Caring A Pluralist Account DRAFT

The version of the paper uploaded here is a draft only and should not be used for citation. The final publication is available at: http://onlinelibrary.wiley.com/doi/10.1111/rati.12179/full CARING: A PLURALIST ACCOUNT Introduction Care ethics has, in the thirty or so years since its inception, developed into a highly diverse and productive branch of ethics. It has been applied in a wide variety of contexts, including the philosophy of education, nursing, social work, and political theory, to name but a few. See, respectively, Chrissie Rogers and Susie Weller (eds.), Critical Approaches to Care: Understanding Caring Relations, Identities and Cultures (Abingdon: Routledge, 2013); Sara T. Fry, ‘The Role of Caring in a Theory of Nursing Ethics’, Hypatia 4:2 (1989), pp. 88-103; Judith Phillips, Care (Cambridge: Polity Press, 2007); Daniel Engster and Maurice Hamington (eds.), Care Ethics and Political Theory (Oxford: Oxford University Press, 2015). Care ethicists have paid relatively little attention, however, to questions in the theory of value. This is understandable given that care ethics is still, if not quite in its infancy, then at least not yet fully matured. However, focussing explicitly on value theory, and in particular on the issue of value pluralism, can help to shed new and interesting light not only on care ethics itself, but also on one of the issues with which it is centrally concerned. In what follows then, I will argue that care ethics is best conceived of as a form of value pluralism, and that such a conception generates a plausible account of the relationship between care and justice. In section two, I argue that the literature on care ethics typically presents caring as a form of value monism. I then show, in section three, that care ethics is better understood as a form of value pluralism. This is because the aims at which different types of care are oriented are often irreconcilable, calling for trade-offs to be made between them. This is one of the hallmarks of pluralist accounts of value. In section four, I provide a brief account of some of the values which ought to be associated with care ethics. Finally, in section five, I show how my argument relates to the debate over the relationship between justice and care, arguing that these are appropriately understood as irreducibly distinct values. Before beginning, it is worth noting that I will not attempt to argue for the truth of pluralist conceptions of value here. Any such argument would require a paper in its own right. Rather, the paper proceeds on the assumption that value pluralism is plausibly true, and that care ethics will therefore not be made less plausible by endorsing it. Given that assumption, the paper shows why care ethics and value pluralism are a good fit for one another. Monistic Conceptions of Care Monistic accounts of value hold that morality is ultimately concerned only with a single sort of value. Thus, the actions and character traits which morality counsels us to undertake and develop are such that they relate positively to that value, for example by promoting or honouring it. Hedonic utilitarianism is a well-known form of value monism, holding as it does that actions are right just in case they maximise expected happiness, and that character traits are virtues just in case they typically give rise to actions of this sort. For one such account, see Julia Driver, Uneasy Virtue (Cambridge: Cambridge University Press, 2001). Pluralist accounts of value, on the other hand, hold that morality is concerned with more than one type of value, and that the values with which it is concerned are not ultimately reducible either to one another, or to some other more basic value. As noted in the introduction, care ethicists tend not to discuss their views with reference to value theory per se. Yet care ethicists have, as one would expect, discussed at some length the question of what it is that care ethics values. Different answers have been given to this question, and it is worth taking note of a number of these, albeit briefly. Doing so will allow us to see that care ethics is often presented as a form of value monism. In her seminal work on caring, Nel Noddings describes care ethics as an approach to moral thought which is focussed on the value of establishing and preserving caring relations. Noddings writes that ‘moral sentiment […] arises from an evaluation of the caring relation as good’. Nel Noddings, Caring: A Feminine Approach to Ethics and Moral Education (Berkeley: University of California Press, 1984), 83. What Noddings means here is that morality is ultimately grounded in an innate perception of the goodness of caring relations; a perception which is itself the product of our receipt of care during infancy. Without this experience of the importance and goodness of care, in other words, we would not be moral creatures at all: moral concerns would simply not matter to us. As Noddings puts it, ‘our inclination toward and interest in