Challenging questions and ethical obligations: the ethics of everyday practice > 21 January 2015

Vicky Singleton


Uncommon values in everyday practices: Fostering the potential for care with compassion

Following the recent widely documented evidence of failures of care and unnecessary patient suffering in Britain, the Department of Health published a revised NHS Constitution including an “expression of values that inspire passion in the NHS and underpin everything it does” (2013, 5). Government statements refer to a set of Common Values to be shared-alike across all locations of care practice in order to ensure care with compassion and to prevent practices that risk patient suffering. Within the Constitution the reach of the values is described more modestly. It is proposed that the values will be tailored to local needs and aim to provide common ground on which to co-operate to achieve shared aspirations. The acknowledgment that care is located and specific and reflects varied needs is welcome, as is the attention to values in care other than quantifiable outcomes and targets. Yet, it is not clear how the values expressed in the Constitution relate to everyday care. Focusing on one of the values, I will argue that while there is widespread agreement that compassion is essential to care, everyday practices of care with compassion are not necessarily an effect of achieving common ground and shared aspirations. Drawing on ethnographic research about the clinical care of patients with alcoholic liver disease I explore the mundane practices of negotiating what constitutes care with compassion. Firstly, I argue that compassion-in-practice is constituted by heterogeneous entities including humans, materials and technologies and is impacted by socio-economic context. Secondly, compassion is specific and variable because it is located. Thirdly, some practices of compassion are in conflict with one another, both within and between locations. The central argument is that values are not ethical abstractions but are rather mundane things that are the result of ‘going on together’ and hence they are continually being re-made in practices (Verran, 1999; Haraway, 2007). This reconfiguration of values as relational begs a question: How to promote values that are deemed to be essential to good care if they are slippery and precarious things done in mundane practices rather than stable ideals to aspire to? I suggest that we do so through promoting relations that foster the potential for the best possible care. Further studies of valuing in everyday practices will help us to understand which specific sets of relations between patients, practitioners, materials, technologies, protocols, policy and socio-economic contexts foster care with compassion. Moreover, if the studies begin by considering values as relational and achieved in practices we will learn how to support the on-going shared work of negotiating the co-existence of uncommon values that is necessary to do caring with compassion.



(to be confirmed)


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