Mind the Economy/ Justice 134

Who takes care of whom?

by Vittorio Pelligra

4 January 2026

7' min read

Translated by AI

Versione italiana

Key points

Dependency as an ordinary fact
Doulia: when care produces vulnerability
From care to capabilities

7' min read

Translated by AI

Versione italiana

Christmas time. For many it is holiday time. We would like to spend a few days in the mountains, we go. For others, the holiday has never really been an option. A family with a disabled child tries to organise a few days out. The first search concerns the accessibility of accommodation. Then transport. Then the distance to the nearest hospital. Then the availability of appropriate services. Each choice requires phone calls, checks, alternative plans, back-up solutions. In the end, the simplest decision is not to leave. Not because theoretically the boy cannot travel. But because organising that holiday is a full-time job. A job that falls entirely on those who take care of him. And which, as is often the case with care work, is neither supported nor facilitated. It is often not even seen. Giving up a holiday is not a detail. It is not a matter of convenience. It is a signal. It indicates the point at which a society for some stops functioning as it should. And we are not talking about moments of emergency, but the ordinariness of life. And it is precisely there, in the ordinariness that becomes a constant emergency, that a profound question of justice is hidden.

Addiction as an ordinary fact

Much of modern political philosophy has built its various theories of justice around an implicit image of the human being: autonomous, self-sufficient, capable of cooperating and returning what it has received. This is the anthropology of the social contract. We have spoken about it at length in recent weeks. Cooperation is fair because it produces mutual benefit. But this grammar only works on one condition: that the participants, at least approximately, have a similar and symmetrical capacity to give as well as to receive. Those who do not have this capacity - children, the non-self-sufficient elderly, people with severe disabilities or even just temporary impediments - are considered by contractualism as exceptions, an 'outlier'. A problem to be managed.

Vulnerability and the resulting dependency are treated as a deviation from the norm, a misfortune affecting some. Never as it really is: a constitutive feature of the human condition. Eva Feder Kittay has clearly shown in her Love's Labor. Essays on Women, Equality, and Dependency (Routledge, 1999) that this approach is not only incomplete, but completely distorted. Dependency is not an accident. It is an ordinary condition of existence. We have all been dependent. All of us, if we live long enough, will be again. To design institutions as if autonomy were the norm is to design systems that work well for only part of the population. Discriminatory institutions by construction.

Doulia: when care produces vulnerability

But this is not an individual matter. It is social and political. Addiction, in fact, never concerns only one person. It presupposes a relationship involving at least one other subject: the caregiver. And it is here that traditional justice theory becomes blind. To name this dimension, Kittay introduces the concept of doulia. The term, introduced by anthropologist Dana Raphael, denotes the supportive relationship towards mothers before and after childbirth. The doula is that figure who helps the mother to care for her child. Kittay's analogy is clear: just as a mother cannot care for a newborn child without being supported, in the same way the caregiver who cares for someone else becomes in turn vulnerable precisely by virtue of that caring action which requires not only emotional closeness, but also organisation of time, constant vigilance, anticipation of needs, mediation with institutions, implies giving up work opportunities, time off and a constant consumption of cognitive and emotional energy. It is a job that produces economic and social vulnerability. And this vulnerability is not natural. It is a product of our social organisation.

The doulia perspective proposed by Kittay emphasises the principle that if a society benefits from the work of caregivers, then they must be recognised and supported by society as a whole. But not as an act of benevolence, but as a requirement of justice.

The example of the missed holiday makes this clear. We are not talking about health emergencies or borderline situations. We are talking about leisure, rest, sociability. Of what makes a life not just survivable, but liveable. Here the doulia takes on a particularly clear form. The problem is not just the accessibility of facilities. It is the invisible work of designing life that falls to the caregivers: planning, checking, anticipating every possible contingency. When this work becomes too onerous, the solution is not a shorter or more spartan holiday. It is renunciation. A renunciation that does not only involve the disabled child, but his whole family. The possibility to rest, to travel, to participate in the social life of the whole family is called into question. Vulnerability spreads along the care relationship. And it does so systematically and, most of the time, invisibly.

