Prelims

Half Title Page

Slow Ethics and the Art of Care

Endorsements

Praise for Slow Ethics and the Art of Care

‘In this meditation on the nature of “slow ethics,” Gallagher considers morally exemplary as well as morally deficient acts to make the case for slow ethics, which places “sensitivity, solidarity, space, sustainability, scholarship and stories” at its centre. We need, Gallagher argues, to slow down to practice care in an ethical way. Most remarkably, the book is itself a beautiful and personal illustration of how “slow ethics” can work to change how we care and, indeed, how we live.’

Joan Claire Tronto, Professor Emerita, Department of Political Science, University of Minnesota, USA

‘Delightful scholarship and deep humanity make this book a rare treasure. It will become a classic, to be read and pondered…slowly.’

Christopher Herbert, Visiting Professor of Christian Ethics, University of Surrey, UK

‘Ann Gallagher is one of the leading international voices in care ethics. In Slow Ethics and the Art of Care, she draws on nearly four decades of experience, observation and scholarship to explore the real ethical choices facing all those who try to care well. This is a wise and deeply humane book that should be read by everyone who’s serious about one of the most urgent human challenges we face.’

Christina Patterson, journalist and author of The Art of Not Falling Apart, UK

‘Population-level challenges from the coronavirus pandemic to ageing and dementia call on us to consider what it means to live a good life, how we should live in relation to each other, and who counts as a member of society. Care ethics offers a crucial way to understand how lives are linked through interdependence. Ann Gallagher's Slow Ethics is both a thoughtful meditation on the nature of care and a practical guide to thinking and doing in uncertain times. This new work will be welcomed by scholars of care ethics and practitioners in care fields and will be of interest to general readers.’

Nancy Berlinger, The Hastings Center, USA

‘Ann Gallagher has written a wonderful “bible” of slow ethics for all the care professions. Lively, accessible and incredibly moving, its lessons are profoundly relevant to the changing world we find ourselves in. Every hospital, every care agency and every funding body should have this book in their library – and put its lessons into practice.’

Tim Jackson, Professor of Sustainable Development, University of Surrey, UK

‘This book offers considerable insight into how health care might be delivered in the current challenging climate and leads the way in developing a new approach.’

Leslie Gelling, Editor of the Journal of Clinical Nursing and Principal Academic in Adult Nursing, Bournemouth University, UK

‘Health care is notoriously fast paced. Health care providers decry how busy they are in their professional lives and lament the lack of time for reflection. Professor Ann Gallagher provides an antidote to this situation in her book Slow Ethics and the Art of Care. Drawing on her extensive experience in nursing and ethics, she persuasively guides the reader to the inescapable conclusion that slowness is a necessity, not a luxury in the provision of health care. Beautifully written and lucidly argued, it should be savoured slowly and ideally with a cup of tea!’

Ross Upshur, Professor, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Canada

Title Page

Slow Ethics and the Art of Care

Ann Gallagher

University of Surrey, UK

United Kingdom – North America – Japan – India Malaysia – China

Copyright Page

Emerald Publishing Limited

Howard House, Wagon Lane, Bingley BD16 1WA, UK

First edition 2020

© 2020 Ann Gallagher Published under exclusive licence by Emerald Publishing Limited. Illustrations © Claire Smith.

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No part of this book may be reproduced, stored in a retrieval system, transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without either the prior written permission of the publisher or a licence permitting restricted copying issued in the UK by The Copyright Licensing Agency and in the USA by The Copyright Clearance Center. Any opinions expressed in the chapters are those of the authors. Whilst Emerald makes every effort to ensure the quality and accuracy of its content, Emerald makes no representation implied or otherwise, as to the chapters' suitability and application and disclaims any warranties, express or implied, to their use.

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN: 978-1-83909-198-8 (Print)

ISBN: 978-1-83909-195-7 (Online)

ISBN: 978-1-83909-197-1 (Epub)

Dedication

For my mother, Mary Margaret Gallagher, who shows me how to be kind

In memory of my grandmothers, Maggie Bonner and Annie Gallagher, who role modelled resilience

And for my daughter, Kiera, who teaches me the importance of space in care

Prologue

[…] there's a story behind everything. How a picture got on a wall. How a scar got on your face. Sometimes the stories are simple, and sometimes they are hard and heartbreaking. But behind all your stories is always your mother's story, because hers is where yours begin.

