The standard argument for longtermism assumes that we should care as much about far future people as about our contemporaries. I challenge this assumption. I first consider existing interpretations of ‘temporal discounting’, and argue that such discounting seems either unwarranted or insufficient to block the argument. I then offer two alternative reasons to care less about far future people: caring as much about them as about our contemporaries would make our lives less authentic and less meaningful. If I’m (...) right, this undermines at least the strongest versions of longtermism. Plausibly, we should do much more for the far future than we’re currently doing. Still, we often ought to act for contemporaries’ sakes, even if longtermist actions would expectably do more good. (shrink)

The target article posits that caregiver cooperation rendered heightened expression of childhood fear an adaptive response to threat. I argue that caregiver cooperation rendered childhood fear expression less accurate as a signal of actual threat, and hence less effective for harm avoidance. Further, other emotional expressions that avoid unwarranted caregiver stress may be more likely to evoke needed care.

Recently a number of AIDS/AZT research studies, carried out by U.S. universities, have come under intense ethical scrutiny. In these studies, control groups of HIV-positive pregnant women were being given a placebo rather than AZT. Such research protocols would be illegal if practiced in the U.S. I examine a number of lamentable ethical lapses in the studies, and conclude that at least some of these ethical problems are traceable to a troubling contradiction between differing international codes of ethics. In a (...) word, some international codes mandate that all research subjects (including control groups) receive the best standard of care available in the country sponsoring the research, while others suggest that providing only a “Iocal” standard of care is ethically appropriate. I argue that these two ethical mandates cannot both be satisfied, and that host country populations will remain subject to exploitation unless this contradiction is resolved. (shrink)

Cooperative child care among humans, where individuals other than the biological mother (allomothers) provide care, may increase a mother’s fertility and the survivorship of her children. Although the potential benefits to the mother are clear, the motivations for allomothers to provide care are less clear. Here, we evaluate the kin selection allomothering hypothesis using observations on Hadza hunter-gatherers collected in ten camps over 17 months. Our results indicate that related allomothers spend the largest percentage of time holding (...) children. The higher the degree of relatedness among kin, the more time they spend holding, supporting the hypothesis of nepotism as the strongest motivation for providing allomaternal care. Unrelated helpers of all ages also provide a substantial amount of investment, which may be motivated by learning to mother, reciprocity, or coercion. (shrink)

Cancer care has transitioned from clinical-based to home-based care to support longterm care in a more familiar and comfortable environment. This care transition has put family caregivers (FCGs) in a strategic position as care providers. Cancer care at home involves psychological and emotional treatment at some point, making FCGs deal with the stress of cancer patients frequently. Due to their limited care competencies, they need supportive care from healthcare professionals in cancer stress (...) management. This study aims to examine how types of demanded healthcare information affect the FCG’s role in reducing the stress of female cancer patients. The mindsponge theory was used in conceptual development and interpretation. Bayesian Mindsponge Framework (BMF) analytics were used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of healthcare information, FCGs with higher demand for cancer-specific information were more likely to need support in reducing the stress of female cancer patients. Meanwhile, FCGs with a higher demand for information about support services were less likely to need support to reduce cancer patients’ stress. Other types of healthcare information have ambiguous effects on the need for support in reducing cancer-induced stress. This study reveals that the demanded cancer-specific information, e.g., cancer prognosis or likely outcome, must be prioritized to assist FCG’s role in managing cancer stress. (shrink)

Care is widely thought to be a role virtue for health care professionals (HCPs). It is thought that in their professional capacity, HCPs should not only take care of their patients, but should also care for their patients. I argue against this thesis. First I show that the character trait of care causes serious problems both for caring HCPs and for cared-for patients. Then I show that benevolence plus caring action causes fewer and less serious (...) problems. My surprising conclusion is that care is a vice rather than a virtue for HCPs. In their professional capacity HCPs should not care for their patients. Instead HCPs should be benevolent and act in a caring manner toward their patients. Keywords: care, ethics, virtue CiteULike Connotea Del.icio.us What's this? (shrink)

Corporations are developing more cost‐effective payment arrangements with health care providers and are shifting costs away from expensive forms of treatment. Although employees may have fewer options as a result, quality of care need not be affected.

