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Ethics and Social Welfare

ISSN: 1749-6535 (Print) 1749-6543 (Online) Journal homepage: http://www.tandfonline.com/loi/resw20

To care or not to care a narrative on experiencingcaring responsibilities

Karin van der Heijden, Merel Visse, Gerty Lensvelt-Mulders & GuyWiddershoven

To cite this article: Karin van der Heijden, Merel Visse, Gerty Lensvelt-Mulders & GuyWiddershoven (2016): To care or not to care a narrative on experiencing caring responsibilities,Ethics and Social Welfare, DOI: 10.1080/17496535.2015.1124901

To link to this article: http://dx.doi.org/10.1080/17496535.2015.1124901

Published online: 14 Jan 2016.

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To care or not to care a narrative on experiencing caringresponsibilitiesKarin van der Heijdena, Merel Visseb, Gerty Lensvelt-Muldersb and GuyWiddershovenc

aSaxion: Research Centre for Community Care and Youth, University of Applied Sciences, Enschede, TheNetherlands; bChair Ethics of Care, University of Humanistic Studies, Utrecht, The Netherlands; cDepartment ofMedical Humanities of the EMGO Institute for Health and Care Research, VU University Medical Centre,Amsterdam, The Netherlands

ABSTRACTThis paper explores caring responsibilities in everyday life by athorough investigation of the lived experience of one woman,called Eva. We reflect on Eva’s relational experiences in taking careof her own life and in relating to situations and events which moreor less are the result of the relational web in which she is situated.Her narrative shows that for her, caring requires a relationship inwhich moral intimacy can be experienced. Therefore, caringresponsibilities rather inflict ambiguous personal struggling aboutreciprocity, vulnerability and openness in her relationships thanabout tension between care for herself and care for the other.Developments in our social and healthcare systems which result intransfer of caring responsibilities towards citizens, require therethinking of concepts of responsibility, care and relationality.Empirical data concerning everyday life may contribute to a betterunderstanding of the complex and dynamic process of personaland particular interpretations of caring responsibilities.

ARTICLE HISTORYReceived 7 July 2015Revised 3 November 2015Accepted 11 November 2015

KEYWORDSMoral philosophy; ethics ofcare; caring responsibilities;social and healthcare system;narrative

1. Introduction

Rapid changes in our Western society demand us to increasingly take responsibility to carefor one another and for oneself, instead of expecting our social welfare state to take care ofus. Health and social care institutions are transferring caring responsibilities towards citi-zens, they close their doors and care in the community is becoming more commonevery day. As a consequence, we find ourselves in multiple roles: we are simultaneouslycaregiver, care receiver, ‘designers’ of our lives whilst simultaneously succumbing toevents that happen to us. As a consequence of these developments in our social andhealthcare systems, we need to rethink concepts of responsibility, self-realization andliving a ‘good’ life. Whilst self-realization was considered to be a central value in ‘creating’one’s own life, in our late-modern society, to live a ‘good’ life, individuals can no longer beseen as autonomous agents who individually choose to whom or what they relate, andwhat their responsibilities are. Care ethicists are aware of the challenges of practicingautonomy and self-realization. They work from the insight that theoretical conceptualiz-ations should be enriched or, more radically, inductively developed by studying the

© 2016 Taylor & Francis

CONTACT Karin van der Heijden kvdheijden@planet.nl

ETHICS AND SOCIAL WELFARE, 2016http://dx.doi.org/10.1080/17496535.2015.1124901

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daily practices of people. Care ethicists acknowledge our dependence on others and howwe find ourselves embedded in a variety of human groups (Goodhart 2014; van Nistelrooij2014; Visse, Abma, and Widdershoven et al. 2014). This critical insight is based uponempirical studies that inform us about how people reflect on caring responsibilities indaily life (Abma et al. 2005; Landeweer 2013; Author et al. 2014).

This paper explores caring responsibilities in everyday life by a thorough investigationof the lived experience of one woman, called Eva, in balancing taking care of herself andothers. For Eva, a good life, a caring life, can be seen as the outcome of a complex rela-tional process that she can only partly control from an autonomous stance. It is intrinsicallyintertwined with the relations one has with others and the responsibility for oneself andother people, which are always contextual and in need of negotiation (Walker 2007).We reflect on Eva’s relational experiences in taking care of her own life and in relatingto situations and events which more or less are the result of the relational web in whichshe is situated.

With this paper we aim to enrich care ethical theories and to contribute to the socialpolitical debate on caring responsibilities of citizens of Western and late-modernsociety. The ethics of care can entail ethical reflection on professional practices and careethicists have been encouraged to undertake empirical studies in healthcare practiceswith professionals, patients and their next of kin (Klaver et al. 2013, 6). The ethics ofcare highly values personal and particular understanding from a lived experience pointof view (Klaver et al. 2013), and that is why we start by focusing upon a singular case(Simons 1990). We will illustrate that the process of understanding the web of caringrelations in the context of a particular life is primarily a hermeneutical endeavour: itgoes beyond ‘grand narratives’ based on philosophies, principles or guidelines on whatcourse one should follow to live a good life, and puts small, practical rationalities at thecentre. In the next section we describe our theoretical stance and the methodology wehave used constructing and analyzing the singular narrative of Eva. Subsequently, Eva’snarrative is presented. We critically analyze Eva’s relational experiences in taking care ofher own life and in relating to situations and events which more or less are the result ofthe relational web in which she is situated. The article ends with a discussion in whichwe link our analysis to the recent discussions in care ethics and social debates on citizen-ship and caring responsibilities.

