibility to practice empirical research in the everyday practices they are part of. This is what our program focuses upon: we provide and form a community of inquiry of students, their practices, our professors and their courses. Not just directed at care in hospitals or nursing homes, but also grounded in policy, education, research and social settings like the home and at work. We are extremely proud and grateful that that we received this esteemed Dutch award”.

Master Care Ethics and Policy

The one-year Master Care Ethics and Policy provides students with an interdisciplinary education focused on improving health care, health systems and policy from a care ethical perspective. The master is specifically tailored to the healthcare and social welfare sector, but also includes guest lecturers and examples from other domains where care is at stake. Our program prepares graduates for staff, management and executive positions in hospitals, long-term care, nonprofits, government, scientific and other organizations, as well as positions in consultancy and research.

Our student population is a mixture of professionals with work experience, and of recently graduated students from other universities. The range of professionals varies from professionals working for nonprofits and local municipalities, to board members of elderly care homes, nurses, midwifes, policy advisors, physical therapists and medical doctors.

All lecturers of the program have close ties with care institutions, where they carry out their own research. Through education and research and through advisory councils and ethical committees they are closely involved in the processes and developments in healthcare institutions. Together they form the Care Ethics research group.

Course in English

The first semester course: Introduction to Care Ethics is offered in English. European students can follow this semester with the Exchange program, including four courses from the Master’s program in Humanistic Studies.

Care Ethics Research Consortium

Prof. Carlo Leget launced CERC with prof. dr. Joan Tronto, who received an honorary doctorate from the University of Humanistic Studies in 2014. On the occasion of each lustrum, the University confers honorary doctorates on prominent individuals, both domestic and international, whose work and life have a significant bearing on Humanistic Studies
Read the laudatio from prof.dr. Carlo Leget for prof. dr. Joan Tronto.

March 16, 2018

Vacancy: PhD Student Maastricht

PhD Student “Synthetic embryos: an ethical reflection”. Dept Health, Ethics & Society, Maastricht University, The Netherlands, start between 1 June and 1 September 2018, 48 months, full time

For a PhD-project on the ethics of ‘synthetic embryos’, a vacancy will become available for a PhD student at the Department of Health, Ethics & Society of Maastricht University, the Netherlands. This concerns a full-time 4 year dissertation opportunity for a philosopher/bioethicist. A project description can be acquired from dr Wybo Dondorp, email: w.dondorp@maastrichtuniversity.nl

Background

Recent reports have shown that, under the right conditions, human pluripotent stem cells can form structures that resemble early human embryos. These “synthetic human entities with embryo-like features (SHEEFs)” seem highly useful for studying early human development, but also raise ethical concerns that are relevant for how this emerging field of research should be regulated.

Aims and methods

This project aims to contribute to a robust and sustainable normative framework for creating and using SHEEFs. In addition to contributing to the international debate, an explicit goal of the project is to advice policy makers in the Netherlands on whether the Dutch Embryos Act is sufficiently ‘SHEEFS-proof’. Methods: conceptual analysis, normative analysis, qualitative stakeholder research (focus group discussions).

Funding and collaboration

This project is funded by The Netherlands Organisation for Health Research and Development (ZonMw), GROW (School for Oncology & Developmental Biology, Maastricht University) and MERLN (Institute for Technology-Inspired Regenerative Medicine, Maastricht University). Collaborating centers are the Department of Health, Ethics & Society (HES), GROW and MERLN (all Maastricht University), the University Medical Center Utrecht (Department of Medical Humanities) and the Hubrecht Institute for Developmental Biology and Stem Cell Research (both Utrecht University).

Location and supervision

The PhD student working on this project will be based at the Department of Health, Ethics & Society of Maastricht University, in Maastricht, the Netherlands with regular visits to Utrecht. The project will be supervised by prof dr Guido de Wert and dr Wybo Dondorp (bioethicists, Maastricht University) together with prof dr Annelien Bredenoord (bioethicist, Utrecht University).

