Kant & Moral Responsibility Towards Ebola Orphans
What moral obligations do we have to the children orphaned by the Ebola epidemic?
By Professor Sarah Holtman (University of Minnesota)
October 10, 2015 Picture: European Commission /Flickr.
West Africa’s recent, and tragic, Ebola epidemic has subsided, as has the hysteria that accompanied it. Recent reports remind us, though, that devastating consequences remain. Among these are broken medical systems – victims of the strains involved in treating thousands of dangerously ill and dying patients and of losing the many local doctors and nurses who themselves succumbed to the disease. A second ramification, less well recognized but no less predictable or compelling, is the unhappy transformation of many children from dependent members of loving families to orphans potentially condemned to fend for themselves or to endure the inadequacies (and often the dangers) of life in institutional settings. It is the plight of these “Ebola orphans” that interests me here. In particular, what moral obligations do we (as individuals, states or institutions) have to these children and to what considerations must we be alert in attempting to fulfill them?
Developing answers to these questions requires some factual background. In particular, as popular media and the websites of international charities attest, three factors compound the plight of African children recently orphaned by Ebola. The first is the extent of adult losses, often including parents, grandparents, aunts, uncles and adult siblings. The second is lack of resources to feed and house orphaned children with available foster families (whether relatives, friends or strangers). The third is the pervasive fear of infection that the epidemic has occasioned. These factors, we are told, have together undermined the widespread practice in many affected countries of caring for orphaned children via a network of extended family and neighbors rather than in institutions.
Widespread loss of multiple adult family members means that many children now lack the extended family most likely to step forward to provide care. Ravaged countries, moreover, were poor to start with. Now Ebola, with its accompanying deaths and quarantines, has made it impossible for many families to plant and harvest crops or to engage in wage-earning work. It has also left them with fewer adults to help provide support for current family members, much less thousands of newly orphaned children. Finally, pervasive fear of Ebola means that, in some cases, even surviving relatives and neighbors are unwilling to offer care to children who have come into contact with the disease, lest deadly infection be the result. Together, these unusual factors leave children at risk of homelessness, hunger and victimization and without the adult guidance and affection central to intellectual, psychological and emotional development.
Given this understanding of the circumstances at hand, the central candidates to consider in assessing who may have moral obligations to protect and care for Ebola orphans (and by extension for child-victims of other disasters whose plights may be similar) are three. They include the adult family members and neighbors who could and would, under normal circumstances, open their homes to these children in keeping with common cultural practice. They also include the domestic state or charitable institutions that can both support and supplement such practices when they falter, and the foreign states and charitable organizations and individuals who might step in to provide aid (whether by assisting children directly or by financing, advising or otherwise supporting local governments, charities or individuals).
Claims that one or more of these entities ought, morally, to offer such aid might have their roots either in notions of charity or of justice. The approach I favor (one with origins in the work of 18th century German philosopher Immanuel Kant) recognizes two distinct categories of moral obligation. Obligations of justice are distinguished from those of charity (or of virtue more generally) by the fact, first, that those who owe such obligations must fulfill them whenever there is the occasion to do so. (For example to satisfy the demands of morality, I must always keep my promises and must never appropriate another person’s property without her consent.) Second, those to whom such duties are owed have a right to fulfillment and a claim against the obligated person or entity that fails to honor that right. By contrast, as Kant explains in his Groundwork of the Metaphysics of Morals and elsewhere, although I must fulfill a general duty to be a charitable person (or perhaps more precisely to develop charity as one of my active traits of character), doing so does not require that I act charitably whenever the opportunity presents itself, nor does it afford those in need a right to my aid or a claim against me if I fail to provide it. Additionally, in determining how I will act charitably when I do, I enjoy flexibility (or playroom). Provided I do not run afoul of other moral demands (for example by allowing my choices to be guided by envy or by unfounded judgments of enmity), I may choose not only the timing of the aid I give, but also the beneficiary, the method and the extent. The question is not what I do on a particular occasion so much as whether, over a span of time, others could, on the basis of my actions, describe me as a charitable person (or as Kant might put it, as a person who has adopted charity as a guiding maxim or principle).
With these categories of moral obligation and potentially obligated parties in place, let’s turn to the questions at hand. What are Ebola orphans owed, on moral grounds, in terms of protection and care? Who bears these obligations? And what special considerations attend their fulfillment? For reasons that will become apparent, I begin with the individuals, extended family and neighbors, who typically undertake such care in the nations in question.
