Care without emotion

Care is often linked with compassion, kindness and love but is this necessary?

Daniel Engster in his 2007 book The Heart of Justice defines

“care as a practice that includes ‘everything we do to help individuals to meet their vital biological needs, develop or maintain their basic capabilities, and avoid or alleviate unnecessary or unwanted pain and suffering, so that they can survive, develop, and function in society’. [1]

Although care is often unpaid, interpersonal, and emotional work, Engster’s definition does not exclude paid work or self-care, nor require the presence of affection or other emotion.

Diemut Bubeck, makes this explicit in her 1995 book Care, Gender and Justice, holding that “care does not require any emotional attachment.” [2]

Indeed, the removal or downplaying of emotions may be seen as an important part of care practice for example to reduce the emotional toll on caregivers, or to care for people who have committed terrible crimes.

“Apart from recommendations as to how clinicians should behave, the literatures on bioethics and professionalism are largely silent as to the frequency, impact, and dynamics of moral appraisals. Mary Catherine Beach and colleagues have argued that physicians' moral obligation includes ‘recognition of the unconditional value of patients as persons’ (italics in original). While conceding that feeling respect for all patients may require ‘internal work,’ they did not describe that internal work or address how it could be accomplished. (…)

Such exhortations gloss over the internal and interpersonal challenges described, for instance, in Groves' landmark article about ‘hateful patients’. There can be little doubt, however, that many clinicians struggle earnestly to control their emotions and judgments in order to meet these professional standards. A study of exemplar primary care physician healers found that their first commitment was ‘a conscious attempt... to be nonjudgmental’. Indeed, one of these physicians reported, "I try to love every single patient. And I especially try to love those I initially hate.’ This commitment can sometimes lead to heroic professionalism, as in the case of a surgeon who dutifully treated terrorists after they had killed members of his family.” [3]

[1] Engster, D. (2007) The Heart of Justice. p28

[2] Bubeck, D. (1995) Care, Gender and Justice

[3] Hill T. E. (2010). How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research. Philosophy, ethics, and humanities in medicine : PEHM, 5, 11. https://doi.org/10.1186/1747-5341-5-11