“YOU CARE FOR EVERYBODY”: CAMERON’S ETHICS OF CARE

Rebecca: Is he a good man?
Wilson: He’s a good doctor.
Rebecca: Can you be one without the other? Don’t
you have to care about people?
Wilson: Caring is a good motivator. He’s found
something else.

House doesn’t like patients. In fact, he doesn’t like people. He’s cynical, insensitive, judgmental, and pessimistic. At times he acts inhumanely. But if there is a medical mystery to be solved, House is our guy. Still, if we were on the doorstep of death, would we really want House to be our physician? Does he represent what we want in a doctor?

The answer to this question, essentially, is no, and Dr. Allison Cameron shows us why. Where House doesn’t give a crap about patients, Cameron demonstrates that she cares about every patient. There is, in fact, something gendered in the way that Cameron practices medicine and deliberates about moral problems that arise in her work. As we shall see, this is the domain of feminist ethics.

Beyond “Doctor Knows Best”: Feminist Ethics

Ethics is the branch of philosophy that explores and analyzes moral problems. Ethics is concerned with questions such as: What kinds of moral principles and values should guide our actions? And what do we mean by right and wrong? Feminist approaches to ethics view such moral problems through the lens of gender. For example, a traditional approach to considering the ethics of surrogacy may have as its focus whether or not such an arrangement constitutes “selling” a child. A feminist analysis of the ethics of surrogacy would be incomplete without adequate consideration of the effects of these arrangements on the lives of the women involved.

All feminist approaches to ethics aim to interrogate and end systems, structures, and practices that oppress women. Feminists concerned with bioethics draw our attention to how health care policies, practices, and institutions can contribute to the oppression of women. Areas of particular concern include genetic screening, abortion, and the doctor-patient relationship.

The relationship between doctor and patient—its nature, its underlying values, what we think it ought to be—provides us with a good starting point for examining how House and Cameron practice medicine. Traditionally, the doctor-patient relationship grants authority based on scientific (medical) knowledge, and rejects subjective, experiential knowledge. Because the majority of physicians are male, and the majority of patients are female, this relationship amplifies gender power differentials by privileging “masculine” knowledge over “feminine” knowledge.¹ If we know anything about House, it’s that he very rarely listens to his patients’ thoughts about their own illness. In “Que Sera Sera,” a man suffering from obesity offers his opinion on the cause of his mystery illness. House arrogantly rejects the patient’s opinion, asking: “Grocery stores giving away medical degrees with the free turkeys now?” In the “Pilot,” House reinforces his authority over his patient, Rebecca, after she refuses any further tests or interventions for her mystery illness. House sees her refusal as tantamount to rejecting his own expertise:

House: I’m Dr. House.

Rebecca: It’s good to meet you.

House: You’re being an idiot. You have a tapeworm in your brain, it’s not pleasant, but if we don’t do anything you’ll be dead by the weekend.

Rebecca: Have you actually seen the worm?

House: When you’re all better I’ll show you my diplomas.

Rebecca: You were sure I had vasculitis, too. Now I can’t walk and I’m wearing a diaper. What’s this treatment going to do for me?

In “Family,” House berates Wilson into believing that doctors do indeed know best, and consequently, they should persuade patients to make the “right” decision:

House: All you had to do was say, “Yes, I do.” God knows that’s a phrase you’ve used often enough in your life.

Wilson: It was a mistake every time. Give it a break. They said yes.

House: That’s not enough for you. You need them to feel good about saying yes.

Wilson: I treat patients for months, maybe years, not weeks like you.

House: I’m taller.

Wilson: If they don’t trust me, I can’t do my job.

House: The only value of that trust is you can manipulate them.

Wilson: You should write greeting cards.

House: Giving parents the chance to make a bad choice was a bad choice.

Wilson: At least it would’ve been their choice.

House: One they’d regret at their son’s funeral.

House’s “doctor knows best” approach to health care seems especially unethical because he refuses to form relationships with his patients. Instead, House relies on his team to establish relationships with his patients, sending his ducklings to gather medical and personal histories, explain procedures, and gain consent. Free of the responsibilities that accompany caring about patients, House can get on with the job of putting together the pieces of the medical puzzle. When he does finally interact with his patients, it’s rarely a warm and fuzzy doctor-patient chat.

House is in constant conflict with Cameron, the duckling who cares so much. Cameron believes her relationship with the patient is integral to providing good health care because it is within this relationship that the honest exchange of information occurs. It is no coincidence that the battles between House and Cameron over patient care are fought along the lines of gender. The ethic of care, placing relationships at the center of moral decision making and action, guides Cameron’s professional practice and is a form of ethical deliberation most commonly associated with women.

