I have written previously about the importance of care in the values and practices of many of the anatomical pathology technologists (APTs) with whom I have spoken during my research. My work has focussed on their role in death investigations but, for the record, this care was also important in the way they spoke about the treatment of all deceased bodies, whether or not they were the subject of a medico-legal death investigation. I do however think that the context of a death investigation changes the calculus. This could be for several reasons, including (non-exhaustively):
- The death is more likely to be contentious, increasing the social, political, personal, emotional and legal consequences of the death;
- The death investigation process may introduce delays, need for prolonged storage, and shifts control over timelines from the next of kin;
- If a medico-legal autopsy is required, or the circumstances of the death have led to decomposition or disruption of the body, then presentation of the deceased for viewing will demand specific technical and or interpersonal skills.
I have been drawn to ‘ethics of care’ in theorising the way that APTs respond to these challenges. In the context of medical practice, ethics of care has often been associated with the work of nurses. It hinges on valuing subjectivity, and recognising that we all exist and function within complex webs of relationships. Doing this leads to decisions regarding care which maximises that individual’s wellbeing as perceived by them. Thus, ethics of care can help us understand the practice of care and in create a normative framework of morality which can guide and evaluate practice/decision making.
I can identify many examples of APTs practicing care – for example, in the way that deceased bodies are stored with reference to their lifetime preferences, the operation of technical skill in reconstruction as well as the way that the bereaved are interacted with. Additionally, the practice of care is valued by APTs both an as act of self-care (i.e. taking pride in technical dissection and reconstruction skills) and because many of them consider care to be a moral value which ought to be prioritised. What I want to consider here is how their care relates to the idea, and enactment, of justice.
Care: justice, or a precondition of justice?
I had originally thought of an ethic of care as an alternative to – or at least a form of – justice. But now I am less sure because I think justice can be distinct from care without that detracting from the importance of care as a precondition to justice.
The question of what ‘justice’ is a whole warren rather than just a rabbit hole, and I’m not too keen on subterranean adventures. Yet I think we can, with relative ease, at least identify dominant understandings of what, in western liberal societies, justice means. Those conceptions can inform legal justice, which of course the coronial and in suspicious deaths the criminal justice, processes are two examples. There is a lot of work on this, but I think that we can draw out common features of fairness, equity and rights. In theories (or ethics) of justice, these are often described in terms that assume that objectivity is both possible and desirable. Given that an ethic of care emphasises the need for subjectivity, relationality and the value of emotion, we might therefore consider ethics of care and justice as incompatible. But I do not think that is the case, or at least not in the case of medico-legal death investigation. Rather, I think that they both co-exist and can be co-dependant.
- Justice needs care: the ideal of justice as fair and objective rests on a myth of autonomy. When we recognise that, we can see the limits of liberal justice as a moral framework. Law, and legal processes, must to some extent be built on this fiction. This is both pragmatic because it creates a structure for decision making and because it is responsive to important context – rights and fairness are necessary to prevent state tyranny. However, justice is also being applied to humans whose ability to function and flourish depends on receiving care. In the context of medico-legal death investigation, the care practiced and advanced by APTs makes formal legal justice more tolerable for a range of actors – from the bereaved, through to practitioners and on to wider society. It injects subjective humanity into a legally mandated process. Care is not an alternative to justice in these cases, but it is both a precondition of it and has value independent of it.
- Care depends on justice too: care is valuable, but it needs to be fair to those who provide it. In our context that means, for example, fair pay and recognition for APTs, adequate resources being provided to facilitate care, and treating the deceased and bereaved with the same level of care whoever they are (recognising this actually means different treatment for different people).
I think that placing the ethics of justice and care together in this way enables us to begin to understand the importance of this often hidden work. Care highlights that emotions and relationships are important and challenges the idea that emotional work is irrational, or not as valuable as less subjective and responsive methods of dealing with people. It shows that care is necessary both for individuals and, in this context at least, as a precondition for effective justice.
As always there are many things I have not addressed. For example, it is not only APTs who provide care of this nature. A similar (if also different) analysis might be applied to coroners officers, family liaison officers and now medical examiners officers. It might also apply to lawyers and judges. I also have not tackled the thorny issue of the deadness of some of the recipients of the care. That’s for another time, save to say that I strongly maintain that we can have relationships with the dead which lead to need for care. But, as I say, another time….
Dead Bodies and the Law 