Daniel Engster's most recent book, Justice, Care, and the Welfare State, is a well-researched and compelling exploration of welfare-state reform and moral theory. Specifically, Engster aims to "bridge the gap" (2) between welfare-state policies and justice theories by employing a nonideal theory of justice--based largely on the ethics of care--to defend a variety of welfare-state supports and programs. Melding care ethics and detailed empirical research, Engster imagines and justifies welfare-state provisions and reforms related to health care and poverty alleviation, as well as specific programs for the elderly, people with disability, and children. In this way, Engster provides a robust vision for the welfare state that is explicitly normative and that focuses on numerous sectors of social support and the interstices among these.
Engster opens the book with a brief discussion of Western welfare states and notes that the welfare state is currently in a "period of significant transition" (1). It is clear that he sees this period of transition as both a problem and an opportunity; on the one hand, he acknowledges that welfare states are in crisis today, largely due to changing economic and social conditions; on the other hand, his analysis is built around envisioning solutions to this problem that are both practical--in particular, fiscally feasible--and just. Not only are these solutions interesting because of this dual perspective, but even more important, it is clear that Engster is trying to move us beyond binary thinking of "what is" versus "what ought to be," thereby disrupting the boundary between the political and the moral (Tronto 1993). This, as discussed in detail below, is undoubtedly one of the most significant contributions of this book.
Each subsequent chapter explores a particular aspect or set of policy provisions often associated with the welfare state, moving from children to health care to the elderly to the disabled and, finally, to the poor. One of the most interesting and, in my opinion, important aspects of this book is that in these chapters, Engster places people firmly at the center of his discussion. For instance, the titles of the body chapters (excepting chapter 3, which is on health care) specify a group of people to whom the social-policy and welfare-state provision is targeted. He does not speak about "child services" aimed at everyone and no one; rather, his chapter is about "justice, care, and children." This is a subtle but often missing component of welfare-state discussions. When we talk about policies in the abstract or as government projects, it is easy to forget that social policies are meant to support real people. Engster challenges us to keep at the fore those the welfare state is meant to help by discussing continually how his vision of the welfare state can support and address real and particular needs faced by real and particular people. Engster's use of the ethics of care is particularly evident here; a key element of care ethics, as Engster explains, is "context, particularity, and relationship" (20). Although Engster's analysis is generally at the macro level, he manages to maintain a sense of particularity by locating people, and our caring needs, at the center of his vision for the welfare state. In other words, I understand Engster's vision of the welfare state, as explicated in this book, as not just a collection of policies or programs, but rather, as a web of caring relations that supports people as they strive to live as well as possible.
Each chapter is well-written and supported by detailed empirical research, but the health care chapter, in my opinion, is a particularly insightful section of the book. In it, Engster makes a useful distinction between health care and care:
From the perspective of care ethics, health care is special, and deserving of substantial public support not so much because of its ability to promote good health (which it shares with numerous other social and environmental determinants) as because of its ability to deliver good everyday medical care to individuals: minimizing their pain and suffering, helping them to overcome minor illnesses, treating their chronic conditions, and enabling them to live as well as is reasonably possible. Most theories of health care justice ignore or downplay the moral importance of these caring dimensions of health care and thus overlook the strongest justification that exists for universal comprehensive health care. (82)
This understanding of the purpose of health care--as not simply about improving life-expectancy and defeating disease (although this too is important, of course), but as providing care and enhancing people's lives as well as possible--is a refreshing take on health care. In a world that is often overly concerned with quantifiable results, things such as pain relief, enhanced function, and quality of life, which are difficult to measure, are often undervalued--and from a welfare-state perspective, underfunded (think of things like home support services, long-term elder care, physiotherapy, and rehabilitation services). By challenging us to reorient how we understand the purpose of health care, Engster's discussion in this chapter is a timely and significant contribution that merits serious consideration, especially in light of the current care crisis faced by Western societies due to numerous factors, including longer life expectancy, an aging population, and the decline of the male-breadwinner model.
