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Legitimacy of Nursing and Caring in Max Weber's Frame of Reference
By Mari Lahtinen
Introduction
Throughout history, the providers of nursing and caring have been female. Women have been married, persuaded or forced to adopt the role of a nurse and a carer. The power of authority has been wielded by the patriarchy, appealing to tradition, natural disposition or the "law of God." The few women who have refused subordination have been labeled as unnatural. (Noddings 2001.) Nursing and caring have been part of the necessary but anonymous domain of society, which in spite of its obvious lack of value has been considered both an obligation and a source of satisfaction. Most women still work in such fields, and most holders of such occupations are female. Are women still working subordinate to authority? Is acquiescence the sole justification of nursing and caring?
I will approach the justifiability of nursing and caring from the frame of reference of Max Weber's (b.1864ñd.1920) classical definition of rationality of action. I will analyze, from a feminist perspective, the applicability of both Weber's thinking and the related concept of responsible rationality as explanations of the foundation of nursing and care.
Max Weber and instrumental rationality
According to Max Weber (1978[1904-1905]), the actions of Western people are characterized by instrumental rationality. This means that maximally effective means are used to reach the goals (Niiniluoto 2001). According to Weber, the goal of Western societal action is continuously and endlessly increasing affluence. One of the major factors contributing to this is the Protestant ethic. The Protestant ethic lays the foundation for western instrumental rationality and its manifestation in social interaction.
Religion at the background of western rationality
According to Weber, all religions in the world have their religious motives, which do not only affect religious actions, but also influence the actions of the economic world within the religion's sphere of influence. Each economic system is thus consistently oriented towards certain religious values. In the Western countries, the values of Christianity prevail. (Hietaniemi 1987:44, Weber 1978.)
In order to understand the Protestant ethic and Western rationality, according to Weber, we must understand the difference between religion and magic. Magical thinking is only possible in a one-level world. Religion, on the other hand, is divided into a "background world" (Hinterwelt) and a visible or manifest world. The manifest world conceals behind it the background world, where religious actions take place. The religious actions taking place in the background world define both our relations to the manifest world and the valuation of things within the manifest world.
According to Weber, the reciprocity between the background and manifest worlds can be presented as two ideal models. In Asian religions, for example, the human being is a container of divinity. The person must be filled with divinity and get rid of evil by becoming part of the prevailing cosmic order and, hence, the divine. In Europe and the Near East, on the other hand, divinity is something personal and distinct from the evil world. The human being in the world is God's tool. Weber points out that the Judeo-Christian faith in salvation was the first pronouncement of a God radically separate from the world. This God is as far from the world as possible: on a high mountain or in heaven. He rules as a personal power and orders people to make the world accord with his ethical principles. The tension between the world and God is most consistent in Puritanism: humans are alone in front of the mighty and hidden God, who poses quite impossible demands upon them. For a Judeo-Christian, the world is merely a means of salvation. For a Puritan, the world is a tool just as, for God, the Puritan is a tool. This explains Weber's practice of life: adequately capitalistic actions precede the rise of capitalism.
The fact that the background and manifest worlds are so sharply demarcated in Europe and the Near East has two paradoxical consequences. Firstly, rationalization (Versachlichung) of the world occurs: the world begins to operate in accordance with its own logic, and all things become instrumentalized. This ultimately leads to secularization and the western process of rationalization. Secondly, the demarcation also has paradoxical consequences for working ethics. The goal of Puritanism was to withdraw from the world and to practise ascetic frugality, but the hard-working and frugal Puritan ended up accumulating capital, which, in the long run, made the world much more secular than the papal worldliness originally opposed by Protestantism. (ibid.)
