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H.B. AugustineH.B. Augustine graduated from Denison University in May 2012 with a degree in Communication and Philosophy. He is now working on a number of social innovations, including Taggle, Ubiquity University, and Integral Publishing House. Contact him at if interested in connecting.


The Application of
Care Ethics to
United States Healthcare

H.B. Augustine

One particular moral issue I believe deserves a great deal of attention and discussion is the notion of healthcare, namely within the United States. In this paper, I will argue that we can better understand the reason underlying our current healthcare debate by recognizing its connection to the gender distinctions, in relation to morality, as outlined by Carol Gilligan's care ethics. I will claim that the reason why someone most likely supports privatized healthcare is that this individual is most strongly influenced by a masculine ethical viewpoint, while the reason why someone most likely supports publicized healthcare is conversely that this individual is most strongly influenced instead by a feminine ethical viewpoint. Because masculine morality emphasizes justice over care, rules over relationships, and autonomy over communion, this means that it is more likely to support privatized healthcare. Because feminine morality contrastingly emphasizes care over justice, relationships over rules, and communion over autonomy, this means that it is more likely instead to support publicized healthcare. In this essay, I will stress the significance of autonomy, in particular, as illustrating masculine morality in addition to the significance of communion, in particular, as illustrating feminine morality. Let us begin this discussion first by briefly reviewing Gilligan's philosophy.

Gilligan calls into question the nature of and basis for a majority of ethical theories prevalent within Western philosophy. She contests the way most if not all prominent ethicists throughout history have approached the subject of morality is one-sided and partially exclusive. Just as we can perceive a Gestaltian image in one of two ways, and just as both of these ways are equally legitimate modes of seeing the phenomenon, so we can apply the same principle to how we regard morality. Throughout history, (male) philosophers have considered morality and its prescription to be a matter of theoretical justification in order to produce a solid principle of some sort on which to base all ethical decisions:

The justice perspective, often equated with moral reasoning, is recast as one way of seeing moral problems and a care perspective is brought forward as an alternate vision or frame.

Gilligan tells us that this moral view – the justice perspective – is but one end of the whole spectrum, which the care perspective complements.

The distinction between these two moral views is rather similar to the dualistic types we see in the Myers-Briggs personality test (e.g. “thinker” vs. “feeler,” “senser” vs. “intuiter,” “introvert” vs. “extrovert,” “judger” vs. “perceiver”). Gilligan says, “Theoretically, the distinction between justice and care cuts across the familiar divisions between thinking and feeling, egoism and altruism, theoretical and practical reasoning.” In supporting this claim and its connection to gender discrepancy, she cites her own experience with women whose definition of moral problems sharply differs from the traditional ways we often conceive of it to be. Looking back at past studies on moral development, as administered by Gilligan's teacher, Lawrence Kohlberg, she notes that these tests were performed on males only.

Kohlberg did not even consider whether the tests would show different results had he incorporated females in the studies as well. Based on the significance of Kohlberg's findings, we still get an illumined sense of what the justice perspective entails. Says Gilligan, “From a [masculine] perspective, the self as moral agent stands as the figure against a standard of equality or equal respect (the Categorical Imperative, the Golden Rule).” The latter statement would indicate that healthcare, according to this particular perspective, ought to be a matter of choice. However:

From a care perspective, the relationship becomes the figure, defining self and others. Within the context of relationship, the self as a moral agent perceives and responds to the perception of need. The shift in moral perspective is manifest by a change in the moral question from “What is just?” to “How to respond?”

Gilligan supports these claims with substantial empirical evidence. In a study involving both sexes/genders, the gross majority of men demonstrated an adherence to the justice perspective – whereas “if women were eliminated from the research sample, care focus in moral reasoning would virtually disappear.” Gilligan concludes by noting that everyone usually has a tendency to regard morality and act according to one perspective or another – just as someone usually has a tendency to perceive a Gestaltian image in one mode or another. Now that we have seen Gilligan's take on morality, let us examine how it applies to the United States healthcare debate. First, we will consider how supporting the privatization of healthcare implicitly indicates masculine morality as its foundation.

Supporting the privatization of healthcare implicitly indicates masculine morality as its foundation because of its prioritization of justice, rules, and autonomy – as opposed to care, relationships, and communion. The notion of “justice” denotes law and individuality, rules and autonomy, because it requires each member of society to live responsibly, industriously, and respectfully with regard (in this case) to the United States' ideals of liberty and merit. Based on this ideology, if a person does not have sufficient access to healthcare, this individual is at fault since he or she has not utilized the opportunities that our political and economic system offers.

The rules of this particular rational-legal establishment allow anyone to do anything, especially for those who embody both integrity and diligence, along with a strong sense of individuality. With integrity and diligence, anyone is capable of making enough money to afford healthcare. With individuality, or autonomy, anyone can achieve virtually anything. If someone cannot afford healthcare, it would be unfair for society still to provide it to him or her since this would be rewarding that person for something he or she has not rightfully gotten. Hence, because offering healthcare to anyone regardless of whether he or she deserves it is unfair, this means that it is likewise unjust – so our lawmakers should not implement it.

