SOCIAL  RESEARCH,  POLITICAL THEORY AND THE ETHICS OF CARE

Research  Review  NS  17,1  (2001)  5 46

Kari  Wainiess

Introduction

What  kind  of  social  research  should  be promoted  and  supported  in  relation  to  the  enormous
challenges  that  problems  of  globalisation  and  changes  in  the  cultures  of  survival  and  care
represent  for  all  of us?  I will  discuss this question  here in  light  of my  experiences  as a feminist
researcher  in the field of care  for  nearly  three decades. This  research  interest developed  when in
the  1970s  I  worked  as  a politically  elected  leader  of  the  board  of public  social  care  and  child
protection  services  in  my  community  a  community  that  is  part  ol* the  Norwegian  city  of
Bergen.  In  this  political  work  we had  to  cope with  a lot  of  challenging  problems  related  to the
care of children,  disabled  and  elderly.  1 often  felt  a strong  lack  of relevant  scientific  knowledge
when having to argue for more resources, new public  services or reorganisation  of existing ones.
I  found  the  dominant  scientific  perspectives  or paradigms  in  the political  planning  discourse  on
public  services  to  he  defective  and  inadequate  for  describing  the  problems  in  the  real  world  of
care in a way that would matter in the political  and planning process.

In  the context  of  a  well-developed  Scandinavian  welfare  state,  many  political  feminists  and
feminist  researchers  found  it necessary  to develop  new perspectives  in research  on care in order
to  strengthen  the  welfare  of  women  and  of  those  dependent  on  care  and  help  in  everyday  life.
The problem of how to carry out research that would really matter in policies and practice of care
was,  and  still  is, a challenging  one, even  in the  Scandinavian  context  and  even  more in a global
context.  And  many  of the  problems  in the relationship between  practice  and  applicable  research
are  the  same.  Therefore  1 will  argue  that  some  of  the  experiences  from  development  of  this
researcli  field  in  Scandinavia  are  relevant  to  most  researchers  who  want  to  carry  out  social
research that matters with respect to policies and practices in the field  of care and survival.

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of the field  of research on care in Scandinavia
empirical  research  in  Scandinavia  and  Britain  has
give  a  short  presentation  of  the  international
i  And finally I will argue that, researchers need to take on
c.-  hitherto,  to  develop  knowledge  that  could  be  a more
(»i >ter care policies and practices.

Scandinavian  Research  on Care  in the 1990s:

Two Parallel  Discourses with  Different  Influence

The word care as a definition  of different  types of activities  in the welfare  state was common
long before  we had  any  women's studies. In connection  with  such  activities we have established
research  activities,  which  in  part  go  further  back  in  time  and  which  are  based  on  other
perspectives  than  feministic  inspired  research,  Research  on  care  for  the  elderly  is  a  good
illustration  of the differences  between  these lines of research.  In this area we find  a development
where dominant paradigms in established  gerontology  -  strengthened  by socio-economic  welfare
expertise  and  market  economic  thinking  — have  contributed  to  an  increasing  extent  towards
defining  the elderly  and  care  of the elderly  as a socio-economic problem  (Eliasson  1996). Based
on  this  view  of  the  problem,  efficiency  and  rational  solutions  are  in  demand  and  are  attractive
qualities  in  welfare  services  for  the elderly.  Feminist  researchers'  see other  sides  of the  welfare
services  and  have  formulated  perspectives  that  go against  this  established  perspective.  The new

perspective  is that researchers  are more concerned  about the real  world  of care—and  do research
on  concrete  care  actions,  skills,  knowledge  and  ways  of  thinking  on  the  practical  level,  at  the
bottom  of  the  we!fere  services  organisations'  hierarchy,  Based  on  this  perspective,  questions
about what care really is and what it means both to those giving and those receiving care, become
of  key  importance.  Feminist  researchers  have  criticised  the  established  planning  perspective,
because  it  is  not  based  on  an  adequate  understanding  of  the  distinctive  nature  of  care  and
therefore  often  generates proposed  reforms  and  measures, which  aggravate the situation  both  for
care workers  and  for  those  receiving  care (Thorsen  and  Wyerness  1999), Both  planning  research
and  feminist  research  in this area are normative in the sense that researchers speak both about the
facts  and  what  is good,  desirable  and  possible. The normative perspective  is, however,  the most
clearly  expressed  in many  of  the  feministic  inspired  reports, as  it is in  such  research  studies that
morals, human values and own views on values are most often  discussed.

Today  we  find  these  perspectives  as  parallel  discourses  in  research  on  the  welfare  services
(Waerness  1999),  With  the  so-called  "quality  assurance"  way  of  thinking  also  becoming  a
dominant  trend  in  the  health  and  welfare  sector,  it  also  seems  clear  that  it  is  the  planning
perspective,  which  has  the  dominant  influence  on  how  these  services  become  organised
(Siagsvold  1999).  The  fundamental  critique  of  this  new  way  of  thinking  appears  so  far  not  to
have  had  any  effect  on  the  public  authorities'  implementation  of  so-called  quality  assurance
programmes  in  this  sector.  Based  on  the  feministic  inspired  perspective,  the problem  with  these
quality  assurance  programmes  is  not  just  that  they  appear  to  be  irrelevant  to  the  concrete
problems  on  a  practical  level.  They  can  also  sometimes  help  to  create  what  Siagsvold  (1995)
calls  quasi-quality,  which  means  making  the  quality  of  care  worse  than  it  was  before.  The
knowledge  from  feministic  inspired  research  has  not  hitherto  had  any  effect  on  the  structure  of
the  care  organisations.  The  public  discussion  on  how  the  health  and  welfare  services  should  be
changed  is still dominated  by academic  experts who mainly  use a language based  on  economic,
technical  and  legal  rationality  a language that  is usually  considered  to be far  removed  from  the
experiences  in  the  real  world  of  care..  For  several  years  now,  this  real  world  has  had  a  key
position  in Scandinavian  and. British  feministic  research on care.

