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2. The Duty to Care
- Indiana University Press
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THE QUESTION OF CARE Why should Abraham care for Isaac? Why should Adrienne care for Jean? Why should we care about the fates of these (and other) parents , or accept their claims to care for their dependent minors? In pediatrics , health care providers face similar questions: Why should medical professionals care about the welfare of families and children? Assuming that there is a basis for care, how should that care obligate parents who are presumably responsible for their children? TWO The Duty to Care I strongly believe that at this end of life [children], there is far less ambiguity about the appropriate place of medicine. That makes me feel better about what I do. In most (but not all) cases there’s no debate about goals—to relieve children’s suffering and cure the child’s disorder. If you can do that you don’t know what that kid will go on to do. That’s really satisfying. When I was with adults as a med student, they would say, “leave me alone.” I asked myself, what am I doing [with adults]? Medicine always involves some discomfort to relieve suffering and attempt a cure. You feel better about yourself at this end of life. —Dr. Michael DeVries, attending physician in Baylin Pediatric Medical Center’s Intensive Care Unit1 I like to hug my patients. There’s an extra level of care that’s possible with kids. You can’t do that with adults. —Dr. Sarah Radford, a resident at Baylin2 You can learn a lot about a culture by learning about the people it marginalizes. Certainly children do not fare well in America. . . . There’s something in me that wants to give children a shot at justice in the world. . . . I’m committed to care of the family and of the vulnerable. —Rev. Charlene Dodson, head chaplain at Baylin3 These queries about parental and professional obligation do not admit of obvious answers. Various religious traditions have approached such issues with reference to the command to love others, compassion for others, or role responsibility. Jews and Christians, for example, are admonished to love their neighbors as themselves, although each tradition exhibits considerable diversity about who counts as a neighbor, what it means to love oneself, how to rank and order love of different neighbors, what kinds of dispositions and actions count as loving, and whether it makes sense to speak of love as commanded.4 However these issues are resolved, the love command implies the virtue of benevolence, a disposition to consider the well-being of others and to act on that disposition in appropriate circumstances. Buddhists hold up the ideal of compassion as a virtue that directs adherents to attend to the suffering of others and the general contingency of life.5 Hindus regulate their lives according to the requirements of dharma, which involve duties within various social roles.6 Muslims believe that adherents have duties to preserve, develop, and beautify God’s creation, duties that include acting for others’ welfare.7 In all of these instances, emphasis falls on how religious believers are to attend to the needs of others, regardless of others’ religious or cultural affiliations. Religions are often seen as encumbering their adherents with a sense of social responsibility, especially toward the vulnerable and needy. For health care providers, professional practice is informed by the Hippocratic tradition, which appeals to patient welfare as a cardinal principle. The Hippocratic oath states, “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. . . . Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.”8 Following the Hippocratic tradition, the Principles of Medical Ethics of the American Medical Association (1957) state, “The principal objective of the medical profession is to render service to humanity with full respect for the dignity of man. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion.”9 Venerable though these traditions are, they fail to indicate why persons who are not religious, who are not members of the medical profession, or who are not from mainstream religious backgrounds should care for others. That is, they do not provide a general basis for the duty to care. Often it is...