The Crisis of Care_ Affirming and Restoring Caring Practices in the Helping Professions

207 Pages·1996·0.77 MB·English

by  Susan S. Phillips

The Crisis of Care : Affirming and Restoring Caring
title:
Practices in the Helping Professions
author: Phillips, Susan S.
publisher: Georgetown University Press
isbn10 | asin: 0878405992
print isbn13: 9780878405992
ebook isbn13: 9780585276519
language: English
subject Caring, Helping behavior, Professional ethics.
publication date: 1996
lcc: BJ1475.C75 1996eb
ddc: 174
subject: Caring, Helping behavior, Professional ethics.
Page iii
The Crisis of Care
Affirming and Restoring Caring Practices in the Helping Professions
Edited by
Susan S. Phillips and Patricia Benner
Page iv
Georgetown University Press, Washington, D.C. 20057
© 1994 by Georgetown University Press. All rights reserved.
Printed in the United States of America.
10 9 8 7 6 5 4 3 1994
.
THIS VOLUME IS PRINTED ON ACID-FREE OFFSET BOOKPAPER
This work was funded in part by the Lilly Endowment, Inc.
Library of Congress Cataloging-in-Publication Data
The Crisis of carev : affirming and restoring caring practices in the
helping professions / Susan S. Phillips, Patricia Benner, [editors].
p. cm.
1. Caring. 2. Helping behavior. 3. Professional ethics.
I. Phillips, Susan S. II. Benner, Patricia E. III. Title: Helping
professions.
BJ1475.C75 1994
174--dc20
ISBN 0-87840-558-5
94-9702
Page v
Contents
Preface vii
Introduction
1
Susan S. Phillips
Narrative:
When Life Threatens 17
Harvey Peskin
Understanding Caring in Contemporary America
21
Robert N. Bellah
Narrative:
Listening to the Heart 36
Lynn Schimmel
Caring As a Way of Knowing and Not Knowing
42
Patricia Benner
Narrative:
Meeting at the Table 63
Douglass E. Fitch
Teach Us to Care and Not to Care
66
Eugene H. Peterson
Narrative:
No Safe Conduct 80
William Visick
Page vi
The Caring Physician: Balancing the Three Es:
Effectiveness, Efficiency, and Empathy 83
E. Dawn Swaby-Ellis
Narrative:
To Care Is to Listen 95
Mima Baird
Preparing Students for the World
97
Jaime Escalante
Narrative:
Photograph 105
Sandi Schaffer
The Corrosion of Care in the Context of School
109
Anna E. Richert
Narrative:
Death by Choice 119
Theresa Stephany
Beyond the Ethics of Rightness: The Role of Compassion
in Moral Responsibility 123
David C. Thomasma
Narrative:
Beyond the Clinical Gaze 144
W. Thomas Boyce
Caring as Gift and Goal: Biblical and Theological
Reflections 149
Joel B. Green
Narrative:
Listening with Care 168
Morris A. Magnan
Philosophical Reflections on Caring Practices
174
Charles Taylor
Contributions 189