Scandinavian  and  British  Feministic Research  on Care: Development  over Time2

In the earliest phase of the Anglo-Saxon  feminist  research  on care we can distinguish  between
two different  discourses:  one that places emphasis  on care as work  and  one that places  emphasis
on  the emotional  aspects of care  (Abel  and  Nelson  1990). Studies  which  placed  emphasis on  the
work  content, analysed  care as a woman-suppressing practice, foil of routine and alienating tasks.
Studies  that  placed  emphasis  on  the  emotional  aspects  considered  care  to  be  a  meaningful
activity, which  makes women  better people.  We might  name these perspectives  "the perspective
of dignity"  and the "the perspective  of misery",  in feminist  research  it is always easy  to criticise
studies  based  on one of these perspectives  wish  the other perspective  as a point of departure  to
develop  scientific  knowledge  on  care  that  should  matter  in policy  and  planning  it  is still  a great
challenge how to balance these perspectives.

In  the  anthology  Caring: A  Labour  of Love  (Finch  and  Groves  1983)  these  perspectives  are
combined.  All  the authors  in this  book  have been  important participants  in the British  discourse
on  care  and  common  to  them  all  is  that  they  study  care  as  a  physically  and  emotionally
demanding  unpaid job that women  carry out in the home. The purpose of this book  was to show
the  hidden  care  work  in  the  family,  how  is is shared  between  men  and  women  and  what  it costs
the  caregivers. Criticism  was  raised  against  this  research, because  it was  too one-sided,  both  in
the  sense  that  it  only  focused  on  the  caregivers  and  not  on  those  receiving  the  care  and  that  it
only discusses  informal  care and  not care as a paid  and professional  work  (Baldwin  and  Twigg
1991; Morris  1991/92; Qureshi  and Walker  1989),

Scandinavian  feminist  research  on  care  included  both  unpaid  and  paid  care  from  the  start.

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Research Review Wi  VIA (2001)  5-16

Care  was  also  defined  as  work  and  feelings  and  dealt  with  caregivers  and  those receiving  care.
The  first  research  seminar  on the  subject  was arranged  in  1978 by the then  Research  Council  of
Norway's  Secretarial  for  Social  Research  on  Women  under the heading "Paid and  Unpaid  Care",
and  the  topics  discussed  had  a broad  basis: care work  in the  private  and  public  sector,  children
and  care,  women's  self-organised  help  arrangements,  care  functions  in  (amities  with  small
children,  new  roles  for  children,  men  and  women,  emotional  fatigue  in  good-natured  caring
women in the welfare  services and the development of professional  nursing  at the end of the 19'1
century. The seminar was based  on the understanding that women had the main responsibility  for
care  both  in. private  relations  and  in  the  public  sector  and  the  following  reasons  were  given  for
why  it  is necessary  to  look  more  deeply  into  the care phenomenon;  "in  order  to proceed  in  the
work  of  extending  the  social  scientific  knowledge  in  this  area,  based  on  a  women's  liberation
perspective,  and  to  give  the  authorities  a  broader  basis  with  respect  to  planning  and
implementing  a  care  organisation  that  takes  into  consideration  the  needs  of  those giving  and
receiving care (NAVF's  Secretariat  for  Social  Research  on  Women  1979, foreword,  my  italics).
Norwegian  feminist  researchers  appear  here  to  be  quite  typical  representatives  of modernity  in
the  sense  that  they  show  great  optimism  both,  with  respect  to  faith  in  the  importance  of
knowledge  and  to  the  friendliness  of  the  Norwegian  welfare  state  towards  women.  New
definitions  and  distinctions  in  the  field  of  care  were  gradually  created,  definitions  that  were
intended  to give  clarification  in the  debate  on welfare  policy  and  thereby  were believed  to have
an  influence  on  welfare  policy  (Wterness  1982).  Involvement  in  welfare  policy  was  included  in
this  research  from  the  start.  "The  social  service  state"  and  its  importance  from  women's
perspective, became an  important  supplement  to mainstream  research  on welfare,  which  up to the
1990s  was  mainly  concerned  with  financial  support,  social  security  systems  and  the  economic
rcdistributive aspects of the welfare  slate.

The  Anglo-Saxon  and  Scandinavian  feministic  inspired  research  on  care  have  gradually
approached  each other and today we can point to three lines of development in this research with
respect to the understanding of what care is:

• 
• 

• 

from  either  feelings  or (manual) work, to both/and  eventually  also intellectual work
from  the  family  via  unpaid  women's  work  in  the  government's  service,  to  the  state  as
either a women-friendly  and/or shaky social  service state
from  focus  on  women  as carers and  care workers  to a perspective  that also  includes  those
who need and receive care.