2. How to live from a care ethical stance?

The question ‘how to live’ has always been a dominant theme in ethical thinking. To aimfor a good and meaningful life is conceived to be innately human. A classic example of anethical theory elaborating on this question is Aristotle’s Virtue Ethics. In a virtuous life anindividual succeeds in perfecting his or her natural disposition (Aristotle, Pannier, andVerhaeghe 1999). In our Western society the question ‘how to live’ has not always beenunderstood from an individual perspective. For centuries the question has been answeredfrom a common Christian framework. How to live a good life was then dictated fromoutside, or if you like, from above. The individual had to live his or her life according domi-nant Christian values, of which care for the other was an essential one. Influenced by theEnlightment thinking, the classic ideal of a good life had been rediscovered. In the philos-ophy of Plato, Diogenes and Epicurus, a good life was a life in which the individual

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intervenes in his or her existence and consciously strives for a good life (Schmid 2001, 9).Modern exponents of such an individual life philosophy are to be found in existentialistphilosophy. Nietzsche wrote, for example, that the individual has to overcome his- orherself, to restrain him- or herself from the prevailing morality, and has to battle for hisor her individual life. Nietzsche’s Wille zur Macht means that one has to draw up particulargoals with one’s own autonomous will, to create his or her life. The individual lives his orher life as such that if need be, he or she would endlessly repeat it, Ewige Wiederweheren-den des Gleichen (Nietzsche and Hawinkels 1979; Nietzsche, Graftdijk, and Würzbach 1992;Nietzsche and Oranje 2006). For Sartre, life is a project in which human beings have to con-stitute their individual existence. All individuals are free and have to decide at their owndiscretion. Neither the Other nor the situation in which one finds oneself in, can maderesponsible for individual choices (Sartre and de Haan 2003, Sartre et al. 2007).

In our contemporary world however, living a good life according to a common Christianframework has not completely disappeared but it is no longer obvious to rely on commonframeworks, principles or guidelines per se. From the 1970s Foucault explicated this indi-vidual agency by an ethic of self-care based on the classic ideal of the Art of Living. In hisethical thinking, care for the self was a combination of reflection and practical action togain individual freedom and autonomy in order to create one’s one life (Dohmen 2009,45). In moral philosophical thinking, this resulted in a shift from emancipation strategiesto life politics. In line with that, several philosophers have elaborated theories about theart of living since the beginning of twenty-first century (Bieri 2012; Hadot and Pennings2003; Kekes 2002). These theories aimed to answer the question of how we should indivi-dually take care of our own lives. Autonomy, freedom and rationality of choices were con-sidered to be central values in ‘creating’ one’s own life. Several authors question the ideaof independence which can be found in these theories (Dohmen 2009; Schmid 2001) orstress the vulnerability and interdependencies of the human being (van Tongeren 2012;Tronto 2013; Walker 2007). The ethics of care entails notions of interdependence, vulner-ability and the human being as a relational being (van Nistelrooij 2014; Tronto 2013; Visse2012). From a care ethical perspective, a good life cannot be prescribed by followingcertain principles or guidelines, but is seen as the outcome of a complex relationalprocess that people can only partly control from an autonomous stance (van Nistelrooij2014; Walker 2007). Some ethicists disagree with the rejection of principles by care ethi-cists and plea for a more dialogical stance: the good is to be acted upon is not decidedin advance but rather critically discussed and established within the encounter of theparties involved (e.g. Rudnick 2001). Our interpretation of care acknowledges this dialogi-cal stance and is based on interconnectedness and interdependence (Hamington 2004, 3).Autonomy is not seen from a monological perspective, but from a relational, dialogicalperspective. Often it is assumed that the person who cares for another person is auton-omous, whilst the person who receives care, loses autonomy. From a care ethical perspec-tive, however, autonomy, can also be lost because one cares, due to the identification withthe other who is involved in offering care (Kittay 1999) and gained while receiving care. Agood life is intrinsically intertwined with the relations one has with others and with theresponsibility for oneself and other people, which are always contextual and in need ofnegotiation (Walker 2007). From a care ethical stance the actions that emerge in these situ-ations are preceded by complex sets of the intertwined identities and values of the peopleinvolved. In care ethics, people are not demarcated ‘selves’ with clear responsibilities.

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Being, or becoming, responsible can be a challenging quest involving processes of moralunderstanding (Walker 2007). Care as an activity and a practice (Tronto 2013) plays acentral role in this—not care as a moral approach, but care as an orientation on thegood life. Care is not only considered a fundamental human need or an attitude, coveringall domains of life, but a social practice. Hence, a good life equals a caring life.

