For some of last year an older family member requiring care came to live with us. Given our circumstances we needed to supplement the care we could provide with a “care package”. In practice that meant a visit twice a day from a “care worker” from a small team who were providing support for a number of “clients”.
I use scare quotes to register an unhappiness with the vocabulary of care. It seems riven with a certain transactionalism and commodification.
I cannot for a second imagine that that is justified by the common experience of such care. That is to say I cannnot imagine that we find the use of such transactional vocabulary apt because such care is in fact in general transactional.
There are reasons for the transactional language – a way no doubt to avoid condescending alternatives – but my failure to imagine its aptness is because of the nature of my experience and encounter with such care. My experience, as I shall say, contradicts it.
Is that contradicting experience universal? Of course not. I can’t deny that there were times when the interaction between my relative and their worker was perfunctory. Team members came and went. At times they seemed stressed and distracted, impatient and hasty.
Even so, speculating on the inherent motivation of such workers seems if not irrelevant then certainly secondary. Even if there are horrifying exceptions, there are more important things to be said not least about the status, rewards and demands placed on such workers before we get anywhere near generalised criticism.
Who could avoid being stressed, distracted, impatient and hasty in the context of ten or perhaps twenty housecalls a day?
But what my use of scare quotes is intended to register is that on occasions what I witnessed transcended the perfunctory and indeed the professional and did so to an extraordinary degree.
What I witnessed was something of a quite different order to anything that might resemble a transaction, something that requires a completely different vocabulary.
I want to say that what I saw, occasionally, but not uniquely, was a miracle.
I saw an encounter between two human beings that was as tender and intense as I could ever imagine, made all the more astonishing by the fact that it was between two human beings that barely knew each other and which took place within an allocated fifteen or so minute slot.
We have come to talk about kindness as a virtue in public service. I think we do so to contrast and show up the way of seeing things that I described above as transactional. Kindness registers a “thicker”, more morally loaded notion of human interaction than the more objectified, commodified forms (e.g., clients or service users and service providers).
But there are occasions when it is not thick enough. The vocabulary of kindness appears distinctly inadequate in the face of the sort of interaction between humans that can happen when, for instance, a carer cares, or a nurse nurses or a doctor doctors. Or for that matter when a teacher teaches.
(It is a matter of some interest, for another occasion, to specify the boundaries of this phenomenon; would one say it of an engineer, a police officer, a politician, a civil servant?)
What I witnessed was care given absolutely without condescension in a way that I can only describe using the conceptual repertoire of miracle, love, sacredness, and so on.
I felt humbled and even to an extent shamed. Shamed that all along I had clearly had some degree of pity and condescension in my heart. Of course in the face of great affliction such things as pity are “justified” but what I saw in the loving care provided to my beloved family member by their carer was something altogether better: a good beyond (mere) virtue.
It is the sort of compassion for the afflicted that Simone Weil described as “a more astounding miracle than walking on water, healing the sick or even raising the dead”.
I think it is part of the essence of this that it came through experience and not reason. It could not have been true and can never be true that (true) love be a means to an end. Love is an end in itself; one either feels it or one doesn’t. There is no “should” or “must” as 2+2 must surely equal 4.
This makes me think of a perceptive remark by R. F. Holland, quoted by the philosopher who has to the greatest degree inspired the thoughts in this note, Raimond Gaita:
“A stance has to be taken unless it goes by default, towards the difference between judgements that are of the highest significance for ethics and judgements that are not. In the former case I would say that it is more a matter of registering an experience or marking an encounter, than passing a judgement. I am thinking now of what can be seen in the unprofitable fineness of certain deeds or characters – and is pointed to by the unprofitable vileness of others; the difference between the unqualified goodness attested or offended against there and the ordinary run of merits and demerits among people and their works.”
I would agree: discerning matters of the highest significance are more a matter of registering an experience or marking an encounter than passing a judgement.
I might have understood my own behaviour to that point in terms of the ordinary run of merits and demerits, but I have now registered what can be seen in the unprofitable fineness of certain deeds and character. I can only aspire to such fineness, to such unqualified goodness.