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One risk  of these  expansions  considered  from  a feministic  viewpoint  is that they  can  lead  to
the basis for the feminist-oriented  research  being  forgotten,  namely  the desire to make visible the
traditional  female  work  and.  the  social  importance  of  this  and  thus  help  to  raise  women's
marginal  status  in  sociely.  Though  perhaps  there  is no great  risk  of  this happening  today  in the
close  to practice  research  on  care,  that  is  research  based  on  the  real  world  of  care.  In  such
research  activities  one  is  constantly  being  reminded,  in  the  same  way  as  the  above-mentioned
seminar  report  from  1978 documents,  that  care  obligations  are not  just distributed  according  to
gender,  but  also  according  to  social  class  (and  eventually  also  ethnicity),  that, the  division  of

7

labour among women  in this area has changed  very much over time and that caregivers can have
great power with respect to those dependent on care, even  if they have little power and  influence
in other relations.

The political-sociological  and empirically rooted research on care has had a strong position in
Scandinavian  feminist  research.  Scandinavian  feminist  researchers  have  participated  very  little,
however,  in  the  international  development  of poliiical-normative  theory  on  care,  This does  not
mean thai  there arc no important  contributors  in this area. Both the Swedish  sociologist  Rosmari
Eliasson  and  to  an  even  greater  extent,  the  Norwegian  nurse,  philosopher  and  historian,  Kari
Martinsen,  have  contributed  important  theoretical  contributions  to  care  el hies,  contributions,
which  in  addition  to being  based  on  important  philosophers,  are  also  based  on  women's  public
care  work  in  the  past  and  present  (Eliasson  1987;  1991;  1999;  Martinsen  1989;  1993;  1996;
2000),  However,  this work  has  still  not  reached  the  in tern a I tonal  theoretical, debate  on  care and
gender.  Thus  their  influence  on  the  care  discourse  in general,  also  in  the  Nordic  countries,  has
hitherto been  more limited  than  the influence  of leading American  feminist  theorists in the  .field.
The American  feminist  theorists  have not been  so much  concerned  about  specific  dilemmas and
problems that the welfare state's care workers face. This is perhaps not so strange, if we take into
consideration  the  big  differences  between  the  Scandinavian  and  American  welfare  state  model.
Greater  understanding  of  this  dominant  division  in  feminist  theory  and  research  on  care  may
contribute,  however, to a more  relevant  insight  into the care crisis that  late-modern  society  now
appears to be in, regardless of which welfare state model they use as a basis.

The International  Theoretical  Discourse regarding Care and  Gender

At the  same  lime as  the  more close  to practice  and  feminist  welfare  policy  research  on  care
grew  in Scandinavia  and in the UK, several  pioneering feminist  studies of a more theoretical and
philosophical  nature  were published  in  (he  US,  The most  internationally  known  and  influential
study  of  a  moral  philosophic  nature  was  Carol  Gilligan's  book  In  a  Different  Voice:
Psychological  Theory and  Women's Development  (1982).3  This  book  is perhaps  the  most  read
feminist  academic  work  in  recent  times  and  in  1984  MS  magazine  voted  Carol  Gilligan  as
"Woman  of the Year".  In Social  Science Citation  Index, a.nd Science Citation  Index from  1986 to
the beginning of  1991 we find  1,100  quotes from  this book  and Carol Gilligan's work has had an
influence  on all academic areas affected  by feministic  theory, from  literature theory to veterinary
medicine (Trorito  1993:76).

One  main  locus  in  the  debate  following  this  book  (the  so-called.  Kohlberg-Gilligan
controversy)  has  been  the  question  whether  women,  and  men  have  a  fundamentally  different
approach  to  morality,  or  expressed  in  today's  terminology  in  feministic  research;  is  morality
linked  to  gender?  Fven  if  Gilligan  has  never  clearly  expressed  that  "the  different  voice"  she
studies  is  always  a  female  one,  most  people  have  interpreted  her  as  describing  a  different
approach  to morality between  the sexes.  An. important  part of the rejection  of her  argumentation
has  been  results  from  empirical  studies, partly  based  on  the same methodology  as  that  used  by
Gilligan,  which  describe  the  same  differences  that. Gilligan  finds  between  men  and  women,  as
differences  between the middle class and working class or between different  ethnic groups. Other
studies  find  no  differences  between  men  and  women  wilh  respect:  to  moral  development  in
populations  that  were  less  privileged  than  Gilligan's  white  middle  class  informants.  These
empirical  studies  show  therefore  that  oilier  differences  than  gender  may  be  significant  to
differences  in  moral  development.  In  addition  to these  empirical  studies, we  also  have  analyses
based  on  other  theories  and  ways  of  thinking  that  give  good  arguments  for  the  difference
between  care  morality  and  justice  as  described  by  Gilligan  as  not  necessarily  being  gender-
related, but also dcscribable as a difference  between classes or between ethnic groups.