 Local family and neighbors
From a western perspective, the obligations of extended family and others who might foster orphans in accord with common practice initially may seem to be ones of charity, ones whose fulfillment these persons could choose to forgo on particular occasions without moral failure. Yet few would deny that an obligation to provide for the basic needs of dependent children is one that we must meet (if we hold it) whenever the opportunity arises. The idea, for example, that biological parents have an obligation to provide their children essentials like food, shelter and clothing, as well as elements of moral and practical education, is widely accepted in the west. And this obligation is not one whose fulfillment or recipient parents may choose. It is one they owe to their own children and must satisfactorily address towards those children at all times on pain of moral wrongdoing (and often under threat of legal sanctions). It is what I have termed an obligation of justice.
Of course, we might attribute this obligation to parents’ intimate biological relationship to their children, with contractual agreements to adopt or foster non-biological children as a less usual way of acquiring the same moral responsibilities. But the fact that one can become a parent, with all of the attendant obligations, via adoption suggests a different analysis. So does the fact that western societies typically supplement or take over parental obligations where children’s needs are not, or cannot be, met. Specifically, what we take to be fundamental in acknowledging a duty of justice, rather than one of charity, with respect to needy children within our community or state appears, on reflection, not to be biological relationship to parents, or even the fact that the child’s presence in the world is the consequence of parental actions. More plausibly, it is that adequate attention to basic needs during childhood is essential to an individual’s development as a person and fellow member of society and thus to acknowledging her as a potential, or developing, human agent.
This way of understanding the western moral outlook on children and our obligation to provide for their basic needs allows us to take a different view of the obligations of extended family and neighbors to Ebola orphans. Practices (and laws) in many western countries address the duty that each has towards her society’s dependent children by assigning fulfillment first to parents and only when it is not met to other adults. Non-western cultures, we can conclude on further analysis, often address this duty differently. They allocate responsibility for childcare, protection, education and the like to the community as a whole. Both western and non-western methods address the underlying obligation, one owed by capable adults to each child as a developing agent who cannot adequately fulfill basic needs. Similarly, each has a different method for fulfilling this shared obligation in cases where accepted practice cannot adequately address the need. In the west, this is a combination of monetary and institutional aid and formal legal provisions for adoption, fostering and guardianship. In nations like those of West Africa, it is an expansion of more communal childcare practices, with extended family and neighbors stepping in to provide more direct care and to be the locus of an increased portion of the responsibility they already hold to see to children’s basic needs.
Using the categories I attributed to Kant, then, the obligations of extended family and other members of children’s more immediate community are ones of justice and must be met for each child and on every occasion when basic needs are under threat. Thus when these community members step forward (as many have) to take Ebola orphans into their homes, we should see them not as undertaking charitable actions that they might have decided to forgo, but as assuming a duty of justice belonging to them as community members. Under usual circumstances, this allocation of responsibility would be sufficient to meet obligations involving children’s basic needs. If extended family were unavailable (due to distance, poverty or illness) a neighbor would more directly take on the responsibility that all shared. But what can be said from a moral perspective when most members are too ill, too poor or already too burdened with extra mouths to feed and extra bodies to house and clothe, and others are fearful that assuming the responsibility they share may lead to deadly infection of themselves or others to whom they also hold obligations of care?
 Domestic institutions
Some of Kant’s more contemporary followers (e.g., Onora O’Neill) suggest that various familiar institutional practices are best understood in the context of such questions. In part, their claim is an extension of the point just noted. Our basic moral obligations, both those of justice and those of charity, are ones that we can satisfy in a number of equally good ways. (E.g., as just discussed, we might fulfill an obligation to provide for dependent children via a biological-parent-centered or a more community- centered scheme). Taking this insight a step further, contemporary Kantians emphasize the role that context can, and should, play in developing the varying practices through which we seek to fulfill such obligations. Matters including the proximity of persons to one another, the presence (or absence) of religious or cultural homogeneity, ease of movement and nature and abundance of available food can not only explain a community’s practices, they can justify those that pertain to moral obligations. For example, if religious homogeneity and communal agricultural practices make communal childcare/child-rearing a more effective means to provide for basic needs than a biological-parent-centered model, then there are reasons grounded in moral obligation for developing and supporting such a system.
But the significance of context to meeting our moral obligations does not end with the development of local practices or systems. For the circumstances that recommend these as particularly effective ways of meeting our obligations can be disrupted or altered. In these cases, theorists emphasize, we need to have, or put in place, measures allowing us to meet obligations despite straitened circumstances. Some such measures may be local, but this is, in particular, a venue in which broader state laws, policies and institutions have an important role to play. These can supplement or repair practices that are functioning imperfectly and shore up or replace such practices when they break down due to temporary conditions that cause excessive strain. We properly see these domestic laws and institutions as vehicles for continuing to fulfill our individual responsibilities (in this case our obligations of justice) when circumstances disable our more usual methods.