This book does, however, have a few limitations based on some simplifying assumptions, several of which Engster acknowledges at the beginning of the book. For instance, in order to contain the scope of the argument, racial and ethnic differences are ignored, and the legal system, political accountability, and international relations are not discussed. Engster's ideas about the welfare state are also "based upon and oriented toward advanced Western democracies" (6), specifically, North America, Western Europe, Australia, and New Zealand. Because of this, the analysis leaves many countries outside of its scope (a necessary limitation), but also masks some of the differences among the countries in question. For example, what it means to care, and how care should be provided, is at least partially cultural and will vary among locations (even in "similar" countries). Thus, although Engster operates on the assumption that the differences among this group of countries are not "significant enough that different welfare policies would be necessary for achieving justice within them" (6), the justification for this assumption is brief enough that the reader is not left entirely convinced.
Engster also employs the term justice throughout the book, explaining early on that the way he uses this term is as "a shell concept that might be filled with any number of substantive values" (25). I understand this particular use of the term justice, and he does indeed acknowledge the literature on justice and care (cf. Held 1995; 2015), but as a reader well-versed in these debates, I find that the use of the term throughout the book is somewhat jarring. This is not to suggest that I see the terms justice and care as antithetical; however, given that there is a rich literature on how these two terms may, or may not, be reconciled, there were moments while reading the text that I had to remind myself of the specific way Engster was employing the term in the book. Significantly, this did not affect the argument of the text; rather, I simply wish to point out that this terminological choice may stand out to readers who are familiar with the justice and care literature.
Lastly, although he often provides compelling ethical justification for the various social services and welfare-state provisions proposed in the book, the question of why such justifications often seem to be unable to foster political change is left hanging. Admittedly, this particular critique may be beyond the scope of his analysis; however, I believe that is worth mentioning, given Engster's commitment to fostering nonideal theories of justice that can help guide policy in a very real, practical way. It seems to me that there is a bit of a tension throughout his analysis concerning the question of how to bridge the gap between politics and morality/ethics (Tronto 1993). On the one hand, Engster does briefly discuss the need to build this bridge, particularly in his discussion of ideal versus nonideal theory early in the text, and certainly the book itself is an attempt to bridge these two areas by using a theory of justice based on care to envision a new welfare state. On the other hand, however, the question of why the moral and political have often been treated as separate realms could be made more explicit. In his conclusion, Engster writes:
Ideal theories surely have their place in thinking about justice, but their value tends to be limited as practical policy guides. In order for political philosophy to function as a useful guide for policy-makers and citizens, . . . it needs to be brought down to earth, made more attentive to social and demographic facts, and become more engaged with social scientific data. (240)
I agree wholeheartedly with this, and I think Engster has done a tremendous job of bringing political philosophy "back down to earth." However, my concern is that this is only one side of the relation that has created this "moral boundary." As Tronto explains:
[M]oralists can prescribe what the correct course of action should be, but if actors believe that their interests are better served by ignoring moral concerns, then they will ignore moral concerns. In this way, we see that the boundary between morality and politics works not only to protect morality from corruption, but also renders morality relatively powerless to change political events. (Tronto 1993, 152)
In other words, as political philosophers committed to disrupting this boundary, we need not only to give serious consideration to how we can make moral theory more politically grounded, but also to consider how to make clear that morality is always/already intertwined with politics, and to seek to bring such moral discussions to the forefront of our democratic deliberations. This aspect of deconstructing the moral boundary is lacking in this exploration. Nonetheless, although I have posed this as a limitation of Engster's book, I also think that it is here that we find the most important contribution of this work. Engster's vision for the welfare state is an impressive step forward in moving beyond this "moral boundary," and despite its limitations, challenged me to consider this problem, and the types of work still needed to address it, long after I finished reading the text.
Overall, this book is a great contribution to the ethics of care literature, as it provides a vision of the welfare state built around the tenets of the ethics of care. It also contributes immensely to the broader--and exceedingly important--task of explicitly merging morality and politics. The impressive use of context and empirical data as well as the implementation of a care ethics lens in a practical, policy-relevant way will appeal to a wide audience, including anyone interested in issues related to the welfare state, care, justice, and political philosophy more generally.
Held, Virginia, ed. 1995. Justice and care: Essential readings in feminist ethics. Boulder, Colo.: Westview Press.
Held, Virginia. 2015. Care and justice, still. In Care ethics and political theory, ed. Daniel Engster and Maurice Hamington. Oxford: Oxford University Press.
Tronto, Joan. 1993. Moral boundaries: A political argument for an ethic of care. New York: Routledge.