The reason why it was so important  for American  feminists to reject Gilligan's  argumentation
was because  it could  be used  to support  the correctness  of traditional  gender  roles  in  American

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Research Review N$  17.1 (2001)5-16

(and  Western)  culture,  and  for  an  understanding  that  men  and  women  were  fundamentally
different.  Thus  it has been possible to define  her argumentation  as being  "essentialist".  This is a
position  that  leading  feminist  theorists  have distanced  themselves  from  in  recent years,  to such,
an extent that in the opinion of many people  "essentialism" has become too loose and uncritical a
basis of criticism.  Several  feminist  theorists have strongly  opposed  Gilligan's  argumentation  and
her  book  has  been  interpreted  as  a  part  of  the  1980s  backlash  of  feminism  (Faludi  1991).
Kohlberg,  Habermas  and  other  male  theorists  have  claimed  that  the  "different  voice",  winch
Gilligan  has  identified,  is  a private  and  personal  voice  and  that  it  represents  a constricted,  less
universal  type of  moral  thinking  than  the male  theorists  in this field. To compare  what  Gilligan
discusses  and  morality  is  claimed  to  be  a  categorical  mistake  (Habermas  1990),  and  care
orientation  can best be  regarded  as  "a  set of coping  strategies  for  dealing with  sexist  oppression
in particular"  (Puka  1990). This  argument  reduces  Gilligan's  ethics of care  to belonging  only  to
the  private  sphere  arid  thus  implies  that  il  does  not  deserve  to be  dealt  with  as  a part  of  moral
theory.

What  then  about  the public  care services?  Has Giliigan's  ethics of care no relevance  in  this
sector?  Based  on (he reality, which  close to practice research  on care has shown  and  focuses  on,
theoretical  conclusions  like  this  seem  very  strange  and  make  me,  as  an  experienced  researcher
concerned  about  the  many  human  problems  in  everyday  reality,  conclude  that  I  have  nothing
relevant  to  learn  from  today's  theoretical  and  philosophical  discourse  on  morality  and  ethics,
whether  this  is  led  by  feminist  or mainstream  theorists.  The  fundamental  problem, which  I was
concerned  about  when  I  read  Gilligan's  book  for  the  first  time,  was  the  following:  Docs
Gilligan's  book  show  a way  of thinking  about  morality  and  ethics, which  is  very  important,  but
which philosophy  and modern  social science suppresses or ignores to a great extent? And can her
distinction between  an ethic of care and an ethic of justice be used as a conceptual  tool to  identify
a  number  of  important  development  trends  in  several  different  social  institutions,  which  we
otherwise  would  easily overlook'? And  furthermore:  axe tliese development trends that, we should
be aware of,  because these are development trends that most of us would consider to be negative
and  undesirable?  With  respect  to  such  questions,  essentialism  - the  discussion  in  relation  to
Gilligan's  work  becomes  irrelevant  and  limitation  of  care  ethics  to  the private  sphere  directly
outrageous. This academic  discourse gives no theoretical  tools with which to understand  the care
workers'  problems  in  being  able  to  provide  human  and  personal  care  in  a  sector  that  sets
increasingly  higher  efficiency  requirements.  It  also  does  not  help  us  to  understand  the  modern
child  family's  problems and dilemmas  in combining gender equality  ideals with the demands of a
fast-changing  working  life.  It  is  hardly  likely  that  the  breadwinner-  housewife  family  can  be
brought  back  to  life  on  a  large  scale,  even  for  those  who  might  so  wish,  and  thus  we  face
increasing pressure on private care resources. Today's  challenge  is to  increase the access to care,
which  also  takes  into  consideration  gender  equality.  This  will  not  be  easy  and  as  Hochschild
(1995) points out,  "to pursue this goal we must  sensitise ourselves to various, competing cultural.
images of care, for it is in the persuasive power of these images that, an underlying straggle might
be  won". In  this  situation,  It will  be an  advantage to also be  able to refer  to relevant  theoretical
discourses.. And  in the last  few  years, there have been theoretical  contributions, which exceed, the
debate on essentialism  and reference  of care ethics to the private sphere, and which  thus can give
important  contributions  to  feminist  empirical  research  on  care  and  thus  to  arguments  for  a
feminist  welfare  policy.

Care  and  Political  Theory

Tronto (1993) basically  criticises Gilligan  in a similar way as many others have done. One of
her most  important  arguments  against  Gilligan's,  and  even more  so against  Kohlberg's  theories,
which  arc the basis of Gilligan's  criticism,  is that  they  are elitist  accounts, which  cannot  explain
how  we can  generate or secure moral  actors who are willing to behave morally  in society.  In the

opinion  of Tronic, the way  in which  Kohiberg describes  morality  leads to the conclusion  that to
be  relatively  well-off  and  well  educated  is  a necessary,  if  inadequate, prerequisite  for  reaching
the  highest  moral  level  (Tronto  1993:75-76),  Giliigan's  theory  does  not  break  with  this  elitist
tendency-  she  also defines  morality  by  a process  of thinking rather  than  as a set of  substantive
principles.  As  many  have  pointed  out,  the  intellectual  skill  of  solving  hypothetical  moral
dilemmas docs not necessarily  result  in a corresponding  skill  in acting morally. An alternative to
this  way  of  thinking  is  to  focus  on  care  as  a  process  and  place  emphasis  on  care  as  practice.
When we analyse care ethics from  such an angle, it is relatively easy to be aware that the analysis
will be incomplete if we do  not make care a key  topic  also of the political  discourse,  Care ethics
must  be  discussed  on  the  basis  of  both  a  moral  and  a political  context.  In  order  to  do  this, we
must break  three boundaries, which  apply  in the academic mainstream discourse on morality and
politics  (Tronto  1993:  6-11).  Firstly,  we  must  break  the  boundary,  which  sees  morality  and
politics  as  separate  spheres.  Care  can  serve  both  as  a  moral  value  and  as  a  basis  for  how  to
achieve a good  society politically.  Secondly, we must break  the boundary, which says that moral
assessments  shall  be  made  from  a  distanced  and  uncommitted  position,  because  this  boundary
means  that  everything  to  do  with  feelings,  the  real  world  and  political  circumstances  will  be
irrelevant  or of secondary  importance.  Thirdly,  we must  break  the  boundary  between  the  public
and  private  sector,  as  has  been  argued  for  some  time  in  feministic  research.  Breaking  these
boundaries  does not  necessarily  mean  that  they  rnusi  be done away with, but can mean  that they
should be drawn  up differently,  if women are to be equal participants in public life.