“It Almost Looks Like He’s . . . Caring”: The Ethic of Care

Carol Gilligan pioneered the ethic of care with her book In a Different Voice, which offers an account of women’s moral development as an alternative form of moral reasoning.² Gilligan and other care-focused feminists argue that ethical theory tends to reflect only the traditional approach to moral deliberation known as the ethic of justice, which encourages the application of abstract, universal rules and principles to moral problems, appealing to notions of impartiality, independence, and fairness. For example, consider the scenario in which a person is thinking about stealing a loaf of bread, which he cannot afford to buy, in order to feed his family. A person who ascribes to the ethic of justice is likely to conclude that although feeding a family is important, the man should not steal the loaf of bread because stealing itself is morally wrong. It is worth noting that House does not exemplify the ethic of justice; indeed, his manipulation and deception of Cuddy and Wilson to support his own Vicodin addiction show that House is rarely interested in doing what is morally right. After interviewing women about the kinds of values that guide their decision making, Gilligan found that the ethic of justice was more likely to be adopted by men than women and argued that this type of reasoning was geared toward masculine language and experience. In an effort to better include the voices of women in moral theory, Gilligan developed an understanding of the ethic of care. In this ethic, the primary consideration in making moral decisions is to maintain and nurture attachments to others. The ethic of care recognizes our responsibilities to others and acknowledges the moral relevance of emotions that accompany caring for another. It also values the claims and experiences of those we care for, and recognizes that selfhood is constructed through, and by, one’s relationships with others.³

Cameron is a powerful example of how the ethic of care can inform professional practice in a health care setting. She works hard to build trust in her relationships with her patients, consistently advocating on their behalf, and refusing to deceive, lie, or bully in order to acquire information, even when she is ordered to do so. As House notes, when presented with a problem, Cameron always attempts to find an answer that involves minimal harm to the parties involved: “Figures you’d try and come up with a solution where no one gets hurt” (“Heavy”).

Cameron values her relationships with her patients, yet her ability to genuinely care for them amuses, bewilders, and annoys House. Cameron’s practice is guided by her sense of responsibility to her patients, in spite of their perceived flaws, difficult personalities, and morally questionable behavior. In “Informed Consent,” House reveals to Cameron that their patient, Ezra, a world-renowned physician, conducted ethically questionable research during his career. House uses this information in the hopes of getting Cameron to abdicate her responsibilities to the patient:

Cameron: So you’re okay with what he did.

House: Doesn’t matter what I think. It’s what you think that’s relevant.

Cameron: Because, if I think less of him, I’ll help you more? You’re wrong. The fact that a patient did bad things doesn’t change anything. He still deserves to have some control over his own body.

Cameron’s practice is also guided by identifying, and attending to, the particular needs of others as they occur in the context of their doctor-patient relationship. This skill seems to be something that House envies, but is unable (or unwilling?) to develop. In “Maternity,” the team races against the clock to identify an unknown epidemic affecting newborns. To prevent the spread of infection, the parents are forbidden to have skin-on-skin contact with their children. While carefully changing the linen on one of the baby’s cribs wearing protective clothing and gloves, Cameron notices the baby’s parents looking at this procedure from outside the room. We see her immediately empathize with the parents as she remarks to Chase: “Imagine not being able to touch your own baby.” To enable the parents to have some contact with their sick daughter, Cameron invites them to hold their daughter while the medical staff changes the bed linen. House assumes Cameron’s empathy is rooted in similar experience rather than in her ability to appreciate the suffering of others:

House: Chase told me about that idea you had, the parents holding the baby. Where’d you get that? Did you lose someone? Did you lose a baby?

Cameron: You can be a real bastard.

And again in “Que Sera Sera”:

House: All right, I give up, who was it? Who in your family had the weight problem?

Cameron: You think I can only care about a patient if I know someone else who’s been through the same thing?

House doesn’t believe the relationship between doctor and patient entails the responsibility to care. When, on rare occasion, House does genuinely care for one of his patients it’s largely because he sees aspects of himself in the patient, or recognizes that they share an experience or history. For example, in “Half-Wit,” House’s patient Patrick is a man who, as a result of a brain injury in childhood, plays the piano masterfully. House’s connection with Patrick is fostered by his own love of playing the piano. Similarly, House’s own experience of becoming suddenly impaired creates a connection with Stacy’s partner Mark, who becomes temporarily disabled and seeks House’s advice (“Need to Know”). In the absence of parallels between patients’ circumstances and his own life, House just doesn’t seem to care for his patients at all.

Where House tends to view each patient as an abstract individual, Cameron sees her patients as embedded in a complex network of familial and social relationships. In making moral decisions, the ethic of care states that we have an ethical obligation to attend to the claims of those we care for, while avoiding hurting them. Cameron’s commitment to this ethic is so strong that she becomes incensed when a patient, Hannah, makes a health care decision that seems to completely disregard the patient’s caring obligations to her partner Max (“Sleeping Dogs Lie”). Confronting Hannah about her decision, Cameron implies that Hannah is selfish because her responsibilities to Max were not morally salient in her decision:

Cameron: Aren’t you at all concerned about what Max is going through right now? Shoving a tube up her rectum. Then they’re going to swab her stomach just like I’m doing. It’s going to hurt just like this hurts, which is nothing at all like the risk she’s taking on the table. You don’t love her, do you?

