Historical Perspective of Ethics of Care

There is vague and indescribable meaning is attached with the word care, which is interchangeably used for caring, compassion, humanitarianism, altruism, beneficence, or philanthropy. â€Å"For where there is love of man (philanthropia)’, reads a famous passage in the pseudo-Hippocratic treatise Precepts (Precepts, 6),†there is also love of the art (philotechnia)[1]. The term â€Å"philanthropia’, means literally ‘Love of Mankind, original meaning of the word was the benevolence of the god for man, this is the term used for Care. Sir William Osler saw in this maxim evidence of Greek physician’s ‘love of humanity associated with the love of his craft-philanthropia and philotechnia-the joy of working joined in each one to a true love of his brother. ’[2] Plato, in the Republic (Republic, 340, C-347 A) raised a question on self- interest is the motive behind all human efforts, especially political activity. Galen, in a work entitled on the Doctrines of Hippocrates and Plato, discusses this specific passage from the Republic, after summarizing it he mentions â€Å"Some pursue the medical art for the sake of money, others for the exemptions granted by law, certain ones on account of Philanthropia, just as others for the glory or honor attached to the art. Hellenistic and roman thoughts on philosophic and popular ethics were also influenced by the humanitarian and cosmopolitan ideas. After the for the century before Christ the word philanthropic came to used the expression of comprehensive love of mankind and a common feeling of humanity. This may be the result of Alexander’s conquest of the East or for lessening importance of individualism of the fourth century. Edelstein quotes that the morality of outward performance characteristics of the classical era was now supplemented by the inner intention. The word Philoanthropia is frequently used by Christen writers but not mentioned that often in new Testament, the word used is agape meaning ‘God is love’. There is gap between these two words as the dynamic of Ethics. Christen Philanthropy means practice of love, mercy and justice are vital element in the worship of God (Micah 6:6-8). Henry Sigerist has viewed about Christianity, he writes’ the most revolutionary and decisive change in the attitude of society towards sick. Christianity came into the world as the religion of healing, as the joyful Gospel of redeemer and of Redemption. It addressed itself to the disinherited, to the sick and afflicted, and promised them healing, a restoration both spiritual and physical. It became the duty of Christian to attend the sick and the poor of the community’. Here the word â€Å"Care’ has got its meaning. Rannan Gillion's statement ‘Mature medical morality has since Hippocratic times incorporated at its centre a moral concern for nurturing and care for its sick patients; meeting the needs of sick patients has been the moral driving force of medical ethics since its inception. Lord Walton describes how Christianity decisively influences the Hippocratic tradition. Doctor-Patient relationship was taught all by Hippocrates, Socrates, Palto and Aristotle. The fundamental to this concept of Doctor- Patient relationship was the concept of philia, used both for the art of medicine and patient. Based on the same idea, this was further developed by the Greek doctor, the relationship developed for the patients that was first influenced first by the love of mankind and second by love of his art of medicine. Despite the belief, there was differential treatment for people based on their status, care to the patient was abstract, not the individual patient, Greeks only seemed to consider discussions on life style and cause of disease to benefit the rich, this was not appropriate for poor and slaves. This was thought that it was unethical to treat deadly disease, for this challenge nature and the doctor would risk paying the penalty. Thus in the Hippocratic tradition the doctor did not treat the incurably sick or terminally ill and he made the judgment in that no doctor would treat anyone leading an immoral life. But in Christianity love for man in nature was transformed into love for thy neighbor and doctor was to treat all patients irrespective of class, stratus, and ability to pay. The work of doctors also involved the care for all sick and consolation of the terminally ill. So Care was a prerequisite for both the development of nursing and medicine, which embraces the quit essential purpose of care. Murdoch perceives to be the warmth and coldness in the morality; it is there are Buber's I and Thou, which has rejected by Noddings. The detached rationality of duty and responsibility is held together with the warmth of love and compassion by virtue of their meeting in God. Buber argued giant Carl Rogers, in a professional relationship, in which one partner has needs which other does not, in which one person comes for help to others, the genuineness of relationship depends upon the maturity which is greater than both partners. The relationship with care taker and giver can be temporary and unequal, necessary detachment is its strength . security and protection for the vulnerable. Objectivity and necessary detachment need to be combined and balanced with the subjectivity and warmth of fellow feeling as true compassion. Here is the meaning of agape, the Judeo-Christian concept of altruistic love, stemming from the all-embracing Thou, the root of Buber's understanding for the me and the you in human relationship. Kant also does not escape the grounding of Judaeo-Christian tradition. His view of morality is influenced by it. Kant although chooses to try and escape the theological imperative and ground his categorical imperative in human rationality alone, as a result of this his moral position could not be grounded. We need to question both extentialist, Noddings and rationalist Kant about † why', why should we care? Nietzsche asked the same to Kant's approach. If our moral outlook is independent of external and objective norms-or perhaps s Gilligan suggests, we become more mature and less abolitionist in our moral understanding – then the effect it is up to us to make our own morality, in that case one is better than other, this is the matter of personal preference. Nietzsche emphasized on personal empowerment, by getting rid of all the constraints of traditional morality that held them back from actualizing their true potentials. . As per them, God is Myth, so the idea of morali ty influenced by the outdated notion should be thrown off. The restriction imposed by the Judaeo-Christian should also be thrown off and one new to take