In this article we work from the care ethical notion of relationality and stress that onehas to relate to situations and events which more or less are the result of the relational webin which one is situated. We focus on caring responsibilities as a key element of taking careof one’s own life, and on which relational conditions are demanded regarding care forothers in daily life.

3. Approach and method

The paper is grounded in hermeneutic philosophy (Gadamer 1975). Ontologically, thispaper works from the hermeneutical notion that there is no objective world ‘out there’,no split between subject and object, but subject and object are closely intertwined anddialogical. Epistemologically, knowledge is not absolute but relational and emerges outof the interactions of people within their social practices. Gaining knowledge is seen asenhancing understanding on what occurs in their lives. In other words, people searchfor how to make sense of unfamiliar situations and do that by relating them to whatthey already understand (Gadamer 1975). This is a process of interpretation of experiences.People interpret experiences, either out loud with other people in the social practices theyfind themselves in, or in communication with non-living things (e.g. a painting a canvas)and through inner dialogue. Who people are; how they interpret the events and situationsin their lives, and how they perceive themselves, is not predefined. Their identities,relations and the meanings gradually emerge and change through processes of (socialand non-social) interaction (Gadamer 1975). From a hermeneutic stance, interpretationis not an ‘interior’ undertaking but it is interwoven with encounters with others or otherevents, things and situations. The achievement of understanding is not a methodology.Instead, interpretation can be seen as a way of ‘being in the world’ (Schwandt 1999).

To understand how people care, and think they should care, and how far, according tothem, caring responsibilities should reach, Walker introduces three kind of narratives:narrative of identity, narrative of relationship and the narrative of values. Narrative under-standing is a central key for making sense of what someone has done, what she caresabout and what she values (Walker 2007, 116–122). Particular understandings showhow they make sense of their own and others’ responsibilities in terms of identities,relationships and values (Walker 2007, 10–11). These three narratives cannot be seen com-pletely separated from each other: our identities can only have been developed amidstother people, and our relationship with the other and the character of it reveals theissues we do or do not value (Walker 2007, 119).

Methodologically, the paper explores the moral and practical deliberations of oneperson living her life in a singular case study of a 44 years old Dutch woman we callEva (not her real name). Eva’s narrative was chosen because of its ‘learning potential’for our research question on how to live a good life (Abma and Stake 2014; Simons1990; Stake 1995). Eva’s narrative contains several tensions that inform us on how she con-tinuously examines her life; how she understands and values her relationships to other

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people; how she learns about what she values, and how she learns about which values sherejects (Voogt 1990). Eva is a woman who, since her childhood is used to reflecting on thesituations and events in her life and as a result of that, was able to articulate her experi-ences in a detailed way. We chose Eva’s story over other care stories for this paperbecause it is exemplary for personal struggling with caring responsibilities, and illustratesthat in a particular history and context, changing positions in relationships entail certainpersonal questions: in Eva’s case about values like reciprocity, vulnerability, intimacy,equality and openness.

Eva’s case has been chosen from an extensive research project that studies 11 middleaged women by individual in-depth interviews. These women have been selected becauseof their experience in life, their education and profession and the different roles and pos-itions in life (partner, parent, daughter, friend, professional, volunteer, and so on). Theywere asked to narrate their life stories and subsequently, these stories have been usedas input for dialogues. The interviews took place according the BNIM (Biographic NarrativeInterpretive Method) (Wengraf 2001, 2011). The BNIM is an open method developed tocollect life stories through in-depth interviews. The interview according to BNIM dividesinto two parts. In the first part the interviewer poses only one question (SQUIN—SingleQUestion aimed at Inducing Narrative). Through this question the respondent starts nar-rating. The interviewer does not disrupt the narrator nor does any other intervention takesplace. The interviewer takes notes of important issues. When the respondent indicates thathe or she has finished her story, a short break will follow. The interviewer uses this break toselect the items he or she would like to discuss in the second part of the interview. In thispart the interviewer invites the respondent to elaborate on these selected items. The inter-viewer asks the respondent about pictures, feelings, thoughts, memories of special inci-dents (Wengraf 2001, 2011).

The SQUIN posed to invite the women to narrate their live stories, was:

as you know, I am interested in life and in experiences of women, how women think and feelabout the things which happened in their lives and what these experiences mean to them.Could you please tell me the story of your life—all events and experiences which havebeen important to you, personally, until today?.