Hannah: I’m not leaving her because I don’t—

Cameron: I’m not talking about the leaving, I’m talking about this. If you care for her at all, you won’t let her do this blind.

Hannah: You’d really tell?

Cameron: Yeah.

Hannah: You’d die?

Hannah’s question—would Cameron sacrifice her own life to ensure that she met her caring responsibilities?—points to an important philosophical criticism of the ethics of care.

Does Cameron Care Too Much?

The ethics of care is appreciated by most feminists as an important contribution to ethical theory because it both recognizes and validates women’s experiences in an area of philosophy that has, for the most part, excluded women. That said, the ethics of care is not without its critics. Many feminists are concerned, and rightly so, that valorizing a moral theory based on a stereotypically female trait—caring—above other types of moral reasoning can lead women to think they should care about others at all times in all contexts, even if this caring incurs a personal cost.⁴

Cameron’s behavior in certain situations provides a good example of how a commitment to an ethics of care may not always be appropriate in informing the way we approach moral problems, and indeed can interfere with our ability to perform tasks required of us. Consider Cameron’s behavior in “Maternity.” House orders Cameron to inform the parents of a sick newborn that their baby is extremely ill and is unlikely to survive the next twenty-four hours. Cameron doesn’t convey the seriousness of the situation to the parents, and Wilson chastises Cameron for not telling them the truth:

Wilson: Allison, their baby’s dying. If the parents weren’t in tears when you left, you didn’t tell them the truth.

Cameron: That’s not how I see it.

Wilson: Do you want them blindsided? Want them coming up and saying, “My God, my baby died, why didn’t you warn me?”

Cameron: So now it’s about worrying about them yelling at us?

Wilson: No, it’s about getting them prepared for the likely death of their child.

Cameron: If their son dies tomorrow, do you think they’ll give a damn what I said to them today? It’s not going to matter; they’re not going to care; it’s not going to be the same ever again. Just give those poor women a few hours of hope.

We learn later on in the season that Cameron watched her own husband die of cancer, and we can see how this experience guides her practice with patients who are facing a loss. What is unique about the ethic of care is that it promotes ethical deliberation that values the role of emotions—sympathy, empathy, sensitivity—in deciding what the best course of action would be.⁵ What is problematic about Cameron’s interactions with these patients is not that she uses her own experience to frame her actions; it is that she lets her emotions derail her professional judgment. In “Acceptance” Cameron is asked to inform a patient, Cindy, that she has terminal cancer. Witnessing Cameron and Cindy laughing in Cindy’s hospital room, Wilson suspects that Cameron has not informed Cindy of the diagnosis:

Wilson: So I take it you were in there informing her?

Cameron: Well, I . . . I hadn’t exactly gotten around to that, but I was just—

Wilson: Doing what? Making friends?

Cameron: Cindy’s divorced. She doesn’t have any kids, no siblings, both her parents are gone—

Wilson: It’s not your job to be her friend. Do you understand?

It’s here that Cameron reveals to Wilson that if she hadn’t married her husband he would have died alone—much like Cindy. In this circumstance, Cameron moves beyond simply contextualizing the moral problem—she is reliving her own experience, unable to disentangle her own emotions from the problem at hand. Her own personal history interferes with, rather than contributes to, her professional practice. Of course Cameron shouldn’t just reject the role of emotions in deciding what is morally best for her to do. Indeed, emotions can help us identify the needs of others and they can encourage us to view moral problems from a range of perspectives. Still, Cameron’s overzealous caring often comes at a price, and it can compromise her professional practice. As the show progresses, this overzealousness increasingly seems to be driving her to adopt House-like tactics in the name of providing “care” to patients. In “Que Sera Sera,” Cameron secretly (and unlawfully) administers an injection to a patient to prevent him from leaving the hospital against medical advice—“I didn’t think he should be discharged so I gave him three grams of phenytoin. I wasn’t going to just let him leave.” Unfortunately, the price of caring too much for her patients means becoming more like House.

You’re Basically “a Stuffed Animal Made by Grandma”

It is probably safe to say that there is no single approach to moral reasoning that delivers the best outcomes for all parties involved at all times. Yet, as the moral center of the show, Cameron casts a spotlight on the ethic of care, providing a welcome contrast to House. Let’s hope that underneath all that cynicism and complaining that Cameron is a “stuffed animal made by Grandma,” House is taking notes.

NOTES

1 Susan Sherwin, “The Relationship of Feminism and Bioethics,” in Feminism and Bioethics: Beyond Reproduction, ed. Susan M. Wolf (New York: Oxford Univ. Press, 1996), 57.

2 Carol Gilligan, In a Different Voice: Psychological Theory and Women’s Development (Cambridge: Harvard Univ. Press, 1982).

3 Virginia Held, The Ethics of Care: Personal, Political and Global (New York: Oxford Univ. Press, 2006), 10-15.

4 Sandra Lee Bartky, Femininity and Domination: Studies in the Phenomenology of Oppression (New York: Routledge, 1990), 118.

5 Held, Ethics of Care, 10.