morality derives from caring’. Noddings, Caring 83. In later work, Noddings summarises her position with the claim that ‘[f]or care theorists, the caring relation is morally basic’. Nel Noddings, The Maternal Factor: Two Paths to Morality (Berkeley: University of California Press, 2010), 33. For present purposes, it is unnecessary to assess the merits of Noddings’ position. What is of interest, rather, is her presentation of care ethics as being centrally concerned with just a single moral value: the value of caring relationships. The preservation of this value not only constitutes the aim of a care-based morality, but is also identified as the foundation of moral agency itself. As presented by Noddings, then, care ethics certainly seems to endorse value monsim. The connection between care ethics and monism is strengthened when we consider expositions other than that of Noddings. Virginia Held, for example, writes that ‘the central focus of the ethics of care is on […] meeting the needs of the particular others for whom we take responsibility’. Virginia Held, The Ethics of Care: Personal, Political, and Global (New York: Oxford University Press, 2006), 10. Held is by no means alone in identifying the meeting of other’s needs as the central concern of care ethics. Similar positions have been taken up by Diemut Bubeck and, more recently, by Sarah Clark Miller. See Diemut Bubeck, Care, Gender and Justice (Oxford: Oxford University Press, 1995); Sarah Clark Miller, The Ethics of Need: Agency, Dignity, and Obligation (New York: Routledge, 2012). Now, accounts of caring based on the meeting of needs clearly differ from those based on the maintenance of caring relationships. Indeed, part of the motivation for understanding caring as being concerned with needs rather than with relationships was to broaden the concept’s normative scope. In this way, it was hoped, it would be possible to allay critics’ concerns that the ethics of care was a parochial moral perspective, concerned only with those already near and dear to us. Whatever the merits of this attempt to refocus the concerns of care ethics, however, the theory is still presented here as being responsive to a single sort of value: specifically, that constituted by the meeting of needs. To be absolutely clear, it is not my claim that the authors mentioned in this section explicitly argue that care ethics is a form of value monism. Indeed, there is no explicit argument either for or against that claim in the literature (that is precisely the point of the present paper). My claim, rather, is that care ethics is often presented in a way which strongly suggests that it endorses monism. As will be seen in the next section however, care ethicists would be well advised to endorse value pluralism instead. Pluralism and Care As seen in the previous section, it is possible to understand caring as oriented around a single value. However, care ethicists would do better to claim that caring takes a plurality of values as its object. There are two main reasons for this. First, the concept of caring is so broad that monistic conceptions of it risk undermining the conceptual distinctiveness of care ethics. In other words, endorsing a monistic conception of value moves care ethics much closer to the territory associated with traditional ethical theories such as utilitarianism, of which care ethics has been highly critical. Second, it is plausible to see caregiving as an activity which sometimes calls for compromises and trade-offs to be made between different, and irreconcilable, goods. This is precisely what a value pluralist conception of caring would lead us to expect. A commitment to value pluralism thus allows care ethics more accurately to reflect the lived experience of caregivers. The rest of this section considers each of these points in more detail. The concept of caring is used to refer to a wide variety of activities. Caring is what happens in hospitals, when doctors and nurses attend to the welfare of their patients. It is what happens in schools and universities when educators take an active interest in cultivating the abilities, and capturing the imaginations, of their students. It is the task which the social worker is engaged in when she argues that a child should (or should not) be removed from the custody of its parents. Caring is also sometimes used to describe government policies and legislation, as when they succeed in lifting families out of poverty. And, of course, caring is the work associated with parenting: changing nappies, cooking meals, bathing and dressing, and, not least of all, providing emotional support when it is needed. Now, it is possible to claim that each of the disparate items on this list are identifiable as instances of caring because they are all oriented around a single sort of value, which caring takes as its focus. In order to make good on this claim, of course, the value which is appealed to will need to be broad enough to range over each of the items listed above. That value