Leah Libresco Sargeant, in a wonderfully written tribute to, and call for support for, “caring work”:
In [Eva Feder] Kittay’s view, care is never a private matter, something that can be contained in a single dyad or family. Dependency creates a chain of need, which extends out into the wider world. She takes the relationship of mother and child as paradigmatic: “The relation between a needy child and the mother who tends to those needs is analogous to the mother’s own neediness and those who are in a position to meet those needs.” Caring for a child makes the mother more dependent, and gives her a just claim on others, just as the baby has a claim on her.
Kittay terms this framework doulia. She adapts doulia from doula, a person who offers care to a laboring mother. In her broader term, she encompasses “a concept of interdependence that recognizes a relation — not precisely of reciprocity but of nested dependencies — linking those who help and those who require help to give aid to those who cannot help themselves.”
Governmental support can be a response to the claims of doulia. A public, universal benefit recognizes that need is universal and that it does not obey a law of reciprocity. A baby cannot pay back the time and attention he needs from his mother; a mother does not need to earn or recompense the care she receives from others. Instead of clean-cut transactions, there is a circulatory system of care and need, where each gives to the one they can, and receives from the person who cares for them, without concern for balancing the books.
This is the spendthrift logic of the communion of the saints, who know that “whatever you did for one of the least of these brothers and sisters of mine, you did for me” (Matt 25:40). It is the action of the woman with the alabaster jar, who pours out perfumed oil over the feet of the Lord without calculation. But the economy of grace, drawing on the inexhaustible power and love of God, doesn’t map neatly into the economy of appropriations, bills, and state-run welfare programs. […]
[The current Medicaid] framework of careworker compensation sees payment through a market lens — what would it cost to change someone’s mind about providing care? What does it cost to get them to sell their services to this particular client? The programs are worried about fraud, auditing timesheets, requiring licensing and certifications. These programs are built as though the primary risk is giving money to someone who may not have earned it.
But, in Kittay’s model of doulia, the reason for payment isn’t to persuade a caregiver to provide care. It is to enable them to offer the care they frequently already wish to provide. Compensation is often framed as wiping out altruism. If money changes hands, then the caring doesn’t count the same way it would if it were offered for free, or even at considerable cost.
In his prayer for generosity, St. Ignatius of Loyola asks the Lord to teach him, “to give and not to count the cost; to fight and not to heed the wounds; to toil, and not to seek for rest; to labor, and not to ask for reward.” The labor of uncompensated caregivers, caregivers who are strained past exhaustion, who are consumed and eaten up by their work, can sound like the fruit of this prayer. But St. Ignatius concludes his prayer by specifying the one reward he hopes for, “to know that I am doing your will.”
Although it is admirable when someone makes tremendous sacrifices to care for others, there is always something tragic about it, too. We see the saintly person at the center of the story, disregarding their own needs for the sake of another, but, at the peripheries of the story, there are others passing by, like the priest and the Levite who hurry by the man left broken and bleeding on the side of the road. The Catholic Church recognizes certain lives as embodying “white martyrdom” — the laying down of one’s life not in a single moment of death, but denial of self through poverty or celibacy. The martyr’s witness is always a testimony to God’s goodness, but, as with the “red martyrdom” of those killed for the faith, the actions of the person demanding the sacrifice can be wicked. It is good to serve the poor, it is sinful to impoverish. It is not God’s will for anyone to be neglected or left for dead, whether they are the initial victim of misfortune or someone who, in giving all they have, is newly vulnerable as a result.
We are not called to stand by and admire the white martyrdom of hard charities. We are called to answer need with our own gifts. But too often, our systems of care work presume that they can wring more and more work out of the families of the vulnerable, trusting that they will sacrifice themselves if we hold back our own help.
Sargeant goes on to tell the story of Tina, a 40-year-old teacher who was essentially required by her hospital and insurance company to coordinate the care for her brother with leukemia after his bone marrow transplant—even if she had to quit her job to do it. “Her work was admirable,” Sargeant writes, “as was that of her friends and relatives, but it is hollow to praise her without condemning the hard-hearted system that handed her this cross to carry, and then abandoned her.”
Here’s how she closes:
There is no sacrifice we make out of love for another that God disdains. But when we leave caregivers and their charges without support, we are like the Pharisees, who, Jesus says, “tie up heavy, cumbersome loads and put them on other people’s shoulders, but they themselves are not willing to lift a finger to move them” (Matt 23:4). From the beginning of the Church, the martyrs gave testimony of the depth of their love for God in their willingness to die rather than to renounce Him. We benefit from their witness, but we have no reason to be grateful to their persecutors. Paul addresses this question in his letter to the Romans, “Shall we go on sinning so that grace may increase? By no means!” (Rom 6:1-2).
Persecution can make visible the love that might have otherwise expressed itself in more hidden ways, but we must learn to see the quiet virtues, rather than rely on sin and suffering to expose these loves to light. In answering the needs of caregivers, in living out Kittay’s vision of doulia, we respond rightly to others’ willingness to become lowly out of love. We honor the willingness to suffer by not demanding sacrifice. Love answers love, and our strengths are given to us only that we might be good stewards in spending them.