Candidate profile

Completed research master in Philosophy or Applied Ethics. Proven interest in bioethical aspects of developmental biology. Experience with qualitative empirical research. Mastery of writing English for publication. Mastery of Dutch will be considered an advantage.

Start: The start date of the project is 1 June 2018.

Terms of employment

The terms of employment of Maastricht University are set out in the Collective Labour Agreement of Dutch Universities (CAO). Furthermore, local UM provisions also apply. For more information look at the website www.maastrichtuniversity.nl > staff > index and forms > HR from A-Z.
Temporary employment: 4 years.

Applications

Applications consisting of a motivation letter and CV can be sent until 8 April 2018 to the below postal or email address (on the envelope/in the header please state “Synthetic embryos”). The first interview round will be held on Monday 16 April 2018 in Maastricht.

Maastricht University
Dept of Health Ethics & Society
t.a.v. Angelique Heijnen
Postbus 616
6200 MD Maastricht
00 31 43 3882145 (except on Wednesdays)
a.heijnen@ maastrichtuniversity.nl

October 31, 2017

Merel Visse

Interview with Merel Visse, PhD, associate professor, University of Humanistic Studies, Utrecht, The Netherlands.

1. Where are you working at this moment?

Currently I work as an associate professor Care Ethics and Policy at the University of Humanistic Studies in The Netherlands. As a scholar and artist, I combine theoretical and practice-based work to inquire about the moral good in care. In addition to regular scientific output such as publications, I also make installations, objects, drawings, paintings, projects and communities.

I have received a grant of my university and for the next three years I will focus on the meaning of creative and artistic practice for understanding the moral good in care. I prefer to work in close collaboration with scientific and civic partners, like health care and policy institutions and local governments, so my work is always the outcome of a relational process. I also teach several courses for graduate students, such as care ethical qualitative inquiry, narrative inquiry and responsive evaluation.
On my website www.merelvisse.com you can find an overview of my work, activities and inspirations.

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

Our view of care ethics is dialectical: we understand and foster good care by dialectically exploring care through both theoretical and empirical, practice-based, lenses (Leget, Van Nistelrooij & Visse, 2017)((Leget, C., Van Nistelrooij, I., & Visse, M. (2017). Beyond demarcation: Care ethics as an interdisciplinary field of inquiry. Nursing ethics, doi: 10.1177/0969733017707008.)). Originally, I began my work in care as an evaluator and qualitative researcher, but I’ve always had a strong focus on theory as well. During the last four years, we have developed a care ethical qualitative inquiry approach that is ‘fed’ by theories and practices of phenomenology, relational ethnography and responsive evaluation approaches. These are approaches that support us in understanding people’s singular and collective experiences with care.

But while working with these approaches, we felt a strong need for a different epistemology and method to enhance our understandings. It’s also due to a new ‘critical turn’ in qualitative inquiry that includes attention for the sensory and affective dimensions of care, and more. The process of drawing or working with photo voice and making artistic objects can be seen as a mode of inquiry. Looking at visual data, and producing visual data help us know differently than knowing through verbalized accounts.

So how to study care by the inclusion of attention for affective, sensory, embodied dimensions of life? I believe this is necessary, because as many care ethicists have emphasized, care is not a virtue, but a practice. And therefore we can only theorize and think ‘care’ by approaches that are congruent with a practice-view.

3. How did you get involved in care ethics?

After the publication of my book and PhD thesis, ‘Openings for Humanization in Modern Health Care Practices’((Visse, M. A. (2012). Openings for humanization in modern health care practices)) in 2012, I received a phone call from professor Frans Vosman. He read my work and invited me to join the Care Ethics group in Utrecht. It was the start of a path that has deepened my work and view on care ethics profoundly.

