Care, ethics, and policy

Firstly, the pandemic was a public health crisis. But the pandemic generated many secondary crises and illuminated underlying tensions and contradictions in our society. And the care crisis was a big one.

The pandemic tore a hole in society’s care infrastructure. Child care evaporated. Home care support disappeared. Schools went online. Elder care was locked down and many facilities became mass infection sites. Stepping into the breach were were, mostly, women, especially moms who quit jobs AND took extra shifts at home. It was a social and familial disaster.

Care is ethics (and can be fun).

This care disaster helped galvanize political and social movements to take action on care and to demand a public response. See #CareCantWait and #PaidLeaveForAll among others. To make their case, care advocates have argued that care is in crisis. They have argued that care is worthy of public attention and public resources by framing care as a kind of infrastructure, and that care is an economy unto itself with job creation and economic benefits. Advocates have argued that heavy care responsibilities are an obstacle to women’s economic empowerment, and as factor for overall economic growth. Care has been framed as a gender-justice issue. Some advocates have framed care as a right.

Still, more than two years since the pandemic began, there is little to show for it. Temporary measures, including paid leave and the expanded child care tax credit, have all lapsed. Funding assistance for child care centers is exhausted. The Build Back Better package which would have institutionalized and expanded care initiatives was proposed, but now abandoned.

Why didn’t the care crisis generate a political and policy change? Why didn’t the arguments work? Each one is true, and each one has a care-related logic that implicates policy, and invokes political and social action. If care is a crisis, we should rush to relieve the emergency. If care is infrastructure, we should invest in it. If care is an economy, we should support it’s growth and regulate it’s excesses. If care obstructs women’s empowerment, we should remove the obstacle. If care can boost the economy, we should prime that pump. If care is a gender injustice, then dudes have to pick up the slack.

The problem, for me, is that we are viewing care as instrumental to something else. The presumption being that care might not seem important by itself, but, if supporting care can help achieve other goals, then maybe it’s worthy of political support and policy action. That’s understandable, because we live in patriarchy and care is identified as women’s work and unworthy. To be worthy, it has generate economic growth, or be infrastructure, or increase labor force participation or something like that.

But, more and more, I think we have to argue for care as something important by itself. To care and to be cared for is human. It is to be human. Humans, inherently, need a lot of care. Starting at birth, humans need constant and pervasive care. In some species, children emerge at birth able to walk and feed themselves. By comparison, humans need years of attention, feeding, training, care, socialization, and support. Even among primates, humans seem to need more care; years and years of intensive care, love, training.

This care — the giving and receiving — is deeply embedded in being human. It’s deep in our genes, otherwise the species wouldn’t survive. And yet, we treat it almost as an afterthought, a side issue to other, more important things. But what if care is an important thing? What if care is the most important thing?

If care is the most important thing, then we enter into ethics; about what matters in life and what should be valued. Care is ethics. Here’s a definition of ethics:

“The science of right conduct and character; the science which treats of the nature and grounds of moral obligation and of the rules which ought to determine conduct in accordance with this obligation.”

The right conduct in accordance with moral obligation. What is the right conduct? What is the moral obligation?

Most people won’t think of care as ethics, and yet, most people are making ethical decisions about care every day. Constantly. How much care to provide? What kind of care? Who gets care? Who provides care? How to balance care needs against other needs? How to balance care work against other work (like your job). How to balance care work and against self-care needs?

These are the daily decisions that consume our lives: which parent should take the morning off work to bring a sick kid to the doctor? Should a daughter leave grad school to attend to an elderly parent who needs full-time care? Should a family go into debt to buy a better wheelchair for a disabled family member?

These are ethical questions. What is the right conduct? What is the moral obligation? We think of these as scheduling questions, or family responsibilities, or budgeting priorities. But they reflect ethical choices in how to value the care needs of others, how to value the needs of care providers, and how to balance these needs against other things. These choices are made within families, usually as private and personal decisions. But they are not simply personal preferences, questions of convenience or aesthetics. And they are not simply negotiating interests; these negotiations for time, money, resources happen in the context of an ethical framework. People make decisions that appear to contradict their self-interest in deference to their ethical values. And care is relational — meaning the act of caring requires a care provider and care receiver, and both the provider and the receiver have care-related needs to carry on their part of the care relationship.

