Thursday, 7 February 2008

The Ethics of Care and Empathy.

The differences between men and women’s attitudes to morality are spelled out by Carol Gilligan and in greater detail by Nel Noddings. These philosophers set out a feminist morality based on caring about the feelings of others and relationships between people. Slote attempts to base morality simply on empathy and is not directly with concerned with relationships. Slote defines a wrong action as follows on page 31.

“Actions are wrong if, and only if, they reflect or exhibit or express a deficiency of a caring motivation, one can claim that actions are morally wrong and contrary to moral obligation if, and only if, they reflect or exhibit or express an absence (or lack) of a fully developed empathic concern for (caring about) others on behalf of the agent.”

In practice this means we have a greater moral obligation to those close to us rather than strangers. Slote argues this definition accounts for our moral intuitions. I want now to look at possible problems with this partialistic account of morality. Because of this partiality I will question the extent of the domain of a care ethic based on empathy.

In chapter 5 on page Slote states it is possible that “In the sphere of morality women are basically superior to men” and on page 73 he thinks it is possible that
“Women can mind being held more accountable for their actions than men”.

These statements I believe point to problems with the domain of a care ethic based on empathy. I accept in general it is possible that women act more altruistically than men. However accepting this does not mean accepting that women act more morally than men. Surely the purpose of morality is to set standards of behaviour that the majority of people can accept and observe. In order to hold a driving licence someone must reach a certain standard of driving assessed by her passing a driving test, any extra driving capabilities are unimportant when assessing her competence to drive. It might then be argued by analogy the same holds true for moral competence.
It might be objected that my argument by analogy is true in most cases but not in hard cases. Consider the case of Ms B [2002, All ER 449] who was a tetraplegic patient who was kept alive by a ventilator and who decided she wished to have the ventilator switched off. Ms B had not consented to being placed on this machine. Whether Ms B desire to have her ventilator switched off should be respected or ventilation continued because ventilation seems to be in Ms B’s best interests is intuitively a moral question. It might then be argued in most cases women do not act more morally than men but that in hard cases such as this women are morally superior to men. If this argument is accepted then perhaps some form of Maternalism would have to be accepted. I believe this objection fails because in some hard cases it is also hard to see how empathic caring can be usefully applied.
Atkins (2000) in the Journal of applied philosophy 17(1)) uses Nagel’s classic paper on what it is like to be a bat to argue that because of the subjectivity of experience it is impossible for us to understand what it is like to be a patient in circumstances such as those of Ms B. I believe it follows in such cases it is not fully possible for agents to exhibit a fully developed empathic concern for others. Slote himself discusses how we could have empathy for an extraterrestrial on pages 125, 6. We can of course be sympathetic, as were Ms B’s care team, but sympathy unlike empathic caring can lead to paternalism or maternalism. I believe if we accept Slote’s attempt to base morality simply on empathy that the domain of morality is defined by the circumstances in which a moral agent can exhibit or express a fully developed empathic concern for others.
I have suggested any system of morality must be one in which the vast majority of the population, to which it applies, can act in a moral manner. It follows if we accept Slote’s idea of morality the domain of morality is defined by the degree of the population can develop an empathic concern for others. It further follows that because we might be unable to develop for others such as Ms B that such cases are outside the domain of morality. It is easy to think of other examples such as that of abortion or stem cell research in which our empathy seems partial. I would argue we can only have empathic caring for the potential mother, in first example and the recipients of any treatment developed using stem cells in the latter. Intuitively these examples seem to examples of moral decisions. However our intuitions may be wrong and the domain of morality restricted to those areas in which most people can exhibit at least a partially developed empathic concern for others. Accepting these ideas about the domain of morality would have important consequences for bioethics. It might be argued many of the questions bioethics is concerned with lie outside the remit of morality. I personally believe cases such as Ms B do lie outside the remit of morality. In such cases I believe clinicians should only be concerned with two questions. Firstly is the patient non-autonomous? Secondly even if the patient is non-autonomous is there a generally agreed best option for this patient? In all circumstances when the answer to these questions is no the patient’s decision should always be accepted. Medical issues such as confidentiality, truthfulness and the scope of medicine are still important but it seems to these are general philosophical questions rather than specialist bioethical ones. Noddings believes a feminist (empathic caring) ethic is an incomplete of morality. If she is right it might then be argued hard cases such as Ms B are indeed moral cases but that a different account of morality must be employed.
The following question arises. What sort of empathic caring is possible for most people? Slote talks about emphatic “caring about” in the definition quoted above. Frankfurt in “The importance of what we care about” (1988) argues if someone cares about something the following holds

“He identifies himself with what he cares about in the sense that he makes himself vulnerable to losses and susceptible to benefits depending upon whether what he cares about is diminished or enhanced.”

Identification, so defined, seems to be a necessary condition for empathic caring. If I am not vulnerable to the feelings of others I am incapable of empathic caring. I may still be capable of sympathy. In order for be to be vulnerable to others the carer must understand what would enhance or diminish what the others care about or love. Slote would probably disagree with this. However it seems to me that Slote must accept that empathic caring requires a carer to be vulnerable to that which diminishes or enhances the emotions of others. This seems only to be possible with a person who shares a lifestyle or part of a lifestyle with someone. It would be difficult to imagine what would enhance or diminish what Ms B cares about because of the subjectivity of experience. It further follows we must accept certain cases that are intuitively moral cases are outside a caring ethic.
However if we accept Frankfurt’s condition for caring does form a basis for empathic caring it can help deal with certain supposed bias’s in Slote’s attempt to base morality on empathy. It might be argued even if women are not more moral than men that because this is a partialistic account they may favour other women in preference to men, men might do likewise. The same might apply to race or religion. However if we accept the above conditions this partiality is caused by our finding it easier to understand. What enhances or diminishes our empathic feelings about someone is whether this person is close to us rather than racism or sexism. Many women may indeed find it easier to understand what enhances or diminishes other women but others may find it easier to understand what enhances or diminishes their partner. Similarly some may understand what enhances or diminishes the things colleague cares about of a different race rather than a non-colleague of the same race. See Slote’s account on page 36.

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