will, in other words, need to be highly abstract, and realisable in any possible context of care. However, this highly abstract approach stands opposed to care ethics’ traditional focus on specific agents, and on the emotional, relational nature of caring. See, for example, Noddings, Caring 5. To embrace monism, in other words, seems to shift the focus of care ethics away from actual cared-fors, and towards an impersonal conception of ‘the good’. To the extent that this occurs, care ethics begins more closely to resemble theories such as utilitarianism, which embody precisely this impersonal perspective. Now, it is certainly possible for care ethicists to endorse the approach described above. To do so, however, would be to sacrifice much of what, to many, has made care ethics so appealing. To see why, consider that care ethics was developed as an alternative, and corrective, to the impersonal and abstract approaches endorsed by mainstream ethical theory. Such approaches were thought to embody a masculine preference for generalisations and principles, and were said to overlook the need for morality to pay careful attention to particular agents and their circumstances. As just seen, an exclusive focus on one highly abstract value would move care ethics much closer to precisely this sort of impersonal approach, of which care ethics has traditionally been highly critical. Of course, this is by no means a fatal objection to monistic approaches to caring. However, it does highlight a significant dialectical cost that would need to be paid by any such view. The second reason for care ethicists to endorse value pluralism stems from the fact that providing care sometimes calls for trade-offs and compromises to be made between the various goods at which care providers aim. These trade-offs are best understood not as a matter of deciding how to pursue a single, fundamental end, but rather as the setting aside of some ends in favour of others. Now, one of the hallmarks of pluralist accounts of value is the claim that different values may sometimes conflict with one another. When this occurs, agents must decide which of the conflicting values they will be guided by. In this respect, then, a pluralist conception of caring is able to reflect the complex reality of caregiving more authentically than monist alternatives. An example will help to make this point more vivid. The medical profession is firstly, and most obviously, concerned with promoting the quality of life of its users. In the UK, for example, the National Institute for Health and Care Excellence (NICE) evaluates the cost-effectiveness of treatments based on how many ‘quality-adjusted life years’ (or QALYs) they are likely to provide for every £20,000 spent on them. This includes not only the treatment and prevention of illness and disease, but also the prevention and reduction of mental and physical suffering. In this respect, good care consists in the pursuit of a specific outcome, and care services will be better or worse according to the extent to which they succeed in promoting the quality of life of service users. We may say, then, that one of the values which underpins medical care is the promotion of quality of life. However, the promotion of service users’ quality of life is by no means the only value relevant to medical care. To see this, consider that such care is also guided by a respect for patients’ autonomy. This can manifest itself in a number of different ways. It might, for example, consist in respecting a patient’s wishes not to receive specific sorts of potentially beneficial treatment. Consent for such treatment might be withheld (or withdrawn) on religious grounds, for example, or because the patient has decided that they no longer want to endure, or to risk, the side-effects associated with certain sorts of treatment. Thus, a patient might choose not to receive, or to discontinue, chemotherapy. Alternatively, she might give instructions that she does not wish doctors to attempt cardio pulmonary resuscitation in the event of cardiac arrest (so-called DNACPR orders). When these preferences are made explicit, clinicians should take them into account when deciding how to proceed with treatment. Respect for autonomy is also evidenced by the way in which clinicians explain diagnoses and treatment options to their patients, and involve them in decisions about their care. Efforts must be made, for example, to ensure that patients fully understand their situation and the treatment options available to them, as well as the risks and benefits associated with those options. In this way, patients are empowered to take an active part in their care, and their capacity as agents is not undermined. In the UK, this respect for autonomy is reflected in the National Health Service’s commitment to shared decision-making, which is captured by the slogan “no decision about me, without me”. For further details, see Angela Coulter and Alf Collins, Making Shared Decision Making a Reality: No Decision about Me, without