Joan C. Tronto argues in Who Cares? (Cornell University Press, 2015) that Americans are facing a "caring deficit"― that there are simply too many demands on our time to care adequately for children, elderly people, and ourselves ― she asks us to reconsider how we allocate care responsibilities.
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When I say “care,” I don’t mean only healthcare, childcare and caring for the elderly. I don’t mean only finding a babysitter on a website called Care.com. I mean, as Berenice Fisher and I defined it some time ago, “in the most general sense, care is a species activity that includes everything we do to maintain, continue, and repair our world so that we may live in it as well as possible. That world includes our bodies, ourselves, and our environment, all of which we seek to interweave in a complex, life-sustaining web.”
Usually, when people hear this definition, they are a little stunned. It is so broad; it seems as if almost everything we do touches upon care. This is true: care shows up everywhere in our lives. Now, we don’t usually think of care on this broad and most general level. Particular care practices — for example, performing brain surgery, teaching middle school, detailing a car — all have different, defining elements. What they have in common, though, is an effort to keep their corners of the world going by doing laundry, planning the financial support of an intellectually disabled adult, preparing children’s lunches, and so forth. Care is about meeting needs, and it is always relational: the skinned knee of a child who fell off his bike isn’t only about scrapes and germs, it is also about creating the conditions for him to feel safe in the world.
Not everyone agrees on the best ways to give or receive care. The standard, “so that we may live in the world as well as possible,” is very flexible. In some caring practices, the requirements are clear. Physicians and engineers are obliged to meet a standard of care that accords with the best scientific evidence. Yet at a more general level, the standards of care accord with society’s values. And these change; what was corporal punishment a generation ago is more often called child abuse now.
If we believe that moral and political issues should have straightforward, principled answers, there is another feature of caring that will seem frustrating. To make caring well a central moral concern presupposes a different kind of moral and political theory because it doesn’t begin from abstract principles and reason down to pronouncements about what is right and wrong. It starts in the middle of things. Care practices don’t suddenly begin; they are already ongoing. Just as in democracy, there are always disagreements, messy distractions, and complications. The trick is to determine the best ways of caring in a particular time and situation. And this depends on establishing a democratic process of assessing and meeting care needs.
So, then, what does it mean to care well? Often we think of care as just some extra put into a task — for example, a more caring nurse makes a point of conversing with his patients before bedtime. But we can and must be more explicit about what constitutes good caring. As a starting place for reimagining democracy along caring lines, Berenice Fisher and I devised four phases of care that help us analyze care practices more fully. We noted that caring well occurs when these different parts fit together.
1. Caring about. First, care proceeds from meeting needs. While some needs seem obvious, discerning a need is actually a complicated task. Even simple examples belie this complexity. The baby is crying: Does it need a bottle? Simply to be held? Most examples are much more complex. The people “on the other side of the tracks” are poor: Why? Such questions invite complex thinking about “the politics of needs interpretation. In the first place, then, care requires caring about: identifying caring needs.
2. Caring for. Second, just because a need exists does not mean that anyone in particular has to address it. In cities, people often walk by the homeless as if they weren’t there, perhaps thinking, “Somebody should do something about that...” Accepting responsibility and realizing that something has to be done is the second phase of care.
3. Caregiving. Once a need is identified and someone has taken responsibility for addressing it, meeting it requires work. The third phase of care is the actual task of caregiving. The epidemiologists need to study how the virus spreads, the floodwaters need to be dammed, someone needs to teach the new students English, and so on. Most caregiving raises questions about good care practices. Do vouchers for food work better than giving people surplus cheese? Does being a stern teacher help students or push them too hard? Is the faucet leak fixed? And here is another complication: The people who recognize the need are not necessarily the same ones who take responsibility for fixing it, and those responsible are not necessarily those for arranging his parents’ doctor visits from another city, so he calls his father’s social worker. But if those who are responsible allocate resources based on a too - limited scope of caring, then they may allocate too little. It’s a frequent problem — hospitals often have insufficient supplies; for example, of telemetry units. Caregivers learn to cope with caring in less-than-ideal circumstances.
4. Care-receiving. After the work of caring is done, another phase remains. How do we know the care was successful? Care-receiving prompts a response. Given how pervasive care is, some of it is routine: washing the dishes after dinner, filling potholes in the spring, etc. But even if care-receivers do not say “Thank you, that helped” — for neither the baby nor the patient still in a coma will necessarily do so — care is not complete until the need is met. That requires looking again at the situation and the resources assigned to improve it. And, often, looking again will lead to recognizing new needs, and the process repeats. Endlessly. Needs never end until we die. Care is always present, rarely visible, always requiring something from us.
As you might expect, caring involves moral and value commitments. Each phase of care can be tied to specific moral practices, and indeed might be a basis for how our democracy imagines a “good citizen.” Because we become better at things as we do them more, care practices deepen certain moral and daily skills. That is what a practice means. Therefore, “caring about” makes us attentive. When we have to be on the lookout for unmet needs, we begin to notice needs more. People who work in women’s shelters are more likely to spot abuse victims elsewhere because these workers are attentive to this type of problem. Next, “caring for” makes us responsible. Taking on responsibilities trains our eye to notice when responsibilities have and have not been taken on by others. It becomes second nature for elementary school teachers to ask, “Who is going to volunteer for the cleanup committee?” because they always think about responsibility among their students. Caregiving also makes us competent. If we are expected to monitor a patient’s blood pressure, then we need to know how to do it. Competence is not simply a technical measure; for most people, it becomes a measure of their excellence. Finally, care-receiving makes us responsive. If we are going to measure the effects of our care, then we need to know what has happened, how the cared - for people or things responded to this care, and what we might do next. In a democratic setting, we will want to ask care - receivers to respond, if they can, to the quality of the care they were given. And in their response, we are likely to hear the articulation of new needs that must then be addressed.
So, care is a complex process, and it also shapes what we pay attention to, how we think about responsibility, what we do, how responsive we are to the world around us, and what we think of as important in life. In short, a functioning democracy is full of people who are attentive, responsible, competent, and responsive.
Care is already everywhere. And we all are not only givers of care, we are also — each and every one of us — receivers of care. This is true of all humans when they are young, old, or infirm. But it is also true of you and me every day. Each day, we arrange to feed, clothe, and surround ourselves so that we may live in the world as well as possible. We care for others and for ourselves, and others care for us. We stop by the grocery store and buy prepared food for dinner and expect the trash to be picked up. All of this caring activity is constantly going on around us. It is so ever-present that we rarely think about it. But now that we have begun to think about it here, let’s notice something else about it. Care is always infused with power. And this makes care deeply political.
Reprinted with permission from Who Cares? by Joan C. Tronto and published by Cornell University Press, 2015.