Helen Kohlen

Interview with prof. dr. Helen Kohlen, Philosophical-Theological University of Vallendar (Koblenz) in Germany.

1. Where are you working at this moment?

I am working at the Philosophical-Theological University of Vallendar (Koblenz) in Germany. It is a small private university that has just been building up an ethics institute in which I am working as a co-director. I teach ethics and palliative care in the nursing faculty. Since 2015, a visiting professorship at the University for Humanistic Studies in Utrecht brought about a close collaboration with care ethicists in Utrecht.

2. Can you tell us about your research and its relation to the ethics of care?

My research addresses the ethics of care in the context of health care practices and the distribution of care work in society. Within this broad research field and having a background in Health Care Studies, English Literature, Political Science and Nursing I have a number different interests.

My first book Conflicts of Care (2009) was based on a field research in clinical ethics. I studied hospital ethics committees in the US and in Germany by foregrounding the development of Bioethics. I found out that the ethics of care has historically been marginalized as a theoretical approach to understand conflicts in clinical practice. Since the language of care is hardly used in German hospital ethics committees, conflicts that could have been represented from an ethics of care perspective tend to be sidelined and dismissed.

Based on the findings, in 2010 a participatory action research project was designed with the intention of developing a program that would empower professional health care actors to move ethics in practice by bringing in care ethical perspectives. I have recently completed a chapter for a new edited collection, Evaluation, Care and Society. It is edited by Merel Visse and Tineke Abma and will be published soon.
My chapter is called Evaluation for Moving Ethics in Health Care Services towards Democratic Care and addresses care ethics as an ongoing practice that involves learning process of democratisation. It describes a model that consists of the three pillars Education, Companionship and Open Space.

3. How did you get involved into the ethics of care?

First, the ethics of care was a finding of my historical analysis ‘The move of bioethics to the bedside‘, seeing that the ethics of care appeared to be as a kind of counter-movement to US- American Bioethics in the 1980s.
Second, I read Elisabeth Conradi’s book ‘Take Care. Grundlagen einer Ethik der Achtsamkeit’ (2001) which I found very convincing. The book inspired me to read Joan Tronto’s book ‘Moral Boundaries. A Political Argument for an Ethics of Care’ (1994).

In 2006 I invited Joan Tronto to the University of Hannover in Germany and she had a lecture on the ethics of care and politics. Since then I have continuously been reading, writing and talking about the ethics of care. For example, I organized a conference (together with Hartmut Remmers) on Bioethics, Care and Gender and we published a collection of articles under this title (2010). In 2014 I coedited (with Gert Olthius & Jorma Heier) the book Moral Boundaries Redrawn. The Significance of Joan Tronto’s Arguments for Political Theory, Professional Ethics, and Care as Practice.

4. How would you define ethics of care?

I would define care ethics as a moral attitude and a set of practices that starts by seeing the human being as being basically dependent and vulnerable. The focus is the relational with regard to the concrete other and the concrete situation in time and space. In my studies I use care ethical questions within a critical lens to analyse what is missing in daily health care practices. These questions raise issues of conflict, power, inequality and irresponsibility.

5. What is the most important thing you learned from the ethics of care?

I have learned that ethics can never be separated from politics and that doing care ethics in the health care arena can never be separated from doing political care ethics. I have also learned that the ethics of care is a movement of people who try to stand up against neo-liberalism.

6. Whom do you consider to be your most important teacher(s) in this area?

Among the ones who have explicitly worked on the ethics of care I consider Carol Gilligan, Joan Tronto, Elisabeth Conradi, M.U. Walker, Annelies van Heijst, Eva Feder Kittay, Frigga Haug to be my most important teachers.

7. What works in the ethics of care do you see as the most important?

  • Carol Gilligan (1982): In a Different Voice, Psychological Theory and Women’s Development. Harvard University Press;
  • Joan Tronto (1994): Moral Boundaries, Political Argument for an Ethics of Care. Routledge;
  • Tronto, Joan (2013): Caring Democracy. Markets, Equality, and Justice. New York, London;
  • Elisabeth Conradi (2001): Take Care, Grundlagen einer Ethik der Achtsamkeit. Frankfurt am Main 2001;
  • Annelies van Heijst (2011): Professional Loving Care, An Ethical View of the Healthcare Sector. Peeters – Leuven;
  • Philips, Susan; Benner, Patricia (1994): The Crisis of Care, Affirming and Restoring Caring Practices in the Helping Professions. Georgetown University Press.