his/her life the way one wants. Nietzsche calls for re-definition of the values and concept of care. As per their view ‘ The sick man is a parasite of society. In a certain stage it is indecent to live longer. To go on vegetating in cowardly dependence on physician and machinations, after the meaning of life, the right to life, has been lost, that ought to prompt a profound contempt of society. It may be more ‘caring' not to ‘care'. The view of re-shaping of the values of society and attitudes of the members of society is further elaborated by the modernist and post modernist philosophy from Heidegger to Foucault. Ethics of Care in Islam In Islam the ethics of care is discussed . Professor Serour, discussing the Islamic perspective, recalls that the first known documents dealing with medical ethics are Egyptian papyri (16th century BC) in which, as long the doctor followed the rules, they were held to be non- culpable, should the patient die. If the doctor transgressed the rules and the patient dies, the doctor paid with his life. Hammurabi set fees according to the social status of the patient. Codes were laid down for physicians and surgeons. Serour cautions those who presume to judge acts of others from a different culture. Ethics is based on moral, philosophic and religious principles of the society in which they are practised. Ethics may differ from one culture to another. He also counsels those with a strong religious background to differentiate between medical ethics and humanitarian considerations on the one hand and religious teachings and national laws on the other. What is legal might not be ethical. The law rarely establishes positive duties such as beneficence and can be, and is, used not only to deny justice but also to deny respect to persons and to do harm. Serour emphasises that ethical norms are guidelines. The context must govern judgement. He adds a fifth principle: The human being should not be subject to commercial exploitation. Islam is governed by the Sharia which, in turn is based, in chronological order, on the Holy Quran (the word of God), the Sunna and Hadith (sayings of the Prophet Mahomet developed by jurists), the unanimous opinion of Islamic scholars or Aimma (Igmaah) and finally, by analogy (Kias). If an instruction on a certain issue is provided in the Quran, it is the one to be followed. Islam permits flexibility, adaptation to the necessities of life and shifts in ethical stands based on the current culture. Dr. K. Zaki Hasan describes Unani medicine as a synthesis of the ancient Greek, Indian and Persian systems. Its practitioners, along with the teacher and cleric shared a common role and culture with a primary social, not monetary, objective. Indian philosophers on Ethics of care: Indian philosophers consider the ethical implications of the Indian classical theories of Karma(Action and Habit) These theories usually proposes rebirth – that is , reincarnation in a human or animal form, in this world rather world, Since, on the presumption of karma, the nature of one's deeds determines one's future state, the universe includes laws of moral payback. Indian classical philosophers weave numerous variations on such views into the overall stances, including Budhdhist,Vedantic, Logis and Carvaka views Ancient Indian thoughts, philosophy developed with rational synthesis , spirituality was the foundation of Indian culture. The fundamental basis of ethics arises from the Hindu belief that we all are art of the divine ‘Parmatman’. According to Vedas(4000 BC to 1000 BC), the call to love your neighbor as yourself is â€Å"because they neighbor is in in truth they very self and what seperates you from him is mere illusion(maya). Closely allied to Hinduism are Budhdhism and Jainsim. These religion proclaim â€Å"Ahimsa† as ‘Saarvatha sarvada sarvabutananz anabhidroha,’ a complete absence of ill-will to all beings. The ultimate aim is for our Atman to coalesce with Parmatman or Brahman to become one. According to the Vedas (4000 RC to 1000 BC), the call to love your neighbour as yourself is ‘because thy neighbour is in truth thy very self and what separates you from him is mere illusion (maya). ’ Closely allied to Hinduism are Jainism and Buddhism. These religions proclaim Ahimsa Paramo Dharma. Most important of all our actions is alzinzsn, non- violence. Patanjali defined ahimsa as Sarvatha sarvada sarvabutananz anabhidroha(1) , a complete absence of ill- will to all beings. Ayurveda is the ancient science of life. It lays down the principles of management in health and disease and the code of conduct for the physician. Charaka has described the objective of medicine as two fold; preservation of good health and combating disease. (2) Ayurveda emphasised the need for healthy life- style; cleanliness and purity, good diet, proper behaviour, and mental and physical discipline. Purity and cleanliness were to be observed in everything: jalasuddi (pure water), aharasuddi (clean food), dehasuddi (clean body), manasuddi (pure mind) and desasuddi (clean environment). Ayurveda calls upon the physician to treat the patient as a whole: ‘Dividho jayate vyadih, Sariro manasasthatha, Parasparanz tavorjanma, Nirdvadvam nopalahhyate. (Diseases occur both physically and mentally and even though each part might be dominant, they cannot be compartmentalised). Ayurveda treats man as a whole body, mind and what is beyond mind. The earliest protagonists of Indian Medicine, such as Atreya, Kashyapa, Bhela, Charaka and Susruta have based their writings on the foundations of spiritual philosophy and ethics. But the one teacher of Ayurveda who established the science on the foundation of spirituality and ethics was Vagbhata, the author of Astanga Hridaya(3) . Vagbhata says:Sukarthah sarvabutanam, Matah sarvah pravarthayah, Sukham ca na vina dharmat, thasmad dharmaparo bhavet_( All activities of man are directed to the end of attaining happiness, whereas happiness is never achieved without righteousness. It is the bounden duty of man to be righteous in his action). Charaka Samhita prescribes an elaborate code of conduct. The medical profession has to be motivated by compassion for living beings (bhuta- daya)â€Å". Charaka’s humanistic ideal becomes evident in his advice to the physicians’. He who practices not for money nor for caprice but out of compassion for living beings (bhuta- daya), is the best among all physicians. Hard is it to find a conferor of religious blessings comparable to the physician who snaps the snares of death for his patients. The physician who regards compassion for living beings as the highest religion fulfils his mission (sidhartah) and obtains the highest happiness.