Me (London: King’s Fund, 2011). In addition to the value of quality of life, then, medical care is also guided by a respect for the value of autonomy. The importance of respecting autonomy in medical care is revealing. As noted in the previous paragraph, respect for a patient’s autonomy can sometimes prompt clinicians to act in ways which do not promote that patient’s quality of life, for example by withholding treatments to which the patient does not consent. This is not to say, of course, that clinicians must always choose between either respecting a patient’s autonomy or promoting her quality of life. This will clearly not be the case, for example, when a patient consents to a beneficial course of treatment. It need not even be the case when a patient withholds consent from a potentially beneficial treatment, for example in circumstances in which that treatment might fail to improve her situation, or may even worsen it. Careful notice should be taken of the word “potentially” in this paragraph. Medical certainties are few and far between, and it is not always possible to know the efficacy of a treatment in advance of its application. For numerous examples of cases in which withholding treatment may actually promote a patient’s quality of life, see e.g. Seamus O’ Mahony, The Way We Die Now (London: Head of Zeus, 2016); Lawrence J. Schneiderman, Embracing Our Mortality: Hard Choices in an Age of Medical Miracles (New York: Oxford University Press, 2008). Nevertheless, situations can arise in which respecting a patient’s wishes runs counter to her medical interest, for example when someone refuses, for religious reasons, to accept a blood transfusion. Examples of this sort show that the values of promoting quality of life and of respecting a patient’s autonomy can sometimes pull in different directions. As noted above, one of the hallmarks of pluralist conceptions of value is the idea that different values may sometimes be irreconcilable. That is, there may be situations in which an agent is forced to choose between competing values, pursuing one at the expense of another. This is precisely the sort of conflict which can be seen to be at work in the previous paragraph. Now, it is important to note here that the claim that values are sometimes irreconcilable does not entail the claim that they are always incommensurable, i.e. that it is impossible non-arbitrarily to decide which of two or more conflicting values carries the most normative weight. This has been shown by Peter Schaber, ‘Value Pluralism: Some Problems’, The Journal of Value Inquiry 33:1 (1999), pp. 71-78. Thus, a very minor infringement of an agent’s autonomy may well be justifiable if it is the only way of bringing about a significant increase in her quality of life. What value pluralism does claim, however, is that when an agent is forced to choose between irreconcilable values, it is rational for that agent to regret the loss of the neglected value. This may still be the case even if the agent believes that, all things considered, she chose the right value to act upon. In other words, a pluralist perspective allows agents to acknowledge that, even though they did as they ought, something of value was lost in the process. Now, this is precisely the sort of response which it seems fitting for a clinician to have after withholding some potentially beneficial treatment out of respect for a patient’s autonomy. Even though the clinician may have been right to do so, something of value has been lost – specifically, the quality of life which her patient stood to gain from the withheld treatment. Making sense of this response is much more difficult from within a monistic perspective on value, however. From this perspective, there is only a single morally relevant value at stake here, and either the clinician has responded to that value appropriately or she has not. If she has, then it is hard to see how she can rationally regret anything about her action: had she acted otherwise, after all, she would have acted badly. Note that the sort of regret we are interested in here is pertains to the clinician’s action, not her situation. She may well be able rationally to regret finding herself in a situation in which she was unable to produce more value than she actually did. This is not the same, however, as having a rational recognition that her action failed to respond to something of moral importance. Value monism can accommodate the former, but it is not clear that it can accommodate the latter. A value pluralist conception of caring, then, is in a better position to represent the moral complexity of actual caring practices than are monistic alternatives. This section has shown that care ethicists would do well explicitly to endorse value pluralism. A pluralist perspective on value faithfully reflects the reality of lived experiences of caring, and preserves the normative distinctiveness of care ethical thought. In both of these respects, a pluralist conception of caring is preferable to one which