8. Which of your own books/articles should we read?

  • Helen Kohlen (2009): Conflicts of Care, Hospital Ethics Committees in the USA and Germany. Campus Verlag;
  • Hartmut Remmers & Helen Kohlen (2010): Bioethics, Care and Gender, Herausforderungen Fur Medizin, Pflege Und Politik (in German). V&R Unipress GmbH;
  • Olthuis, Gert; Kohlen, Helen; Heier, Jorma (2014): Moral Boundaries Redrawn. The significance of Joan Tronto’s Argument for Political Theory, Professional Ethics, and Care as Practice. Peeters Publishers 2014;
  • Kohlen, Helen: Care transformations – attentiveness, professional ethics and thoughts towards differentiation. Commentary, Nursing Ethics 18, March 2011: 258-261 (peer-reviewed);
  • Kohlen, Helen: Sorge als Arbeit und Ethik der Sorge – Verbindungslinien zwischen beiden wissenschaftlichen Diskursen. In: Conradi, Elisabeth; Vosman, Frans (2016): Praxis der Achtsamkeit: Schlüsselbegriffe der Care-Ethik. Fankfurt, New York: Campus, S. 193-225;
  • Kohlen, Helen: Sterben als Regelungsbedarf, Palliative Care und die Sorge um das Ganze. Ethik in der Medizin, 2016, 28(1), 1-4.

9. What are important issues for the ethics of care in the future?

First, on a rather theoretical level, I think it is important to continue talking about the ethics of care and render visible what it can do in contrast to other theories.
Second, on a rather empirical level it needs to be shown what comes up when issues of concern are debated from a care ethics perspective as for example, in the area of bioethics, the debate about embryonic research.
Third, within the field of medicine and nursing it is important to refine the questions within an ethics of care for specific areas like neonatal care or dementia care.

10. In Utrecht our ambition is to promote ethics of care nationally and internationally. Do you have any recommendations or wishes?

I want to thank you very much for the excellent work you are doing in this area, currently, especially for organizing the Care Ethics Research Consortium.
From a teaching perspective I wonder, what could be done to distribute all the good work on the ethics of care that is already out there and I have the idea of writing a textbook for graduate students.
From a research perspective, I would be interested in a European Research Project on the Ethics of Care in Clinical Care.

Who cares? Caring with technology

‘Who?’, put short and simple, sounds rather banal, but has turned out to be a missing question in current debates about future perspectives of care arrangements in Germany for the („more and more demented“) elderly. Who cares for whom – concretely, day to day with attention and competence since we are facing a huge care gap from the side of the care-givers: While the number of future care-receivers is doubling, the amount of potential care-givers is declining (Klie 2014; Kohlen 2010).

Over the last couple of months I have been observing a discourse in politics and academia in Germany that shows an excitement about technological advancement in home care and which is supposed to secure the elderly in their home despite certain diagnostic signs and self-perceptions of frailty. Nevertheless, as studies have revealed (see especially Alistair Niemeijer 2015, Jeannette Pols 2012) the use of technology is arranged and continuously re-arranged by somebody.

Home Care

In home care, the cyclic process of integrating technology is mostly done by nurses who keep an eye on how patients handle the self-made measurements on their body and do the interpretation. In her ethnographic studies, Jeannette Pols (2012) shows how nurses and patients re-shape care when they start using telecare devices. Actual care practices employing surveillance technology do not resemble the hopes of the industry and policy makers. Surveillance technology cannot substitute care practitioners and it is not known whether there will be new challenges including pressing ethical questions facing “good” practices as we can learn from Alistair Niemeijer’s study (2015).

Last week after my lecture on Ethics, care and gender, students handed in their essays about the topic. While reading the essays over the last days I realized that the question “who is taking care of whom in the future?” was something they have not come across before. One student put it like this: “In order to prepare the future of home care we need to consider different structural formats, that is to say, what are possible arrangements; and who is supposed and willing to do the care work” (Theresa Wied).


Right now, we know: Not only the care-receivers are mostly women, but also the care-givers. In home-care as well as in the elderly homes, two out of three carers are women. Among the care-givers who do informal care – without support from professional care practitioners – are more than 70% female and less than 30% male. Professional home care is done nearly only by female nurses (90%) and the numbers are closely the same when we look at the female care givers in nursing homes (Schneekloth 2006, Kohlen 2010).

One concluding thought: to engage with current scholarly work as well as political statements by policy makers on care and technology is to enter different discussions and see how is dealt with the who- questions. “Thinking from women’s lives” (Harding 1991) in which care often occupies an important place through the life span might be a fruitful idea.