A central thesis of this chapter is that to naturalize bioethics, one must adopt the perspective of the ethics of care. Doing so not only would question basic presuppositions of medicine and nursing but would also better orient bioethics to vulnerability (and therefore carnality), thereby offering a more relational, situated understanding of what health care is all about.

Theoretically and on a practical level, the ethics of care already influences present-day bioethics, at least in the Netherlands, where I live. At the University Medical Center of Groningen, the director of the Center for the Ethics of Care is Marian Verkerk, one of the Dutch pioneers of the ethics of care. In other hospitals, but also in nursing homes and institutes for mentally handicapped people, psychiatric patients, and children, there are many professionals who sympathize with the ethics of care. They view it as a contribution to their work, because of its person-oriented, practical, situation-specific approach. Economic and managerial thinking has a heavy impact on the health care system here as well: in the 1990s the implementation of managed care rationalized the way of working, and in the beginning of the third millennium, although Dutch health care is still partly financed by public means, the principle of the marketplace was introduced. In this chapter, however, the focus is on ethics.

In Western history, two paradigms have governed institutional health care.