is monistic about value. Endorsing value pluralism also has wider implications for some of the debates internal to care ethics. I will consider some of these in §5. Before doing so, however, I will briefly discuss some of the values to which caring is plausibly responsive. This will complement the argument of the present section by showing how conflicts between values may occur in a variety of caring contexts. Caring Values Two of the values associated with caring were discussed in the previous section, specifically those of autonomy and quality of life. These were discussed in the context of medical care, but they are clearly also relevant outside of that context. Parenting, for example, is also concerned with both of these values, at least insofar as parents try to keep their children safe and healthy, and attempt to cultivate within them the ability to think and act for themselves. Having discussed these two values, it is natural to ask which, and how many, other values caring is also concerned with. This question merits a much more extensive discussion than can be provided here, and in what follows I provide only a sketch of what a value pluralist approach to care ethics might look like. A more fully developed account would emphasise the contextual nature of caring by discussing, in detail, specific examples of caregiving. One of the issues which that account would need to address would be whether the various values associated with caring are equally important in all contexts, or whether different situations call for greater attention to be paid to some values rather than others. Developing such an account is likely to have implications at both the theoretical and the practical level. Theoretically, it will both clarify and enrich our understanding of the concept of caring. Practically, it has the potential to be used a tool (one among others) with which to determine how best to provide care. It does this by focussing carers’ attention on the specific values around which their caring activities ought to be structured, and by allowing them to ask how they ought to respond to those values. While providing such an account is therefore a worthwhile task, in the rest of this section I aim only to identify further some of the relevant values. One of the most apparent of these values is that of maintaining caring relationships. This value has been affirmed many times in the literature on caring, and has recently been identified by Stephanie Collins as one of care ethics’ constitutive normative claims. Stephanie Collins, The Core of Care Ethics (New York: Palgrave Macmillan, 2015). Thus, for example, Eva Feder Kittay writes that relationships ‘forged through the care of a vulnerable dependent’ are ‘fundamental to our humanity’. Eva Feder Kittay, Love’s Labor: Essays on Women, Equality, and Dependency (New York: Routledge, 1999), 25. Kittay has parent-child relationships specifically in mind here, but her point generalises to include a wider range of caring relations. Of course, not all relationships are such that care ethicists are in favour of their preservation. Abusive relationships, or those which are in some other way harmful to those involved in or affected by them, are among those which care ethicists wish to reserve the right to criticise. With this in mind, then, we can say that it is not caring relationships per se which care ethics values, but rather nurturant relationships. I have borrowed the term ‘nurturant’ from Kathleen Lynch and Judy Walsh, ‘Love, Care and Solidarity: What Is and Is Not Commodifiable’, in Kathleen Lynch, John Baker and Maureen Lyons (eds.), Affective Equality: Love, Care and Injustice (Basingstoke: Palgrave Macmillan, 2009) pp. 35-53. I prefer to use the term ‘nurturant’ as opposed to ‘caring’, because even abusive relationships may contain some elements of care. Such relationships cannot, however, reasonably be described as nurturant. I will not attempt to provide a full characterisation of nurturant relationships here, but it is plausible to think that such relationships will, at a minimum, enhance the wellbeing of those involved in them. However nurturant relationships are defined, their maintenance is plausibly seen as one of the values to which caring responds. In addition to the value of nurturant relationships, care ethics is also guided by the value of dignity. The importance of dignity to caring has recently been stressed by Sarah Miller. According to Miller, ‘that we respond [to the need for care] is not enough. Of crucial importance is how we respond’. Sarah Clark Miller, The Ethics of Need: Agency, Dignity and Obligation (New York: Routledge, 2012), 73. Miller’s point here is that certain sorts of care involve tasks which, if not carried out in a sufficiently sensitive way, risk damaging the cared-for’s sense of self-respect. Such tasks most obviously include helping others to perform intimate bodily functions, such as bathing, dressing, and going to the toilet. However, any caring task risks diminishing the dignity