These insights came before the COVID-19 pandemic.
I have in other contexts acknowledged the insight of Graham Leicester and Maureen O’Hara that every real emergency is also a conceptual and ultimately existential emergency. That is palpable when it comes to the catastrophy that is a global pandemic.
I want though to add a thought: perhaps in all such cases we are confronted by a moral or ethical emergency too.
That moral or ethical emergency is expressed in the following sentence which a human being (who I shall not dignify with a name) said out loud (or at least wrote down): “spending £350 billion to prolong the lives of a few hundred thousand mostly elderly people is an irresponsible use of taxpayers’ money”.
It does not add anything to the horror of this remark that one of the elderly people written off here is my beloved family member. Even if that were not true I would still consider such a thought unthinkable.
One might be tempted to suppose that that claim can only be metaphorical because in stating it one has essentially already thought it. One has performatively contradicted onself.
But I mean thinkable here not in a thin, abstract sense – an idle thought – but in the thickest and realest sense I can possibly muster. In that sense, such a thought is utterly unthinkable and that is a literal truth.
For what it’s worth I take the attempt to think this thought to be a reductio ad absurdem of at least the more superficial forms of consequentialist thinking in which the end justifies the means. Indeed as it happens I think it hits home hard against any form of consequentialist thinking. But that sort of philosophical oneupmanship is a complete distraction from what I feel impelled to say about it.
Of consequentialist thinking and epithets of precisely this sort philosopher Stuart Hampshire wrote:
“epithets usually associated with morally impossible action, on a sense of disgrace, of outrage, of horror, of baseness, of brutality, and, most important, a sense of a barrier assumed to be firm and almost unsurmountable, has been knocked over, and a feeling that if this horrible, or outrageous, or squalid or brutal, action is possible then anything is possible and nothing is forbidden, and all restraints are threatened.”
This is what I want to say, not just in the name of my “elderly” relative but in my own name: I refuse to allow this thought to be tolerated as thinkable to avoid knocking over a barrier that must for the sake all human decency remain firm and unsurmountable.
As Hampshire says, if such as thought is thinkable then anything is possible, nothing is forbidden and all restraints are threatened. That is utterly intolerable.
Regrettably, I understand that to be a normative thought, expressing an ought perhaps more than an is.
As Raimond Gaita says: “Just as you can tell what kind of person someone is partly by what she finds morally unthinkable, so you can tell the essential character of a nation by noting what is undiscussible in it. Nations and their political and moral cultures are partly defined by what is undiscussible in them.”
Unfortunately the well has been poisoned, the waters muddied. It is as if the boundaries and constraints of the thinkable and the discussable have been loosened to such an extent that the necessary contrasting idea of the unthinkable has been devalued.
That we are meeting the potential horror with our collective eyes wide open and not leaving those who care professionally to meet this alone.
It is not so much that everything is now thinkable as that just so much is now deemed unthinkable. We now no-platform and excommunicate at the drop of a hat. We have utterly devalued the currency.
It cannot be called out in a way that can easily be heard.
There is an ideological dimension to this that one might well describe in terms of the qualities of the human heart (that carry with them implied notions of leadership): hard hearted (“right”) versus bleeding hearts (“left”).
When faced by a real emergency that is at the same time an existential emergency one might find oneself imagining that amongst our political leaders there is no choice but to think precisely these supposedly unthinkable thoughts: if essentially sacrificing “a few hundred thousand mostly elderly people” (“a lesser evil”) in the short run saves our economy with all the horror that brings (“a greater evil”) then that is a price worth paying.
We have heard such things before: if torturing a few Muslims to extract actionable intelligence will thereby save thousands of lives then so be it. If sacrificing some civil liberties protects our way of life then sacrifice we must. And so on.
These are often presented in philosophy classes – the ticking bomb or trolley problem – and in the media perhaps more than anywhere else. In the media they are often presented as hard cases that only tough leaders have the balls to confront, and indeed must confront.
