Caring for the Vulnerable 

The ethics of care and more justice-centred moral theories have often been        pitted against each other. However, while they tend to prioritise the value of care over        that of justice, care ethicists do recognise the necessity to incorporate both of them for        the elaboration of an ethic genuinely protective of vulnerability. Indeed, caring        relationships can often be marked by unjust expectations or unfair access to resources        that would allow for the minimisation of specific, unjustified vulnerabilities. Care        ethicists themselves have sometimes been criticised (particularly by liberal feminists)        over their tendency to put too strong an emphasis on care and an insufficient one on        justice, seemingly reinforcing the stereotypical image of women as self-abnegating,        selfless caretakers who subordinate their humanity to the needs of others (Nussbaum,        1999, p.13).  

Because the caring qualities historically displayed by women were cultivated        under patriarchal rules and societal organisations, the fear is that the ethics of care        might ‘deflect attention from the oppressive social structures in which [care] takes        place’ (Held, 2006, p.220). Mackinnon expressed such concerns eloquently in reference        to Gilligan’s famous identification of women’s diferent voice : 

I say, give women equal power in social life. Let what we say        matter, then we will discourse on questions of morality. Take        your foot off our necks, then we will hear in what tongue        women speak. So long as sex equality is limited by sex        difference, whether you like it or don’t like it, whether you        value it or seek to negate it, whether you stake it out as grounds        for feminism or occupy it as the terrain of misogyny, women        will be born, degraded, and die (Mackinnon, 1987, p.45). 

Pointing to the necessity of promoting and prioritising justice and equality, which is at        the heart of the feminist movement, these critics view the endorsement of care as an        attitude that tends to encourage and reinforce the unjust assignment of caring work to        women (Held, 2006, p22).  

Beyond the scope of feminist thought, these remarks could also be applicable        to other vulnerable populations. A discourse that emphasises so strongly the        recognition and acceptation of caring, dependent relationships might leave aside crucial        appeals for equality and justice in the face of unjustifiably exploitative relationships (or        legitimate aspirations to a higher level of autonomy on the part of particularly        vulnerable people). If the interdependence that links all living beings together and the        existence of a shared vulnerability cannot be denied, there remain indeed some forms of        vulnerability that are wrongfully shouldered by disadvantaged individuals; and the        ethics of care need to guard themselves against the accusation of maintaining an unjust        status-quo. It is especially important in the case of pre-emptive psychiatry, given the        role that environmental, societal and familial adversities are said to play in the       

development of serious mental health issues. Caring for at-risk individuals may well be        of primordial importance, but if these adversities to which they owe many of their        vulnerabilities could be lessened, shouldn’t a normative moral framework encourage        this line of action just as much as it enables caring relationships? 

Additionally, though the significance of particular relationships is now more        readily recognised by various ethical theories - including more dominant ones which        were previously very reluctant to do so - the account given by care ethicists is still        opposed by a wide range of moral philosophies that strongly adhere to universalism.        O’Neill, whose work is in line with Kantian ethics, admits that emphasising the        importance of existing relationships ‘may be an understandable corrective or        supplement to positions that treat impartiality or justice as the whole of ethics’, but she        strongly disagrees with the idea that particularism, as embodied by the ethics of care,        can provide a convincing account of morality, especially since ‘it must exclude those to        whom we have either unwholesome attachments or commitments, or none at all’        (O’Neill, 1996, p.97).  

Care ethicists have therefore attempted to integrate both ideas of care and of        justice into their moral reflections, although they do insist on the predominance of care        as an essential value when justice can only appear, chronologically and functionally, as a        secondary claim. Bubeck illustrates this when she makes clear that she supports the        ethic of care as ‘a system of concepts, values, and ideas, arising from the practice of care        as an organic part of this practice and responding to its material requirements, notably        the meeting of needs’ (Bubeck, 1995, p.11). The partiality asserted in the value of caring        is, in many instances, in direct conflict with the required impartiality of justice. The        argument put forward by some care ethicists, however, determines that caring tends to        be a more inclusive value (Held, 2006, p.72), and one which is also more effective in        promoting respect for others through large networks of relationships, compared to the        ideal of justice when it is detached from the realities of dependence and mutual support: 

Universal human rights (including the social and economic        ones as well as the political and civil) should certainly be       

respected, but promoting care across continents may be a more        promising way to achieve this than mere rational recognition.        When needs are desperate, justice may be a lessened        requirement on shared responsibility for meeting needs,        although this rarely excuses violations of rights (Held, 2006,        p.17).  

As such, while the value of justice is recognised within the ethics of care, impartial and        equitable responses to vulnerability are seen as secondary to caring ones. The rhetoric        of rights remains too individualistic for many care ethicists, heralding the view of the        rational, independent and autonomous subject and in denial of our inescapable        vulnerability.  

In conclusion, the ethics of care have made of the recognition of a shared,        universal vulnerability the core impulse that generates moral responsibilities. It is in        response to others’ dependence and susceptibleness that one should cultivate beneficent        relationships - relationships that avert degrading and exploitative connections between        individuals and within the political, social, and economic organisation of communities. 

As I intend to show in Chapter 5, I believe the responses to vulnerability        brought forward by care ethicists to be a bit too focused on protection and care, and too        wary of the principle of respect for autonomy. These two issues are, I argue,        particularly problematic when dealing with the ethics of pre-emptive psychiatry.        Nevertheless, Held’s and other care ethicists’ contributions still play a large role in the        account of vulnerability I defend in this dissertation, as will become clear in the        following chapter. 

II. DEONTOLOGY 

Deontology, as the moral theory which provided the necessary socle for        universal human rights, might be said by some to be both quite adept at considering       

and protecting vulnerable people and also, at the same time, the least likely approach to        provide fully satisfactory responses to the existence of vulnerability.  

It is thanks to this notion of rights that deontology manages this particular        feat. Formulated simply (perhaps too simply, as will be shown further on),        deontologists elaborate, on the one hand, a strong account of individual or collective        rights, and of the obligations that correspond to these rights. They ensure in this way        that everyone is guaranteed the freedom to exercise their agency and will as they see fit        (unless it encroaches unjustifiably on someone else’s liberty). On the other hand, the        foundational premises of this moral theory favour the establishment of        negatively-formulated duties, giving rise to human rights that can mostly be        encapsulated by the idea of non-interference.  

Defenders of welfare rights have been fighting for the recognition of positive        obligations within the deontological framework with more or less success, often having        to back down when facing libertarians’ more straightforward reasoning. O’Neill, despite        her defence of obligations of virtue, admits that a distinction between these different        kinds of rights is undeniable: 

Universal rights to goods and services, such as welfare rights,        are in fact unlike liberty rights. It is true that rights of both sorts        need institutional structures for their enforcement, but liberty        rights do not need institutional structures to be claimable and        waivable. By contrast rights to goods and services can be        claimed or waived only if a system of assigning agents to        recipients has already been established, by which the        counterpart obligations are ‘distributed’ (O’Neill, 1996, p.131).   

As a result, it is often alleged that ‘it takes more to justify an interference than to justify        the withholding of goods or services’ (Foot, 2002, p.83).  

Deontology, then, could be argued to provide too little assistance to        vulnerable individuals and vulnerable populations if it fails to recognise the legitimacy        of welfare rights, even though it does provide a solid protection to each against the        interference of others. What I want to defend, in this section, is the idea that        deontology can account for the ethical relevance of vulnerability, and recognises the        necessity to provide morally adequate responses to it in one way or another - be it from        an unapologetic libertarian standpoint, or from the welfare-rights position. 

1. The Consideration of Vulnerability in Staunchly