So understood, domestic remedies for the plight of Ebola orphans at the state level are ones that address obligations of justice belonging, in the first instance, to individual community members. They are, we might say (with some contemporary Kantians), best understood as methods that these individuals, now viewed as citizens of the state, put in place (through their representatives) to better meet such obligations than is possible via individual effort or local practice alone. Officials charged with administering, and often developing, reevaluating and reforming, these laws and institutions act not as individuals representing their own interests and fulfilling their personal obligations. They act as institutional authorities whose duty, when carrying out official tasks, is what we might call (with Ronald Dworkin and others) one of institutional justice. It is the duty to interpret relevant laws and work within institutional structures to fulfill (or better fulfill) the duties that belong to citizens as individuals.
In the case of Ebola orphans, the precise character of these institutional duties will depend on the laws and institutions in place in affected states. But they will include employing these political measures either to address Ebola orphans’ basic needs or to shore up local structures (through money, resources, education and the like) so that they function as well as they would in normal conditions (or as nearly so as is possible). Institutional duties of justice will also require officials to assess the likely effects of new care mechanisms on established practices with special attention to whether such effects will likely be to the benefit or detriment of the children to whom duties are owed. Relevant in assessing detriment will be not only what is necessary to care for children’s physical needs, but also what conduces to their development as adult community members with lives, livelihoods, families and communities of their own and as citizens who join together for larger mutual governance aimed at better meeting their duties of justice. For (as philosophers including Elizabeth Anderson and Martha Nussbaum note) each of the above is an aspect of a fully developed human agent.
 Foreign states and international organizations
The stories of children at risk in the face of the Ebola crisis and its aftermath, though, are stories of care systems that are broken or deeply overburdened at the national as well the local level. Proponents of international action typically adopt one of three perspectives. I term these blithe humanitarianism, international-intervention skepticism and state-centered cosmopolitanism. As explained below, my own Kant-based outlook supports the third of these, which I will suggest incorporates the most morally attractive elements of the other two.
Blithe humanitarianism advances its call for aid chiefly as a means of alleviating children’s physical and emotional suffering and their exposure to violence, victimization and disease and of augmenting their inadequate developmental opportunities via education. The notion of children as embedded members of cultural, religious and political communities is not the focus for these humanitarians. Their principal concern is the individual child and her physical, emotional and intellectual development. The maintenance and development of the individual as community member, much less the repair and strengthening of justice-based practices and institutions, are largely side issues for those who take this perspective. Moreover, these humanitarians understand their obligations to needy children as ones of charity. On this view, individuals might choose to aid particular Ebola orphans, e.g., through monetary donations to aid organizations or even by offering hands-on aid in afflicted countries. Doing so, though, is just one way among many of carrying out one’s moral obligation to act charitably. Likewise, when blithe humanitarians call on nations and international organizations to provide aid for these children, they do not claim that foreign entities and individuals must help every Ebola orphan as a matter of justice. We can perhaps best describe them as highlighting (in the spirit of some contemporary libertarians) one way in which we might fulfill our flexible duties of charity.
A sometimes stinging, counterpoint to the humanitarianism just described, international-intervention skepticism emphasizes, first, that blithe humanitarians take too narrow a view of the welfare of Ebola orphans and similar children in need. For the basic needs of any child include not only the physical, psychological and educational ones that the humanitarian emphasizes, but also the fostering of the child’s respect for herself both as a valuable individual and as a member of a self-governing civic community. It is not enough, says the skeptic, that attention to other basic needs allows the child to develop physical, emotional and intellectual capacities central to functioning in these roles. She must learn to see or identify herself as an active participant in them. With its focus on providing for the needs of unfortunate members of unfortunate states and cultural communities, blithe humanitarianism is more likely to undermine than to foster such an outlook, with dire consequences for children, local communities and states alike. Moreover, states, individuals and organizations that follow the blithe humanitarian in ignoring this danger or denying its moral significance in fact engage in a variety of injustice. For they fail to acknowledge and support persons and communities as appropriately self-governing entities.
To the extent that they offer aid at all then, say intervention skeptics, foreign states and citizens and international aid organizations should seek not to save individual children, or indeed children as individuals. They should, rather, provide what funding they do to local and state agencies for use in strengthening those domestic institutions most likely to foster the development of a self-governing citizenry. More, whether even this variety of aid can be justified is a matter that potential providers always must consider. For, on this view, foreign aid is inevitably a crutch that threatens to foster dependency and undermine the very strengths it should aim to support. Thus those contemplating aid to Ebola orphans and similar groups must, on pain of injustice, carefully evaluate not only what form of aid to offer and to whom. They must ask whether the aid that some would see as a mark of moral virtue would in fact mire benefactors in injustice.
