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The Ethics of Care

And so 2023 is upon us. Whether we are fatigued, ready, still traumatised, here we go…

I cannot help asking myself what would mobilise the world to consider the care of older and vulnerable people an ethical, or indeed, a human rights issue. What will it take to change the way that older people and people living with cognitive impairments are treated within Care Homes? When will we see that medication is mostly used as a chemical restraint and that many of the standard practices are indeed serious human rights infringements? What will it take to open our hearts and minds to genuine human caring, treating every older and vulnerable person the way that we would like to be treated? What will it take?

Prof Arthur Kleinman delivered this poignant lecture at UCT medical school a few years ago. I will never forget him saying that it was only once he became the Carer for his wife living with dementia that he truly began to understand what “caregiving and goodness” really mean. It would seem that in his case the true understanding settled once and for all when he himself became the vulnerable Caregiver for someone whom he loved. I was in high school when I had to help my grandfather get dressed because he could no longer do this himself as a result of his cognitive impairment. To this day I remember the texture of his skin, his smell, the whiteness of his skin and the rough hands as the result of a life of gardening. His arms and legs were stiff, it was not easy to get his clothes on. But most of all I remember the look in his eyes – the deep sense of vulnerability, of total surrender.

Prof. Andries Baart is the father of the theory of presence. For him, presence is about a specizc way of caring, and indeed caring in a relational way, starting to know the person. The reason why I could care for my grandfather in the most humble and loving way, is because of the relationship that we fostered over many years, and the reciprocal relationship of love. This is not easy in a formal care setting, where there is so little time and so few people to perform tasks. I do however believe that it is possible to do so if we start to focus on our own contextual and relational situatedness within care home settings.

The Care Home setting is a relational setting. Every person within this setting is part of a relational network – they are mothers and sisters and children and partners. If we can create a context within which relationships are honoured, respected, acknowledged and celebrated, it will be so much easier to create an environment in which true relational care, with presence, is possible. This would however be dependent on the approach that we take, not necessarily on the “training” that we do… But what does this mean in practice? It means that we have to develop an approach to people that is different from the institutional setting in which people are classized according to job descriptions and diagnoses, where we are in relational care partnering with people, not with “patients”.

Why is this so difzcult when it sounds like the most logical thing on earth? Can we not just use a “method” that everyone can copy and paste? Sadly not. It requires a deep transformation of the way that we approach every person and every act of caring. This will only happen in creating true, authentic and meaningful relationships.

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