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Levels of care reasoning

While research has focused on gender differences, it has obscured Gilligan’s (1982) conceptualisation of the ethic of care as a theory of development. She outlined a developmental sequence in care-based reasoning based on a follow-up study of 21 women, diverse in age, social background, and marital status, who were clients on pregnancy counselling sendees and abortion clinics. These women struggled with a moral crisis whether to continue or abort a pregnancy. Difficult situations raised contemplation of how self and others are affected by a decision and how hurting would be minimised, leaving the ultimate choice for the women themselves. Individual crises differed in character, revealing successive developmental perspectives in women’s thought. Gilligan was cautious about calling them stages as Kohlberg did, leaving the validation of her findings to further studies. Below, they are called “levels,” following the classification system of care-based reasoning and related studies (see Skoe, 2014).

In Gilligan’s (1982) study there were young girls at the first level, concerned selfishly with their own survival; how to manage financially and emotionally without support. At the second level, women have adopted conventional norms of social responsibility of protecting others at one’s own expense. They were confronted with the decision-making that would hurt somebody in any case: the unborn baby, the father, and other family members, and they were willing to minimise hurt by sacrificing their own needs and hopes. Finally, there were women who constructed a moral conflict in a totally new way at the third level, recognising and asserting their own needs based on their “inner voice” rather than the expectation of others, and taking responsibility for their judgment and choice. Those women realised that self and others are still interdependent and that life can only be sustained by taking care of both self and others. Between the main levels there were also two transitional points where women’s thinking was under change and out of balance (Gilligan, 1982).

Gilligan retreated from studying moral development and moved on to the narrative inquiry of moral voices (Gilligan, Brown, & Rogers, 1990). Skoe (1998, 2014), however, continued her work by devising and validating a developmental measure of care-based reasoning, the Ethic of Gare Interview (EGI, hereinafter). The measure distinguishes three main levels (stages) and two transitional levels, reflecting a growingly complex understanding of interdependence of self and others and responsibilities in human relationships (see Table 5.2).

TABLE 5.2 Levels of care development (adapted from Gilligan, 1982; Skoe, 1998, 2014). Printed with permission. Copyright The Finnish Educational Research Association

1. Survival (caring for self)

Moral thinking is characterized by caring for self to ensure survival and personal happiness. The person tends to think about relationships in a self-protecting and pragmatic way. Moral conflicts emerge mainly if one’s own needs are in conflict. There is little, if any, evidence of caring for other people and their lives or feelings. Generally, self-interest serves as a basis for moral judgment.

1.5 Transition from survival to responsibility

Moral thinking is characterized by an emerging sense of responsibility towards other people. Concepts of selfishness and responsibility first appear, and the person can criticize one’s own judgment and behaviour for being selfish. Although aware of the needs of others, the person still decides to do what she or he wants, what feels good, or what will best protect herself or himself. Self-interest remains the main criterion in moral decisionmaking, and caring for others occasionally takes place.

2 Caring for others

Moral thinking is characterized by elaborations of responsibility and providing care for other people, especially dependent and weaker ones. Being good is equated with selfsacrificing care for others. The person seeks to follow social norms, and there is a strong need for security. Moral conflicts arise, especially over the issues of hurting, and others are often helped or protected at the expense of self-assertion.

2.5 Transition to reflective care

Moral thinking is characterized by a re-evaluation of the relationship between self and others, as the person questions the moral value of protecting others at one’s own expense. Truth and honesty in relationships is emphasized. Compared to the “black-and white” worldview of the previous level, complexities and nuances are expressed. In solving the conflict, one feels partly responsible for other people but is also concerned about oneself and wants to assert one’s own views and needs.

3 Caring for self and others

Moral thinking is characterized by balancing needs of both self and others and attempts to minimize hurt or harm of everyone impacted in the situation. The tension between selfishness and responsibility is resolved through a new understanding of the interconnection between others and self. The morality of action is judged on the basis of its actual intention and effects. The criteria for goodness have moved inward. No longer restricted by social convention, the person is able to make complex moral choices, accepts responsibility for decisions, and takes control of one’s own life.

The ECI consists of four dilemmas that are administered in a semi-structured interview format. In addition to a real-life conflict generated by the participant, three standard interpersonal dilemmas are presented involving conflicts about unplanned pregnancy, marital fidelity, and care for a parent. These dilemmas are included in the measure to present common interpersonal concerns where the helping of others could be at the expense of hurting oneself (Skoe, 2014). The interviews are audio-recorded and then scored according to the Ethic of Care Interview Manual (Skoe, 1993). In scoring, it is important to discern whose needs and concerns the participant takes into account in the situation and the reasons for the suggested decision, rather than the decision itself. For example, the person should stay married or divorce for the sake of children (Skoe, 1993, 2014).

Studies with the ECI so far have involved over 1500 participants, ranging from 10 to 85 years of age and involving several nationalities from North-America and Scandinavian countries (Skoe, 2014). Cross-sectional studies and three longitudinal studies have unanimously supported the suggested developmental sequence of the levels originally proposed by Gilligan (Juujarvi, 2006; Juujarvi, Myyry, & Pesso, 2012; Pratt, Skoe, & Arnold, 2004). Care reasoning among adults seems to vary across all levels. The construct validity of the levels of care reasoning is supported by findings of positive relations to volunteer helping (Pratt et al, 2004), affective empathy and perspective-taking (Juujarvi, Myyry, & Pesso, 2010), complexity of reasoning, and consultation with others (Skoe, Pratt, Matthews, & Curror, 1996). Furthermore, 51 forensic psychiatric patients who had committed serious violent crimes scored at the lowest ECI levels with two exceptions (Adshead, Brown, Skoe, Glover, & Nicholson, 2008), whereas 25% of social work students had achieved the highest level at the end of their studies (Juujarvi, 2006; Juujarvi et al., 2012).

While gender differences have been non-existent at least among college-educated young adults, levels of care reasoning have been found to be associated with ego identity development, especially for women (Skoe & Diessner, 1994; Skoe & von der Lippe, 2002). This corroborates Gilligan’s (1982) classic notion that women’s conceptions of self and morality are interwoven and may explain the finding that women face more care based conflicts in their everyday lives than men (Jaffee & Hyde, 2000; Skoe et al, 1996). Which factors do explain advances in care development? Gilligan (1982) proposed that life crises are catalysts for care development, creating an opportunity for moral growth but also for disillusionment and nihilism. In Juujarvi’s (2006) longitudinal study the only regressed participant was a male, full of anger and despair, who has recently lost custody of his children. Pratt et al. (2004) found that parents’ emphasis on caring and autonomy-encouraging upbringing practices enhanced care development from age 16 to age 20. Juujarvi et al. (2012) observed that affective empathy and preference for values of self-direction predicted care development among nursing and social care students. The examination of specific determinants of care development is still underway, but empirical evidence so far suggests that encouraging children and youth to empathise with other people’s emotional states, as well as to explore their own values as a basis for independent decision-making may boost care development.

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