Originally, I was trained by professors Tineke Abma and Guy Widdershoven of the VU University of Amsterdam, Medical Humanities, who introduced me to the fields of responsive evaluation, qualitative inquiry, practice-based work and Gadamerian hermeneutics and empirical ethics. I was introduced to evaluation scholars like Bob Stake, Thomas Schwandt and Jennifer Greene with whom I’ve just developed a special Volume on Evaluation for a Caring Society (in press, to be published by IAP publishers this fall).

In my book from 2012, among other topics, I discussed the meaning of the work of Margaret Urban Walker in the light of several empirical (phenomenological) studies on how caregivers and care–receivers experienced good care. The book consists of published papers that – each in its own way and each based on empirical studies – were built upon the collaborative-expressive model of Walker. Professor Andries Baart, my former colleague, introduced me to a care ethical view on qualitative inquiry. That opened up a whole new way of thinking about ‘practising care ethics’.

4. How would you describe care ethics?

My father is in cultural heritage and as a child, I remember him closely looking at buildings. I learned that the material world embodies many traditions and stories. I remember him telling me about different kinds of mortar in between the bricks and how the mortar (which is tiny and detailed) strongly influenced the outlook of the whole. That is what care does, the performative dimension of care: just like mortar, it is in ‘liminal’ space, holding people together (or not) in ‘life sustaining webs’, to use Fisher’s and Tronto’s words. In addition, I saw my father negotiating with owners, engineers, restaurateurs and representatives of local governments. All these people had different stakes when living in and preserving the built environment. In hindsight I know that this is where my training in responsive evaluation (which is all about negotiation and dialogue) and later on, in care ethics began.

It’s a little bit of a long introduction to show you how my view on care ethics has grown. I see care ethics as a way of knowing and inquiring about what is ‘good’ in historical, aesthetical, temporal and spatial ways. Care ethics is an epistemology that is featured by hermeneutical understanding, listening and experiencing the world around us, together with others. It is about the moral dimensions of living in (and on) our own tapestry of people and relationships. Care ethics – as described in Leget, Van Nistelrooij & Visse (2017) – asks about the normative in a dialectical way: honoring both theory and practice.

A practice view on care acknowledges that people and their lives are part of an intrinsic and complex tapestry that critically counter-thinks notions like agency, (self) management and control. Care ethics acknowledges the ambiguity and complexity of everyday situations in care: that is what matters to me profoundly. People ‘undergo’ and ‘accept’ being in certain kinds of positions (e.g. of a caregiver and –receiver). Care ethics is, as my colleague Alistair Niemeijer so aptly phrased it, ‘inherently dialectic’. The dialectic nature of care ethics has been developed by our chair Carlo Leget in his publication on the re-examination on the empirical and the normative (Leget, Borry, De Vries, 2009)((Leget, C., Borry, P., de Vries, R. (2009). ‘Nobody tosses a dwarf!’ The relation between the empirical and the normative reexamined. Bioethics. 2009 May;23(4):226-35. doi: 10.1111/j.1467-8519.2009.01711.x.)). By keeping theory and practice ‘in tension’, care ethics can be further developed and understood.

5. Whom would you consider to be your most important teacher(s) and collaborators?

Currently, my most important teachers are outside the field of care ethics, if I may speak of an “in- and outside”. For example, I especially admire the work of the philosopher Hans Georg Gadamer and more recently, the French philosopher Jean-Luc Marion. I prefer to work ‘slow’: I learn through careful, slow reading and reflection.

Currently, my most important collaborators and teachers are my colleagues and (former) students of the Care Ethics group. We carry out research in collaboration with several Dutch cities and health care institutions and this work ‘in the mud’ humbles me and shows me new perspectives and challenges. Every project is run by a core team of researchers who I feel privileged to collaborate with.

Co-authoring papers with colleagues is very rewarding. I have written papers with colleagues, such as Alistair Niemeijer, Inge van Nistelrooij and Carlo Leget. With Tineke Abma, I have just developed a special Volume on Evaluation for a Caring Society. Several care ethicists contributed to that Volume, like Helen Kohlen, Karin Dahlberg, Maurice Hamington and Jeannette Pols, as well as several responsive evaluators like Melissa Freeman, Anders Hanberger, Gustaaf Bos, Hannah Leyerzapf and others.