Physically frail, badly educated girls, brought up to lead useless lives as idle gentlewomen, married to dominant husbands, and relegated to "separate spheres" of life—these phrases have often been used to describe Victorian upper-middle-class women. M. Jeanne Peterson rejects such formulations and the received wisdom they embody in favor of a careful examination of Victorian ladies and their lives. Focusing on a network of urban professional families over three generations, this book examines the scope and quality of gentlewomen's education, their (...) physical lives, their relationship to money, their experience of family illness and death, and their relationships to men (brothers and friends as well as fathers and husbands). Peterson also examines the prominent place of work in the lives of these "leisured" Victorian ladies, both single and married. Far from idle, the mothers, wives, and daughters of Victorian clergymen, doctors, lawyers, university dons, and others were accomplished and productive members of society who made substantial public and private contributions to virtually every sphere of Victorian life. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

Influences on social traits involve a tangled interplay of genetic, social, and environmental factors. Moreover, there is increasing awareness that gene–environment correlations are real and potentially measurable. Such gene–environment correlations can mislead if they are uncontrolled and genetic associations are interpreted as being purely because of direct genetic effects. This complexity is cause for more and better investigation, not a reason to refrain from researching one of the potentially important factors (genetics) influencing trait variation.

Agonizing care: care ethics, agonistic feminism and a political theory of care ‘Care’ is central to nursing theory and practice, and has been described in a variety of ways. Intense conversations about care have been developing in other fields of study as well, from the social sciences to the humanities. Care ethics has grown out of intellectual exchange between feminist thought, moral theory and the critique of traditional western political philosophy. However, care ethics (...) is not without its critics, as these accounts of care have also sparked vigorous challenges. This paper traces the construct of care through nursing theory, care ethics, feminist critiques of moral and political theory and agonistic feminism to outline a set of problematics that a political theory of care should engage. It discusses how care is conventionally posited in more or less essentialist, universalizing and naturalizing terms. It introduces the ideas of feminist theorists who resist dichotomizing care and the political, and situate care in the context of power and politics. The tensions between care feminism and agonistic feminism are highlighted in order to explore the potential of theorizing both care and nursing in political terms. (shrink)

The perception of time shifts as patients enter hospice care. As a complex, socially determined construct, time plays a significant role in end‐of‐life care. Drawing on Buddhist and Western perspectives, conceptualizations of linear and cyclical time are discussed alongside notions of time as interplay of embodied experience and concept. Buddhist understandings of self as patterns of relating and the theory of ‘dependent origination’ are introduced. Implications for understanding death, dying and end‐of‐life care within these differing perspectives are (...) considered. These explorations contribute to the growing dialogue in nursing between Buddhist and Western traditions. (shrink)

In her essay ‘The Curious Coincidence of Feminine and African Moralities’ (1987), Sandra Harding was perhaps the first to note parallels between a typical Western feminist ethic and a characteristically African, i.e., indigenous sub-Saharan, approach to morality. Beyond Harding’s analysis, one now frequently encounters the suggestion, in a variety of discourses in both the Anglo-American and sub-Saharan traditions, that an ethic of care and an African ethic are more or less the same or share many commonalities. While the two (...) ethical perspectives are indeed sisters, in this article I argue, first, that they are not identical twins, and, more strongly, that the family resemblance between the two is significantly less than has been recognized. I highlight key differences between representative forms of an ethic of care and a sub-Saharan communitarian morality, after which I argue, second, that the latter better captures some central feminist concerns and moral considerations generally. That is, I maintain that an African ideal of community, when understood in a philosophically refined way, provides an important, relational corrective to the ethic of care. (shrink)

Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but (...) it does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues. The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers. (shrink)