Page vii
Preface
This book argues that examining our exemplary caring relationships can prompt us to
redesign the structures and processes of our public caregiving institutions in order to
better facilitate practices of caring. The premise is that we must first understand the best
of our caring practices by attending to the notions of the good life and skilled ethical
comportment embedded in them. Listening to narratives of practice enables that kind of
attention, and the reader will find many narratives in this book, both free-standing and
incorporated in chapters.
There is a subtext in each chapter that concerns recovering a vision, concrete strategies,
and moral space for caring practices. Teaching, nursing, medicine, psychotherapy, and
pastoral ministry are written of from the inside in terms of excellent practice and
qualitative distinctions (Kierkegaard, 1962; Rubin, 1984; Taylor, 1989) that interact with it
in the everyday work of helping professionals.
The authors in this book write of actual, less than ideal, circumstances and the real people
who practice care within those circumstances. If caring practices are to be noticed,
affirmed, and restored, this must happen in the context in which they take place. The
reader is invited to examine the narratives in terms of the practices of care illustrated in
them. How is the story itself constituted by ethical concerns? What is being protected?
What are the visions and relational issues of the one caring and the one cared for? In what
ways are technological, managerial views of the person overcome so that the other person
is encountered as a particular person with a distinct history and concerns? We believe it is
essential to recover the vision of what is possible in actual practices today in order to
discover the mandates for reshaping our institutional structures, environments, and
economics to serve attentive, sustaining, and healing relationships.
Page viii
We have a strong tradition of considering theory liberating and practice enslaving or
unenlightened; however, this is not always the case (Taylor, 1989). As the narratives in
this book show, excellent, instructive practice that embodies distinctions of worth creates
the vision of what ought to be and how to live toward that vision. A dominant strategy in
all the helping professions has been to objectify and standardize as much of the
professional activity as possible in the quest for quality control. But this strategy obscures
the requisite judgment and particularized relationships required in the helping
professions.
A helping professional is not a teacher, nurse, physician, psychotherapist, or pastor
simply by virtue of possessing large quantities of information and adhering to
objectifiable codes of behavior that limit (or exclude) judgment and response (Rubin,
1984). These practitioners do possess the necessary information and behavior codes; they
also have experientially embedded standards and visions of excellence. They have notions
of what counts as excellent and poor practice, qualitative distinctions about what counts
as preserving personhood, fostering growth, restoring wholeness and integrity, offering
encouragement, and so on. By examining concrete instances of caring practice we can
recover distinctions of worth within the practice.
There are many paradoxes in caring practices. If the helping professional acts on general
principles to "act caringly" as a means of self-improvement or salvation, or as a means of
controlling fears of finitude and vulnerability, then the caring practice will suffer. The one
cared for will be objectified, enslaved, or infantilized rather than liberated and
strengthened by care. These are real dangers that have fueled the epidemic level discourse
on pathologies of care, burnout, and codependency. The parallel danger is to pathologize
care in general for fear of inauthentic care or from failure to hope that authentic,
nonparasitical care is possible and essential even in a world where it seemsand
isimpossible ever to care adequately for all needs. A huge burden on individuals
accompanies the North American view that caring is psychological, a private attitude
possessed by certain persons. We no longer understand our connection, however
tenuous, with moral sources and communities of care and, so, see ourselves as stoically
shouldering the concerns and labor on our own.
In the best caring practices both the community and the individual serve and are
preserved. In narratives of excellent practice there is
Page ix
an ethical discourse of learning that goes both in the direction of the one caring and that
of the one cared for. Caring relationships set up the possibility of mutual realization, not a
power discourse in which one person gives, helps, and does not learn from the other,
while the other person merely receives and learns. The reader will see in the narratives
many instances in which the caregiver learns and is transformed by the caregiving
relationship. Such encounters teach much about our shared humanity and the spiritual
dimensions of assisting fellow human beings in the midst of suffering, loss, and living the
finite gift of life. Those receiving care are called upon to trust and appropriate the help
that is offered. That, too, requires attentiveness, attunement, learning, and the
relinquishing of obstructive control for the sake of care.
In our culture of independence and self-determination, the practices of opening oneself to
another's care are even more emaciated than those of giving it. As Robert Wuthnow
points out in Acts of Compassion (1991, p. 175; see Bellah's discussion of this in his
chapter), we are people who remember Jesus' story of the Good Samaritan in "its
subjective, individual, and moralistic aspects." We identify ourselves with the hero whom
we see as acting outside of a community of care. We do not like to think of ourselves
lying helplessly by the side of the road. However, we all do rely on the kindness of
strangers and others, and the restoration of caring practices involves recognizing what it is
to enter relationships of care that undermine radical independence and self-determination.
We, the editors, have learned much from the authors of this book and from those who
have become part of the community of conversation around this project. Because much
of the material in this book comes from personal experience and heartfelt commitments,
we have been moved by the trust of those writing on these pages.
This book grew out of conversations among many people at New College Berkeley, a
small graduate school for the laity, affiliated with the Graduate Theological Union in
Berkeley, California. Since the late 1970s New College Berkeley has been a locus of study
and dialogue for scholars and helping professionals interested in reflecting on everyday
life and practice in the light of faith. The courses sponsored by NCB have displayed a
breadth and depth of interest and reflection mirrored in this book. NCB courses have
been a place where personal narratives have been considered rich sources of
Page x
knowledge, both metaphysical and ethical. We trust that this book will be useful for
courses and discussions where the goal is to examine the everyday challenges of living
out an ethic of care.
The editors of this book met through New College Berkeley seminars and community
gatherings while we were both graduate students at the University of California, Berkeley.
At NCB we found a community in which to explore the spiritual and moral dimensions of
our scholarly work. While our professional lives have diverged during the past years, we
have sustained these conversations through friendship and through NCB.
We express our gratitude to the New College Berkeley community of scholars that has
supported and shaped this work in numerous ways; specifically, to Richard Benner, Joel
Green, Frank and Lois Andersen, David Gill, Bill and Grace Dyrness, Laurel and Ward
Gasque, David Batstone, Margaret Alter, and many others. While an explicitly Christian
institution, we have experienced New College Berkeley as a school and community with
sufficient faith to open conversations wide and allow wisdom and goodness to enter
through many channels.
We also must acknowledge the teaching and writing of Robert Bellah, Hubert L. Dreyfus,
Jane Rubin, and Charles Taylor who have supported this work with their ideas and their
encouragement. For intellectual challenges and financial support we are indebted to James
Wind and the Lilly Endowment Inc. Much gratitude is due John Samples of Georgetown
University Press who understood the significance of this work for ethics and public
policy.
There are others who have enabled us in this work and deserve mention here. Maryann
Aberg, David Anderson, Mima Baird, Robert Bevier, Charles Eaton, Sharon Gallagher,
Bill Ghirardelli, Carrie Ghirardelli, Suzanne Gordon, Kim Hamilton, Abby Heydman, Bill
Jersey, Bonnie Johnston, Sister Mary Brian Keller, Amy Keltner, Jeff Lazarus, Victoria
Leonard, Leonard Nielson, Ellen Ogle, Earl Palmer, Kate Peterson, Carole Rudy, Harriet
Smith, Josephine Wood Smith, Lee SmithBattle, David Soister, Don Strongman, Mary
Thompson, Janet Visick, and others helped us think about a conversation among the
helping professions and encouraged us when the work seemed daunting.
Bill Visick was a special friend and source of encouragement during the shaping of this
book. He cared for us and taught us about faith, hope, and love. Throughout the three
years of work on this