In order  to progress  in the thinking  on  new  moral  boundaries  Tronto  (1.993:  105-107) care is
seen  as a process  in  four  phases:  1) acknowledge the existence  of a. need  for care that  should  be
met. (caring  about), 2) assume  responsibility  for  this acknowledged  need  for  care  and  determine
how  this  should  be met  (taking  care  of),  3) the  direct  work  in  meeting  this  need  for  care  (care-
giving),  4)  the  recipient's  situation  alter  care  has  been  given  (care-receiving).  Even  if  these
phases  cars  overlap  each  other  in  practice,  this  division  is  fruitful  in  order  to  identify  several
aspects of the gender and  class-related  division  of responsibility  and  labour with  respect to care,
which  also  makes the care  issue  in  today's  society  relevant  for  further  development  of political
theory.  Here  are  a  few  important,  examples:  men's  care  responsibility  for  the  family  has
traditionally  been  limited  to  "taking  care  of"  (phase  2),  while  women  have  responsibility  for
providing  specific  care-giving  (phase  3). The  division  of  labour  between  a  doctor  and  nursing
staff  can  be  described  in  the  same  way,  even  if  in  the  health  sector  we  eventually  have  a
hierarchy  within  phase  2,  where  also  leaders  in  traditional  female  professions  have  a
(subordinate)  place.  By  including  phase  4, we  recognise  that  the original  definition  of the  need
for  care was not  necessarily  correct,  that recipients  could  assess their situation  differently  to the
carcgivcrs.  When  we  define  care  in  this  way  as  practice  and  process,  it  is  clear  that  there  are
many  possibilities  for  conflict  between  and  wilhin  the  levels.  These  may  be  value  conflicts  or
conflicts  regarding allocation  of scarce resources in the  form  of time or money.  In the real world
you  will  hardly  find  care  processes  that  can  be  described  as  being  completely  free  of  such
conflicts,  if we include all these four phases,

from  a  purely  conceptual  point  of  view,  care  is  both  particular  and  universal.  What  is
construed  to  be  adequate  care  varies  between  cultures  and  between  different  groups  in  society.
Despite  these  variations,  care  k  a  universal  aspect  of  human  existence,  All  people  need  care,
even if the need  requirement  varies, not jusl  based  on cultural  differences,  but also on biological
differences,  A baby  cannot survive without  care, and disease, disability and ageing mean  that the
need  is  greater  than  it  would  otherwise  be. Therefore,  care  is  not  universal  with  respect  to  the
specific  needs in question, but everyone needs some kind of care.

In both the  Western  world  and  in many  other cultures, direct care giving (phase 3) has always
been  a job  assigned  to  the  lowest  groups  in  the  hierarchy;  women,  slaves,  servants.  The  direct,
and  specific  care  for  children,  as  well  as  for  the  sick  and  the  elderly  has  nearly  always  been