Individuals and families wrestle with these as questions every day. They involve difficult choices and balancing interests, capacities, and needs. The choices people make around care are expressions of their values, of their own character, of what is “right”. These are ethics.

I didn’t invent this idea. Psychologists and moral philosophers like Carol Gilligan, Joan Tronto, and Nel Noddings have been defining and exploring care-ethics for many years. Feminist economists like Nancy Folbre and Diane Elson have worked to demonstrate care’s contribution to economic progress and validate care work’s critical role in social and human welfare. They have been trying to make visible this critical element to human life, even while the rest of economics and policy mostly ignores it.

There is no single path for how to approach care. Everyone is unique and will have different perspectives and positions on responsibility, capacity, time, interest, values. There are many cultural differences, class differences and nearly infinite variations on personal and family situation. Care decision-matrix changes over time. Children grow older and need less care. Family members get sick and need care; they get better and need less care. Elderly relatives need progressively more care as they age, then they die and don’t. Some families can substitute money for time and personal labor, they can hire help or pay for services.

Why am I making such an overbearing point about care being ethics?

Because, all this work, struggle, time, and ethical wrestling happens, mostly, outside the view of public policy. And I think politicians and government need to adopt care as a motivating focus for policy. Government treats care as a secondary or incidental concern. Support for care is patchy, incoherent, and extremely thin. Families seeking external support find labyrinthine and contingent assistance for the care they need and the care they provide. Child care, pre-K, health insurance, disability insurance, hired assistance, medicaid, home-based and community services, Social Security, eldercare. Applying for assistance is difficult, complicated, cumbersome, invasive. Whole industries are emerging not to provide the care, but to assist families in managing the complex and cumbersome processes of finding help for care. They call them “concierge services.”

Policy-makers have historically tried to solve specific care problems with narrow and standardized solutions. Rather than seeing the endeavor to provide and to receive care as a holistic and universal human experience, policy is divided, targeted, means-tested, limited.

But my view is that public policy should embrace the same care-ethics that individuals and families wrestle with every day. Politicians and the government should adopt the goal that anyone who needs care will get care. Politicians and the government should also adopt the position that people who provide care are doing something deeply ethical and should be recognized, supported, and when possible compensated for the valuable, life-affirming work. This includes all parents, family care providers, children taking care of elders. And finally, government should recognize that care is relational; care is needed by someone and care is provided by someone. This is not an abstraction, but an actual human relation that is interactive, iterative, and temporal. As a society, we should be able to identify, honor, and support these relationships better and more formally.

I wrote an essay last year, in which I tried to demonstrate how some of the pandemic-response measures, though well-meaning, were not actually care-sensitive. There are many examples. But it’s easier to criticize something than to reconstruct it.

So, I feel this as a personal challenge: to figure out how to apply care-ethics into public policy. How can we sensitize policy to the ethical considerations that people are making in their lives around care? How should policy and public resources support care providers and care receivers and strengthen the relationships between them? Can we re-envision the need to provide care, not as a problem to solve, but as a central human endeavor that enriches the lives of care providers as well as care receivers. So many people want to provide care to their loved ones, to friends and neighbors, even to strangers, but find obstacles in their way and an economy that doesn’t “count” care, rendering it nearly invisible and undervalued.

The next challenge is to envision an ethic of care as a philosophy that animates policy, rather than treating care as secondary and private. What policy principles embody an ethic of care? How would we operationalize an ethic of care in running the government, running businesses, managing organizations? How do we move institutions from being care-blind, to being care-sensitive, then to being care-supporting?

This may sound difficult or abstract. But I actually think it could be rather simple, practical, even mechanical. You can see an ethic of care implicitly animates projects such as this Care Policy Scorecard, which offers a fascinating and impressive effort to capture and quantify the question. Just as any major government action has to conduct an environmental impact review, federal policy should have a care impact assessment. Will the policy make life easier for care providers? Enable better or more care? How will people who need care be impacted? How will people who provide care be impacted?

There are specific and measurable dimensions to care. Things like impact on time, proximity of care provider to care recipient, categories of care providers, taxonomies of care work. These can be assessed, refined, quantified and used in policy. It’s an interesting challenge, an important challenge. But we’ll only do it if we value care in the first place.

To be continued….

Note: This was first published on Medium, May 13 2021. Reprinted with permission.