An ethic of care can be distinguished from an ethic based on autonomous rights, utilitarian principles, or indeed principles of any kind, since care has less to do with intellect than with emotions and will. Moreover, an ethic of care is consistent with the example of Jesus and the virtues advocated by the apostle Paul. Emily A. Hitchens and Lilyan S. Snow make their case with particular reference to accounts by Civil War nurses, who developed the skills of care without precedent and without the expectation of cure that scientific medicine has aroused. Hitchens and Snow teach nursing in the School of Health Sciences at Seattle Pacific University.
Reproduced by permission from Christian Scholar's Review
The discussion of ethical behavior and decisions in American health care is traditionally based on ethical principles that consider the rights of persons and groups. The seeking of informed consent, telling the truth, doing good and preventing harm, and respecting the right of persons to decide for themselves are examples of a rights-and-duties model: The rights of persons define the duties that others have toward them.1 For instance, the right of a person to decline the use of heroic measures to support life, in the use of a "Living Will," is generally considered to define the permissible actions of the health care team as the person nears death. Ethical dilemmas often arise when rights conflict with each other, and judgments are made on the basis of the merit of competing principles. Another model of ethical decision-making deals with the principle of doing the greatest good for the greatest number. In public health, in particular, the community’s needs are compared with the available resources, which are deployed to give the greatest benefit. In both of these examples, decisions can be made without interacting directly with a person whose life is affected.
A body of literature, largely in nursing, has identified another means of describing an ethical stance in medical practice: that of caring. The word caring comes from the Old English cearn: grief or sorrow; worry. We worry about what we care about, what matters to us. We care for, we take care of, we are careful; we are attentive, solicitous, protective, nurturant, responsible. What caring comes down to, in the end, is what we do to nurture and support those people who matter to us.2
Caring, then, includes caring about and caring for, both the emotional and willed commitment to the good of another, and doing those things that are right to accomplish that good. Gadow points out that caring is the "highest form of commitment to patients."3 The commitment to the good of another is the standard for judging the rightness of actions, including what is done for curative reasons.4 Gadow describes the clevastatingly uncaring and (in a caring framework) unethical treatment of a burn patient against his will—the intention to cure without reference to the patient’s view of good for himself.5
Caring about and caring for come together in acts of commitment: fidelity, keeping promises, going out of one’s way, taking responsibility, developing competence.6 Relationship is what differentiates caring fidelity and promise keeping from an approach based solely on principles, which tend to produce decisions made at a distance. Caring at its heart happens in the context of relationship.
Because caring is relational, it includes attending to the well-being of the caregiver. This is not only for the pragmatic reason that caregiving requires good physical, emotional, and spiritual health, but because the caregiver is, as a human being, an equally deserving person.
While the caring literature is largely not Christian, the examples of caring embody the biblical virtues of love, patience, kindness, goodness, faithfulness, gentleness, self-control (Gal. 5:22). Compassion, a theme throughout the Old and New Testaments, is caring acted out:
When Jesus saw the crowd harassed and dejected like sheep without a shepherd, he felt with them in the center of his being (Mt. 9.36). When he saw the blind, the paralyzed, and the deaf being brought to him from all directions, he... experienced their pains in his own heart (Mt. 14:14).. . And so it was with the two blind men who called after him (Mt. 9:27) ... and the widow of Nain who was burying her only son (Lk. 7:13).. . . He became lost with the lost, hungry with the hungry, and sick with the sick.7
Caring is both a virtue and a practice, which depend on each other. Both are developed by use, and they become skillful when practitioners work to become engaged with others and to reflect on how their care was effective or not–how it meets the emotional, physical, and spiritual needs of the patient.8 Benner describes practice that embodies characteristics of caring as "skillful ethical comportment."9 This practice takes into account the persons of the caregivers and care-receivers, and it is always bounded by the context of the situation. Caring practice cannot be abstracted from the actuality of the caring relationship.