Research Review NS  17.1  (2001)5-16

exclusively  delegated  to  women,  hi  the  late-modem  society  specific  care  work  is  still
downgraded,  unpaid  or  poorly  paid  and  to  an  overwhelming  extent  left  to  those  who  have  the
least power in society.  A consequence  of the unbalanced  distribution  of care roles and care work
is that  the  relatively  most privileged  groups  can  ignore  much  of the  strain  care  entails, because
they  never  have  to  face  this. Tronto  (1993:121)  calls  this privilege  "privileged  irresponsibility".
This concept  might be useful  in explaining why the approach  to the care problems is so marginal
in  the  political  discourse  and  why  the  male  intellectual  elite  so  easily  refers  care  ethics  to  the
private  sphere.  Women  belonging  to  the  elite  do  not  immediately  assume  such  a  position  of
"privileged  irresponsibility".  To  several  of  the  pioneers  in  women's  studies  it  was  the  tension
between  the  academic  world's  definition  of  reality  and  family  life's  requirement  for  everyday
care that  gave the inspiration  to  theoretical  rethinking  (Smith  1987). The whole of the growth of
feminist  research  in  opposition  to  the  established  academic  world  cars perhaps  be  said  to  be  a
result  of  large  groups  of  women  being  given  access  to the academic  world, but  without  it being
possible in any  simple way  to hand  over the practical  care of their  own children  or the family  in
genera]  to  other  women.  This  was  not  an  easy  matter  economically  or  ideologically  for  most
women  in  the  Western  world  who  entered  academia  in the  1970s  and  who  eventually  began  to
make their  mark  in the  academic  and  political  debate.  The time of  house-maids  in  middle-class
households  was  over  and  other justifiable  and  financially  reasonable  child  care  for  working  and
studying  mothers  was  in  short  supply  at  the  time  large  groups  of  women  populated  the
institutions  of  higher  education.  Feminists  have  argued  strongly  for  several  different  practical
measures  to make  it easier  for women  to combine work  and  motherhood. Many  have also argued
in  favour  of the  need  to  change  the  ideology  that  links  mother  and  child  so closely  together by
defining  mother's  care  as  being  unique  and  necessary  for  a  child's  development  and  welfare.
This  has  partly  been  done  through  historical  studies  to  show  that  mother's  love, in the  sense of
how we have defined  it in our time, is not something "naturally" given, but is a modern  ideology,
which  has  helped  keep  women  at  home  (Badinter  1981,  Haavind  1975).  By  highlighting  the
reality  of  fathers'  increasing  care  for  their  children  and  of  the  advantages  of  different  types  of
professional  child  care  from  an  increasingly  younger  age,  Western  feminism  has  helped  to
change  the  understanding  of  motherhood  on  which  family  law  and  much  of  the  welfare
legislation  has been based.  In several  Western  countries the basis of the legislation  in these areas
has also changed  "from  relational  to individual  motherhood",  as Syltevik  (1996) has called  it. It
must be said that feminism  in the Scandinavian  countries has succeeded  to some extent both with
respect  to  socio-political  measures  and  ideological  changes,  in  that  it  lias  become  easier  for
women  in  these  countries  to  combine  motherhood  and  paid  work.  Use  of  paid  care  leave  has
increased  considerably,  fathers  participate  to a greater  extent  in  this  leave  (Brandth  and  Kvande
1996), and the number of places in state-subsidised  kindergartens have increased drastically. The
gender  equality  ideal  appears  to  be  in  strong  evidence  among  today's  families  with  small
children  and  in  the  public  sector.  It  is even  acceptable  thai  men  in  relatively  high  positions can.
leave  meetings  at  work, because  they  have  to pick  their  children  up  from  kindergarten.  On  the
other  hand, we are  far  from  having realised  any gender equality  with respect to salary and  career
or  with  respect  to  workload  in  the  home.  Many  parents  of  small  children  probably  pay  a high-
price  in the  form  of a heavy  workload  when  trying to live up to today's  ideal  of gender  equality
(Syltevik  2000),

If we take  a closer  look  at the changes on the  labour  market,  the trend  in Scandinavia  today,
as in the rest of the modern  world,  is towards demanding  increasingly  more of each employee, at
least  if  this  person  wants  to  make  a  career.  The  labour  organisations  have  become  "greedier
institutions"  and  market-orientation  has  also  increased  in  the  public  sector.  Today,  when
according  to  the  Norwegian  gender  equality  ombudsman,  pregnant  women  appear  to  be  the
victim  of  unlawful  discrimination  at work  and  help  with  the housework  is introduced  as  a perk
for women  in  career jobs,  this  is perhaps  also  a sign  that we  in  Scandinavia  axe also  in  a  trend
where greater gender equality  can only  be achieved  by increasing the social differences  between

11

women, as several  studies  have pointed  out  applies  in other Western  countries (Anderson  2000).
This  means  that  more  of  the  direct  care  work  must  be  handed  over  to  low-paid  women,  as  in
order  to  achieve  managerial  positions,  women  must  achieve  some  of  the  "privileged
irresponsibility"  with  respect  to care  that  up to  now  has mainly  been  reserved  for  men.  Perhaps
this Trend today  is about  to become just  as strong as the trend that men are about to give up some
of  their  "privileged  irresponsibility"  by  using their  right  to care  leave  and  having  responsibility
for  collecting  the  children  from,  kindergarten.  Both  of  these  development  trends  will  lead  to
greater gender equality. But the  latter  trend  will  also result in greater  social  differences  between
women  in a way  that  probably  will  also  reduce  the chance of care values gaining a bigger  place
in  the political  discourse.  Regardless  of how  we  might  assess  today's  development  trends  with
respect  to  distribution  of  care  responsibilities,  we  need  greater  political  focus  on  working
conditions  for  those  care  workers  who  perform  the  specific  everyday  care  of  our  children,  the
sick,  disabled  and  elderly.  We  also  need  political  focus  on  what  division  of  responsibility  and
labour  in  care  we  want  to  have,  and  what  division  actually  exists  between  the  family  and  the
poJitical  authorities.

A New Concept  in  Research  on Development  Trends in Public  Care

"The  Rationality  of Caring"

"The rationality of caring  " was  a concept created  in the early phase of the empirically  based
research  on  care  (Waerness  1984).  This  concept  should  show  that  rational  action,  reason  and
feelings  were  important  for  providing  good  care  both  in  the  private  and  public  sphere.  This
concept  was  also  important,  in  showing  that  the  rationality  which  dominates  in  planning  and
research  on  public  care,  overlooks  important:  aspects  of  what  are  important  knowledge  and
available courses of action  in order to be able to provide good care (Waerness and Gough  1985).

