Care, sacrifice, and reproductive justice - with Inge van Nistelrooij
Episode 17 of Careful Thinking
The 17th episode of the Careful Thinking podcast features my conversation with Inge van Nistelrooij. Inge is a care ethicist, based in the Netherlands, where she works as a self-employed ethicist with care organisations, a consultant for professional care practices, an ethics educator for professional teams, and a facilitator of ethical reflection and ethical case deliberation. She is also a part-time Associate Professor of Care Ethics at the University of Humanistic Studies in Utrecht.
Inge studied for a doctorate in theology at the University of Tilburg with Annelies van Heijst, then spent a number of years working for religious organisations and as an ethics trainer and ethics policy advisor in care organisations, before going on to study for a PhD at the University of Humanistic Studies with Frans Vosman. Her thesis was published in book form in 2014 as Sacrifice: A Care Ethical Reappraisal of Sacrifice and Self-Sacrifice. Since then, Inge has published widely in the field of care ethics, on subjects such as empathy and relationality, with a recent focus on reproductive care.
Inge was one of the co-editors of the 2022 collection Care Ethics, Religion and Spiritual Traditions, and she's co-editor of Recommitting to Reproduction: Shifting Care Ethics Towards Reproductive Justice, which will be published next year. Inge's Dutch-language monograph Baarzaam: Basisboek Zorgethiek voor zwangerschap, geboortezorg en ouderschap (‘Basic book - Care ethics for pregnancy, maternity care and parenthood’) will also appear in 2025.
I got to know Inge's work when I contributed a chapter to the collection on care ethics and spiritual traditions that she co-edited, and I'd also been aware of her role as one of the founding members of the international Care Ethics Research Consortium, whose inaugural conference I'd attended in Portland in 2018. I also enjoyed reading Inge’s thought-provoking book on sacrifice and learned a great deal from it. Inge and I have since corresponded about a number of matters related to care ethics, but this was our first opportunity to have a proper conversation about her work.
Inge van NistelrooijWe began our conversation on the podcast by discussing Inge’s doctoral study in theology and the influence of her supervisor Annelies van Heijst, before exploring the ways in which Inge’s experience of working for care organisations, and also becoming a mother, informed her thinking about care and sacrifice, which became the focus of her second doctorate in care ethics. Turning to that thesis, and the book that resulted from it, Inge talked about the literary examples that she used to illustrate her argument about the role of self-sacrifice in care. We then discussed the influence on Inge’s thinking of feminist theologians such as Catharina Halkes, and of philosophers like Jean-Luc Marion and Paul Ricoeur, and particularly the insights their work offers into the tension between agency and passivity in care.
The second half of our conversation on the podcast focused on Inge’s recent research and writing on childbirth and motherhood, which explores the phenomenon of obstetric violence and makes the case for reproductive justice. Inge suggested that care ethicists have tended to overlook the practices of mothering in recent years, perhaps for understandable reasons, but she argues that care ethics has much to offer as a ‘revolutionary theory’ for understanding current debates around pregnancy and childbirth, something that she explores further in her forthcoming edited collection.
Our discussion of reproductive care, together with Inge’s account of the way her personal experience of mothering had informed her thinking about care, provided an interesting sequel to my conversation in the previous episode with Elissa Strauss, who also spoke about parenting as a personally transformative experience, sparking her interest in feminist care ethics. This in turn followed on from my conversation in Episode 14 with Susi Ferrarello, whose recent work - and forthcoming book - also focus on pregnancy and early motherhood. And my guest in the episode before that, Sarah Munawar, spoke about how her traumatic experience of giving birth during the pandemic had shaped her attempt to develop a Muslim feminist ethic of reproductive care. So these last few episodes have seen an interesting thread developing, on the connections and tensions between reproductive care, motherhood, and feminist care ethics.
Here are a few quotations by Inge from the podcast episode:
I'm aware that autonomy is very vital. It's really crucial also in developing your own personality and your personal life. But care ethics also made me aware that something else might also be the case, that is…during the course of your life, in many ways, and perhaps also during every day, you're also affected by other persons, by what happens to them, by what they ask of you, by what they expect of you [and] the theme of my [theology] thesis thereby became the tension or the dialectics between this autonomy, on the one hand, and what other people or other things that happen to you, how they affect you...You also get guided not only by choosing or deciding, which is often very much emphasised in our culture, I think, but it's also sometimes developed by finding yourself in situations, by receiving appeals of others, by being affected by the suffering of others. So then it's not about your choice, so much as by…finding yourself in a situation in which you still might have to make a choice. But sometimes it's impossible to make that choice, because you're the only one who needs to do something, to rescue somebody or to help or comfort somebody. So this is a tension, I think, which is very much common to...care practices and to caring.
