In the book GOED GEDAAN (in English WELL DONE) the bio ethical approach (Beauchamp / van Willigenburg) is compared with an ethic of care approach (Tronto).
This comparison not only takes place from a theoretical point of view but also from a practical point of view (palliative care). Contrary to the bio ethical approach, the ethic of care approach does not have an argumentation model. In this book an attempt is made to develop such a model, based on the philosophy of Charles Taylor. The development of this model is necessary, in order to make comparison of both ethical approaches in practical situations and in a methodological way possible.
Some conclusions
1. Concerning Moral Dialogue
The bio ethical approach is a problem solving directed dialogue which takes place only between caregivers. Care receivers play a role in the informative phase of this dialogue and are confronted with the outcome (the best solution or best way to act), presented by caregivers.
The ethic of care dialogue takes place between caregivers and care receivers and is focused on giving meaning to a moral situation (including the relation between caregivers and care receivers).
2. Concerning Interpretation
Within the bio ethical approach, deductive explication of moral problems takes place in the framework of 'the four principles'. These principles are respect for autonomy, 'doing good', 'avoiding evil' and justice.
Within the ethic of care approach inductive interpretation of a moral situation takes place from a contextual point of view and in terms of 'strong evaluation' and/or explicit made responsibility.
3. Concerning Decision Making
The bio ethical approach may be recognized by a fully developed programmed instruction for making decisions. The outcome always is a best way to act (including not acting at all).
Within the ethic of care approach the outcome not always is a best way of acting. Sometimes it is, sometimes it is not. The dialogue as such also has a certain value. It concerns mostly searching for meaning and maintaining relations between caregivers and care receivers.
Questions
Naturally a lot more might be said about the comparison between the two ethics. A large problem in both approaches is the tension between paternalism and respect for autonomy.
Paternalism always seems to play a role in 'care and cure' relations. The emphasis on autonomy was intended to minimize the influence of paternalism and finally ended up in a contractual relationship. There are doubts about this development. Is this the ultimate result? Can care relations be modified into contractual relations? Apparently they can, but what are the effects concerning articulation in needs?
Another problem seems to be the distance in 'care and cure' relations between 'givers' and 'receivers'. One can say that this distance is more extensive in the bio ethical approach compared to the ethic of care approach. Generally speaking (problem solving) contacts are short in the cure area, so some say that bioethics are better applied here.
Mutatis mutandis this distance is smaller in the ethic of care approach, and because relations last longer here (searching for meaning in a final situation), one can say that this ethic can better be applied in the care area.
Important in 'GOED GEDAAN' is the point of view that people are moral beings with as most important moral maxim 'being true to yourself'. The sources of this 'self' and the meaning of the input from these sources create a form of self understanding in which 'being true to yourself' can be articulated (Taylor). Inherent to this self understanding are important values, which can be derived from images about 'good' care and how to create care relations. Because people continuously develop themselves in an always changing reality, it is evident that the development of values also is a dynamic and ongoing process.
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