Competing goods and fallacies of care: Moral deliberations at the end of life in the nursing home

Abstract

While care is often either implicitly or explicitly conceived in terms of “doing good,” the morality of care is more complex than this association would suggest. Nursing home care, in particular, is both characterized by institutional demands for regulation and standardization, and the subjective practices of care workers. These can represent different notions of good care. Based on ethnographic fieldwork among people with dementia, family members and professional caregivers in nursing homes in the Netherlands, I present a case of a resident's sudden death, which revealed a fallacy of care. A fallacy of care refers to an uncritical approach to the “good” in care that overlooks its potentially harmful outcomes. I show that recognizing such fallacies is not only a matter of recognizing the “bad” that may result from “good” care, but of the friction between multiple “goods.” In this case, protocols and care practices advocate different notions of the good that coexist, compete, and exclude one another, producing moral distress and forming hierarchical, if contested relations.