A caring approach to knowledge production has been portrayed as epistemologically radical, ethically vital and as fostering continuous responsibility between researchers and research-subjects. This article examines these arguments through focusing on the ambivalent role of care within the first large-scale experimental beagle colony, a self-professed ‘beagle utopia’ at the University of California, Davis. We argue that care was at the core of the beagle colony; the lived environment was re-shaped in response to animals ‘speaking back’ to researchers, and (...) ‘love’ and ‘kindness’ were important considerations during staff recruitment. Ultimately, however, we show that care relations were used to manufacture compliancy, preventing the predetermined ends of the experiment from being troubled. Rather than suggesting Davis would have been less ethically troubling, or more epistemologically radical, with ‘better’ care, however, we suggest the case troubles existing care theory and argue that greater attention needs to be paid to histories, contexts, and exclusions. (shrink)

Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non‐Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health‐seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions and improve health (...) outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two‐Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self‐identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma‐informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families. (shrink)

According to Gawande, Lazaroff “chose badly.” Gawande suggests that physicians may be permitted to intervene in choices of this kind. What makes the temptation to intervene paternalistically in this and similar cases especially strong is that the patient’s choice contradicts his professed values. Paternalism appears less problematic in such cases because, in contradicting his values, the patient seems to sidestep his own autonomy. This chapter addresses the dangers of overextending this interpretation. I argue that it is not so easy to (...) judge when a person is not genuinely exercising autonomy, and that choosing contrary to one’s own values does not necessarily amount to sidestepping one’s autonomy. The key insight is to recognize the importance of the attitude of caring as an integral part of some expressions of autonomy. This will allow us to develop an alternative picture of minimal autonomy, according to which it is possible to choose against one’s values while genuinely exercising autonomy. For practical purposes, in medicine and elsewhere, this means that, in cases like Lazaroff’s, those tempted toward paternalism must exercise particular caution before they deem a choice to be disen- gaged from autonomy: even if a choice contradicts the person’s own values, it might be rooted in caring, and then, despite initial appearances to the contrary, it may still command the highest level of protection against paternalism. (shrink)

The concept of care can be explained in various ways, and it can present a different meaning to each person. Nurses are increasingly aware that good nursing care consists of ‘more’ than the competent performance of a number of caring activities. For many nurses it is less clear what this ‘more’ means and what importance it has in nursing. This article will develop a view concerning care considered as a moral attitude. It is argued that care (...) can be considered as a foundational normative concept in the ethics of the nursing profession. The aim is to clarify that nurses do not derive their specific caring identity just from the set of tasks that they perform but also from the way in which they commit themselves to the caring process. (shrink)

BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, (...) 97% of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses (...) hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development of home‐care nursing. (shrink)

Nonprofits are a major part of the U.S. economy and they are not immune from corporate malfeasance controversies. Even Congress has expressed concern about the crisis in nonprofit governance. The nonprofit response to Congress has been a historic initiative recognizing critical challenges to nonprofit governance. In contrast to their for‐profit counterparts, nonprofits are committed to missions serving the public benefit and not to shareholder profits. Accordingly, their missions and financial resources are intrinsic to their very existence, which is built upon (...) the public trust. That trust is rooted in fiduciary responsibility and reflected in best practices. This article traces the history of the nonprofit public trust and fiduciary standards and examines principles of Sarbanes–Oxley and other best practices as they apply to nonprofits. The authors sampled 80 health‐care nonprofit corporation web sites from eight asset classes to determine compliance with Sarbanes–Oxley and identification of fiduciary duty, ethical values, and other best practices. Among the very largest health‐care nonprofits, many comply with Sarbanes–Oxley and identify fiduciary duty, ethical values, and other best practices. However, there are substantial deficiencies in such compliance and identification among all remaining seven asset classes ranging from 99.9 million to less than 100,000. The results appear to corroborate the urgent necessity for reform articulated by the Congress and the nonprofit sector. Nonprofit governance has entered a new era where best practices must be implemented to sustain the public trust. (shrink)

The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in the (...) practice of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)

The Kenya-born philosopher Henry Odera Oruka (1944 - 1995) persistently, and consistently, made proposals for a different moral approach to addressing, and possibly solving, some of the root causes of human conflicts across the world. I will call it “taking suffering seriously” as the basis of his idea of a global-level collective justice which, for him, raised the idea of the ethics of care to the level of global justice. I propose in this paper to show that this concern (...) can be found to be pervasive in Oruka’s works, connecting many of his well known positions as well as less known ones, and to discuss its philosophical merits. (shrink)