To uncover the dimensions of caring practice, authors have examined the literature and personal accounts of the experience of caring. In an early review of caring literature, Carper cites knowledge, patience, honesty, trust, humility, hope, and courage as components of caring.10 From nurses’ narratives of their caregiving, authors have defined the qualities of knowing the patient, being with another in an engaged manner, doing for patients what they cannot do for themselves, and enabling patients to do what they need for their own health.11
Our interest in the roots of caring as ethical comportment in the face of suffering led us to letters, diaries, and memoirs of Civil War nurses. From these sources we drew a picture of ethical behavior and additional themes of caring. These nurses were, in a sense, "inventing nursing": their work predated formal nursing education in the United States, and many of them went on to found schools of nursing after the war. They volunteered because it was the right thing to do, knowing the needs for care that would accompany the battles. Their experiences are paradigms of a compassionate and moral response to suffering. The situations they describe were not amenable to "fixing"; there was no cure for the war, for the terrible wounds and disease, or the loneliness and death on every side. What these nurses brought was care: order, cleanliness, and food when it was possible, and simple being with at all times.
There was no lack of work to do. In this bloodiest of all American wars, 620,000 men died. There were at least 10 million cases of sickness; probably a quarter of the Union men and half of the Confederates were on sick call in the first year of the war, and both sides lost five times as many men to disease as they did to wounds.12
Caring as Commitment
The nurses’ letters and diaries speak of the suffering borne by the soldiers and by the families who came to the camps, although they seldom mention their own hardships except in passing. The pervading impression that their diaries give is of a religious calling and commitment to the work of giving care:
Why, oh, why, were we selected to do this work, unless we, more than any others, want to be here, and can be here–surely there is a Providence in all our ways and days, and our plans are made for us and plans that we should have made are frustrated to our great disappointment at first and joy and satisfaction afterwards.13
Jane Swisshelm, working at Campbell Hospital in Washington, D.C., speaks of washing the soldiers’ feet with awe and a clear connection to caring for the wounded feet of Christ.
I have been here in the hospital ten days, dressing wounds, wetting wounds, giving drinks and stimulants, comforting the dying, trying to save the living. The heroic fortitude of the sufferers is sublime, yet I have held the hands of brave, strong men while shaking in a paroxysm of weeping. The doctors have committed to my special care wounded feet and ankles, and I kneel reverently by the mangled limbs of these heroes, and thank God and man for the privilege of washing them.14
Few of the nurses write at any length about their Christian commitment per se; it was for most women, in those times, a given, as it was for most of those to whom they wrote. Georgeanna Wolsey’s question, "Why, oh, why, were we selected for this work?" is also answered by Emily Parsons:
There is one thing I try to remember,–that we are in the hands of One who knowest best, and He will put me where it is best for me to go. If He sees it is best for me to continue in my work, He will give me a place, and if He does not, I shall pray to be willing to do just what He wishes.15
It is evidence of a strong and faithful commitment to caring for others often for the purpose of carrying out God’s work—that these nurses continued to come back into the wards day after day, with little reward. The commitment to the soldiers and to their purpose in nursing was revealed by the value they placed on their charges.
Caring as Valuing Without Judgment
The nurses’ respect for the wounded shows in the words they use– "fortitude," "privilege," "heroes" –regardless of manners or courage, or whether enemy or not. Whether the nurses were caring for soldiers one by one or man aging care for many, they also showed the essential characteristic of caring as an ethic: valuing others well enough to participate in their suffering. Valuing without judgment is a theme in many of the nurses’ stories. They cared for the soldiers as they came, without prejudice. Julia Wheelock, a union nurse during the Peninsula Campaign, thus describes a group of wounded soldiers in a stable near Belle Plain:
Many of these were Rebels...I could not pass them by neglected. Though enemies, they were nevertheless helpless, suffering human beings. I deemed it best to act in accordance "If thine enemy hunger, feed him."16
And another nurse reports the following conversation:
"Have you friends in the Army, madam?" a rebel soldier lying on the floor of the car said to me as I gave him some milk. "Yes, my brother is on Meade’s staff." "I thought so, madam. You can always tell when people are good to soldiers they usually are sure to have friends in the Army." Another said, "We are rebels, ma’am, why do you treat us so good?"17
Valuing without judgment is the foundation for compassion, which is the emotional component of caring.