Western instrumental rationality
Modern capitalism was thus considered by Weber one particular manifestation of Western rationality. Rationality is not a feature unique to Western culture. Still, the Western countries differ crucially from the Eastern countries in terms of which aspects of life are rationalized and in what direction (Gronow & T–tt– 1996). According to Weber, western rationality is reflected in market behaviour, the law, administration and professional ethics. By market behaviour, Weber refers to the tendency of even the law and institutions to promote computability and efficiency. At the same time, the possibilities of steering the economy on grounds other than mere efficiency diminish: human actions are guided by instrumentality and speculation. This eliminates the possibility to foster substantial types of economy that would aim to satisfy collective needs. The legal system, in turn, encourages actions parallel to market behaviour. This means that appreciation of content is completely alien to the administration of justice, and cases are settled with strict abstract and formal rules. In this way, Western rationality becomes alienated from the principles of substantial justice. (Hietaniemi 1987, Gronow & T–tt– 1996.)
Increasing rationalization results in growing administrative bureaucracy; matters are solved in line with formal judicial rules, and practices based on the "ethics of fraternity"are inapplicable. The ultimate manifestation of Western rationality is professional ethics. Professional ethics is a religious impulse of Protestant asceticism. Professional ethics brings market behaviour, justice and bureaucracy into practice. Work becomes an end in itself. (Weber 1978, Hietaniemi 1987, Gronow & T–tt– 1996.)
According to Weber, non-rational actions remain outside instrumental rationality. He describes non-rational actions in terms of traditional, affective and value-rational actions. Weber points out that traditional rational action resembles reactive imitation or blind repetition: traditional action is based on uncritical, internalized habits. Affective rational action is guided by emotional states and rarely involves conscious reactions. Value-rational action is oriented by absolute value goals of, for example, aesthetic, ethical and religious actions. A certain line of action must be followed regardless of all consequences. Value-rational actions are more systematic and consistent than affect-driven actions. They comply with the orders and demands posed by the actors to themselves. (Weber 1978, Gronow & T–tt– 1996)
According to Weber, however, the ideal type of social action is goal-rational action. It prioritizes the optimally effective choice of tools to reach any goal. This means that both objects and expectations concerning other people's behaviour are used as prerequisites or means to attain a certain rationally desirable outcome or an intentional personal goal. The climax of goal-rational thinking is monetary costñbenefit analysis based on a comparison of quantitative costs and benefits. (ibid)
Weber's constraints
According to NÖtkin (1986:156), the only relevant criterion of action in Weber's definitions is the maximization of personal benefit. This rationality of modern business is pivotally based on resource planning, calculation of financial resources and, specifically, male power (Ve 1994:44). Such limited rationality is actually only materialized in public institutions consisting of male citizens. It inevitably defines women's actions as being part of the private domain, or family life. Private action is a necessary prerequisite for public life, although it fails to obey the same laws of rationality as public life. (NÖtkin 1986:160.)
Weber's analysis ignores the role of work outside the public economy because it does not fit the definition of rationality (Ve 1994:44). The values of capitalism based on Western rationality do not include nursing and care, which focus on persons and interpersonal relations. When working with people, we cannot talk about efficiency or productivity, and the principle of profit-making free trade cannot be applied to nursing and care. (Held 2002, Nelson & England 2002.) As Hietaniemi (1987:43) pointed out, in Weber's thinking "caritas" and modern rationality are just as incompatible as fire and water.
When considering the premises of Weber's definitions of action, we must also allow for the temporal distance. Weber wrote his books at the turn of the 19th and 20th centuries, when the first signs of the recognition of women and women's actions and work were barely visible. Weber himself, however, was not aware of these signs, but considered women and the work done by women quite invisible and insignificant. Weber's subject was man: "a man of honour," "an honest man" and "a business associate." Still, the book also contains verbal imagery related to women. According to Weber, "money is of the prolific" and "its offspring can beget more." (Weber 1978:49-50.) Money is hence gendered. Money is a means of exchange, it changes hands, and it is the most instrumental instrument -and female. Weber also concludes that the modern organization of capitalist enterprises would not have been possible without accountancy and the differentiation of the household from the company. Having thus set apart housework, Weber continues to advocate rationality as a basis of action merely as one dimension of economic life. (Weber 1978.)