After reading the first interview using the holistic-content perspective (Lieblich et al. 1998),a first indication of particular existential concerns or life themes emerged. Next, theauthors subsequently coded and analyzed these themes in more detail (McCormack2000) to prepare the dialogue. In the dialogues the interviewer focused on the evolutionof thinking (assumptions, prepositions, ideas, motives and judgements) in order to discussimportant key values and their specific meaning for the individual respondents. No newissues or themes occurred during the dialogue. The interviews as well as the dialoguestook place at the respondents’ homes. The reason for visiting them at home was thatthe interview would take place in a safe and private environment. Moreover, as thewomen lead busy and active lives, it was most efficient and easy if she could stay athome. After the interviews, which were tape-recorded and transcribed in their entirety,an interpretative narrative analysis has been carried out by the first and second authors.The other authors critically reflected upon their interpretations and asked clarifying ques-tions, after which the interpretations have been adjusted. Interpretative narrative analysisinterprets the ways in which people perceive reality, make sense of their worlds and

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perform social actions (Lieblich et al. 1998; Riessman 2008). The analysis consists of foursteps and leads to a reconstruction of Eva’s narrative. First, the transcript is read severaltimes until a pattern emerges that informs us about main themes and experiences ofthe narrator. Then, the transcript has been open-coded. This means the researcherassigns themes and events that relate to the main question. Attention has been paid tofrequently used words, silences and how the respondent speaks about herself andother persons, for instance her relationship with her children and husband, and also to lin-guistic elements (discourse, metaphors). Next, a draft of the interpretation of the respon-dent’s narrative is written by the first and second authors. These authors discussed how toinclude narrative elements (time, space, beginning, middle and ending), and the balancebetween themes in the original data (transcript) and the draft. To enhance the quality ofour reconstruction and analysis, the other authors critically questioned the two firstauthors on their methodological decisions and interpretations.

In another procedure used to enhance the quality of our analysis, the interpretation ismember-checked with the respondent by asking her: does what we have written makesense to you? How does this account compare with your experience? Have any aspectsof your experience been omitted? A conversation between the first author and the respon-dent followed. The respondent agreed with the text and the narrative on her experiencethat is presented below. Following the constructed case closely we critically analysed howEva examines her life.

4. Eva’s narrative

Eva is a sparkling, active woman in her mid-forties settled with her husband and their threechildren, (girl 10, boy 8 and boy 5 years old) in a small city in the South of the Netherlands.She is a well-educated, professionally and socially involved woman who multi-tasks herselfthrough the ‘rush hour’ of her adult life. She enjoys her life amidst loved ones, friends andher colleagues and her professional life as a veterinarian. The story is an illustration of awoman who is used to question issues of life incessantly from an early age on. Interpretingher experiences became an integral element of her life: an attitude to get to understandlife as well as to think about values which concerns her. Raised as an only child in a quiet,intellectual homely ambiance she learned to discuss with her parents, who were both highschool teachers, in a conscious and intelligent way. With no religious framework to hookon, they taught her to think independently and challenged her to express her own values.Her experience as a child as ‘being alone’ might have given her an extra impulse todevelop these cognitive skills in order to stay connected with her parents. She interpretsthis mental connectedness as profound human contact, one of the dominant values sheidentifies later on in the narrative. Eva mentions that being raised as an only child in aquiet, intellectual homely ambiance means she needs to withdraw herself from othersfrom time to time to restore contact with herself. In her youth she could daydream forhours without being interrupted. Although she feels that almost nothing she didescaped her parents’ attention, she experienced a proper degree of freedom to act andto think for herself. She regrets the fact that she does not have any brothers or sisters.As a child she longed for that so much that she wrote ‘brother or sister’ on her gift listat the Santa Claus party: ‘Yes, now, what, what I can tell about that gift list is just thatevery year I, what I truly preferred was a brother or a sister’. Although her parents were

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very thoughtful and bought her a little dog to give her some companionship, she stillcould not dispute with siblings of her own age and still had to compete with herparents at home. She observes her position as ‘being alone’ and in a way as being an out-sider. For example, she perceives that on the one hand she verbally could not level withher parents, and on the other she used grown-up language compared to her classmates atschool. This made her feel ‘different’. Another impact of being an only child identified byEva was her urge to independence and freedom. Later in life, in the early years of herrelationship with her first husband, they shared this need for a certain level of freedom.This relational freedom entailed her for a kind of intellectual independence, a freedomof thought which is crucial for Eva. This kind of freedom brings connectedness in a waywhich is very familiar to Eva because her parents demonstrated it to her during heryouth. She calls it ‘profound human contact’ and might even consider it a way of takinggood care of the other.

Eva is still in touch with some of her friends from university. Being a student shedoubted if she would join a student society but when she finally decided to do so shereally enjoyed it. In this group, at that particular moment in her life, she seemed tohave experienced a kind of connectedness, friendship and moral intimacy that diminishesher urge to withdraw herself. It was a web of relationships which she experienced as beingproperly balanced and okay.

The relationship with her first husband changed completely when he was diagnosedwith a mental illness (bipolar). Eva explains that she had to leave him because ‘hetotally lived on me’ and that she could not live that way. Although she knows for surethat she took the right decision, it is still hard for her to accept it:

… that a part is what very, ehh, yes, that is, that is a part of my life, that is very deep down,hmm, that is, I carry that very much with me. Uhmm, yes and also my decision to leavehim back then, I still have difficulties about that as well but it was no longer possible, and Iwas not longer able to do it, he felt so far away from me. And, ehmm, well, I now actuallyhave to think, I also have at that time, I really got along well with his parents, I also lostthem in the process then, that they could not handle that I left him, well, actually alone.And I wrote them ehmm, half a year ago, well no, four months ago or so, after thirteenyears of no contact, I wrote them a letter because I thought, it is simply not possible thatwe will never contact each other anymore. That is not possible…

