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When the woman in labour is your cousin: professional fairness and the ethics of care

Farhana Akter Fellow
· 4 replies
BioethicsAnalyticIslamicCare ethicsNel NoddingsVirginia Held#care-ethics#midwifery#partiality#professional-ethics
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Its coordinates: 3.3.1 Bioethics and Medical Ethics

Last month my cousin came in to our district hospital to deliver her second child. It was a busy night: four other women in labour, one of them in difficulty, and only two of us on the ward.

Everyone expected things of me. My aunt expected me to stay at my cousin's side. The women from her village who came with her expected me to bring her first to the doctor. My cousin herself just wanted my hand. And the woman in difficulty, whom I didn't know at all, needed me more than any of them.

I did what the ward rules say: I went to help with the woman with the complication. My cousin delivered safely with the midwife. But she hasn't quite forgiven me, and part of me hasn't forgiven myself.

I've been reading Nel Noddings, who says caring starts with "engrossment" in the particular person in front of you, and Virginia Held, who says care is a full moral theory and not just a supplement to justice. I find them beautiful and true to my work. But on that night, the hospital's rule, which is impartial on purpose, was the thing that protected the stranger, and I think it was right.

Is there a way of thinking about care that explains why I owed my cousin something real, and also why I was right to leave her? Or are these two separate moralities that just have to fight it out at four in the morning?

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4 replies

  1. Nadia Haddad

    Fellow

    Farhana, this happens in every hospital and nobody teaches anyone about it. My thought: the person in front of you wasn't only your cousin. The woman in difficulty was also in front of you, and Noddings's engrossment applies to her too. Care ethics doesn't say "care for relatives"; it says respond to the need of the one you encounter. On the ward, you encountered five women. Your cousin was the one with the strongest relationship, and the other woman was the one with the greatest need.

    Helpful · 3
  2. Tsion Bekele

    Fellow

    In Addis we have the same pressure, and it often comes as family expecting a relative who works in the hospital to "arrange" things. I think the impartial code is not opposed to care here. It's what makes it possible for the ward to care for strangers at all. If every midwife put her own relatives first, the women with no relative on staff would always be last. The rule protects the people without connections.

  3. Bilal Rashid

    Fellow

    In the Islamic tradition there's a strong duty to kin, silat al-rahim, and also a clear teaching that a trust (amana) must be discharged to whoever it belongs to. Your post was an amana. What I've found is that people can usually accept a decision like yours if they hear the reason from you, gently, afterwards. Have you told your cousin about the other woman? Not to justify yourself, but so that she can see what you saw.

    Helpful · 1
  4. Elin Hedqvist

    Fellow

    Held distinguishes care as a practice from care as a value, and I think that helps. The practice of care was what your colleague gave your cousin: competent, attentive, safe. The relationship with your cousin is a value you didn't abandon by leaving the room; you'll keep it up in a hundred ways she'll see later. What you couldn't do was make the relationship decide who got the scarce thing that night. That isn't two moralities fighting. It's one recognising the conditions it works under.

    Helpful · 2