I have always found myself on the intersection of several disciplines and I believe this is vital for the quality of my work. Now, while developing this Consortium, I discovered that there are so many people from a wide range of fields who contribute to care ethics and theory. I look forward to meeting them very much.

6. What publications do you consider the most important with regard to care ethics?

Eva Feder Kittay’s Love Labor
Joan Tronto’s Caring Democracy

Epistemology:

Margaret Urban Walker’s Moral Understandings
Richard Bernstein’s Beyond Objectivism and relativism. Science, Hermeneutics and Praxis.

And with regards to our dialectical view between they and empirical work:

Johnson & Parry’s Qualitative Research for Social Justice.

7. Which of your own books/articles/projects should we learn from?

This depends on your own background and interests. Soon, the special volume on Evaluation for a Caring Society will be published (fall 2017, IAP publishers). In the past, I have published about different topics, mostly related to how to ‘operationalise’ care ethics as a political ethic. On my website, you can find an overview for my publications and projects. Please email me when you would like to receive one of my papers, I’d be happy to share them.

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

I see many opportunities to increase the socio-political impact of care ethics. To do so, we need to build bridges between care ethicists who are conceptually oriented and care ethicists who mainly do empirical work, both empirical research and policy design and programs. By collaboration, we can create synergy. The new Care Ethics Research Consortium will be a platform for that.
I also believe in creativity. That is the topic I’m currently focusing on: creativity in the moral domain.

9. Do you know of any research-based projects in local communities, institutions or on national levels, where ‘care’ is central? Please describe

Yes: there are so many! Our research group carries out a rich variety of practice-based care ethical projects in close collaboration with several Dutch cities, residential elderly care institutions, hospitals, for-profit organisations (like a pharmacy) and communities. Most of these projects result in peer-reviewed publications as well. One example is a large Dutch elderly care organization that aims to work according to relation centered care. We facilitated an action-research project, based on a care ethical stance, to guide participants towards new understandings on relation centered care.

10. The aim of the consortium is to further develop care ethics internationally by creating connections between people who are involved in this interdisciplinary field, both in scientific and societal realms. Do you have any recommendations for us?

I would especially like to build bridges between conceptually and empirically oriented care ethicists, to develop international research grant proposals together. I believe that by increasing our practice based work, we will put care ethics more centrally on the societal agenda.

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October 12, 2017

Inge van Nistelrooij

Interview with Inge van Nistelrooij PhD, assistant professor Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands

1. Where are you working at this moment?

I am an assistant professor of Care Ethics at the University of Humanistic Studies, Utrecht, The Netherlands. As far as we know, we have the only Master’s degree in care ethics throughout the world. Together with my colleagues Carlo Leget, Merel Visse, Frans Vosman, Alistair Niemeijer, Vivianne Baur and Anne Goossensen we teach (pre)master’s and graduate students, and do research here, in cooperation with many societal partners.

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

My PhD research was a philosophical-ethical study on self-sacrifice in caregiving (2014a, 2014b, 2015, 2017) and brought together care ethics, examples from literary fiction, movies and history, phenomenology, theology, political theory, and hermeneutics. My present research draws upon this work for thoughts and insights that I continue to elaborate and develop further. My research revolves around central insights of care ethics and care theory: relationality, affectivity, care as an attuning practice, embodiedness, vulnerability and dependency, and the political theory on care. I am now connecting all of these dimensions with empirical research. Also new themes emerge, like family care, care and the lived experience of pregnancy, birth-giving and child care, embodied forms of moral case deliberation, and the practice of belonging to a community.