Later in the interview she recounted that in Belgium, where they lived at that time, shespoke to a civil servant in order to organize the hospitalization of her husband. Thisman told her the story of his bipolar father and how his illness made their whole familysuffer. She thinks that this conversation made her finally decide:

… how tough and difficult it is, but this, I do not want this, such a life… [… .] well, it is, it isreally as if you… as if the world is upside down. Yes.. yes. And then I thought, no, I can’t dothis. If I have to suffer a few more moments like this, that I can’t stand. But I really thought andstill think till this day on, I think it is difficult. Hmm. I also know that it was right and I also knowthat I couldn’t have done anything else, but I also notice regarding his parents and regardinghimself, I still think it is very difficult and it also is not out of my head. It is not gone. (Hadot andPennings 2003)

At the time of the interview Eva is seized by thoughts of illness, and the finiteness ofhuman life. Two women in her immediate environment, her direct neighbour who wasborn on exact the same day as Eva, as well as the babysitter who takes care of her children

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a couple of days a week, have been diagnosed with terminal cancer. Eva mentions thatthese two women endure their difficult situations in their own personal way. The babysit-ter asks, as Eva calls it, in her own upfront way for practical support. She asks for help whenshe feels that Eva and her husband who works in the local hospital, could be of assistance,especially in the medical field. Although Eva regrets that she and the babysitter do nothave a more intimate contact about the brute impact of the illness on the babysitter’slife, and the way she deals with her coming departure from life, Eva feels quite comfortablewith the straightforward role the babysitter gives her. For Eva it is in line with the characterof the babysitter as well as with the character of their relationship. Eva still experiences therelationship as properly balanced. More complex is the support the neighbour asks fromher. Mere practical support does not fit Eva’s expectations. Before the neighbour got ill,they got along very well, sharing the usual things of daily family life. They even tooksome vacation trips together as families. With the illness of the neighbour Eva feels thatall intimacy between them stopped. She tries to talk with her neighbour about theillness and offers her emotional support. The neighbour however, seems to exclude Evafrom her personal and emotional life. She only asks Eva to help her with, as Eva statesit, ‘trivial practical matters’. Eva expresses her troubles: ‘..because there..that.. I can’tcope with that thus not very long then, that way of caring… yes, I really would like tocare, but then… something also should… something also should happen then… ’ Sheclarifies

… I can still hear myself saying: if you would like to discuss things, or things which are impor-tant to you, or things you would like to pass on… if I can in any way help you with that, Iwould be most delighted to do so. And… yes, that… she is not able to do that, and she isnot going to do so and she surely doesn’t need to do so… eh… . but I in that way reallylook for that. Yes. And.. and if that does not come, then, .. yes.. then I notice, then… then, Ido not longer know. And that… and that already means not allowed to touch anymore,you know… no longer… although she does accept other people, who she knows lesswell..ehm.. and not me…

Eva articulates her lack of understanding about the role the neighbour gives her (onlypractical support), how the neighbour perceives their relationship (practical withoutmoral intimacy) and about the choices the neighbour makes for what appeared to bethe last few months of her life (planning events instead of using the time left to spendwith loved ones). Eva feels excluded because Eva cannot visit her neighbour (althoughother people do):

.. also in visits, that eh… , now, a school teacher well then, ehh, you know… that there surewas a moment she could visit. And for me it was very difficult to find a moment to stop by. Butthat is.. that says it… .

At that point, she interprets her relationship with her neighbour as ‘losing each other’.Eva’s inability to comprehend her neighbour’s handling of the situation stimulates Eva

to explore her own thinking about what she mentions as ‘the essence of life’, and aboutwhat she would do when she knew her life would end soon:

And that.. that I thought for myself: ahh, but that… that would not be my essence anylonger.. for me… it..it.. I started truly thinking about how would my end be then? And forhow long/what time would I.. ehhm.. choose for… for treatment till it does not workanymore?.

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It illustrates Eva’s open-minded view on existential issues of human life. She does not(only) interpret these two situations of terminal cancer in her intimate circle of acquain-tances as threats. They also trigger Eva to examine how these issues influence theirrelationships, and how they change their contacts. She discovers that the deliberationsher sick neighbour makes, do absolutely not come close to what Eva thinks she woulddo herself being in such a position. This gives rise to questions about how Eva still canfind a way to share thoughts and intimacy. It also triggers a collaborative process of think-ing about the meaning of life and about the essence of Eva’s own life. This thinking processenables Eva to critically think and evaluate her core values such as ‘profound humancontact’. In her experience as an only child discussing with her parents, profoundhuman contact was mainly a cognitive or intellectual activity. She mentions that acertain alacrity to display one’s vulnerability to each other is needed to be able todiscuss deep and profound personal thoughts. Her relationship with her neighbour illus-trates for Eva that if neither one person can, nor wishes to, open up to share his or herdeeper thoughts and sentiments, it leaves the other one empty handed. Importantmoral questions about how they perceive themselves and their lives will not be discussed.Although accidental factors like being neighbours and having children of the same agebrought them together, Eva experiences her relationship with her neighbour as a closeone and expected her neighbour to share moral intimacy with her when the illness pre-sented itself. The way the neighbour handles her illness makes Eva realize that her neigh-bour has a different perception about their relationship, as well as about connectedness,and that she is not in a position to change her neighbour’s attitude on that. The alteredcondition of the other, and the new moral expectations involved, changed the characterand symmetry of the relationship in such way that it finally led to the ending of therelationship. This ending of a relationship because of a changing symmetry is not newfor Eva: the most important reason for leaving her first husband was the fact thatbecause of his mental illness, moral intimacy between them vanished. In both alteredrelationships Eva could not find a way to share thoughts and intimacy nor to restore anopen contact. The fact that for Eva, profound human contact has been considered as away of taking good care of the other, retrospectively explains why Eva could not live upto the neighbour’s expectation of her being a mere practical caregiver. At the end ofthe interview Eva fantasizes about herself being old and grey, sitting on a little chair asa wise old lady who finally sees through life, and has learned that all experiences, wonder-ful and difficult ones, one way or another contributed to a ‘good life’, a caring life.