The Relationship of Compassion, Attending, Knowing, Doing For, and Being With
Compassion is the ability to feel with another person. The first step in acting compassionately is to attend to the other. It may be, for instance, that someone who has physical pain may be suffering not only because the pain is unrelieved, but because the pain reminds them of an uncertain and frightening change in their ability to be independent or productive. Or the suffering may result from lost hope as much as from physical illness. Walt Whitman described just such a sufferer, and what can happen when someone simply understands the feelings and responds to them:
Take this case in Ward 6, Campbell Hospital, a ... farmer’s son, aged about twenty or twenty-one.. . . Most of December and January last he lay very low, and for quite a while I never expected he would recover.. . . He now lay, at times out of his head but quite silent, asking nothing of anyone for some days, with death getting a closer and a surer grip upon him; he cared not, or rather, he welcomed death. His heart was broken. He felt the struggle to keep up any longer to be useless. God, the world, humanity—all had abandoned him. It would feel so good to shut his eyes forever on the cruel things around him and toward him. As luck would have it, at this time I found him ... and noticed his glassy eyes, with a look of despair and hopelessness.. . One learns to divine quickly in the hospital, and as I stopped by him and spoke some commonplace remark ... I saw as I looked that it was a case for ministering to the affection first and other nourishment and medicines afterward.. . I sat down by him without any fuss; talked a little; soon saw that it did him good; led him to talk a little himself; got him somewhat interested; wrote a letter for him to his folks ... soothed him down ... gave him some small gifts and told him I should come again soon. (He has told me since that this little visit, at that hour, just saved him; a day more and it would have been perhaps too late.).. . . For a while, I visited him almost every day, cheered him up, took him some little gifts. — . . For a couple of weeks his condition was uncertain ... but of late he is doing better.. . He will not die but will recover.18
Whitman, the nurse, did not talk about his own feelings, but his actions were compassionate. He was able to enter into the world of this young man, and by his usual means of chatting and giving little gifts, to relieve the heart of the suffering, the experience of having been abandoned. He describes what he did as "distributing" what he had:
... to do the best that is permitted, I go around distributing myself and the contents of my pockets and haversack in infinitesimal quantities, with faith that nearly all of it will, somehow or other, fall on good ground (p. 93).
Whitman learned how to be skillful in caring, in the way he "divined" what to do:
He who goes among the soldiers with gifts, etc., must be aware how he proceeds. It is much more of an art than one would imagine. They are not charity patients but American young men of pride and independence. The spirit in which you treat them and bestow your donations is just as important as the gifts themselves; sometimes more so. Then there is continual discrimination necessary. Each case requires some peculiar adaptation to itself (p. 94).
Whitman describes four basic elements of caring: attending to others with respect, knowing them well enough to understand what to do, doing for them what they need, and simply being with them, without any particular agenda.19 Attending is the most fundamental element of all: the caregiver is paying attention, on purpose, and not thinking about something else at the same time. Attending gives us a chance to pick up on subtle cues about the other person, the surrounding environment, and the rhythm of the relationship.
Knowing, doing for, and being with are interwoven. Knowing develops from the experience of doing for; as the nurses worked many weeks in the hospitals, they saw patterns in their patients’ conditions. The better they knew their patients, the more likely they were to be able to respond almost intuitively, before a need could be identified.20 Knowing also grows out of being with, in those times when one is simply there. Being with is for those times when there is nothing that one can say or do to cure the situation. Being with is difficult work, since it requires quietness, faithfulness, and patience. Doing for is properly founded on knowing the person, in the situation. What is right for one person or one situation may not be right for another.
