IJFAB: International Journal of Feminist Approaches to Bioethics

Midway in Martha Holstein’s article, these words occur: “[P]eople [should] get the help they need, when they need it, in the way that they would like to receive it, without exploiting family members or imperiling their dignity or self-respect” (24). In an essay that brims over with worrisome news, that this seemingly anodyne sentence appears in the section devoted to utopian thinking is perhaps the most dispiriting thought it conveys.

Not that there isn’t keen competition for the role. Holstein reminds her readers that the roots of the present and building crisis in long-term care sink deeply into an ideology especially entrenched in the United States; she suggests, as well, that the pernicious norms and rather bizarre notions of fact cherished within that mythos are entwined with values we have reason to defend: sexism, hostility to dependence, and exploitation of family are tangled with intimacy, relationship, caregiving, and love. The stubborn persistence of the thought that women are to provide the brunt of direct caregiving for the elderly and infirm, as well as for the young, disheartens; the insouciance about the costs women thereby incur to their social legitimacy as well as to their financial solvency, despite decades of feminist analysis and activism, appalls. That the exacting, profuse, and prolonged care required by our form of life—and therefore presumably to be prized to the extent [End Page 36] that we take ourselves with any seriousness—is so effectively made to disappear as a part of political life, testifies to the centrality of women’s oppression. Advances along the lines of marriage equality, we’ll get; fundamentally, its opponents have only expressive values at stake. As the crisis in caregiving helps make plain, real gender equality would mean goring a lot of powerful men in their pocketbooks as well as in their self-conceptions; the defenses are, as Holstein suggests, “almost impenetrable” (7). The prospects of significant progress in any reasonable amount of time are very much dimmer.

An important question that Holstein’s article prompts concerns whether theorists can have much of a role in increasing the odds that societies generally—and the United States in particular—will respond to growing needs for care in ways that are morally defensible and practically sustainable. Bioethicists and other normative thinkers can handily dismantle the notion that dependency after maturity falls only on the few (many of whom deserve it, due to improvidence or other bad choices), or that women are best suited by nature and inclination to provide the care that’s needed. In the course of a single paper, Holstein makes a perfectly effective case that all this is an illusion, and the assortment of authorities she cites make that case exhaustively among them.

It might seem, then, that the contributions of theory to achieving justice in this sphere of social life have been made for all practical intents and purposes; what’s needed now is political activism, organization, and rhetorical more than philosophical skills.

Yet here and there, one finds some features of Holstein’s argument that might be further developed in service of her overall agenda—which, given her own distinguished history of activism, is clearly practical. Consider, for example, the familiar notion (familiar to feminists, anyway) that “independence” is an incomplete concept (“independent of what” is always, in principle, a pertinent question, and “of other people” always, in practice, a false answer). Holstein drives this point home repeatedly, as when she writes, “Our need for others is neither pathological nor avoidable, nor the result of human failings but is a universal and an inevitable part of human development” (). This thought has a companion, not prominent in the article. As writers from Iris Murdoch (1970) to Marilyn Frye (1983) have argued, the love that sustains the goods of intimacy—those very goods that people look for in family-based caring—requires a vivid and effective sense of the distinct reality of those we love. Thus, just as there is no independence that does not presuppose significant dependence on others, there is no love that fails to...