5. Discussion

Already starting in Eva’s youth, Eva’s narrative illustrates a recurring experience of a backand forth movement between herself and the other to understand how she finds abalance between on the one hand being faithful to her own personal attitude towardsdirecting her own life and on the other, responding to moral and practical appeals ofthe outside world. In her narrative, we can distinguish at least two kinds of situationsthat Eva experiences: sometimes she finds herself in relationships with people withequal opportunities and where both partners can be—in potential—either caregiverand care receiver, whilst other times, she finds herself in a position where she functionsprimarily as a caregiver. This impacts on her perceived sense of self, and how she

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would like to provide care (or not). Her ‘tellings’, seem not so much grounded in tensionsbetween care for herself and care for the other. Instead, Eva seems to struggle with ambig-uous reciprocities, vulnerabilities and balances between openness and distance in herrelationships. Eva continuously reflects on her experiences to understand values likecare for the self, care for the other, meaning, connectedness, freedom and autonomy.Her narrative illustrates that her experiences are closely intertwined with her personalhistory, her relationships and the current ‘realm of life’. Changing relationships with theother stimulates her examination towards practical understanding and understandingof moral values of herself and others.

5.1. Balanced positions

During her youth one of Eva’s significant relational experiences is living as an only childwith her parents. From them she learns to think independently and to express her ownvalues. She experiences mental connectedness with her parents and she interprets thisexperience as profound human contact. Eva tells us it is one of her dominant values inrelationships and life. Since she was young, Eva has an urge to independence andfreedom, but nevertheless, as a student she decides to join a student society and livesin a student house amidst other girls. She recounts that she is still in touch with someof the friends from that phase in her life. In that group she experiences a connectednessand moral intimacy that diminishes her urge to withdraw herself compared to other situ-ations in which she finds herself. In these friendships she perceives an equality whichmakes the relation properly balanced for Eva. She states that she manages to stayclose to herself and meanwhile participate in the dynamics of the group. This can be inter-preted as a ‘right’ balance between dependence and independence in the sense of Evaexperiencing a balance between being an ‘isolated’ individual with a certain amount ofagency whilst simultaneously being a committed part of a group. Later in life in theearly years of her relationship with her first husband, Eva also experiences, from her per-spective, a proper balance between herself and the other: between dependence andindependence. Both spouses needed a certain level of freedom, for a private coursewithin the relationship, which made them at ease together. Simultaneously they experi-enced moral intimacy by their commitment to share and support each other’s individualand shared lives. So for Eva one main feature of a fruitful relationship is a balance betweena sense of independence and dependence. But what happens to Eva when these are outof balance?

5.2. Changing positions: the caring relationship

Eva’s situation changed dramatically when her husband was diagnosed with a mentalillness (bipolar). Firstly, Eva responds by taking care of her husband, but this changedgradually as the nature of the relationship changed. In time, Eva fell into the positionof caregiver primarily, instead of primarily embodying (and experiencing) the positionof the ‘wife of’. After some time, Eva finds herself withdrawing from the relationshipand indirectly she ascribes this to the lack of moral intimacy she experiences. Becominga caregiver, the previous balance in caring responsibilities altered (who takes care ofwhom and how?). She no longer perceived themselves in a romantic relationship with

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a proper balance between dependence and independence, but she experiences agreater amount of being affected by her husband in another way.