Importantly distinct from the preceding views, state-centered cosmopolitanism also shares some of the values and concerns central to each. This cosmopolitanism claims, first, that both citizens and states are morally required to view members of foreign nations as what we might call “fellow citizens of the world.” We must, in other words, see them as individuals to whom each of us owes more than the mere moral minimum of refraining, e.g., from unwarranted harming or killing. Second, the state-centered cosmopolitan holds that states have a special relationship with their citizens, one that is founded in notions of self-governance and that foreign citizens must duly respect on pain of injustice.
What allows the cosmopolitan to hold these two positions without inconsistency, and what most distinguishes her from humanitarians and intervention skeptics, are the grounds foundational to her view (grounds that again have their origins in Kant’s moral theory). The cosmopolitan (with Kant) agrees that we have moral obligations (both of charity and of justice) extending to all of our fellow human beings. While these include obligations to address shared basic physical, emotional and psychological needs, from her Kant-based perspective it is “autonomy” that is essential to any person’s humanity and so to treating her with due respect or regard. Persons, says the cosmopolitan, are autonomous in two senses. Viewed individually, each functions as a person when she attains and employs a capacity to develop and pursue a plan or conception of a valuable life and to commit herself to a set of moral principles to regulate that life. We can term this personal autonomy. Full realization of one’s personhood, though, also requires participation with others in the joint project of developing, enacting and employing just laws and institutions to regulate life within a smaller subset of humanity. We can term this civic autonomy. We must honor autonomy in both senses if we are to treat fellow citizens (and indeed ourselves) as morality demands.
The cosmopolitan thus agrees with the humanitarian that, as states and individuals, we have moral obligations to foreigners, among them Ebola orphans. For the cosmopolitan, though, where basic needs are at stake these are not obligations of charity owed to relative strangers more generally. They are obligations of justice owed to each fellow citizen of the world, that is, to each individual member of our shared human community. Moreover, the basic needs in question are richer and more complex than the humanitarian admits and, as a consequence of these complexities, demand that the nature of our aid be sensitive to the development of each recipient both as a self-governing person and as a citizen able and disposed to participate in the governance of her local community and her home country.
The cosmopolitan thus likewise shares with the intervention skeptic a concern that aid may undermine capacities for self-governance in both individuals and states. But because she also has a richer conception of community and citizenship, one in which we are ideally governors of our own lives, active participants in domestic governance and working members of an international community of persons, she rejects the skeptic’s narrow moral analysis of the circumstances justifying or demanding international aid efforts. On the state-centered cosmopolitan view, where basic needs are at issue (as they certainly are in the case of Ebola orphans), we must seek to meet these needs on pain of injustice. How we do so will depend on determining what type of aid, conditions on distribution, coordinating bodies and the like are best designed and positioned to address the full panoply of basic interests, autonomy in its various guises chief among them, in each needy child.
Considerations Favoring A Kantian Framework
 General Features
On the Kantian account I have sketched, Ebola’s West African orphans (like other dependent children) have claims of justice on capable adults to provide for their basic needs. We properly assess these needs by asking what is required for these children to develop and function as adult persons who realize both individual and civic autonomy. We properly determine more particular responsibilities, including demands for positive action and cautionary limits, by recognizing the related roles communities on the local, state and international (or cosmopolitan) levels play in their realization. Appealing aspects of this framework (and reasons for putting it to use in determining what we indeed ought to do) include its acknowledgment of the strong moral obligations we in fact recognize regarding children’s basic needs, its ability to see moral practices in varying locales as species of these duties, and its emphasis on the relationship between what I have termed institutional and cosmopolitan duty and the more fundamental moral obligations of individuals. In these ways, the Kantian account, as I have presented it, takes our moral intuitions and practices seriously, helps to resolve seeming inconsistencies between duties at different levels and in varying locales, and acknowledges, highlights and explains both the relevance of current conditions to evaluating how best to carry out our moral obligations and the importance of sensitivity to, and respect for, practices and traditions not our own.
These strengths are most evident when we apply Kantian theory to a concrete moral problem. So I close with a particularly vexed question — how properly to respond to domestic caregivers who attempt to avoid both infection and stigma by refusing to take in Ebola orphans. As noted above, fear and stigma are hardly the only reasons why extended family and neighbors have hesitated to give Ebola orphans refuge. But what can be said about obligations where these indeed are contributing barriers to care?