Tronto explores the “care crisis” that now pervades advanced industrial societies, in which women are doing more paid work and, consequently, less of the care work of civil society. Tronto urges advanced industrial societies to rethink who is responsible for care and recognize the role that government should play in ensuring that care is provided for those who need it. Unfortunately, citizenship has traditionally been defined in ways that make no provision for responsibilities to care (...) for others. Tronto observes that “privatizing” care by relegating it to the marketplace does not provide a solution to the care crisis, since paid care work is subject to exploitation, partly because it is often done by illegal immigrants from Third World countries. Despite expecting privatization to be the likely solution to the problem, Tronto nevertheless recommends that care work be regarded as a governmental responsibility in order to make it more valued publicly. (shrink)

Background Various authorities recommend the participation of patients in promoting patient safety, but little is known about health care professionals' (HCPs') attitudes towards patients' involvement in safety-related behaviours. Objective To investigate how HCPs evaluate patients' behaviours and HCP responses to patient involvement in the behaviour, relative to different aspects of the patient, the involved HCP and the potential error. Design Cross-sectional fractional factorial survey with seven factors embedded in two error scenarios (missed hand hygiene, medication error). Each survey included (...) two randomized vignettes that described the potential error, a patient's reaction to that error and the HCP response to the patient. Setting Twelve hospitals in Switzerland. Participants A total of 1141 HCPs (response rate 45%). Measurements Approval of patients' behaviour, HCP response to the patient, anticipated effects on the patient–HCP relationship, HCPs' support for being asked the question, affective response to the vignettes. Outcomes were measured on 7-point scales. Results Approval of patients' safety-related interventions was generally high and largely affected by patients' behaviour and correct identification of error. Anticipated effects on the patient–HCP relationship were much less positive, little correlated with approval of patients' behaviour and were mainly determined by the HCP response to intervening patients. HCPs expressed more favourable attitudes towards patients intervening about a medication error than about hand sanitation. Conclusions This study provides the first insights into predictors of HCPs' attitudes towards patient engagement in safety. Future research is however required to assess the generalizability of the findings into practice before training can be designed to address critical issues. (shrink)

Whether we should respect international law is in dispute. In the United States, international law is dismissed by the left as merely promoting the interests of powerful states. It is attacked by the right as irrelevant and an interference with the interests and mission of the United States. And it follows from the arguments of many liberals that in the absence of world government the world is in a Hobbesian state of nature and international law inapplicable. This article reviews the (...) thinking of Kant, Locke, and Rawls, among others and shows how arguments against respect for international law can be answered. It questions arguments based on the analogy between states and individuals, and between international law as it has developed and law based on an ideal social contract between individuals. It then turns to the ethics of care, a recent addition to moral theory, and examines its major characteristics and recommendations. It considers how the ethics of care would view international law and the guidance this moral approach could provide for international relations. The article shows how the ethics of care is compatible with various current trends, and how thinking about globalization and greater international interdependence would benefit from greater attention to it. The article argues that the ethics of care would clearly support respect for international law as it has developed, but that it would even more strongly support addressing current problems in ways that would, in the longer term, make appeals to law and its enforcements ever less necessary. Keywords: international law; the ethics of care; moral theory; political theory; social contract; states; groups; Hobbes; Kant; Locke (Published: 16 September 2011) Citation: Ethics & Global Politics, Vol. 4 , No. 3, 2011, pp. 173-194. DOI: 10.3402/egp.v4i3.8405. (shrink)

This article considers the moral notion of care in the context of Quality of Care discourses. Whilst care has clear normative implications for the delivery of health care it is less clear how Quality of Care, something that is centrally involved in the governance of UK health care, relates to practice.