This repeats itself when Eva is confronted with the illness of two women in herimmediate environment. In these situations she experiences difficulty in finding aproper way of dealing with the changed relationship, the positions she finds herselfin, and her view of who she is and the tensions that evokes. From Eva’s perspective,she feels that her care giving alters the balance of her relationships. Tension eruptswhen Eva no longer feels connected to the other person, when she experiences aloss of the original nature of the relationship (couple, friends or neighbours), and as aconsequence, a loss of the profound human contact she longs for. Eva becomes a care-giver primarily affected by the needs of the other, and experiences challenges to livingthis other identity and relationship. Her response is to withdraw from the relationship, asthe primary needs of her ‘old’ relationship (equality, reciprocity, intimacy, vulnerabilityand openness) are no longer being met. Eva experiences a lack of reciprocity, especiallyconcerning the lack of vulnerability and openness of the others. She concludes thatretreating from the relationships gives her pain and sorrow, but is the price she hasto pay. To continue the relationship she interprets as traveling a moral route in whichshe is not taking ‘good care’ of her own life. Finally, she feels herself reducing and asa consequence the relationships end. From a care ethical perspective, this shows howviews on identity, positions and moral expectations directly relate to the caring practice.From a care ethical perspective, different routes can be followed that can be understoodby looking at how Eva perceived her identity and her relationships. For example, Evacould have accepted her change in relational position: in other words, she could haveaccepted her developing caregiver identity and its related position coming to the fore-ground temporarily, and could have adjusted her moral expectations of the relationshipsfor the time being. She could have perceived her identity and relationship to be basedon fragility and the interconnectedness of her own interests and those of others, withoutexpecting the other to do the same. This could still have meant she decided to leave herhusband, or reduce the friendship with her neighbour, but in addition, she might havebeen able to see herself as a caregiver. Her other ‘selves’—the wife and the friend—could have ‘come to life’ by developing friendships or romantic relationships outsideof the former relationship. She could still provide care, to give, and by doing sostrengthen how she serves others. This is not a conscious decision or choice. Eva’s‘selves’ can only come to life because she is part of the lives of other people andbecause she is part of a certain practice and context. At the time of the interview,Eva decided to contact her ex-husbands parents. She might have decided not tocontact her ex-husband because she knew he did not want her to interfere in his life.But most likely, Eva did not contact him because she was unable to deal with thechanges in her position (from a primary caregiver to a person more at distance). Herposition in the relationship with his parents did not change. Eva tells about the griefshe felt when she lost them at the time she divorced their son. She contacted thembecause she felt the need for the profound human contact she experienced in theirrelationship; the urge to become part of their lives again.

This account relates to how care ethicists perceive the self in the context ofrelationships:

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[… ]seeing the self as continuously needing others to come to life, finding the self as existingwith and for others, being part of others’ lives and narratives, being called before speaking,being affected by others, and being only temporarily autonomous, due to basic fragility.(Van Nistelrooij 2014, 223).

5.3. Good care

Eva’s narrative illustrates indeed that once the basis on which the relationships wererooted disappeared, continuation is only achievable when Eva finds a way to deal withthe current situation by evaluating and reconsidering her particular interpretation of‘good care’ in which values like equality, reciprocity, intimacy, vulnerability and opennessare crucial. Some care ethicists criticize an understanding of care which suggests a sharpdistinction between the interest of oneself and others, stating that a binary approach isneither ontologically nor psychologically convincing. Mature care intends to take intoaccount the interests of both parties of the caring relationship (Petterson 2012). Thisapproach tends to compromise between the two extremes of selflessness and selfishness.For Petterson however, this intermediate position is not optional: inability (or unwilling-ness) to provide care, she considers immature. In her view, caring skills can and mustbe developed (Petterson 2012, 377). In her professional life Eva does take care of otherliving beings: caring responsibilities, reciprocity, intimacy, equality and openness playout in a totally different way compared to her personal relationships. Eva’s identity inher professional relationships is primarily one of a caregiver not expecting reciprocity, inti-macy, equality nor openness. In her role as a professional caregiver, Eva shows that thatshe is ‘capable’ and willing to care and that she does not reject caring responsibilitiesas such: that is, in Pettterson’s view ‘mature care’. What might be the reason that Evadid not use these caring skills in personal relationships? In line with Petterson we mightregard this as immature, and conclude that Eva’s positions varied between immatureand mature depending on the different realms of life (professional and personal) Yet,we wonder whether this is really a suitable interpretation. It seems that the tensions inEva’s life circled around other aspects of care, especially related to intimacy.

5.4. Moral intimacy

It was not her urge for freedom and independence but the lack of mental connectednessthat was Eva’s most important reason to end the caring relationships. To understand howshe came to the point of ‘stopping caring’, we should look at Eva’s history and context.Grown from experiences during her childhood, Eva understands moral intimacy, equalityand reciprocity as of utmost importance. Instead, later in life, she finds herself in situationsthat demand that she should care without these, as she does not experience any recipro-city and moral intimacy. Her narrative illustrates that for Eva, caring for the other requires arelationship in which ‘moral intimacy’ can be experienced. Therefore, caring responsibil-ities rather give rise to ambiguous personal struggling about reciprocity, vulnerabilityand openness in her relationships, rather than about tension between care for herselfand care for the other. Eva’s interpretation of profound human contact as a mainlymental encounter in which people express and share their inner thought to each other,corresponds to what Bieri notes as ‘moral intimacy’ (2012). Bieri defines moral intimacy