The Contextual Nature of Caring as Ethical Practice
Caring is ethical in that it is the right thing to do in the circumstances. Louisa May Alcott showed this ethic in action when she was nursing at Union Hotel Hospital in Georgetown:
The next night, as I went my rounds with Dr. P., I happened to ask which man in the room probably suffered most; and, to my great surprise he glanced at John.. . . "He won’t last more than a day or two, at furthest ... you’d better tell him so before long; [women have a way of doing such things comfortably, so I leave it to you.. . . ]" It was an easy thing for Dr. P. to say: "Tell him he must die," but a cruelly hard thing to do.. . . A few minutes later ... I saw John sitting erect, with no one to support him, while the surgeon dressed his back ... [he] looked lonely and forsaken just then, as he sat with bent head, hands folded on his knee, and no outward sign of suffering, till, looking nearer, I saw great tears roll down and drop upon the floor.. . My heart opened wide and took him in, as, gathering the bent head in my arms, as freely as if he had been a little child, I said, "Let me help you bear it, John." Never, on any human countenance, have I seen so swift and beautiful a look of gratitude, surprise and comfort, as that which answered me more eloquently than the whispered—"Thank you, ma’am, this is right good: this is what I wanted!" "Then why did you not ask for it before?" "I didn’t want to be a trouble; you seemed so busy, and I could manage to get along alone." "You shall not want it any more, John."21
Unlike principle-directed ethical decision-making, ethical caring gives no formula for deciding what to do. Ethical caring depends on the meaning of the situation for the care-giver and the care-receiver. It is, by its nature, adapted to each situation.22 What to do depends on the persons, on their relationship, in the context. In this passage, Alcott describes entering into the world of the sufferer. She did not hesitate, or wait for him to ask. Her action was an unconsidered response, quick, wholehearted, and right, based on her deep knowledge of the situation. Rather than to consider whether she had an ethical obligation to follow the doctor’s orders or to attend to more critically ill patients, she acted on her knowledge of the patient and of the hospital context. We can glean from other parts of the story that while she had a special affection for this man, she valued and cared for all of the men in the ward. She had gotten to know them in the course of her taking care of them, and she cared about them. She intended to do whatever she must for their good, to care for them. Caring for each one involved doing just for each one what he needed.
This man had suffered without murmuring until the nurse came in to "make friends" with him. The caring bond between them made it possible for him to talk about his fears, to rely on her comforting presence during painful treatments, and at last to grasp her hand as he died. While his pain never lessened, his suffering was eased. Because the nurse knew him, she was able to provide what he needed for wholeness in the moment.
Caring as Courageous Management
The ethic of caring also involves managing the personal, physical, and organizational environment. Civil War nurses used the fundamental public health principle of engineering the environment to enable the men under their care to get well if it was at all possible, or at least to be as comfortable as they could be. We must remember that these nurses were breaking ground at nearly every turn. They had to invent ways to provide the proper care for the soldiers in their charge, and most of them met opposition from bureaucracies. In their letters they tell us about how they managed by stepping in where they were needed, setting things in order, making do with what was at hand, persevering, and doing whatever it took.
Towards the latter part of November, I learned from bitter experience the meaning of the phrase "red tape," so commonly made use of in the army. I also fell in with a practice which I had always greatly abhorred, that of kidnapping–not black men, however, but white men—soldiers. But in this business I never had–as many kidnappers must have any remorse of conscience. Perhaps it was because I stole with the free will and consent of the stolen, but somehow I felt that I was bidden "God-speed." I know I had the benediction of the soldiers and their friends, and God’s approval; what more could I ask? My kidnapping consisted in bringing sick men from Camp Convalescent without permission.23
Back of this house I live in is ... our erysipelas ward.. . There was no woman in there to keep things nice; no one hardly would go in or near it; it was looked upon as a sort of Botany Bay among the wards. I found the wards dirty: no whitewash, old wooden bunks, mat tresses that had not been changed for a long time; everything requiring renovation . . .We revolutionized the place. We got in an army of whitewashers, for lime is a disinfectant. While the new Doctor superintended whitewashers ... I got in iron bedsteads, new mat tresses, pillows, bed furniture, mosquito nettings; had the tables and cupboards washed ... everything is now as clean and nice as any other ward.24
. . . we were a little band of almost empty-handed workers literally by ourselves in the wild woods of Virginia, with three thousand suffering men crowded upon the few acres within our reach.