The concept of care can be explained in various ways, and it can present a different meaning to each person. Nurses are increasingly aware that good nursing care consists of ‘more’ than the competent performance of a number of caring activities. For many nurses it is less clear what this ‘more’ means and what importance it has in nursing. This article will develop a view concerning care considered as a moral attitude. It is argued that care (...) can be considered as a foundational normative concept in the ethics of the nursing profession. The aim is to clarify that nurses do not derive their specific caring identity just from the set of tasks that they perform but also from the way in which they commit themselves to the caring process. (shrink)

Background:Less sedated and more awake patients in the intensive care unit may cause ethical challenges.Research objectives:The purpose of this study is to describe ethical challenges registered nurses experience when patients refuse care and treatment.Research design:Narrative individual open interviews were conducted, and data were analysed using a phenomenological hermeneutic method developed for researching life experiences.Participants and research context:Three intensive care registered nurses from an intensive care unit at a university hospital in Norway were included.Ethical considerations:Norwegian Social Science (...) Data Services approved the study. Permission was obtained from the intensive care unit leader. The participants’ informed and voluntary consent was obtained in writing.Findings:Registered nurses experienced ethical challenges in the balance between situations of deciding on behalf of the patient, persuading the patient and letting the patient decide. Ethical challenges were related to patients being harmful to themselves, not keeping up personal hygiene and care or hindering critical treatment.Discussion:It is made apparent how professional ethics may be threatened by more pragmatic arguments. In recent years, registered nurses are faced with increasing ethical challenges to do no harm and maintain dignity.Conclusion:Ethically challenging situations are emerging, due to new targets including conscious and aware critical care patients, leaving an altered responsibility on the registered nurses. Reflection is required to adjust the course when personal and professional ideals no longer are in harmony with the reality in the clinical practice. RNs must maintain a strong integrity as authentic human beings to provide holistic nursing care. (shrink)

In the current global care regime, care shortages in wealthy nations such as the United States, Canada, Italy, and Hong Kong are being addressed through the global supply of cheap migrant care labor from less wealthy nations. This paper argues that Feminist Care Ethics has a great deal to offer in the analysis of this global care regime. Joan Tronto's own critiques of the migration of care workers have focused on analogies between workers and (...) imported slaves: both are intrinsically exploited, vulnerable, excluded, and stigmatized. She argues that this situation undermines human virtue and the possibility of adequate care, and she advocates instead a model wherein caregiving is seen as a basis for .. (shrink)

The gender effects of COVID-19 are complex, and extend much beyond the issues of care work and domestic violence that have captured global attention. Some effects have been immediate, such as job losses, food shortages, and enhanced domestic work burdens; others will emerge in time, such as the depletion of savings and assets and pandemic-related widowhood, which would make recovery difficult. I use examples from India to outline the complexity of such outcomes, the limitations of the many telephone surveys (...) conducted during the pandemic, and the importance of anticipating both the immediate and the sequential effects. We can anticipate these effects by drawing on our knowledge of preexisting gender inequalities and people’s coping strategies under crises, as well as real-time media alerts. Prior conceptualization can help us design better surveys for capturing both the visible and less visible impact of the pandemic, as well as formulate more effective policies for mitigating the adverse effects. I also highlight the advantages of group-based approaches for protecting women’s livelihoods during such crises, and emphasize the need to create a synergy between feminist theory, evidence gathering, and policy formulation. (shrink)

Care workers and families often engage in deception in everyday interactions with people affected by dementia. While benevolent deception can be justified, there are often more respectful and less risky ways to help people with dementia seeking to make sense of their lives.

In German-speaking countries the term spiritual care becomes more and more popular, not only in the realm of palliative care but also amongst pastoral care takers. In this article I argue that favouring of the term 'spiritual care' is not only a tribute to the changing situation in German-speaking countries, but also a way pastoral care takers want to deal with the challenges they face in a secular, multicultural society. I will discuss whether the use (...) of the term 'spiritual care' is a way to 'lower the profile' of pastoral care and trying to be less explicit about the institution the pastors represent and the worldview they hold. This might look like an easy escape but does not foster the interaction in a multi-cultural space. (shrink)

After a brief review of the literature on Student Evaluation of Teaching (SET), I employ a Foucauldian analysis to argue that student evaluations are forms of power that involve aspects of both discipline and governmentality. After examining how SETs are used to improve teaching, I identify some techniques that instructors use to respond to SET that undermine the legitimate interests of students or the educational institution. I endorse a hybrid model where a single global teaching question is used for summative (...) purposes and fifteen or twenty additional questions are used for formative purposes. Finally, I argue that to resist the normalizing pressure of SET, instructors might, as Foucault suggested, return to the Hellenistic concept of the care of self. Through techniques of the care of self, it is my hope that instructors could cultivate a more robust subjectivity, a subjectivity less vulnerable to the normative power of student evaluations. (shrink)

Large differences in scientific productivity between male and female researchers have not yet been explained satisfactorily. This study finds that child care and lack of research collaboration are the two factors that cause significant gender differences in scientific publishing. Women with young children and women who do not collaborate in research with other scientists are clearly less productive than both their male and female colleagues.