of the cared-for if it is carried out in a way which suggests that the cared-for is a burden, or that providing such care is experienced by the caregiver as an unwelcome obligation. One of the values which should guide practices of care, then, will be that of the dignity of the cared-for. As Miller puts it, care should be provided ‘in a manner that befits [people] as beings with dignity’. Miller, The Ethics of Need, 86. Finally, and very briefly, I wish to suggest that a further value associated with caring will be that of personal development. Cf. Milton Friedman, On Caring (New York: Harper and Row, 1971), 1. The notion of personal development as I am using it here encompasses, but also goes beyond, the more familiar notion of developing one’s talents. This is because personal development is not an exclusively first-personal activity. Indeed, one can promote the personal development of any number of agents other than oneself. With this in mind, the value of personal development is likely to be highly significant not only in the context of self-care, but also in contexts of educational care, such as schools and universities. Of course, this is not to say that personal development will be the only value relevant in such contexts. Also of importance, for example, will be the aforementioned values of dignity and autonomy (thus a caring educator will allow students’ studies to be guided, to whatever extent possible, by their personal interests, and will also ensure that instruction takes place in a way which does not erode students’ confidence and self-respect). Now that more of the values around which caring is oriented have, if only tentatively, been identified, it is possible to see how further instances of conflict between them may arise. Take, for instance, the values of personal development and relationship preservation. These may come into conflict when an important aspect of an agent’s personal development can be made possible only through the neglect of one, or some, of the agent’s nurturant relationships. An example of this sort of conflict is provided by Bernard Williams’ well-known discussion of (a somewhat fictionalised version of) Paul Gaugin, who is able to further his artistic talent only by neglecting the needs of his family. See Bernard Williams, ‘Moral Luck’, in Moral Luck: Philosophical Papers 1973-1980 (Cambridge: Cambridge University Press, 1981) pp. 20-39. The value of personal development may also come into conflict with that of autonomy. For example, a guardian or teacher might recognise in one of their charges an aptitude for a particular course of study, and try to guide that charge in a particular direction on account of this. They might continue to do this even in the face of their charge’s continued protests, should they be convinced that they know what really is best for her. Here, a trade-off must be made between the charge’s autonomous decision to pursue certain ends rather than others, and her potential for personal development in an area in which she may prove particularly gifted. My purpose in noting these examples is not, of course, to endorse a particular sort of resolution to them. Rather, it is to provide further support for my claim that caring is structured around a set of potentially conflicting, and hence irreducibly distinct, values. Of course, much more needs to be said about the interplay of each of the values identified in this section. It is also possible that further consideration will allow additional caring values to be identified. For present purposes, however, enough has been said to provide an outline of a pluralist approach to care ethics. I now turn briefly to consider the relevance of the present argument for the care/justice debate. Pluralism and the Care/Justice Debate Early work on caring was rather dismissive of normative perspectives based on justice. This is because justice was seen as part of a patriarchal perspective, one exemplified by those traditional ethical theories which focused on rights and duties, as opposed to affect and commitment. However, in response to a number of powerful criticisms, most care ethicists came to accept the need for justice to play some sort of role in a fully developed ethic of care. For two such criticisms, see Claudia Card, ‘Caring and Evil’, Hypatia 5:1 (1990) pp. 101-108; Joan C. Tronto, Moral Boundaries: A Political Argument for an Ethic of Care (New York: Routledge, 1993), 170. The way in which justice and care are to be related, however, is an issue over which there is as yet no consensus. This is in part owing to differences of opinion regarding which of the two perspectives – that of justice, or that of care – is normatively more fundamental than the other. Those who would assign normative priority to caring have attempted to reconceive justice in explicitly care ethical terms. For example, Noddings has argued that principles of social justice can be modelled on familial instances of caring, and that an examination of the best sort of caring as it occurs