Responsible rationality
According to NÖtkin (1986), however, underlying reasons for action can also be approached from perspectives other than instrumental rationality. The term "responsible rationality" (omsorgsrasjonalitet) proposed by Norwegian sociologists, refers to action justified by conscious responsibility. Such action maintains and sustains, and its consequences and significance are recognized widely and over long time spans.
According to Ve (1994:46-47), responsible rationality differs from western instrumental rationality even in its view of humanity. Western instrumental rationality views human beings as means to maximize profit. In responsible rationality, the human being is an authentic subject and a goal in him/herself. The human being's intrinsic value characterizes interpersonal relations in both the private and the public domain. Interpersonal relations are unique and cannot be exchanged or replaced by other interpersonal relations. In actions motivated by responsible rationality, the actors try to take into account totality and continuity, while goal-rational action focuses on partial accomplishments. Responsible rationality is interested in other people's wellbeing and the consequences of one's actions and activities. It includes responsibility for the consequences of one's actions and willingness to modify one's behaviour in view of its possible consequences. Acceptance of unilaterality (non-reciprocity) is also central to responsible rationality. (See also Meyer 1986.)
The ways of gaining knowledge by instrumental and responsible rational actions are also different. The knowledge desirable from the viewpoint of instrumental rationality is objective and procured with the best scientific methods. From the viewpoint of responsible rationality, theoretical knowledge is important and essential, but practical knowledge is still the priority. In responsible rationality, actions gain depth and significance through tacit knowledge based on trust, understanding or experience. (Ve 1994.)
In Ve's view the types of rationality shown by women and men are not biologically determined, but socially constructed, gender differences. She believes the actions of women have been restricted to nursing and caring, and their experiences have hence reflected this reality. Since experience is of crucial importance, the gendered division of tasks has merely enhanced the difference between the experiences of women and men and hence also the difference in what is called rationality. All in all, instrumental western rationality is specifically a manifestation of male rationality.
According to Meyer (1986:150), caring actors do not only produce and reproduce concrete care, but also social relations and the reciprocal ability to grow and renew. Caring is not merely maintenance of reproductive resources, but also a mode of interpersonal, social communality. Caring thus has the same potential to cross boundaries as does any social relationship. Meyer further underlines the special feature that care is based on personal interpersonal bonds. It consists of reciprocal giving and taking between social actors. In NÖtkin's (1986:157) opinion also, responsible rationality combines the different aspects of social life. It blurs the line between work and other social interaction. Responsible rationality as the underlying justification of work implicitly includes a sense of the importance, justification and moral obligation of work.
Responsible rationality also prefers to view things as bothñand instead of eitherñor. This helps to avoid extreme and absolute alternatives. Instead, solution which ares satisfactory from the holistic viewpoint are sought. Responsible rationality is capable of empathy, reciprocity and self-reflection. It also involves avoidance of risks and a sense of responsibility. NÖre and LÖhteenmaa (1992) invite attention to the relationship between responsible rationality and altruism. They believe it is possible to differentiate between responsible rationality and altruism, which they call altruistic individuality. According to NÖre and LÖhteenmaa, altruism is close to responsible rationality, but highlights the recognition of others, even at the cost of one's own wellbeing.
Responsible rationality has broken out of the straitjacket of gendered thinking. Women as nurses and carers have been considered subordinate to authoritarian expectations and norms, not social actors capable of reasoning, choosing and assuming responsibility for their actions. According to Ve (1994), rational responsibility also deals in a positive way with the bonding of women with other people: for a person with responsible rationality, people are really subjects who cannot be considered mere instruments to maximize one's benefit. As Ve points out, female researchers have moved a good distance away from Weber's typology.
The tottering foundation of the patriarchy
Genevieve Vaughan (1997:23,28) views critically the entire foundation of Western rationality. According to Vaughan, Western rationality is patriarchal. Rationality presently consists of the domination the patriarchal global economy by white men, whose activities are enabled by white women, who do the nursing and caring and all other tasks that are not part of the patriarchy. According to Vaughan, the self-justified actions of patriarchal Western capitalism are questionable. According to her, the Western rationality-based capitalism involves distortions and subordination, which can be approached through the concepts of exchange and giving.
