Asha Bhandary

In this article, I respond to symposium articles by Clark Wolf, Elizabeth Edenberg, and Helga Varden. With shared sympathies for anti-oppression liberalism and social contract theory, they urge me to develop the theory of liberal dependency care (LDC) in new directions — respectively, as a form of subject-centered justice, with a political liberal justification, and with a Kantian foundation for ‘private right.’ I respond by explicating the inclusivity that is built into the arrow of care map and the variety of contract theory I advance. Furthermore, I insist that anti-oppression liberalism need not formulate its claims in political liberal terms.

Inequalities in expectations to receive care permeate social structures, reinforcing racialized and gendered hierarchies. Harming the people who are overburdened and disadvantaged as caregivers, these inequalities also shape the subjectivities and corporeal habits of the class of people who expect to receive care from others. With three examples, I illustrate a series of justificatory asymmetries across gender and racial lines that illustrate (a) asymmetries in deference and attendance to the needs of others as well as (b) assertions of the rightful occupation of space. These justificatory asymmetries are cogent reasons to evaluate the justice of caregiving arrangements in a way that tracks data about who cares for whom, which can be understood by the concept of the arrow of care map. I suggest, therefore, that the arrow of care map is a necessary component of any critical care theory. In addition, employing a method called living counterfactually, I show that when women of color assert full claimant status, we are reversing arrows of care, which then elicits resistance and violence from varied actors in the real world. These considerations together contribute to further defense of the theory of liberal dependency care’s constructivism, which combines hypothetical acceptability with autonomy skills in the real world. Each level, in turn, relies on the transparency of care practices in the real world as enabled by the arrow of care map.

This author's reply addresses critiques by Daniel Engster, Kelly Gawel, and Andrea Westlund about my 2020 book, Freedom to Care: Liberalism, Dependency Care, and Culture. I begin with a statement of my commitment to liberalism. In section two, I defend the value of a distinction between conceptions of persons in the real world and in contract theory to track inequalities in care when indexed to legitimate needs. I argue, as well, that my variety of contract theory supplies the normative content needed to reject the subordination of women of color. Acknowledging the enduring danger of expressive subordination, I emphasize my theory's compatibility with the full social inclusion of people with disabilities. Section three then defends liberal dependency care's compatibility with radical critique and transformative change by emphasizing the abstract nature of its core theoretical module. Finally, in section four, I reaffirm conceptual distinctions between autonomy skills, care skills, and a sense of justice by explicating their theoretical roles. In that section, I also embrace Westlund's insight that theorists of justice need to have skills enabling responsiveness to other perspectives. To this new requirement for actual theorists of justice, I further add that we must attain capacities to engage critically with our society's norms. Thus, the final section of this article supplements the justificatory module of liberal dependency care, building from the necessary conditions specified as two-level contract theory toward an account of necessary and sufficient conditions for this liberalism's justificatory module.

This summary of Freedom to Care begins with the core claims and conceptualizations upon which the theory of liberal dependency care rests. It then summarizes the book's chapters. The first five chapters (Part I) delineate its theoretical foundations, which include the two-level contract theory approach to distributive justice for caregiving arrangements. In Part II of the book, chapters six through nine, I formulate liberal proposals for justice-enhancing social change before identifying cross-cultural metrics of justice for the internal evaluation of caregiving arrangements.

This essay responds to Jan Narveson’s libertarian commentary on my earlier work “Liberal Dependency Care.” There, I argued that the underlying logic of the circumstances of justice warrants adding care to a liberal theory of justice. In this essay, I rebut Narveson’s skeptical claims about the liberal credentials of my justificatory argument by identifying the extent to which my view shares the same reasonable constraints on liberty as those defended by John Stuart Mill. I also suggest that a libertarian refusal to add care to the core functions of the state is plausible only if women’s labor remains invisible. Finally, I refute Narveson’s contention that my strong procedural principle of care provision is incipiently totalitarian. The case for public support to teach basic levels of attentiveness and responsiveness is analogous to the case for teaching the foundational skills of arithmetic, which are legitimately taught in primary and secondary schools.

This paper advances a framework to conceptualize societal care-giving arrangements abstractly. It is abstract in that it brackets the meaning of our particular relationships. This framework, which I call “the arrow of care map”, is a descriptive tracking model that is a necessary component of a theory of justice, but it is not a normative prescription in itself. The basic idea of the map is then multiply specifiable to track various ascriptive identity categories as well as different categories of care labor. In this way, the idea of the arrow of care map serves as a conceptual frame within which to begin to understand every human society’s care-giving arrangement. I characterize it as a component of “ideal theory” insofar as it seeks to clarify our values, without the immediate aim of formulating principles to govern a just society. The resultant partial theory of justice is one that responds to non-ideal theory’s critiques of the ideological nature of liberal contractarianism’s idealizations and abstractions while moving towards new visions of a just society.

Though accountable care organizations (ACOs) are increasingly important to American healthcare, ethical inquiry into ACOs remains in its nascent stages. Several articles have raised the concern that ACOs have an incentive to avoid enrolling high-cost patients and, thereby, have an incentive to deny care to those who need it the most. This concern is borne out by the reports of consultants working with newly formed ACOs. This paper argues that, contra initial appearances, there is no financial incentive for ACOs to avoid enrolling high-cost patients.