Moral obligation or moral support for high-tech home care?

As our technical capacity has grown in medicine, the costs of medical care have grown enormously. Costs--especially those for the care of the severely handicapped, chronically ill, and terminally ill--have grown so large that they pose a threat to a host of other goods sought by our society. In such a setting, it is not surprising that policymakers and other thinkers have begun to ask who should be responsible for various forms of care. It once would have been unthinkable to ask whether parents were responsible for their children's health care and almost unthinkable to ask whether adult children should be responsible for the care of their elderly parents. Today such questions are being pressed.[1] They are often posed as questions of moral obligation and the limits of moral obligation. Natural Caring and Moral Support When policymakers begin an analysis of health care with discussion of moral obligation, they are usually seeking firm rules to guide policy, and sometimes they are even anticipating laws to enforce certain behaviors. For example, having decided that, under most conditions, fathers have a moral obligation to support their minor children, we feel justified in encoding the obligation in law and enforcing it. Correspondingly, if we were to decide that adult children have a moral obligation to care for their elderly parents, we might well describe this obligation legally and create the machinery to enforce it. A better way to begin is to assume that most people who have experienced care themselves want to care for their loved ones. The task of an enlightened society is to help them do so. An ethic of care inverts Kantian priorities.[2] insisted that ethical acts are those done out of duty (defined logically and derived from logical principles) and that acts performed out of personal love have no moral status. Hence, duty has a higher priority than love or compassionate inclination. In an ethic of care, however, caring out of love or inclination--what we might call natural caring--has a higher priority than ethical caring, and ethical caring is invoked primarily to create, restore, or enhance the preferred state. Even here, the senses of obligation in Kantian ethics and in an ethic of care are very different. Whereas duty is defined terms of rules logically derived from principles in Kantian ethics, the duties of ethical caring arise out of memories of caring and being cared for and the value placed on caring relations. In Kantian ethics, we turn to an analysis of principles and duty; in caring, we turn to our memories of caring and being cared for--to a vision of our best selves. When we recognize that natural caring is both the means and end of ethical caring--that is, that the capacity for ethical care develops out of natural caring and the purpose of ethical care is to restore natural care--we are ready to explore a different approach to moral life and to public policy. Instead of establishing and trying to enforce rules based on a notion of minimum moral obligation, we ask how we can encourage the highest possible level of natural caring. Instead of forcing people to do their fair share, even if reluctantly, we ask what the public can do to make it more likely that people will want to care for others. This approach has many implications for education and for public policy generally.[3] For present purposes, it suggests a thorough analysis of capacities and sufferings throughout the network of care. What Do These People Mean to Each Other? When people are called upon to become caregivers--whether or not that care requires handling technology--it is important to know what caregivers and cared-fors mean to each other and to assess the strength of relations throughout the web of care. We cannot decide on the basis of formal relations what one person owes another. We ordinarily think of parents having an almost total obligation for the care of their children, but one can imagine a mother less than eager to care for a semi-comatose teenager who overdosed on drugs after repeated efforts to "keep him clean. …