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Working again in the care sector and meeting so many people working there...seeking their own autonomy as well as the way that others affected them...the theme of my thesis came back there. I noticed that I could learn a lot from their work. And it was so interesting to...try to build the bridge between intellectual thought and theories, on the one hand…but also to speak daily to people who are working and having to deal with these tensions between autonomy and heteronomy in their work…Many of the talks that I had with people working there pertain to the question of responsibility and its boundaries. So many people say to themselves and to each other, to their colleagues, something might feel as if it's your responsibility, but you must stick to your task. So there are limits to your responsibility. Don't take them home with you, or leave it to others. You must also care for yourself…So this is...the discourse between care professionals. But I noticed that there was a large contrast to how they actually felt and how difficult it was for them to deal with their boundaries of responsibility. And they did take things home with them, and they did feel responsible, even though perhaps if you looked at it more formally, it wasn't their responsibility. But it kept lingering in their minds. And sometimes they even went back in their spare time to their work to look if their patient or their client or their resident was still OK. So people do cross their boundaries very often. And they also told me that in those moments they felt that they were loyal and truthful to their original inspiration for care work. So this was intriguing, saying one thing but doing something else, and quite constantly, people also saying, ‘Well, at a certain point in time, I faced my own boundaries or my limits. I was on the verge of a burnout’, or ‘I really had a burnout, and I decided that I would really stick to my limits and try to be…careful for myself. But then I felt that I lost the heart of my work.’
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Between having studied theology and working in those care institutions, I had become a mother myself...So even though I had... intellectually dealt with the topic of autonomy and heteronomy, something had shifted fundamentally in my life because I had high ideals of becoming a parent and of co-parenting together with my partner...But we also felt that when you're...completely engrossed in caring and loving your kids, you cross your boundary all the time...and you do more than you ever imagined yourself capable of doing...So theory and practice really became two different topics. And also I felt...that we did sacrifice quite a bit in those years. They...demanded their toll on us. We survived and we are in good health at present, but I saw this...struggle with sacrifice and self-sacrifice, both with care professionals, and I had experience with it myself. So that was triggering me. I started re-reading my old and newer publications in the field of care ethics, and I saw people writing about the commitment that is demanded by care and the effectiveness that is also demanded by care. But nobody said, ‘and sacrifice is part of that commitment’. It was the other way around, many of the authors in care ethics say, ‘but of course it's not something that can lead to sacrifice or to self-sacrifice’…I think many of the care ethicists and care ethics theorists…are from a feminist background, as I am myself. And I only later became aware, of course, that self-sacrifice and sacrifice are...a big cornerstone of an ideology that pressures women particularly…So I can imagine that many of the care ethical thinkers also…refrain from embracing this topic because it has...so much the effect of marginalising women and particularly mothers. But I still thought...if people are struggling with that or if people are actually doing that, we must try to understand what is happening there.
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I think the important idea that struck me [in the work of the philosopher Jean-Luc Marion] is in how many ways our life is affected by things that are given. So it made me much more aware of how on a day-to-day basis I am subjected to influences from the outside...But also Marion's work is more about the limitations that we undergo in what is given to us. So my body tells me sometimes that I need to rest or that I need to eat, and I really need to do that then. But the real important things come from other people who demand me to do certain things. So the first thing that…the suffering of another human being does to me, is it derails me, it decentres, I become aware that I'm not the centre of the universe, and it unsettles me too. And then the moment of decision comes. But it is the second moment. The first moment is the moment of decentring or derailment. And when I have to decide, I can, of course, decide to turn my back on a suffering other person, but it will haunt me then...But I can also respond in a way that I acknowledge the suffering and that I respond to it. But the response in Marion's work is always the second moment. And I think this notion has been lost many times. When we discuss our responsibilities, we think that we can decide about our responsibilities, that is, a sort of set of tasks that are assigned to us or something, or that we have accepted ourselves or taken upon ourselves, and that we can also decide the limits of...And in the literal sense, a responsibility is a response to something else. And I think it's worthwhile for care ethics, because care ethics is also a responsive ethics...So there's first the need or the concern or the suffering or the appeal of another person. And then we have to respond. Care is a response to a need.
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‘Obstetric violence’ is a term coined by women and women's movements in South America. And it's about things that happen while giving birth…violent things that happen...to birthing persons….being aware that sometimes the focus lies so much on the baby that is being born, to the neglect...of the persons giving birth. But neglect is only one form of violence. And I don't define the term ‘violence’, because in accordance to care ethics epistemology, I think it's important to stick to the knowledge that is there with the participants in practices...So people feel that they are violated, for instance, when they are not taken seriously, when they are neglected, when they are made invisible, when their voice remains unheard or unresponded to. And many times in birth practices, things happen which would not happen to other patients. So, for instance, consent is not asked…And I think it's important...that…maternity care is responsive to both involved in the birthing process, both the birthing person and the baby who is being born...So I think this is a very relevant topic to care ethics, actually, because care ethics is a relational ethic and it can offer a sort of alternative framework for when things are getting rough in the birthing process…Care ethics is relational. So good care, according to care ethics, can only be good care if it's beneficial to both. So you cannot…cut the two apart, but you look at the birthing process as a process in which two persons ‘become’. One becomes a separate human being, the baby, and the other one becomes a person who has given birth, not always a mother, but at least a parent or a surrogate mother, but a person who has ‘become’, has given birth to a baby. And I think good care is only good when it has benefited both in that process.
You can listen to the whole episode here, or wherever you get your podcasts.
You can download a transcript of the episode here:
The header image is the painting ‘Sacrifice’ (1993) by Slav Nedev. I’m grateful to the artist for permission to reproduce it.