After gathering up every available implement of convenience for our work, our domestic inventory stood, two water buckets, five tin cups, one camp kettle, one stewpan, two lanterns, four bread knives, three plates, and a two-quart tin dish, and three thousand guests to serve.. . . Notwithstanding these difficulties, within fifteen minutes from the time of our arrival we were preparing food and dressing wounds.25
We were called to go on board "The Wissahickon,". . . to bring off twenty-five men said to be lying there [at West Point] sick and destitute.. . . It was night before the last man was got on board. There were fifty-six of them, ten very sick ones.. . . As we were laying mattresses on the floor ... the captain stopped us, refusing to let us put typhoid fever below the deck, on account of the crew, he said, and threatening to push off, at once, from the shore. Mrs. Howland and I looked at him! I did the terrible, and she the pathetic,—and he abandoned the contest.26 (Katherine Wormeley)
Ethical Caring as Vulnerability and the Responsibility for Self-Care
The ethic of caring, the moral response to suffering, comes at a price. It means that the one caring is open and vulnerable in the relationship.27 Vulnerability embodies not only the possibility for growth, but the risk of exhaustion. When caring for is mostly hard, dirty, and unappreciated, the caregiver is at risk for disillusionment, indifference, and breakdown, as one can see in this account by Amanda Akin Stearns:
Shortly after diet was attended to, No. 21 suddenly had an epileptic fit, and the young Catholic priest and a woman from one of the relief societies being on hand, both were extremely interested, and I suppose thought me extremely cool, as I am becoming quite automaton-like in my manner.28
Burnout is a constant risk without self-care, which includes finding meaning in the work. And since we dwell in relationships, in which our well-being and the well-being of others are connected, care for ourselves is also care for others.29
Late one afternoon ... a train of ambulances arrived at the depot with over one hundred wounded rebels to be cared for through the night. Only one among them seemed too weak and faint to take anything. He was badly hurt and failing. I went to him after his wound was dressed and found him lying on his blanket stretched over the straw.. . A could not think of him as a rebel. He was too near heaven for that. He wanted nothing and had not been willing to eat for days, his comrades said. I coaxed him to try a little milk gruel flavored nicely with lemon and with brandy. One of the satisfactions of our three weeks [in Gettysburg] is the remembrance of the empty cup I took away afterwards and his perfect enjoyment of the Supper.30
I see such awful things. I expect one of these days, if I live, I shall have awful thoughts and dreams—but it is such a great thing to be able to do some real good; assuage these horrible pains and wounds, and save life even—that’s the only thing that keeps a fellow up.. . . 31
Last evening I suddenly decided that I must have a rest and recruit before this terrible warfare is renewed, and before our wards are again filled with wounded soldiers.. . . 32
It is a life of hard work, and uncertain work: you never know one week where you may be sent the next. I have gone wherever I was asked since I came here, and nearly killed myself,—though I do not mind that,—and now if I get my strength back, I shall keep where I can use it, and not, by getting sick, become of no use or comfort to anybody. We must have our bodies in good order, if we want to do for others33.
Many nurses learned to keep a healthy distance with wit instead of alienation:
To and fro rushed matrons, maids, and convalescent "boys," skirmishing with knives and forks; retreating with empty plates; marching and counter-marching, with unvaried success, while the clash of busy spoons made most inspiring music for the charge of our Light Brigade:
Beds to the front of them,
Beds to the right of them,
Beds to the left of them,
Screamed at with brimming bowls,
Steamed at by army rolls,
Buttered and sundered.
With coffee not cannon plied,
Each must be satisfied,
Whether they lived or died;
All the men wondered.34
The Ethic of Caring as a Support for the Health-Care Community
The community of care is the way for caregivers—physicians, nurses, family members—to provide the best of care without depleting themselves. When compassionate persons reach out to serve others, they enrich and empower themselves and their communities as well. Caregivers who permit themselves to be in open and vulnerable relationship with the cared—for find that they often receive far more than they give, and build new connections with communities of support.35
However, caregivers as much as any persons in our society can suffer from misdirected efforts that focus on action alone. In the "bottom-line" oriented society, doing for gets more attention than any of the other components of ethical caring. Contemporary life sets the trap of valuing doing for without valuing or making it easy to take time for complete caring. And yet, doing for is incomplete without attending to others, without knowing them and our purpose in community together. Doing for without the rest of caring is the search for cure without care, and is impoverishing. Like Whitman’s abandoned young soldier, a community that has lost a sense of caring has a broken heart. Community life, on the other hand, provides us with constant opportunities to practice caring. Caring is the center of true community life, and it is the "glue" that holds a community together.
