Marian Barnes reports on how a feminist ethic of care, which is a different approach to morality than the dominant theories, has had a significant influence on social policy and practice in the UK. In turn, reflecting on that practice can yield important improvements in the ethics of care as a moral theory, and Barnes’ book contributes very importantly to this process.

It is fascinating for those of us who have participated in the development of care ethics as moral theory, while being relatively unfamiliar with day-to-day practice in social work, socially provided care of the disabled, and the like, to see how the theory plays out in an area of application such as that described by Barnes. And we can see how this everyday practice reinforces much of our theory, and should lead us to call for the revision of some aspects of it. Barnes’ emphasis on the ‘lived experience’ of those providing care and those being cared for is right on target, in my view, and very valuable. ‘A key argument of an ethic of care,’ she writes, ‘is that care as practice and as moral and political value cannot be understood in the abstract. We need to consider the lived experience of giving and receiving care, and how context, conflicts and power impact the difficult moral decisions as well as the practical tasks of care’ (p. 40).

Together with her interpretations, Barnes’ focus on the experience of care illustrates the process by which normative moral theory ought to be developed and progressively improved. And it shows how morality in practice in the area of social policy ought to be guided by the values of care, and how policy can continually be made better.

The ethics of care has grown out of a feminist appreciation for the enormous amounts and value of caring labour, traditionally done by women, but relatively ignored by dominant moral theories. This labour ought to be shared by men, and is utterly essential: no human being would survive without large amounts of care in childhood. Most persons need additional care when ill or aged, and some persons need care throughout their lives. Care should not be marginalised as a ‘private’ concern; society has a responsibility to see that the needs to which care responds are met. Barnes builds especially on the work of Joan Tronto, Selma Sevenhuijsen and Eva Kittay.

Once attention is paid to care, the values embodied in its practices, values such as attentiveness, sensitivity, responsiveness, meeting needs and fostering trust, loom large. It can be seen how these are not just values for the contexts of family and friends, as many suppose. They are values that should be influential in society and even in global relations. The ethics of care has the potential to be a comprehensive moral theory, or, more modestly, the appropriate moral theory for all the care that is needed in society and the world.

Fundamental to care ethics is the view of human beings as relational, rather than as autonomous, self-sufficient individuals pursuing their own interests, the model made dominant by the social contract tradition of political theory and then expanded into any number of other areas. Barnes shows how much more fruitful the relational view is for considering issues of social policy. To take just one example: in evaluating the situations of the elderly, it is most important to examine their relations with family, friends, those who care for them and society. It is this ‘web of relationships which older people themselves identify as key’ to their sense of well-being (p. 182). We can infer from Barnes’ discussion that although persons can base their legal interactions on the contractual image of the individual, they would do well to recognise that they are more deeply related to others by the care that is so essential to human life and that ties us together into communities capable of political governance.

In the UK, there has in recent years been a reaction against ‘care’. Many receiving care, such as the disabled and elderly and their spokespersons object to the ‘paternalistic, overprotective services that do not enable disabled people and others to exercise the same choices that “you or I” might wish to do’ (p. 64). Rather than being treated as demeaned recipients of care, they would rather be understood as autonomous choosers of services available to them.

It should still be recognised, Barnes argues effectively, that an ethic of care and ‘an emphasis on relationality, rather than on competing rights, offers a better way of understanding the lived experiences of carers and those who receive care’ (p. 44). The reaction against care, Barnes shows, is based on a faulty understanding of the ethics of care, which should include and be based on the perspective of the cared for as perceptively as of the care provider. The ethics of care has the resources to distinguish poor and disrespectful care from the good care advocated, which must include respect and sensitivity, empathy and recognition of the full moral personhood of all those involved in relations of care. Caring relations are what are central and they should be evaluated continually and reformed when unsatisfactory.

Some early work in care ethics emphasised the perspective and experience of care givers – mothers for instance – and may have paid insufficient attention to that of recipients of care. Empirical work in the field of social policy, in the meantime, focused on the work and experience of care givers (p. 35). The dangers of care in practice becoming paternalistic, domineering and insensitive may have been somewhat neglected. However, adequately developed versions of the ethics of care fully understand the equal importance of the perspectives of the cared for. They also understand the relational realities of persons and care.

One of Barnes’ most valuable discussions is of reciprocity, and of how caring relations can reflect it. A good caring relation is not a bargain that one individual will care for another now, such as a child, so that the carer will be cared for later, as in old age. It is a shared experience of the mutual values of care, of what it expresses and of its results. Even in the care of the severely mentally disabled, the point of view of the recipient of care can be at least partially apparent, and appreciated. And in many other cases, the perspectives of recipients of care should not only be taken into account in hands on practices of care, but in the formulation of social policies about care. Barnes’ account of respectful and participatory deliberation concerning such policies is illuminating.

One minor criticism of this book: Barnes tries to develop the descriptions and evaluations of policies and practices as ‘care full’ or ‘care less’. One can hope that this infelicitous linguistic usage will not become widespread.