The problem is not only practical. It is cultural. Institutions are designed around an implicit idea of the citizen: available, autonomous, unburdened by caring responsibilities. Those who deviate from this profile are treated as special cases, as exceptions to be accommodated. The doulia serves to unmask this idealisation. It shows that a substantial part of social functioning depends on individuals who cannot be fully autonomous precisely because they are making the autonomy of others possible. The benefits of their work go to society as a whole, but the costs, on the other hand, fall on them alone. Giving up a holiday is therefore not an individual choice. It is the predictable outcome of a social and institutional organisation that functions on the assumption of unlimited availability of unrecognised care work.

There can be care without justice but there can certainly never be justice without care. Virginia Held explains it well when she states that 'Care is the most fundamental value. There can be care without justice: historically, there has been little justice in the family, but care and life have gone on without it. There can be no justice without care, however, for without care no child would survive and there would be no people to respect' (The Ethics of Care. Oxford University Press, 2006, p. 17). Held draws a direct consequence from this. If care is a fundamental social practice, then it cannot remain confined to the private sphere. It cannot depend on individual sacrifice or family 'vocation'. It must become an institutional design criterion. Care, in this perspective, no longer takes place in a private relationship, but becomes public. It is here that the doulia becomes a political lens. A just society is not one that intervenes ex post with bonuses or buffer measures. But one that does not systematically make caregivers vulnerable.

From care to capabilities

Chicago philosopher Martha Nussbaum takes this a step further by translating these insights into a grammar of rights. Her capabilities approach, developed together with economist Amartya Sen, shifts the focus of justice from redistributive issues to what people must be able to do and be in order to live a life of dignity. It is not enough to have a right if it remains on paper. It is not enough to have a bicycle to be able to say you have a right to sustainable mobility if the roads are dangerous. It is not enough to give a disabled person a wheelchair if then the lift in his building is too small to access it. It is not enough to have the abstract possibility of taking a holiday if then logistical and organisational obstacles make it practically impossible. In the capabilities approach, it is not so much the resources a person possesses that count, but what they are actually able to do (doing) and be (being) thanks to those resources. It is the 'substantial freedoms' that count, Sen. Nussbaum would say. She draws up a list of capabilities that any just society should guarantee at least above a minimum threshold. These capabilities include play, leisure, the ability to travel, to participate in social life. But many of these capabilities are not exercisable without care work. Guaranteeing them also means guaranteeing the material, temporal and emotional conditions for those who provide that care. Justice does not demand that all have the same lives, but that all have the same basic opportunities to flourish. In this sense, doulia is not a marginal addition to the capabilities approach. It is a condition of possibility. Without policies that support caregivers, capabilities remain abstract statements, valid only for those without dependency burdens.

Who takes care, then? This is not a moralising question. It is a political question. As long as we continue to think of justice around an idealistic citizen, free of addictions and caring responsibilities, the burden of vulnerability will always be dumped on the same or the same. And it will do so in the least visible places: in the leisure time that disappears, in the holidays that do not take place, in the school that does not include, in the normality that becomes inaccessible. The doulia forces us to recognise when and where the system only works because someone is paying an invisible cost. It reminds us that autonomy is not a starting assumption, but a fragile outcome, sustained by caring relationships. And that a theory of justice that ignores this fact is not simply incomplete. It is unjust.

If a society treats vulnerability and the resulting dependency as an exception, then citizenship remains conditional. Not by default of intention, but by default of design. Taking this evidence seriously does not mean renouncing the social contract or the benefits of cooperation, but recognising that justice cannot be built only for those who fit the 'norm'. A society that really works is one in which even those who cannot contract are nevertheless included in the structure of public expectations. Not as an exception, but as an ordinary part of the institutional design.