3. How did you get involved in care ethics?

At the age of 18 I wanted to become a spiritual counsellor in hospitals and studied theology. There Annelies van Heijst introduced my fellow students and myself to care ethics. It felt like coming home: an ethical theory that drew upon everyday life’s questions, both on the personal, organisational and political level, that immediately struck a chord with me. Van Heijst’s work has not only become an enormous source of inspiration for myself, she has also developed our Master’s degree program in Care Ethics and Policy. So in more than one respect, hers are the shoulders on which we stand. Of course she was the supervisor of my doctoral thesis with which I graduated in 1995 (cum laude).

This thesis won the thesis award of the Tilburg University and was published as a book, not the first, but still one of the first Dutch books on care ethics, in 1996. As a result, I have been lecturing and publishing on care ethics ever since.

4. How would you describe care ethics?

Of course I could refer to the definition that my colleagues and me developed together (Leget et al 2017, forthcoming). But let me try to phrase it in some other words. Care ethics is an ethics that draws upon the practices to which we owe our lives, in which we are all inevitably involved and on which we spend time every day, i.e. the practices of care. Caring for ourselves, others we live with or meet, our environment, the world. Caring as a practice that essentially builds a ‘life-sustaining web’. What is more, caring is a practice in which we acknowledge and express who we are and aim to be personally and together with others, on an intimate scale with family, friends and colleagues, but also within institutions (e.g. the academia, health care), and as a society. Caring involves our body, our language, our attitude, our abilities, our knowledge and intuitions, the stories that we have heard and the inspiring examples that we received from other people’s lives, our best intentions, and our art. But no less does it involve our vulnerability and dependency, as well as our mistakes and failures, our pain and shortcomings, our misunderstood efforts and the inevitable harm that we cause each other. And care ethics draws upon all of this for seeking the good.

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

A Dutch newspaper’s motto has been: ‘whetstone of the mind’. I think that this is what care ethics has taught me: to continuously sharpen insights. It taught me to challenge and change my thoughts and beliefs, over and over again. When I was a student, my thoughts about care and ethics differed quite a bit from what I have been thinking ever since I experienced pregnancy, becoming and being a mother, for instance. The enormous gap between what society expects of its citizens as entrepreneurs on the one hand, and the caring practices of personal life (caring for dependent others, being marginalized when dependent upon care) on the other, still puzzles me. And again, new perspectives challenged the previous ones when for years I taught ethics and trained professional caregivers in ethics. But really, I trained with them. They showed me the institutional and organizational pressure in which they work, the hierarchical power imbalance and lack of moral space, and also how and why they still, sometimes, found meaning in their work. New books and new teachers taught me to change my views again, for instance when submerging myself in French phenomenology and hermeneutics during my PhD study. Stories from fiction and real life, movies, experiences with loved ones who suffered or died, recovered or had to adapt their lives and identities to chronic illness, questioned the perspectives that I had understood before. And new government policies that transfer various forms of caring back into the informal sphere, on top of the care burden for the family, and how new forms of ‘belonging’ on a local level are expected to come about, lead to increasing need for research.

What I think all this comes down to, is that care ethics has taught me the importance of particularism, plurality, temporality, perspective, and the humble claims we can make of ‘truth’, especially in ethics. This does not lead to a conclusion of relativism, but rather to acknowledge the truth of a continuous, multidimensional, hermeneutical dialectic.

6. Whom would you consider to be your most important teacher(s) and collaborators?

As said above, Annelies van Heijst has been my most important teacher and collaborator. Further, I owe a lot to my PhD thesis supervisor Frans Vosman, who encouraged me to read Paul Ricoeur’s work. But it all began and still carries on with what I have learned from the works of Joan Tronto, Nel Noddings, Margaret Urban Walker, Eva Feder Kittay, Sarah Ruddick, and Carol Gilligan, of course. For my new themes I learn a lot from the works of Maurice Hamington, Helen Kohlen, Sophie Bourgault, my colleagues Carlo Leget, Merel Visse and Alistair Niemeijer, all of whom I am grateful to also cooperate with. New teachers, whose books inspire me and whom I would love to collaborate with in the future, are Christina Schües, Daniel Engster, and Jeannette Pols. And I love the lessons, inspiration and collaboration that I continue to receive from all the professional and informal caregivers and care receivers whom I meet as friends and students and in my family.