The relational nature of the ethic of caring thus provides the foundation for living in a Christian community. The Body of Christ is served in every situation by considering the right thing to do to prevent or heal suffering. Robert Bellah and his colleagues argue that an ethic of caring is essential for community today when "the individual can only rarely and with difficulty understand himself and his activities as interrelated in morally meaningful ways with those of other[s].. . ."36
Henry Nouwen speaks of the "discipline of community," a discipline that can be found in health care as in any other community:
Celebrating together, working together, playing together—these are all ways in which the discipline of community can be practiced.. . The discipline of community makes us persons; that is, people who are sounding through to each other ... a truth, a beauty, and a love which is greater, fuller, and richer than we ourselves can grasp.. . . The discipline of community is a true discipline of prayer.. . . [It is] obedience practiced together.... The question is not simply, "Where does God lead me as an individual person who tries to do his will? More basic and more significant is the question, "Where does God lead us as a people?" This question requires that we pay careful attention to God’s guidance in our life together and that together we search for a creative response.37
For Christians, caring is not optional. It is clearly mandated by the biblical principles of loving one’s neighbor, caring for others in the name of Christ, "rejoic[ing] with those who rejoice, [and] weep[ing] with those who weep" (Rom. 12:15). The secret is that the one who cares is cared for in the doing. The caring ethic sets up the way for caregivers to be in community with each other, rather than in competing positions. There is no choice of care or cure: the answer to health-care decisions is care and cure, without leaving caring to situations where cure is no longer possible. Caring must be present in every encounter and every plan.38
The words of the Civil War nurses show the richness of the ethic of caring:
We all know in our hearts that it is thorough enjoyment to be here,—it is life, in short; and we wouldn’t be anywhere else for anything in the world.. . . Hundreds of lives are being saved by it. I have seen with my own eyes in one week fifty men who must have died without it, and many more who probably would have done so. I speak of lives saved only; the amount of suffering saved is incalculable.39
Let no one who sincerely desires to help the work on in this way, delay going through any fear; for the worth of life lies in the experiences that fill it, and this is one which cannot be forgotten. All that is best and bravest in the hearts of men and women, comes out in scenes like these; and though a hospital is a rough school, its lessons are both stern and salutary; and the humblest of pupils there, in proportion to his faithfulness, learns a deeper faith in God and in himself.40
1 L. P. Brockett, and Mrs. Mary Vaughan, "The Hospital Transport Service," Woman’s Work in the Civil War (Philadelphia: Zeigler, McCurdy, and Co., 1867); F. Lumpp, "Is Health Care a Right?" Nursing Ethics: Theories and Pragmatics, ed. L. Curtin, and M. J. Flaherty (Bowie, Maryland: Brady Communications Co., Inc., 1982), p. 25.
2 Patricia Benner, and Judith Wrubel, The Primacy of Caring (Menlo Park, California: Addison-Wesley, 1989); M. M. Leininger, Care: The Essence of Nursing and Health (Thorofare, N.J.: Slack, 1984).
3 Sally Gadow, "Covenant Without Cure: Letting Go and Holding On in Chronic Illness," The Ethics of Care and the Ethics of Cure: Synthesis in Chronicity, ed. J. Watson, and M. A. Ray (New York: National League for Nursing, 1988), pp. 5-14.
4 Barbara A. Carper, "The Ethics of Caring," Advances in Nursing Science 1.3 (1979): 11-20.
5 Gadow, "Covenant Without Cure," pp. 8-13.
6 Simone Roach, "Communities of Caring," Curriculum Revolution: Community Building and Activism (New York: National League for Nursing, 1991), pp. 123-138.