Because obligated parties include three distinct groups, the response must be threefold. It is difficult to know, of course, the aims and reasons driving local community members who express fear of Ebola orphans and consequent unwillingness to take them in. Some surely worry that they will violate other duties of justice, to care for birth children for example, should they foster a child who harbors the virus. In a prevailing state of panic, others may process less cogently, simply attempting to place as much distance as possible between themselves and the virus from a sense that doing so can ward off disaster. Finally, there may well be those who are opportunistic, who simply seek a convenient reason to shirk moral responsibilities they do not wish to assume.
Of these, the interesting cases are the first two. (The opportunist shirks when he can, and special features of the Ebola crisis are here irrelevant.) Our response to what we could call cases of moral conflict and panic must be similar to each other. In each of these cases, one factual issue is at the forefront. Is the Ebola orphan in fact likely to pose a danger? Given lack of access to reliable information and the dire consequences of infection, the decision to proceed cautiously while one gathers information on this score certainly is not unreasonable. Likewise, in these conditions, a panicked desire to avoid contact is a natural and predictable, though irrational, response. Under the circumstances in play, the most that can be asked of potential local caregivers, morally speaking, is their best moral and factual analysis of the case at hand. And when panic paralyzes the ability to make this analysis, we must further acknowledge that human moral agents are not perfectly rational and cannot be held to such standards under conditions of poor information, reasonable lack of trust and the like. Thus we cannot, given the state of information and other relevant circumstances, demand that autonomous agents throw caution (and comparable other moral responsibilities) to the wind and take in orphans come what may. Neither the cautious information collector nor the victim of panic is guilty of a culpable failure to shoulder responsibility.
These features of local responsibility — the significance of autonomous judgment, the potential presence of competing duties, reasonable uncertainty about the factual terrain and natural emotional reactions — must likewise shape assessments of responsibility at other levels. For on the model provided here, it is the local responsibilities that are primary. Perhaps the most obvious responsibility at the national level is an informational one. Potential caregivers cannot function as autonomous individuals seeking to fulfill both life plans and moral obligations in the absence of adequate factual information. Where, as here, there may be uncertainty about orphans’ health and the possibility that they could transmit infection to others, it is crucial that available information include disclosure both of relevant facts and ongoing uncertainties. Anything less could undermine individuals’ ability to determine how best to attempt to meet moral obligations and would fail to demonstrate respect for potential caregivers as autonomous moral decision makers.
Given that some caregivers will reasonably choose not to take the risks potentially involved in providing care and others may continue to harbor irrational but natural fears even in the face of reliable information, states must also be prepared to undertake care in the face of these decisions and attitudes. The state is the vehicle through which citizens bear joint moral responsibilities that cannot fully be met through local action. Barriers to adequate local solutions include not only inadequate resources (food, shelter and the like), but also what we might call autonomy-related barriers of conflicting moral obligation, factual uncertainty and natural, though irrational, fear. Each is a risk to the satisfaction of our moral obligations. On the Kantian model, providing a satisfactory remedy for each is part of the state’s obligation.
That this is so, though, highlights a further consideration to which state policies and institutions must be sensitive. For where refusal to care for children in accord with local practice may stem from a sense that the child is a danger or risk due to contact with a dread disease, there is the chance that children in state facilities will come to see themselves as social outcasts or even as unworthy to be treated as members of their community. These conceptions of self and relation to community can, of course, deeply injure a child’s sense of self-respect, her understanding of herself as a community member, and her willingness to press for her own rights and to bear her moral responsibilities. If the state is to treat Ebola orphans as developing moral agents and citizens, properly fostering the attitudes required for the realization of autonomy, it must seek to combat this kind of damage. Institutions most likely to succeed on this score are those that seek to foster close relationships between children and caring adults, to offer good quality education and opportunities for social development and to reintegrate children into local communities when this is consistent with their physical, psychological and autonomy-related well-being and development.
It is perhaps with regard to these last needs that international entities, in the form of foreign states, charitable institutions and individuals, play their most important role. As already noted, on the Kantian model these international players, like domestic ones, have duties of justice to Ebola orphans. But in fulfilling them, they must be especially careful to support orphans through the domestic institutions and practices that are part of their local and political communities. Especially conducive to this aim are contributions to domestic programs designed to provide accurate information, to care for orphans without homes in the local community, to address children’s more immediate emotional, physical, psychological and autonomy-related needs and to support long-term education efforts both for children and the larger community. For these not only address the basic needs of orphaned children but support institutions and practices foundational to developing and employing both personal and civic autonomy.
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