–Mitch Albom (For One More Day, 2006).

In 2012, the late John Drummond invited me to contribute a chapter to a book entitled: Philosophy of Nursing: 5 Questions (Forss et al., 2013). The first question was: ‘How were you initially drawn to philosophical issues regarding nursing?’ I began this way:

At the age of seven I was led to believe that I was responsible for my ‘sins’ and that if I repented, I would be forgiven. I went to confession regularly and shared my list of transgressions of the ten commandments with a priest. These may have ranged from telling lies, to being disobedient, to having dishonorable thoughts about a parent. Sometimes I struggled to come up with material for the monthly unburdening. I would then worry that I had to have something to confess but feared that this would have to involve some fabrication which could be construed as lying. Already I had a sense of the complexity and ambiguity of the moral life.

This book starts and ends in rural Donegal, my first home and site of that early moral angst. The book is informed by over four decades of engagement with care as a nurse, ethicist, teacher, editor and researcher. The book stems from a strong commitment to illuminate, to celebrate and to promote the art of care. It stems from a desire to share a better way to think about, and enact, ethics in care. It stems also from a desire to do all possible to prevent what happened to my mother from happening to other people.

My mother, Mary Margaret, was the fourth of 10 children brought up in rural Donegal. She did not enjoy school and was pleased to leave at 11 years old and to go to work as a nanny, caring for the six children of a local farming family. My mother's mother, Maggie Bonner, had also gone out to work early, walking from her childhood home in west Donegal to the hiring fair in Letterkenny (see http://www.donegaldiaspora.ie/place/hiring-fairs). There, she would strike a deal with a farmer and go to work for this stranger for 3 to 6 months at a time, living and working on the farm. Both women worked hard and considered themselves fortunate, my mother told me, to work for farmers who treated them well.

My father, like many Irish men of the time, spent some of his early adult years working in construction in England and Scotland. He lived frugally and wired money back weekly to maintain his family in rural Ireland. The year after I was born, my mother, then pregnant with my sister, travelled to Scotland to visit my father who was working near Glasgow.

During the visit, my mother became unwell and was admitted to a local hospital. Soon after admission, she overheard one of the nurses say something along the lines of: ‘These people coming over here to have their babies’. Just after this episode, the nurse ran a bath for my mother which was too hot. However, my mother lacked the confidence and courage to say this. When she emerged from the too hot bath, her skin was red. She recalls the nurse looking at her body and asking: ‘What's that dirty rash on your body?’

My mother was alone, a long way from home and worried about the well-being of my unborn sister. She said the nurse's comments left her feeling belittled and low. The memory of this episode has never left her, and she cites this as the reason she did not wish any daughter of hers to become a nurse. My mother's experience reminds me of Maya Angelou's words. As an African American poet and novelist, Maya Angelou is reported as saying:

I've learnt that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

Almost 60 years on, my mother has not forgotten how that nurse made her feel.

My mother was, then, less than enthusiastic when I told her I was planning to become a nurse. Following in the footsteps of my aunt Anne. I trained as a State Registered Nurse, at the Royal Victoria Hospital on the Falls Road in Belfast. This was the early 1980s, during ‘The Troubles’ in Northern Ireland. ‘The Troubles’ downplays the devastating consequences of the 30-year conflict, from 1968 to 1998, which resulted in the over 3,500 deaths, 100,000 people suffering physical disability and over 500,000 who became victims due to loss, bereavement and trauma as a result of bombings, shootings and other forms of violence (McKittrick et al., 2008).

I soon learnt that, even in the darkest of times, good care-giving provides comfort to those in the most desolate situations.

Care-giving promotes human flourishing, eases suffering and, where recovery is not possible, enables people to die well. Critically I learnt that, whereas sectarian lines were drawn outside of that Belfast hospital, inside there were only people needing care and people willing to give care. During my time in the Royal Victoria Hospital School of Nursing, I recall no discussions of sectarianism, discrimination or disrespect. There was an assumption that care would not discriminate, that care would be respectful, that care would aim at what was good and right and would and could mitigate the distress and devastation inflicted by humans on humans.