7 D. P. McNeil, D. A. Morrison, and H. J. M. Nouwen, Compassion: A Reflection on the Christian Life (Garden City, New York: Image Books, 1982), p. 17.
8 Patricia Benner, "The Role of Experience, Narrative, and Community in Skilled Ethical Comportment," Advances in Nursing Science 14.2 (1991):1-21; Donald A. Schön, The Reflective Practitioner: How Professionals Think in Action (New York: Basic Books, Inc., 1984), pp. 49-69.
9 Benner, "Role of Experience," p. 4.
10 Carper, "Ethics of Caring," pp. 14-15.
11 Benner, "Role of Experience," pp. 3-4; Kristin Swanson-Kauffman, "Caring in the Instance of Unexpected Early Pregnancy Loss," Topics in Clinical Nursing, 8 (1986): 37-46.
12 S. Brooks, Civil War Medicine (Springfield, Illinois: Charles C. Thomas, 1966), p. 106.
13 Anne L. Austin, The Woolsey Sisters of New York: A Family’s Involvement in the Civil War and a New Profession (Philadelphia: American Philosophical Society, 1971), p. 56.
14 Anne L. Austin, History of Nursing Sourcebook (New York: G. P. Putnam’s Sons, 1957), p. 404.
15 Theophilus Parsons, ed., Memoir of Emily Elizabeth Parsons (Boston: Little, Brown and Company, 1880), pp. 59-60.
16 Julia S. Wheelock, Boys in White: The Experience of a Hospital Agent in and Around Washington ,(New York: Lang and Hillman, 1870), pp. 204-205.
17 P. D. Robinson, Two Ladies at Gettysburg (Densington, Maryland: The Village Press, 1973) p. 21.
18 Walter Lowenfels, ed., Walt Whitman’s Civil War (New York: Alfred A. Knopf, 1960), pp. 88-91.
19 Swanson-Kauffman, "Caring," pp. 40-44.
20 Patricia E. Benner, From Novice to Expert: Excellence and Power in Clinical Nursing Practice (Menlo Park, California: Addison-Wesley, 1984).
21 Louisa May Alcott, Hospital Sketches (Boston: J. Redpath, 1863), pp. 50-52.
22 Benner, "Role of Experience,"; Carol Gilligan, In a Different Voice (Cambridge: Harvard University Press, 1982).
23 Wheelock, Boys in White, pp. 55-56.
24 Parsons, Memoir, pp. 100-101.
25 W. E, Barton, The Life of Clara Barton, Founder of the American Red Cross (Boston and New York: Houghton Mifflin Company, 1922), pp. 176-177.
26 "The Hospital Transport Service," in Brockett and Vaughan, Woman’s Work in the Civil War, pp. 306-307.
27 Nel Noddings, Caring: A Feminine Approach to Ethics and Moral Education (Berkeley: University of California Press, 1984), pp. 30-58.
28 Amanda Akin Stearns, The Lady Nurse of Ward E (New York: The Baker and Taylor Company, 1909), pp. 190-191).
29 Gilligan, In a Different Voice, pp. 145-48.
30 Robinson, Two Ladies, p. 23.
31 Walt Whitman’s Civil War, p. 161.
32 The Lady Nurse of Ward E, pp. 190-191.
33 Memoir of Emily Elizabeth Parsons, p. 96.
34 Hospital Sketches, pp. 34-35.
35 Lilyan S. Snow, Nurse Volunteers in AIDS-Related Agencies (Seattle Pacific University: 1991).
36 Robert N. Bellah, et al., Habits of the Heart (New York: Harper and Row, 1985), p. 50.
37 Henri J. M. Nouwen, Making All Things New: An Invitation to the Spiritual Life (San Francisco: Harper and Row, Publishers, 1981), pp. 86-88.
38 Gadow, "Covenant without Cure," p. 14.
39 Marilyn M. Culpepper, Trials and Triumphs: Women of the American Civil War (East Lansing: Michigan State University Press, 1991), p. 333.
40 Hospital Sketches, pp. 75-76.
The Ethic of Caring: The Moral Response to Suffering. Christian Scholar's Review
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