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as an encounter between people which in itself is experienced as worthwhile. Therefore,complex and deep thoughts and sentiments like indignation and rancour, moral humilityand repentance but also loyalty and admiration for moral ‘grandeur’, can develop. Becauseof these sentiments people become important for each other in ways which would nothave been possible when they only were sensible partners in a social play. Moreover,they get important for themselves because these moral thoughts and sentimentsimplicitly raise the question who we would like to be. Bieri thinks moral intimacy is arelationship between people which makes it possible for them to show their ability totake an essential critical distance from themselves (Bieri 2012, 27–28). Eva takes thismoral intimacy as an indispensable value in handling a caring relationship. Hence Eva’snarrative illustrates that we should go beyond judging whether decisions to care or notcare are mature or immature, whether feeling responsible or taking responsibility is some-thing to ‘decide’ autonomously. From her story, caring responsibilities were not things Eva‘decided’ upon rationally. Instead, being part of a complex web of relationships, her situ-ation of care, her decision to care (or not care) emerged as an outcome of the doings andsayings of the people and material circumstances involved (Schatzki 2012). In line with VanNistelrooij, a moment of choice to care ‘encompasses both more passivity and more capa-bility’ (Van Nisterlrooij 2014, 224). Eva’s choice has not disappeared but rather ‘standsagainst a much wider horizon of identity connected to others, to one’s believes aboutthe self, to the institutions and positions that one accepts and assumes, and to the mean-ings that one embraces’ (van Nistelrooij 2014, 226). Hence, Eva’s struggle with caringresponsibilities seemed to have led to a personal, authentic choice to withdraw, and to‘stop’ caring for her husband. As a result of changing relationships with the Other, Evagot herself into situations in which her particular interpretation of ‘good care’, in whichvalues like equality, reciprocity, intimacy, vulnerability and openness are crucial, disap-peared. To understand why she ended the relationships and ‘stopped caring’ we haveto understand Eva’s history and social context. From this we could infer that Eva takesmoral intimacy as an indispensable value in a caring relationship. Therefore, we concludethat her ‘capacity to care’ ended when moral intimacy disappeared.

6. Conclusions

Developments in our social and healthcare systems result in the transfer of caring respon-sibilities towards citizens. Citizens ought to take responsibility for their own lives andsupport each other, instead of ‘passively’ consuming services. This is framed as the‘responsibilitization’ of our society.

Our reflection on caring responsibilities in the personal realm by a thorough investi-gation of the lived experience of Eva, illustrates possible struggles that could arisewhen we transfer caring responsibilities to citizens. Hence, it raises questions such aswhat does it mean for ourselves and for (the dependence of) others being both caregiverand care receiver at the same time; what happens when a (caring) relationship changescompletely; and, does living a ‘good’ live in our late-modern society stands for a continu-ous struggle properly balancing our caring responsibilities? Should we even focus oncaring responsibilities, or what’s going on beyond that? In this article we reflect onEva’s relational experiences in taking care of her own life and in relating to situationsand events which more or less are the result of the relational web in which she is situated.

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We saw that in daily life, caring responsibilities rather give rise to ambiguous personalstruggles of reciprocity, vulnerability and openness than about tension between carefor herself and care for the other. Our perspective on caring responsibilities seems to bethe outcome of both personal history and the current relational webs in which one is situ-ated, and Eva’s narrative illustrates that in her case ‘moral intimacy’ is an indispensablecondition for care. It is especially relevant to include this notion in a relational view onresponsibilisation, when our welfare states continue encouraging citizens to ‘participate’and actively take care of one another. As our paper has illustrated, this can be highly pro-blematic, because it is assumed that everyone is part of a social support network andcapable of supporting others.

To conclude, we think that Eva’s narrative and our interpretations, contribute to thewider political discussion on citizenship and what the British political thinker Goodhartcalled ‘the progressive dilemma’ the tension between solidarity on the one hand—meaning a high trust/high sharing society—and an increasing diversity of values andways of life on the other (Goodhart 2014, 49). Goodhart argues against the false oppositionof self-care (self- interest) versus relationality and responsibility (co-operation) and empha-sizes that it does not connect to the way people live their lives. Self-realization, autonomyand the free authorship of our own lives are important values but we also acknowledgeour dependence on others and find ourselves embedded in a variety of human groups(Goodhart 2014). Our paper shows that from a lived experience point of view, balancingcaring responsibilities between citizens mutually, highly depends on the context of theirparticular lives and the practical understanding and understanding of moral values intheir caring relations.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Karin van der Heijden, MA, is a graduate at the University of Humanistic Studies, Utrecht, theNetherlands and a researcher and teacher at Saxion, University of Applied Sciences, Enschede,The Netherlands. In her empirical ethical study she traces philosophical and care ethical conceptsin individual narratives.

Merel Visse, PhD, works as assistant professor and senior researcher and Chair, Ethics of Care at theUniversity of Humanistic Studies, Utrecht, The Netherlands.

Gerty Lensvelt-Mulders, PhD, is a professor of Epistomology, Methodology and Research Principlesand Rector of the University of Humanistic Studies, Utrecht, The Netherlands.

Guy Widdershoven, PhD, is a professor of medical philosophy and ethics and Head of the Depart-ment of Medical Humanities of the EMGO Institute for Health and Care Research, VU UniversityMedical Centre, Amsterdam, the Netherlands.

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