The epiphany that sparked my thinking and writing about slow ethics – leading to this book – happened in Stockholm in 2013. This was just after the publication of substantial reports detailing the nature and causes of suffering of patients and families at Mid Staffordshire hospital in England. The idea was developed and consolidated during a sabbatical which took me from Tuskegee University in Alabama, to the Hastings Centre in New York, to University College Cork, to the University of California in San Francisco and on to Xiamen University in China and Kyoto Tachibana University in Japan.

From childhood, reading books has been one of my greatest pleasures, and it is through books, more than any other reading material, that I have acquired disciplinary knowledge and the most interesting and impactful insights.

However impactful my reading, it is my mother's experience that motivates me to do what I can to make it less likely that harm and humiliation happens to anyone else. Care-givers, for the most part, take pride in the art of care-giving. They put the interests of care-recipients, families and communities first and recognise the significance and privilege of the work they do. However, care-givers are humans who are not always kind, who are not always just and who do not always care as they should. Engaging with philosophical scholarship and empirical research enables us to better understand why bad things happen in care and to have a clear sense of the theory that underpins the ‘shoulds’ and ‘oughts’ of care-giving practices.

‘Slow ethics’ is an approach that is applicable within and beyond formal care-giving contexts. I hope that readers will benefit from reading stories, which aim to ‘show not tell’, and the elements of sensitivity, solidarity, space, scholarship and sustainability.

This book is then, dear reader, something of a bricolage of stories and insights selected from my experience of the best of care-giving and illuminated, I hope to best effect, by slow ethics.

Acknowledgements

Many people have contributed to this book, knowingly and unknowingly, and I am grateful to all of you for your friendship, love and collegiality. I am unable to name everyone who has made a positive impact during the writing; however, please know that lack of mention does not amount to lack of appreciation.

A thank you, first, to those friends and colleagues who so trustingly contributed stories and so generously read and provided feedback on book chapters, namely, Emiko Konishi, Jane Leng, Reuben Warren, Lillie Head, Anne Hughes, Jacky Spencer-Davies, the nursing team at Laguna Honda, Giles Paiba, Robert Gannon, Christopher Herbert, Julia Gittoes and Pete Morriss. I am indebted to Ross Upshur and the anonymous reviewer who read and commented so helpfully on the penultimate full draft. If the book is well received, credit goes to all of you. If not, I bear full responsibility for paying too little attention to your good counsel.

Gratitude is owed to Melaine Coward, Helen Griffiths and Emma Ream, at the University of Surrey who supported my sabbatical from 2017 to 2018. This book is an output from that inspiring sabbatical journey.

I will be forever grateful also to colleagues and students who hosted me so generously during my sabbatical: in the USA, Rueben Warren and the bioethics team at Tuskegee University, Alabama; Nancy Berlinger and colleagues at the Hastings Centre in New York; and Barbara Koenig, Lindsay Forbes and colleagues at the University of California, San Francisco; in Ireland, Joan McCarthy and colleagues at University College Cork; in China, Yonghui Ma and colleagues at Xiamen University; and in Japan, Professor Noriko Kawahara and colleagues at Kyoto Tachibana University. A Fulbright Scholarship award greatly enhanced my sabbatical experience, and I thank Elizabeth Mucha, Ana Pereira and other Fulbright staff for inducting me into this enriching community.

A special thank you to Anna Cox, the most positive colleague and friend imaginable, and to members of the Advisory Group at the International Care Ethics Observatory who so generously support and guide our work. Sarah Banks, Joan McCarthy and Anne Scott kindly shared references. Others deserve thanks for so patiently enduring my less than full attention in recent months and for providing unwavering positivity during the writing. Colin deserves a special mention for his relentless love and support. Friends Rob, Spencer, Sam, Dennis, Douglas, Verena, Chris, Carrie, Craig & Suzie regularly checked my progress and encouraged me to complete the book.

Thank you also to Ben Doyle at Emerald who commissioned the book, and Katy Mathers and Paula Kennedy who graciously endured postponements with delivery of the manuscript. They were, perhaps, not terribly surprised that a book on ‘slow ethics’ would arrive a little late. A final credit for the expressive drawings in the book is to Claire Smith. Claire is a formally trained fine artist and lecturer who now continues to practice, alongside a professional role in managing and training designers. She is also a dear friend to my daughter, Kiera.