This apparent dilemma is represented beautifully in Dick Cheney’s fourth wall breaking speech at the conclusion of Adam McKay’s superb Vice:
https://www.youtube.com/watch?v=6E-v5yDBR64
“I will not apologise for doing what needed to be done”. I will not apologise for thinking what needed to be thought. Thinking the unthinkable so that “your loved ones can sleep peacefully”.
But one may well ask (evoking Shakespeare’s Macbeth): at what cost sleep?
The sense in which such things are unthinkable is not psychological. Thinking the unthinkable is not just a matter of mental toughness, of having “the right stuff”. As if one just needs to grit one’s teeth, gird one’s loins. In the end this has got very little of anything to do with psychological toughness. This is about moral toughness.
Toughness precisely not to think the unthinkable or find an uneasy balance between a lesser and greater evil. As Gaita says, “a lesser evil is still evil”.
The toughness here is the toughness needed to realise that there is no such choice. There are no such trade offs. There is no balance to be struck.
For that to be clear I need to risk taking seriously what I have said cannot be taken seriously, viz. to think what it would be, for instance, to let hundreds of thousands of people die to save the economy.
One cannot be said actually to have thought this thought unless one is willing to think what it would actually amount to. Literally leaving them to die? Without support? Without medical treatment? Would we seek to ease their passing? Would we restrain their families from seeking to help?
And so on.
Each question more brutal than the last until every last bit of (moral) sense is knocked out of the sentence. All that would be left to be thought would be that what is needed is a final solution. Godwin’s Law writ large.
But that most practical of reductio ad absurdems is not the basis of what makes such a thought unthinkable. That has the form of an argument and the passing of a judgement that suggests we are in a rational conversation and we are seeking compromise, a balance, a lesser of two evils.
But here we might well consider not a rational argument but a possible encounter. Let us suppose that the carer who cared for my beloved relative found themselves confronted by that choice. Or my nurse friends? My GP who has looked after my family for over ten years?
The very thought experiment is horrifying to me. Even more horrifying for the fact that it is exactly this situation that we may well be approaching in this pandemic.
Let us imagine then how such people could be made to confront the thought that we let hundreds of thousands of mainly elderly people die to save our economy? By something enshrined in law? Guidance? Instruction from employers?
Inconceivable.
But . . . what is the alternative to thinking the unthinkable? Would we potentially let millions die to save the hundreds of thousands? Here we are caught utterly in something approaching madness. The words “let” and “save” here are stripped of all sense.
If it must be said, and there is risk in feeling obliged to say it out loud: we would do everything in our power to save everyone, absolutely every last person. We would risk absolute tragedy rather than suffer the moral catastrophy that would come from “letting hundreds of thousands of mainly elderly people die to save the economy”.
The point is that to act at the cost of our soul individually and collectively is a price that simply cannot be paid. It would murder sleep. Haunt us utterly.
And so here we are. It cannot be faced but due to an unfolding pandemic, in every care home, in every intensive care ward, such events will unfold.
But not, it is essential to say, in the vast number of cases, the unthinkable choice we have been discussing. The choices that will be made are real and carry with them utterly unimaginable moral weight. They are the clinical choices that nurses and doctors make every day.
In the face of hundreds of thousands of such choices, however tempting, we cannot simply take the “easy” way out and accept we must always be justified in doing the lesser of two evils, in my example, thereby condemning hundreds of thousands to die. There is in fact no free pass. There is no way out, or around, or away from the moral reality. There is no justification of any sort here.
All we can do is hold out a hand and seek to ensure that we are all accountable for the circumstances and context in which such choices are to be made.
In that very context, confronted by the emergency that is COVID-19, the Scottish Government has published an ethical advice and support framework.
In a section headed “Ethical Considerations” the document states some fundamental principles:
- Everyone matters.
- Everyone matters equally- but this does not mean that everyone is treated the same.
- The interests of each person are the concern of all of us, and of society.
- The harm that might be suffered by every person matters, and so minimising the harm that a pandemic might cause is a central concern.
For what it is worth, and since apparently we need to be reminded, I agree.
This note is intended simply to emphasise that (at the cost of forfeiting our souls) amongst the harms to be minimised in confronting the pandemic is the moral harm.
Rough Ground 