The Ethics of Caring
by Gill Matthews
What does it mean to care?
Again there are several alternatives to consider:
Comfort or cure?
Curing people sounds exciting. Simply providing comfort like food, personal hygiene and pain relief is much less glamorous.
Consequently, money is allocated to research into potential cures for disease in preference to comfortable beds or appetising food for patients.
Sometimes terminally ill patients suffer discomfort in the pursuit of a cure. If the treatment only prolongs the patient’s life for a few months, but makes those months a miserable experience, is this caring?
Care is different from cure. Care considers the needs of the whole person – cure just treats the disease. From the Christian worldview, it is clearly not wrong to desire cure. For example, Jesus felt compassion for the two blind men he met near Jericho and so he cured them (5).
But we try desperately to find a cure because we don’t want to face up to the hard truth that we are mortal. Illness, ageing and death may be kept at bay, but they will never go away. Caring needs to occur whether or not there is a cure.
Dependence or independence?
A person can become too dependent on care and end up being dominated by the carer. This could arise from the person being unwilling to help themselves, or from the cares having a desire to feel needed. Most rehabilitation programmes aim to give maximum independence. However, if a person can’t become independent, he or she could end up feeling worthless or a burden.
God created us to be interdependent. For example, God created Eve with the words: ‘It is not good for the man to be alone. I will make a helper suitable for him'(6).
The idea of interdependence may make us flinch. We attach so much value to independence that it appears to be an insult to be referred to as a helper or in need of help. When interdependence is working well, caring can be seen as enabling each other to live the fullest possible lives.
Professionalism or self-sacrifice?
For many healthcare professionals caring is part of a professional response. A nursing careplan, for example, itemises a series of interventions that promote the best interest of the patient. Caring is moved out of the sphere of morality and into one of professionalism. To be uncaring is to be unprofessional rather than immortal.
Some argue that professional care is a service that needs to be provided as efficiently and effectively as possible, where one stranger in need. In this case it ceases to be the response of compassion from one human being towards another.
The opening statement of the UKCC Code of Professional Conduct for the Nurse, Midwife and Health Visitor (1984) reflects some of this viewpoint: ‘Each registered nurse, midwife and health visitor shall act, at all times, in such a manner as to justify public trust and confidence, to uphold and enhance the good standing and reputation of the profession, to serve the interest of society and above all to safeguard the interest of individual patients and clients.’
Professional bodies become the ultimate reference point for ‘right and wrong’ behavior. The ultimate fear is to be disciplined or struck off their register. This gives enormous power and responsibility to the governing bodies as they define what is right and wrong behavior.
Being caring also becomes restricted to people in the caring professions. However, even they, once home from work, rid themselves of any obligation to care.
Obviously a desire to be professional is praiseworthy. But as a sole motivation to care it could reduce patients to objects of professional practice, rather than fellow human beings in need. It strips caring of any notion of love.
Jesus set a model of caring that goes further than is demanded by professional requirements. He showed that caring is an expression of self-sacrificial love, deriving from God’s character of love.
Quality or quantity?
In a society with many elderly people and life-support technology, the question of quality as well as quantity of life has become an issue of debate. Is it still ‘caring’ to sustain the life of someone who is in a persistent vegetative state, unable to move, eat, speak or wash themselves or apparently to respond to other? Should we aim to increase the quality or the quantity of a person’s life?
One of the problems is measuring quality of life. Various systems have been tried, but they all tend to value people by asking how much they can achieve. A treatment is then measured by how much extra achievement it can allow the person.
From a biblical perspective, quality of life has far more to do with our spiritual lives, God’s relationship with us, than it has to do with physical disease or limitations.
The high value of human life comes ultimately from God’s decision to have a relationship with us regardless of our capacities. This can transcend physical disease or even severe disability.
Therefore someone’s actual or potential relationship with God needs to be taken into account when assessing ‘quality of life’.
Giving quality care also means providing appropriate care. It may not be possible to keep a person alive. but it may be appropriate to care for him or her at home or in a hospice, rather than a hospital.
Who should we care for?
This is the big question of resource allocation in the NHS today. Should we use medical or social criteria?
Social criteria have been used in the past. In the early 1960’s a committee was set up in Seattle, USA, to make recommendations for kidney dialysis. It looked at aspects like the person’s wealth, marital status, psychological stability, Scout leadership and church membership. It became known as the Seattle ‘God’ Committee, was strongly criticised, and closed down (7).
It’s easy to disapprove of the idea of using social criteria, but medical criteria often merge into social criteria. For example, well-educated and affluent patients have the best changes of looking after themselves or their children. There may be no point starting a treatment if the patient is not able to keep up with all of its demands.
Consider this. If you were to enter a healthcare profession, would you be biased towards patients who fit the following criteria?
- who will be restored to being productive in society?
- who are not convicted criminals?
- who are good-looking?
- who are our own relatives or patients under our care?
- who have not brought their illness upon themselves?
In response to a question about whom we should care for, Jesus told the story of the Good Samaritan who took care of a Jewish man who had been beaten up.(8) A modern day equivalent might be a Serb nursing a Bosnian Muslim. Caring should overcome all our prejudices.
Care defends the defenceless
The Bible warns that if we ignore God we will tend to ignore the needs of the most vulnerable and defenceless in our society. The prophet Isaiah rebukes Israel: ‘Seek justice, encourage the oppressed. Defend the cause of the fatherless, plead the case of the widow.'(9)
Who are the ‘oppressed’ and ‘defenceless’ in our society? The poor? The homeless? People with disabilities? Unborn babies? People who are frail and elderly? These are the people most likely to be unjustly discriminated against in the distribution of healthcare resouces.
In countries with publicly funded health services like the UK it is easy to complain about inadequacies. However, resources are finite, and the demand for healthcare will always exceed them.
How can we meet the biblical demand to care for all? If the example of Jesus’ caring is one of self-sacrificial love, are we not placing an enormous burden o the already over-stretched caring professionals and relatives, expecting them to ‘go the second mile’ when they are close to burnout themselves?
Perhaps the first step is to campaign for more national resources to be used in all aspect of caring, even at the expense of increased taxation.
Secondly, the whole community should provide ‘care in the community’. We need to protect aspects of life that build communities and find ways of rebuilding a sense of community in areas of cities, towns and countryside where the drive to supply individual choice and privacy has destroyed it.
Far from being seen as a burden, the sick and vulnerable should be seen as a gift to all of us to learn how to care and to give the unconditional love to others which God gives to us. If we learn to care for them, as we would like to be treated ourselves, we need not want when it is our turn to be dependent.
- Matthew 20:29-34
- Genesis 2:18
- Calabresi G, Bobbitt P.Tragic Choices. WW Norton & Co. New York, 1978. pp 110-112.
- Luke 10:25-37.
- Isaiah 1:17.
Gill Matthews is trained as a nurse and is currently doing humanitarian work in Bosnia. She has degree in English.
Christian Medical Fellowship (CMF) Files No. 5, 1999