Conclusion

In a variety of settings—mythological, religious, philosophical, psychological, theological, moral, and practical—the notion of care has developed throughout history, influencing moral orientations and behaviors. The tasks for the future will be to more fully understand the richness and complexity of the history of the idea of care, do justice to the texts that have imaginatively portrayed it and the thinkers who have made this idea central to their work, and enter into dialogue with them.

This history reveals, not a unified idea of care, but a family of notions of care. Yet it is a fairly closely related family, for the ideas of care are united by a few basic sentiments, some formative narratives whose influence stretches over time, and several recurring themes. Furthermore, in the history of the English word care, this single word serves a range of meanings but with a subtle coherence.

The meanings of the word care fall into four clusters. The basic meaning is associated with the origins of the word, which are found in the Middle High German word kar and more remotely in the Common Teutonic word caru, meaning "trouble" or "grief" (Simpson and Weiner, pp. 893-894). Correspondingly, the primary meaning of the word care is anxiety, anguish, or mental suffering. A second meaning of care is a basic concern for people, ideas, institutions, and the like—the idea that something matters to the one who is concerned. Two other meanings of care, sometimes in conflict, are found at a more practical level. One is a solicitous, responsible attention to tasks—taking care of the needs of people and one's own responsibilities; and the other is caring about, having a regard for, or showing attentive care for a person, for his or her growth, and so forth. In a sense, all the meanings of care share to some extent a basic element: One can scarcely be said to care about someone or something if one is not at least prepared to worry about him, her, or it. The truly caring health professional is one who worries about—is concerned about—his or her patients, especially the patients who cannot take care of themselves.

Several distinctive features stand out in this history of care. The metaphysical and religious dimensions of care appear forcefully and repeatedly in history, emphasizing that care is essential to understanding humans and the human condition. The history of care shows that, at one level, care is a precondition for the whole moral life. It also manifests various frameworks for an ethic of care, including evolutionary ethics, virtue ethics, an ethic of growth, an ethic of response, and duty ethics, yet one does not find a formal and systematic ethics of care in the sources examined.

Repeatedly in this history one encounters a dialectical element in which pairs of ideas of care struggle against each other: care as worry or anxiety versus care as solicitude; the care that enables growth versus the effort to care that robs a person of self-care; or taking technical care of the other versus caring about the other. There is much to learn from history about the dark side of care and how humans might deal with it.

A key historical puzzle is why the notion of care has not become better known and has not exerted more influence in ethics, in view of its highly significant, if somewhat limited, history. The answer lies, in part, in the fact that care has always been a minority tradition of thought and practice. As this survey exemplifies, care is a deeply engaging emotion/ idea that has confronted and challenged rationalist, abstract, and impersonal systems of thought, with far-reaching social, political, ethical, and religious implications. In this sense, care has had a countercultural role.

More recently, care may be acquiring a "mainstream" importance, especially in the area of the ethics of healthcare. The following two entries will show how some elements in the history of the idea of care have become ingredients in an emerging ethic of care in the context of healthcare, while other historical elements have been overlooked.

All ethics assumes a vision of the human condition. The ethics of care rests on a vision of the capacity to care or be concerned about things, persons, a whole life-course, a society, one's self. The history certainly is not compatible with reducing care to caregiving. The Myth of Care suggestively offers a care-based genealogy of morals that is deeply ingrained in human psychology, anthropology, religion, and altruistic service. The philosophical and psychological developments in the idea of care have built on this basic vision of being well cared for. That the history of the idea of care also suggests many practical ideas—for example, the call and the limits of taking care of others; dealing with the negative side of care; and the intergenerational function of care—makes it all the more useful for a contemporary ethic of care.

WARREN THOMAS REICH (1 995)

SEE ALSO: Alternative Therapies; Beneficence; Chronic Illness and Chronic Care; Compassionate Love; Feminism; Human Dignity; Long-Term Care; Nursing Ethics; Obligation and Supererogation; Paternalism; Professional-Patient Relationship; Women, Historical and Cross-Cultural Perspectives; and other Care subentries

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