7. What publications do you consider the most important with regard to care ethics?

The top 5 would be:

Joan C. Tronto, Moral Boundaries,
Eva Feder Kittay, Love’s Labor,
Margaret Urban Walker, Moral Understandings,
Sarah Ruddick, Maternal Thinking, and
Annelies van Heijst, Professional Loving Care.

But still, care ethics is developing and perhaps the most important publications are those who carry the torch at present, carving out new space in international politics, disability studies, feminist studies, health care policy, family ethics and family policy, philosophical anthropology, moral epistemology, environmental ethics (for which the Dutch Henk Manschot coined the term ‘terrasophy’), as for all of these there is still so much work to do. Naming just a few would do injustice to others. The establishment and development of this international care ethics research consortium, is essential for connecting people of all six continents together, preventing a fragmentation of care ethics.

8. Which of your own books/articles/projects should we learn from?

Probably my dissertation Sacrifice. A care ethical reappraisal of sacrifice and self-sacrifice (2015, Leuven: Peeters) would be valuable, but my recent articles draw upon that work and develop it further:

Nistelrooij A.A.M. van, Visse M.A., Spekkink A & Lange J. de (2017), How shared is Shared Decision Making? A care-ethical view on the role of partner and the family. Journal of Medical Ethics (doi:10.1136/medethics-2016-103791)
Nistelrooij, A.A.M. van & Leget, C.J.W. (2016). Against dichotomies: on mature care and self-sacrifice in care ethics. Nursing Ethics, 1-10. doi: 10.1177/0969733015624475
Nistelrooij, A.A.M. van, Schaafsma, E.P. & Tronto, J.C. (2014). Ricoeur and the ethics of care. Medicine, Health Care and Philosophy, 17 (4), 485-491. doi: 10.1007/s11019-014-9595-4
Nistelrooij, A.A.M. van (2014). Self-sacrifice and self-affirmation within care-giving. Medicine, Health Care and Philosophy, 17 (4), 519-528. doi: 10.1007/s11019-013-9523-z

I am currently developing the following projects:

a care ethical view on pregnancy, giving birth and the practice of parenthood as an embodied and meaningful caring practice;
a care ethical view on ethical reflection (including non-verbal, embodied knowledge) and what this requires of the setting of a caring institution, together with prof. dr. Helen Kohlen, Philosophisch-Theologische Hochschule Vallendar, Germany;
diversity and caring as co-creative practice in a (local) community.

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

There are many. The core questions remain: how can we include the practices and experiences of everyday life in all its plurality and particularity in moral thought; how can we build a (national and international) society that puts these practices, experiences and knowledge central; and how can we thus carve out space for what those involved in caring experience, know, and have to tell. One of the most urgent questions, I think, in my Western society is the marginalization of those who cannot meet the demands of self-management, independence, participation, and finding their way in the institutional maze of care. Too many are simply overburdened with their condition, with their caring tasks either for themselves or for close others, and require that we as a society are affected by them and care for them. Instead, they are hardly heard, their caring needs are not met because they do not meet the strict criteria that the system poses, or they are losing their supporting network in a cycle of loss: loss of job, loss of status and means, loss of contacts and network, causing increased marginalization and loneliness.

10. How may care ethics contribute to society as a whole, do you think?

I think that the important thing for us to do is to keep sharpening our insights, uncovering real life experiences through empirical research, keep bringing our insights to the fore, educating students and thus disseminating our insights. The problem for small countries like The Netherlands is, that academic requirements demand us to publish in English, international journals. That is essential for the academic exchange, but it simultaneously is a serious threat for our societal impact in our own community.

