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The importance of Trust in Care as a Practice

Finally – a post that’s relevant to my research. It’s my first one, so go easy one me. This brief post on the ethic of care considers the relation aspect of practical care-giving, and questions whether the important factor that does the work is actually the existence of trust between the cared-for and care giver. This is very much a work in progress. Interested parties are welcome to comment, but please do not cite without the author’s permission.

The importance of Trust in Care as a Practice

Care ‘work’ occurs when we help another to meet their needs, especially where this would be impossible or very difficult without our assistance. But writers disagree about what activities should count as care work. Least disputed is the labour associated with particularly familial healthcare and child care: caring for children, temporarily sick, long-term disabled and elderly infirm. But a paid child-minder might alternatively be seen as primarily providing a service to parents (despite also providing care to children).

Clement describes care as taking:
place in the context of a personal relationship between caregiver and recipient. Second, the care worker acts to promote the well-being of others. Finally, the care worker is typically motivated in her work by a feeling of concern for the for the recipients of care. (Clement 1996, p.56)
Clement claims care work requires firstly a ‘personal relationship’ between carer and cared-for, and secondly that it enhances the well-being of the cared-for, and is thirdly (partially) motivated by a caring attitude, or concern for another’s well-being.

It is worth considering what we mean by ‘personal relationship’, as this seems to imply the richness of long-term, well-acquainted companionship. For example, suppose someone waits hours in a minor injuries facility before seeing a doctor for less than two minutes. The doctor advises them to take painkillers and not to worry. The doctor assessed the symptoms before giving advice and reassurance, and in my view the doctor provided care. Perhaps this can be said to be a normal patient-doctor relationship, but not a ‘personal relationship’.

A person directly providing care to another will have some kind of at least brief, basic interaction with the person they are caring for. In providing and receiving care, a superficial relationship is enhanced: we know slightly more about each other than we otherwise would have. But if we decide to count this as a relationship sufficient for care, this seems more as a result of the care, rather than a necessary condition for it. Had the patient not presented for treatment, there would have been no relationship at all.

But for small, one-off acts of caring we do not find the continuity that we might expect in a personal relationship: only a very thin relationship (some minimal interaction to determine needs and appropriate responses) is required. However, while I believe a personal relationship in all its implied richness is unnecessary for small care acts, I agree that ‘caring is necessarily relational’ (Tronto 1995, p.102): our acts must be directed towards an object, someone we provide care for and are concerned about.

For ongoing care, this relationship must deepen, as care-giver and care-receiver become better acquainted.. These deeper, personal relationships require greater levels of trust between the cared-for and care-provider, as this is necessarily a relationship of unequal power. The care-receiver is dependent on the carer, and particularly vulnerable to a long-term carer. Good care must also be trustworthy. It is this trust, a necessary ingredient for a relationship of any kind to develop, that we should see as fundamentally necessary to a caring relationship between the cared-for and care-recipient.

Small one-off acts of care may lead to the development of a caring relationship, but in most require just enough trust between the parties to allow the caring to take place: the cared for person must trust enough to accept the care offered. This small spark of trust will develop with ongoing care, as the care-giver must demonstrate themselves to be trustworthy. I need only trust the doctor in the emergency room to provide me with care (rather than, say, take my wallet or assault me) once. But I must trust my family doctor every time I make an appointment.

It might be argued that trust cannot be considered a necessary requirement for practical care to take place. Ambulance crews provide life-saving care to many patients who are unconscious and unable to demonstrate trust by actively accepting the care offered. But this complaint also holds for relationship requirements. A patient arriving in the emergency ward unconscious cannot be said to have a relationship with a doctor they have never met, any more than they can be said to trust the doctor or consent to treatment. In this unusual case, we presume consent, but I believe we are importantly presuming trust as an essential part of the presumed relationship with the doctor.

This is very much a work in progress. Interested parties are welcome to comment, but please do not cite without the author’s permission.

Bibliography

Clement, G., 1996. Care, autonomy, and justice : feminism and the ethic of care, Boulder, Colo.: Westview Press.

Tronto, J.C., 1995. Women and Caring: What can Feminists learn about moraility from Caring? In V. Held, ed. Justice and care : essential readings in feminist ethics. Boulder, Colo.: Westview Press, pp. 101-116.

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