The U.S. 2010 Patient Protection and Affordable Care Act exempts members of health care sharing ministries from the individual mandate to have minimum essential insurance coverage. Little is generally known about these religious organizations and even less critical attention has been brought to bear on them and their ACA exemption. Both deserve close scrutiny due to the exemption’s less than clear legislative justification, their potential influence on the ACA’s policy and ethical success, and their salience to current religious (...) liberty debates surrounding the expansion of religious exemptions from ACA responsibilities for both individuals and corporations. Analyzing documents of the United States’ three largest health care sharing ministries and related material, I examine these organizations and their ACA exemption with particular consideration of their ethical dimensions. Here a thick description of the nature and workings of health care sharing ministries precedes a similar account of the ACA exemption. From these empirical analyses, five ethical and policy concerns emerge: the charity versus insurance status of these ministries; the conflation of two ACA religious exemptions; the tension between the values of religious liberty and of justice; the potential undermining of ACA policy goals; and the questionable compliance of health care sharing ministries with ACA exemption requirements. An accurate and informed understanding of HCSMs is required for policymakers and others to justify the ACA exemption of health care sharing ministry members. A sufficient justification would address at least the five ethical and policy concerns raised here. (shrink)

This paper tries to understand the phenomenon that humans are able to empathize with robots and the intuition that there might be something wrong with “abusing” robots by discussing the question regarding the moral standing of robots. After a review of some relevant work in empirical psychology and a discussion of the ethics of empathizing with robots, a philosophical argument concerning the moral standing of robots is made that questions distant and uncritical moral reasoning about entities’ properties and that recommends (...) first trying to understand the issue by means of philosophical and artistic work that shows how ethics is always relational and historical, and that highlights the importance of language and appearance in moral reasoning and moral psychology. It is concluded that attention to relationality and to verbal and non-verbal languages of suffering is key to understand the phenomenon under investigation, and that in robot ethics we need less certainty and more caution and patience when it comes to thinking about moral standing. (shrink)

Adolescence is a valuable phase of life, not just because it is the phase of learning in school and preparing for a working life. During the COVID-19 pandemic it became clear that the rights, experiences, and lifeworlds of adolescents are considered less important than the needs of school, work, and productivity. However, there is an ethical claim for people to have a good adolescence, and this means that the losses of social contact, experiences, time, and space demanded of adolescents, in (...) order to protect older and vulnerable groups during the COVID-19 pandemic, should be taken seriously. A distinctive quality of adolescence is that it cannot be repeated, nor can these experiences be replicated as adults. First experiences of independence, friendship, love, informality, recklessness, and youthful exuberance are intrinsically valuable and cannot be substituted for later in life. It is therefore not surprising that adolescents have sought and found their own spaces during the pandemic, some of them forbidden, because lock downs and closed social spaces have relegated them to the confines of their childhood bedrooms. In this paper, I explore an ethic of a good adolescence, which was impacted on by the COVID-19 pandemic, and consider what can be learned from this situation. Adolescents are to be taken seriously, their experiences are no less valuable than those of adults, and the losses they have suffered for the benefit of others should be honored. As far as possible, young people should be supported to have a voice in public discourse and in finding spaces to be adolescents. (shrink)

We are well into the political season that guarantees the election of a new president. Actually, this season, the election cycle began in November 2006, as soon as the off-year election ended. Not surprisingly, health care and reforming health care are major issues for the election — although somewhat less important than they were before late 2007.I use the phrase “not surprisingly” because there are easily understandable reasons why health care tends to be an election issue whenever (...) we are electing a new president. One obvious reason is that, for several decades, we have been plagued by sizeable numbers of people without health insurance and even more importantly, by unsustainable increases in health care spending and substantial numbers of people experiencing patient safety and clinical appropriateness problems. I regard the unsustainable spending and safety and quality problems as especially important because they affect all of us — not just the 15% of the population that is without health insurance. (shrink)