In  socio-political  planning,  therefore,  there  is  limited  understanding  that  instrumental
rationality,  which  forms  the  basis  of  planning  and  organisation,  has  limited  validity  when
providing  care  for  individual  persons.  General  knowledge,  which  is  interesting  and  useful  to
administrators and politicians, is often  of little help to first  line care workers. In order to solve the
specific  problems  in  the  real  world  of  care, we  require  a way  of thinking  that  is contextual and
descriptive,  rather than formal  and abstract. The concept "the rationality of caring" suggests that
personal  knowledge  and  a certain  ability  and  opportunity  to understand  what  is specific  in each
situation  where  help  is required,  are  important  prerequisites  in order  to be  able to provide  good
care. This means that human  and  moral qualities  in public care can only be elicited  in  situations
where there is not a lot of bustle, but where there is enough  quiet so that those requiring help are
confident  arid are sure that the helper sees them as persons with specific  needs. Or in other words
that  in his  or  her  state  of helplessness,  a person  feels  to  be in good  hands. This  also means  that
each helper must  not be too busy. So far I have not seen that economic  studies on "efficiency"  in
the  public  sector  have  taken  into  consideration  this  important  aspect  of  care-giving  work.
Economic  efficiency  in this sector  is preferably  measured  as care for  as many people as possible
in the shortest possible time.

Several  empirical  studies  on  public  care  have  been  able  to  confirm  the  fruitfulness  of
theorising based on the concept of the rationality  of caring as a critical  understanding of the type
of  modernisation  that  the  public  care  services  have  undergone  in recent  years  (Andreassen  and
Jagmann  1992;  Bungum  1994;  Christensen  1998;  Gough  1987;  Szebehely  1995;  Slagsvold
1995).  As a  "sensitising  concept"  (Blurner  1969:  147-148)  this concept has proved  to be  useful
in showing  the negative aspects of this modernisation,  to which  it may be difficult  to relate. This
may  be  the  explanation  why  most  of  the  research  on  planning,  and  public  reports  in  this  area,
ignore  the  results  from  the  feministic  inspired  research  on  care  (Waerness  1999). When  several
researchers, who  have  worked  on the basis of this perspective  for  a long time, published  a book
entitled  Blir  omsorgen  boric?  Eldreomsorgens  hverdag  i den  senmoderne  veljerdsstat  (Is care
disappearing?  The reed world of care for the elderly in the late-modern welfare state), we cannot

expect  to  arouse  any  special  interest  among  planners  ami  researchers  within  the  economic
discourse,  despite  the  interest  from  professionals  working  in  the  field  and  despite  our  basis  for
critique being the  following:

Research Review NS  17,1 (2001)  5-16

Our  critical  view  is  not  based  on  a  kind  of  nostalgic  understanding  that  care  for  the
elderly  was  better  "before".  It  is primarily  based  on  the  fact  that  we,  as  experienced
researchers in this area, have found several  examples of good kinds of care practice and
relations  between  caregivers  and  those  needing  help  in  today's  care  services  that  we
believe  are about  to be  run  over  or disappear  in  the modernisation  process  in progress
in  this  sector.  We  •  >»  •*** < ls> >i  pi i "i  •*  > 1 
consideration  to the <h-,lm' U c «!< >i <>4 i  >< 
reforms  in  this  sect  >t  lh<" tail  IMI  V 
good  care,  is  rathei  >ts  \ !l •• <>i ih • i  1 »* '  i 
(Thorsen and W;ent< ••-,  i / '5 

* o  n  , ,i'iil  nurses  who  provide
> '  <u  misation  arranges  for

I> .HI ti  «<>-s  do  not  pay  enough
> <  ><  tiu  i \] < _ propose changes and

. i  , i  ! ' 
t 

' ')

In economists'  analyses  of efficiency  and  productivity  in  the  nursing  and  care sector we  find
cause  to  express  certain  reservations  and  doubt  regarding  the  use  or  value  of  the  efficiency
measures  used  (refer  for  example  to  Erlandscn. et  al.  1997,  Edvardsen  et  ai.  2000). This  can  be
expressed  as follows;

One may ask the question whether we arc so far removed  from  data for real  nursing and
care services  that the study  has  no value.  We wouid  argue that  the efficiency  measures
relate after  all to variables and  factors  of."great  interest  to the municipalities  (Edvardsen
etal. 2000: 10).

But  even  with  the  reservations  regarding  die  validity  of  the  measures  that  this  study  gives
voice  to  in  the  text,  one  can  conclude  in  the  summary  that  the  calculations  tell  which
municipalities  can  function  as teachers  for  the  inefficient  municipalities.  Important  objections  to
such  measurement  of  efficiency,  which  the  feministic  inspired  research  on cure  have  made,  are
usually  not discussed  in economic  studies on efficiency  in this sector,  if there  is any reference  at
all to the feet that such research  oasts.