11. Do you know of any research-based projects in local communities, institutions or on national levels, where ‘care’ is central? Please describe.

I see institutions trying to do so, especially institutions for those whom we used to call people with mental disabilities. But, as the organization Prisma has stated, we should call them people with a societal disability, as the problem is not their mental state, but the ways in which society makes it difficult for them to participate. We are developing our cooperation in research together with Prisma.

Also new, inclusive communities have come about and increasingly seem to grow in numbers, in which people with and without visible impairments live together.

But in our country the dominant discourse in politics, caring institutions and local communities is still that of autonomy, self-management, independence, etc. in a way that still marginalizes caring from the public and political deliberation.

12. The aim of the consortium is to further develop care ethics internationally by creating connections between people who are involved in this interdisciplinary field, both in scientific and societal realms. Do you have any recommendations for us?

I hope and wish that the consortium helps increase the impact of care ethics, by bringing researchers together and enabling cooperation in research and education. I definitely believe that cooperation leads to greater impact, that exchange inspires, that co-constitution of ethics improves its quality, and that care ethics will help build a better society for all. My wish would be to create an international structure that supports this research network. Thoughts that come to mind are: an expert centre that coordinates and supports an international journal, a website, a research fund, annual or biannual conferences etc.

July 6, 2016

Utrecht Care Ethics

Care ethics is an interdisciplinary field of inquiry, which is driven by societal questions. Since the beginning of the 1980s, in this field various movements and disciplines have an interdisciplinary conversation, among which philosophy, ethics, social sciences, political and policy sciences, and nursing sciences.

The contribution made by the research group at the University of Humanistic Studies is a specific form of ethics. The key question of the Utrecht Care Ethics is: What is good care, given this particular situation? In order to answer this question we use a theoretical framework, which functions as a multifocal interpretative lens.

Theoretical framework

The theoretical framework is built around the concept of care, which is broadly understood. Caring is primarily seen as a social and political practice. This means that people continuously attune to others and themselves, in professional settings or otherwise, and always in an organised society. People ‘attune’ in order to maintain, continue, and repair our ‘world’ so that they can live in it as well as possible. In practices the morally good can emerge and be experienced by those involved. In this process those who receive care play a crucial role.

The theoretical framework, built around the concept of care, is fed by two sources. On the one hand, the interdisciplinary discussions known as ethics of care, which run for more than thirty years now, and various forms of empirical research on the other.

Conceptual and empirical research

These two sources, conceptual and empirical research, are in a dialectical relation to each other. Conceptual and theoretical insights are being questioned and enriched by empirical research and vice versa. In other words: we have a normatively loaded care ethical theory that is simultaneously used as a theoretical framework and as a hypothesis that is tested and adapted on the basis of empirical research and theoretical reflection.[pullquote]What is good care, given this particular situation?[/pullquote]

Within the theoretical framework a number of developed concepts (‘critical insights’) are guiding, such as relationality, contextuality, affectivity, practices, vulnerability, bodiliness, attention to power and position, and meaning.

Methodological toolkit

The empirical research methods used in Care Ethics at the University of Humanistic Studies focus on lived experiences, practices of care, and the way society is organised (the political-ethical dimension). The methodological toolkit, which is used and developed further for this goal, contains the following methods: phenomenology, narrative analysis, discourse analysis, institutional and auto-ethnography, visual data-analysis, and responsive evaluation.

Epistemological position

Summarizing: the theoretical framework, drawing upon the above mentioned ‘critical insights’, directs the empirical research approaches towards the lived experiences of those who are involved in caring practices, on these practices as such and/or their political context. In this way(s) insights are gained about the morally good that emerges here.

Thus, the epistemological position of the Care Ethics research group can be described as expressive-collaborative and embodied. We only get access to the good when we relate different positions, perspectives and types of knowledge to each other, by being in dialogue and using participatory types of research.

December 11, 2009

Christa Schnabl

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.