There is a vast amount of evidence across countries that the use of health care services (including hospitalizations, physician services, and clinical preventive services) is positively associated with income, education and other markers of socioeconomic position. In some analyses, lower socioeconomic status (SES) is associated with greater physician and hospital use, although it appears that these findings are primarily driven by higher rates of poor health status or medical need in socioeconomically disadvantaged populations. Three general sets of explanations have (...) been investigated to explain SES differences in health care use: (1) financial access or affordability differences (e.g. the poor use fewer services because they have fewer financial means); (2) knowledge, attitudinal and cultural differences in seeking care (e.g. the poor use fewer services because they value and/or understand the benefits of health care less than other people); and (3) health care system factors (e.g. the poor use fewer services because of ways in which the health care system is organized). The empirical evidence from a number of countries suggests that health care system variables, especially non-financial components of access, offer the greatest explanatory power regarding SES differences in utilization. The policy implications of such findings are important, for they suggests that providing universal coverage or offering free health services to the poor is not a panacea for reducing social inequalities in health care utilization. Research across countries also suggests that, although SES differences in the use of health care services may contribute to some portion of observed SES disparities in health status, the contribution here is likely to be small. Social inequalities in health status are driven by myriad factors other than access to and use of personal health services. (shrink)

Growing data on the socioeconomic determinants of health pose a challenge to analysis and application of fairness in health. In Just health: meeting health needs fairly, Norman Daniels argues for a change in the population end of our thinking about just health. What about clinical care? Given our knowledge of the importance of wealth, education or social status to health, is fairness in medicine served better by continuing to avoid considering our patients’ social status in setting clinical priorities, or (...) by attempting to equalise existing health inequalities by giving priority to the socioeconomically disadvantaged at the point of care? In this article, I argue that doctors should not attempt the latter. Granted, giving priority to low status would go some way towards compensating unjust health inequalities and the impression of being left aside in other social spaces. It would represent reverse discrimination, but could still be justified inasmuch as disadvantaged groups could be identifiable, and as long as the intent was compensation rather than retribution. However, under current circumstances such priority would risk being attributed arbitrarily, would represent a form of medical proselytising, risk leaving the worst-off with less by alienating the powerful, and require teaching doctors to act in strongly counter-cultural ways—possibly at great cost. Crucially, however, we protect both equal health and equal regard by treating all alike: priority to low status would promote the first somewhat, but at the expense of sacrificing the second. (shrink)

Nel Noddings is arguably one of the premier philosophers of moral education in the English‐speaking world today. Although she is outside the mainstream theory, research, and practice traditions of cognitive‐developmentalism (the Kohlberg legacy) and of character education (which is in public ascendancy), her body of work is unrivalled for originality of insight, comprehensiveness and coherence. Whilst Carol Gilligan's In a different voice (1982) introduced the ethic of caring into academic and public discourse, it is Noddings ‘who has done most to (...) outline a specific feminist position on moral education’ (McClellan, 1999, p. 104), and whose influence extends to educational practice. This essay explicates Noddings's vision in sufficient depth to make the foregoing claims credible. Thematic focus is given to her attention to the ethical self or ethical ideal. The paper also examines Noddings's perspective on character education and the need to incorporate a morality of evil into any serious educational philosophy or practice. It is less a critical appraisal of that vision and perspective than an invitation to others to more fully engage with Noddings's writings.1. (shrink)

Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcare. We argue that one prominent approach, the Rawlsian approach developed by Norman Daniels, is unable to provide such reasons and such care. This is because of (...) a central feature in Daniels' account, namely that care should be provided to restore people's opportunities. Daniels' view is both unable to provide pain relief to those who need it as a supplement to treatment and, without justice-based reasons to provide palliative care to those whose opportunities cannot be restored. We conclude that this makes Daniels' framework much less attractive. (shrink)