Conclusion: the Responsibility  of Social  Research  on  Caring

Feministic  inspired  research  on  public  care  has  had  quite  a  significant  scope  in  the
Scandinavian  countries,  without  this  having  any  special  influence  on  planning  and  organisation
of  welfare  services.  As  mentioned  already,  there  are  Nordic  studies  on  philosophical  and
theoretical  care  thinking,  which  are  based  on  women's  care  work  in  the  public  sector.  In
particular,  Kari  Martinsen's  historical  and  philosophical  studies  in  the  last  few  years  have  had
increasing  influence  among  nurses.  A  separate  book  about  her  care  thinking  for  use  in  basic
nursing training has  now been published  (Alvsvag  and Gjengedal  2000). Her  work has formed  a
school  in  Nordic  research  on  nursing  and  her  normative  care  theory  is  claimed  to  have  had  a
great  influence  on nurses  and student nurses  (KJrkevol! 2000). However,  in the same way as the
empirically  based  research  on women  within  the field of care, this care theory  is very  critical  of
the  economical  and  technological  rationality  that  dominates  the  developments  in  today's  public
health  and care  services.  It  is also  not  in dialogue  with  the economic  discourse  in this area  and
thus  has  no  influence  on  the  planning  and  organisation  of  these  services.  The  influence  on
attitudes  from  this  way  of  thinking,  which  lakes  place  through  education  of  care  workers,  can
therefore  make matters  worse. Those working  in this sector can experience  increasing  frustration
due to the gap between  how care should  be and how  it is. And  this can also mean  that even  more
of  those  who have  the  possibility  to  do  so, seek jobs  where  they  do  not  have  to  provide  direct
care for  individuals requiring help.

A  problematic 

relationship  between  a  dominant  economic  discourse,  and  other

13

approximations  to social  and humanistic  research  on care, is a general  problem  both  on  national
and  international  levels  of policies  and  planning.  It  is also  an  important  part  of  the problem  of
how  to  carry  out  research  that  could  matter  in  relation  to the problems  of  globalisation  and  the
changes  in  the  cultures  of  survival  and  care.  Philosopher  Martha  Nussbaum,  who  has  co-
operated  for  several  years, inter  alia,  with the Nobel  Prize  Winner  in Economics, Amartya  Sen,
within  the  area  of  development  economy  under  the  direction  of  UN,  expresses  this  problem
related  to the work  al  The World  Institute of Development  Economics Research  (WIDER.) at the
UN University:

Given  the public  dominance  of  economics, any profession  that  cannot  get  itself  taken
seriously by it will  have tough  going. But economics  is extremely  sell-satisfied,  and  its
tendency  to  repudiate  non-formal  and  foundational  work  as  irrelevant  to  its  concerns
poses a major problem  (Nussbaum  1998: 778),

On  the  other  hand,  Nussbaum  criticises  the  philosophers  for  only  communicating  with  their
own kind  and  for  not being  able  to discuss  the problems  "at  a high  degree  of sophistication  in a
dear  and jargon-free  language,  with  concrete  factual  or  narrative  examples"  (Nussbaum  1998:
778). Furthermore, she finds that the feministic  researchers, whether they are philosophers or not,
are  far  better  at  communicating  with  a  broader  public.  She  indicates  that  this  may  be  because
"feminist  theory  lias  usually  kept  its  feet  squarely  planted  in  the  empirical  reality  of  women's
lives  (Nussbaum  1998:  780).  Nussbaum  argues  convincingly  that  feminist  philosophers  should
be more involved  in this area, interest  themselves more in the facts  and people's  experiences and
communicate  more directly  witJi planners, politicians and  workers within development  economy.
In  her  opinion,  the  fact  that  economists  arc  so  unwilling  to  accept  philosophical  critique  gives
extra good reason to do this.

The  description  Martha  Nussbaum  gives  of  this  problem  in  development  economics  has
many  similarities  with  the  problems  I  have  described  here  for  social  research  on  care  in  the
context  of a Scandinavian  welfare  slate. Like her assessment  of development economies,  1 feel  it
is  necessary  that  feminist  philosophers  and  ethieists  in  general  become  more  involved  in  the
concrete  problems in the real  world of care. They should  also be able to analyse and discuss these
in  a  language  with  which  also  practitioners  in  the  field  feel  comfortable.  It  should  also  be a
responsibility  for  theorists  and  also  empirical  researchers  in  this  field  to  try  to  break  the
dominance of the economic  discourse in planning and organisation  of public care. Though, this is
not  easy,  it  should  not  stop  us  from  trying.  Care  researchers  should  also  try  to  influence  the
education  of  care  workers  so  that  they  become  more  aware  of  how  organisational  structures
create  problems  with  respect  to uniting  ideals  about  good  care and  today's  economic  efficiency
requirement.  In the  longer  term  the goal  should  of course be not only to break  the dominance  of
the economic  discourse, but  the more ambitious  one, to try  to develop  a. genuine cooperation  on
research  across  the  two  discourses,  which  currently  run  parallel  and  have  such  a  different
influence on the policies and planning on all political  levels in the modem  world.

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Notes

Not  everyone  whom  I  have  defined  as  feminist  researchers  has  been  or  defines  themselves  as

feminists.  It is appropriate however to call their research  "feministic  inspired research on care".
* I have based  much of this paragrapli on Szebeheley (1996) and  EHasson (1996),
'' Other  sucl)  works  1 can  mention  are  Hochschild  (1975), Chodorow  (1989),  Noddings  (1984). There
are also some  very good  empirical  studies  from  the US thai deal  with  gender-Jinked division  of labour
in  the  family  with  respect  to  care  (refer  for  example to  Hochschild  1990), but  naturally  enough  these
were related  to the welfare  stale discussion  thai characterised  the Scandinavian  and British studies.

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