What I mean by “unjust,” in this case, is “contradicting the principle or ideal of autonomy.” When we provide someone with healthcare and this individual has not “earned it” since he or she did not act autonomously enough, this – for masculine morality, at least – is unjust. In sum, we can see that the United States is both ideologically and structurally based on masculine morality (not surprisingly by (our) Founding Fathers), which values a libertarian outlook on justice and the way we should uphold it in conjunction with institutions such as healthcare. Now that we have seen why the privatization of healthcare aligns most with masculine morality, let us see why its publicization instead aligns most with feminine morality.

In contrast to the reason behind supporting privatized healthcare, people most often advocate publicized healthcare because they value the significance of care, relationships, and communion over the significance of justice, rules, and autonomy. The notion of “care” denotes subjectivity and pluralism, relationships and communion, because it sees that even if someone does not live responsibly, industriously, and respectfully with regard to the ideals of liberty and merit, still we can infer that this individual lives in such a way for a reason. Perhaps this person experienced a difficult childhood and never gained sufficient self-esteem in order to be motivated enough to earn enough to afford healthcare. Maybe he or she is happiest working nonprofit, yet doing so does not allow him or her to make very much money even though it does much good both for him or her and for others. Say this individual is psychologically depressed, either by means of nature or nurture (or both), and turns to drugs to address it since all forms of psychotherapy do not work – and, because of this, is financially dependent on purchasing more drugs as opposed to saving money in order to access healthcare.

Regardless of the reason why someone cannot afford healthcare, what remains for the feminine moralist is that this person, ultimately, “did not choose” to be in his or her situation, as it was mostly forced upon this individual. Extending healthcare to all citizens, despite their circumstances, demonstrates more care than does keeping healthcare exclusive only to those who can afford it. Therefore, someone most influenced by a feminine ethical view will most likely rather have (United States) healthcare become publicized as opposed to remain privatized. Now that we have seen why we can regard this issue in terms of Gilligan's gender distinctions in relation to morality, let us consider which side of the debate is right.

In the end, neither masculine (morality) nor feminine (morality), neither the justice perspective nor the care perspective, is better than the other is. Both of these ethical views serve their own necessary purpose. Without any regard for justice, rules, and autonomy, we would be living in a state of nature in which humanity's ability to reason, organize, and obey would be utterly wasted. In this state, murderers would go unpunished and honest, hardworking individuals would not see any kind of reward for their merit. Without any regard for care, relationships, and communion, we would be denying all the subjectivity in life – we would be living like a machine. Detaching ourselves from individuals, and regarding them as objects, is important to some extent for morality. However, if we detach ourselves from individuals so much that it causes us to regard them more as things than as people, as objects than as subjects, then we likewise lose track of what makes us human – our interiority, our feelings, thoughts, intuitions, and consciousness. Although both ends of this moral spectrum are equally valuable, sometimes acting on one is necessary as opposed to acting on the other. Put differently, morality – according to what Gilligan suggests – is situational.

Sometimes, acting “masculinely” may be what is necessary. For example, if a student commits global plagiarism when he or she already knows that this violates the rules, we cannot leave this individual unpunished. We must teach him or her that committing plagiarism is wrong – we must make this person experience some degree of suffering so that he or she will learn not to make the same mistake again. In other words, we must make this individual more of a responsible or autonomous moral agent by exposing him or her to appropriate repercussions for not doing so. In contrast, though, sometimes acting “femininely” is instead what is necessary.

For instance, say someone talks behind his or her friend's back. The friend discovers what the other person did and has the option of either forgiving him or her, or deciding that this individual is no longer worthy of his or her friendship. Say the other person feels extremely sorry for what he or she did and expresses this to the friend. In this situation, it would be better for the friend to forgive the other person and give this individual a second chance, since it would be better for their relationship than would be the alternative. If morality, in this sense, is situational, then what should we believe and do for the situation of United States healthcare?

We must find a way of incorporating both masculine and feminine approaches in this particular instance. We must find a way that transcends yet includes both emphases on autonomy and communion, liberty or individuality and altruism or plurality. We cannot keep healthcare completely privatized but we also cannot publicize it and not implement any way of keeping people from “mooching off of it.” Perhaps the solution to this problem lies in publicizing healthcare, but doing something else that would make United States citizens more responsible and autonomous. Perhaps the solution to this second half of the original solution lies in bettering our education system. If we make education – especially public education – significantly more empowering, inspiring, and overall effective, then we can infer that the individuals it conditions will be significantly more likely to live with the kind of masculine justness that United States ideals demand. Perhaps we can conceive of another solution other than bettering education. Regardless, what remains is that the way we should address healthcare in general (let alone any ethical issue) should contain and embrace morality, and its application, as holistically as possible – by valuing both masculine and feminine, justice and care, rules and relationships, and, especially, both autonomy and communion.

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