Vaughan believes that western rationality and capitalism are based on profit-oriented exchange: one gives in order to get something in exchange. In exchange, givers use other people's needs and their satisfaction as means to satisfy their own needs, and this is considered by Patriarchy as intrinsic to humanity. Exchange is pivotally based on speculation and profit, self-centred and ego-oriented. According to Vaughan, however, exchange is not the characteristic human way to act, but giving is more primary. Giving consists of responding to another person's needs. According to Vaughan, freedom to respond to needs is a matter of quality rather than quantity: no effort is made to quantify or control the giving. Giving is a quality that cannot be constrained. Because giving is qualitative, it has not been conceived of as the basic factor underlying interpersonal relations. The dimension of giving is present in all people and in all domains of social actions, but it is not easily seen because it is difficult to measure and define. The process of responding to needs establishes a bond between the giver and the receiver. This bond is unique and involves two subjects: the actions of recognizing a person's needs and responding to them affect both the giver and the receiver. (Vaughan 1997: 30-34.)
Discussion
If we use the Weberian frame of reference, the legitimacy of nursing and caring ranges through a spectrum from non-existence to altruism. Weber does not acknowledge "caritas" as a justifiable or rational activity. Responsible rationality labels nursing and caring as a conscious choice, which involves deliberate, selective responsibility. When we use the concept of responsible rationality, we accept "rationality" as a word, but assign to it a meaning notably different from Weberian instrumental rationality. Still, the basis remains rooted in the ideal of patriarchal rationality. Altruism as a foundation of nursing and caring consists of unselfishness, benevolence, sacrifice and charity. Underlying that is an attempt, or ethical imperative to improve the welfare of others. Altruistic individualism, in its extreme form, verges on martyrdom.
Vaughanian thinking, however, does not accept the approach based exclusively on patriarchal terms. Seen from this viewpoint, nursing and caring consist of "mothering" that is parallel to responsible rationality, non-gendered and present in all domains of life. It is conscious, responsible and aware of long-term consequences. Nursing and caring are holistic and interested in others.
From Vaughan's viewpoint, it is not intrinsically important whether nursing and caring are defined as rational or non-rational. The more interesting issue is to analyze the logic of the action. The "reciprocity" of responsible rationality can be specified from this perspective: nursing and caring are not symmetrically reciprocal. This means that their reciprocity is not based on patriarchal exchange of instrumental rationality, but on qualitative giving. This is not, however, altruism in the sense that the giving would require one to sacrifice one's own person. What is given in nursing and caring is not immediately returned, but may be given further to a second or third person or possibly even to someone quite unknown to the carer.
Western instrumental rationality would naturally also instrumentalize nursing and caring. The instruments have included the Son, bread, wine, the woman and one's fellows as well as money and machines. The most important thing, however, is that it is not even desirable to bring the giving in nursing and caring anywhere close to the concept of exchange of instrumental rationality. Firstly, the giving in nursing and caring is qualitative and therefore difficult to define with the concepts of exchange. Secondly, the giving in nursing and caring pertains to human beings and human values, which is incompatible with instrumental thinking. Thirdly, nursing and caring do not, generally speaking, aim to quantify their practices. Maybe Weber was perceptive enough to anticipate this: caritas is not rational as the kind of patriarchal ideal he considered it to be.
There is, however, some parallelism between Weber's and Vaughan's thinking. In the Weberian framework, the gift would be equally desirable for giving would "beget." The "reproduction" of exchange based on Weber's instrumental rationality takes place between the parties to the exchange A and B: A gives something to B and expects B to give the same or preferably even more in exchange, i.e. A expects his giving to "reproduce." In Vaughanian thinking, "reproduction" is equally desirable, but in a different sense. "Reproduction" takes place away from the giver, and the giver is not necessarily even aware of this "reproduction." Giving is going on. Therefore, nursing and caring are not an instance of exchange based on patriarchal instrumental rationality.
References
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