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The Moral Economy of Care
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27 October 2026

American labor unions are in crisis. Unionization rates have been in decline for decades. Hospital workers' unions, however, are growing. Today, they are among the most potent forces in the American labor movement. The Moral Economy of Care seeks to understand both the historical developments that have led to this state of affairs, and the ethical dilemmas of striking and workplace conflict in hospitals today.
The COVID pandemic laid bare the moral injury care workers suffer due to the burden of balancing patient wellbeing against market incentives. Pablo Gastón argues that these longstanding ethical tensions are linked to care workers' mass scale mobilization, with deep roots in the history of care work in the US. The notable successes of today's hospital workers' unions, Gastón argues, can be explained by their ability to leverage a rhetorical framework that reconciles the tension; care workers strike because they care, whereas capital is uncaring. Following two unions working to organize California hospital workers over the course of seven decades, this book shows how moral conceptions of caring shaped collective bargaining patterns in hospitals in the twentieth century.
"For decades it was argued that patient care was such a moral imperative that unions, strikes, and even decent pay were out of step with American health provision. But in his persuasive and pathbreaking history, Pablo Gastón shows how rank and file nurses turned this injunction on its head, making patient care and workers' control a compelling justification for militant unionism in a profit-maximizing hospital ecosystem." —Nelson Lichtenstein, author of Why Labor Unions Matter
Acronyms
1. The Strike Dilemma
2. An Insulating Distinction
3. Against the Methods of Unions
4. How to Justify a Strike
5. The Limits of the Law
6. A Caring Class
7. Suits and Nuns
8. Can Capital Care
Notes
Bibliography
Index