in the home may be used as a guide to the development of social policy. Nel Noddings, Starting at Home: Caring and Social Policy (Berkeley: University of California Press, 2002). Alternatively, Michael Slote has argued that laws may be recognised as just if and only if they express benevolent (i.e. caring) motives on the part of the legislators who enact them. This approach explicitly mirrors Slote’s agent-based approach to care ethics, according to which an act is an instance of caring (and hence morally good) if and only if it expresses an agent’s benevolence. Michael Slote, The Ethics of Care and Empathy (New York: Routledge, 2007). Care-based conceptions of justice are contentious, largely because of the worry that they rest on a problematic over-extension of the concept of care. Alternative approaches to the care/justice debate therefore sometimes suggest that justice is the more fundamental concept of the two, and that a just society will be one which adequately supports the provision and distribution of care. For two such approaches, see Daniel Engster, The Heart of Justice: Care Ethics and Political Theory (New York: Oxford University Press, 2007); Joan C. Tronto, Caring Democracy: Markets, Equality, and Justice (New York: New York University Press, 2013). Against these approaches, it has been argued that they fail to take the importance of the care ethical perspective seriously enough, and that they merely offer an application of existing political theory to the domain of caring. Virginia Held, ‘Care and Justice, Still’, in Daniel Engster and Maurice Hamington (eds.) Care Ethics and Political Theory (Oxford: Oxford University Press, 2015) pp. 19-36. In addition, it has been argued that a concern for justice neither is, nor should be, the primary concern of caring institutions or practices: ‘Educational institutions are certainly social institutions, but their first virtue is hardly justice. […] Opportunities for education should be distributed fairly, but first systems of education must be created’. Held, ‘Care and Justice, Still’, 25. A plausible solution to this debate is suggested by the adoption of a pluralist conception of value. According to this solution, justice is to be recognised as a value distinct from, but no more or less fundamental than, that of care. Of course, such an approach requires the recognition of values other than those associated with caring, but this is something which we should acknowledge anyway. Consider, for example, that it is commonplace in philosophy to talk not only of moral value, but also, for example, of aesthetic or epistemic value. To claim that justice is a value in its own right is not, therefore, an egregious inflation of the taxonomy of values. Furthermore, by resisting the temptation to reduce justice to care, or vice versa, the autonomy and normative significance of each of these concepts is fully preserved. Of course, this move creates the potential for irreconcilable conflicts to arise between justice and care, just as they can between any other set of values. On such occasions, mediation between the two perspectives will be called for, with the importance of the claims made by each side being carefully assessed. However, the need to adjudicate between the relative merits of justice- and care-based perspectives is something which is already acknowledged in the literature, and is therefore not a cost of endorsing the pluralist approach I have outlined. The approach which I have outlined here is in agreement with some of the claims made by Grace Clement, Care, Autonomy, and Justice: Feminism and the Ethic of Care (Oxford: Westview Press, 1996), 121. It should be noted, however, that Clement’s approach is not an explicitly pluralist one, and only recognises the potential for conflicts to arise between justice and care perspectives, rather than from within the care perspective itself. Conclusion Care ethics is typically presented as a form of value monism. Whilst it may take this form, care ethics is more plausibly understood as a form of value pluralism. Caring practices are guided by a number of distinct aims, and the pursuit of some of these may at times require the neglect of others. Such trade-offs between irreconcilable goods is one of the hallmarks of a pluralist conception of value. Adopting such a conception allows care ethics more accurately to represent many of the lived realities of caregiving than would the endorsement of value monism. Additionally, a pluralist approach points to a plausible account of the relationship between justice and care, which sees justice as a value distinct from, but no more or less fundamental than, those associated with caring. Given the above points, this paper should prompt care ethicists to consider themselves value pluralists. In addition to this, however, it should focus attention more fully on the relevance of value theory to normative issues associated with caring, and encourage further reflection and engagement with the issues which it has addressed. 10