This chapter contains sections titled: Care and Gender in Contemporary Capitalist Societies Supporting Care and Moving Toward Gender Justice The Consequences of Property‐Owning Democracy for Gender and Care Conclusion References.

Care-supporting policies incentivise women’s withdrawal from the labour market, thereby reinforcing statistical discrimination and further undermining equality of opportunities between women and men for positions of advantage. This, I argue, is not sufficient reason against such policies. Supporting care also improves the overall condition of disadvantaged women who are care-givers; justice gives priority to the latter. Moreover, some of the most advantageous existing jobs entail excessive benefits; we should discount the value of allocating such jobs meritocratically. Further, (...) women who have a real chance to occupy positions of advantage have most likely already enjoyed more than their fair share of opportunities; they lack a claim to more. Women can have a complaint grounded in the expressive disvalue of sexist discrimination. This gives them special claims against men occupying the vast majority of top positions and against their higher share of opportunities for positions of advantage. But their claim does not speak against care-supporting policies. (shrink)

Vulnerability and empowerment are central concepts of contemporary development theory and ethics. Vulnerability associated with human interdependence is a wellspring of values in care ethics, while vulnerability arising from social problems demands remedy, of which empowerment is frequently the just form. Development planners and aid providers focus upon improving the wellbeing of the most vulnerable – especially women – by empowering them economically, socially and politically. -/- Both vulnerability and empowerment are considered in this volume. Jay Drydyk argues that empowerment (...) is necessarily relational, not simply a matter of expanding choices. Christine Koggel reviews Drydyk’s discussion through the lens of feminist relational theory, considering how norms, structures and institutions shape, delimit, and promote empowerment. Gail Presbey examines empowerment in East African women’s lives through the writings and biography of Wangari Maathai. Stacy Kosko considers indigenous self-governance and participation in shared governance. Serene Khader reflects upon postcolonial feminist criticism of the concept of adaptive preference. Vida Panitch discusses the economic vulnerability that surrounds the global market in surrogate birth. Anupam Pandey provides a review of third world eco-feminist activism and literature. Ann Cudd envisions international humanitarian intervention to support female autonomy against oppressive state and social institutions. (shrink)

The argument of this article is framed by a debate between the principle of humanity and the principle of justice. Whereas the principle of humanity requires us to care about others and to want to help them meet their vital needs, and so to be partial towards those others, the principle of justice requires us to consider their needs without the intrusion of our subjective interests or emotions so that we can act with impartiality. I argue that a (...) deep form of caring lies behind both approaches and so unites them. In the course of the argument, I reject Michael Slote’s sentimentalist form of an ethics of care, and expound Thomas Nagel’s moral theory, which seems to lie at the opposite end of a spectrum ranging from moral sentiments to impersonal objectivity. Nevertheless, Nagel’s theory of normative realism provides unexpected support for the thesis that a deep and subjective form of caring lies at the base of even our most objective moral reasons. (shrink)

This article assesses the potential for basic income to become a tool for empowering women in the household and in the workplace. Recent debates among feminist political theorists indicate that it is not obvious whether basic income has the potential to push our society toward greater socioeconomic gender justice. I show that arguments for and against basic income put forward by feminist theorists rely on implicit assumptions about how women's work should be conceived—assumptions that are not shared (...) among all of them. I also argue that these beliefs can be sorted into two dichotomies: one concerned with the suitability of remuneration for caregiving, the other with the question of who should be responsible for caregiving. I conclude by explaining the possible causes of the divergences in the views of feminist supporters and critics of UBI, and by recommending ways to arrive at common conceptual grounds. (shrink)

Using an ethnographic case study based in a UK state school for 11- to 18-year-olds, this paper explores the tensions that arose when the senior leadership team (SLT) introduced a justice-based ethic-of-care that prioritized good grades and equal treatment for all pupils over a feminist ethic-of-care (preferred by most teachers in non-leadership roles) that accentuated individual pupil need and placed greater emphasis on a broader social education. Through highlighting the tensions between a feminist ethic-of-care and a more ‘masculine’ style, (...) justice-based approach to care-ethics, the paper extends the organisational care-ethics literature. We emphasise that such tensions occurred whether the different ethics were enacted by men, women, or non-binary individuals. In order to better understand the tensions between these two ethical approaches, we draw upon the theoretical work of Donald Winnicott, which highlights the importance both of maternal and paternal roles during infancy. We update Winnicott’s ideas, noting how maternal and paternal caring roles can be undertaken by people of varied gender identities. Building on Winnicott’s theory, we propose a new ‘Parentalist’ ethic-of-care, which has the potential to balance and hold together ideas of both a feminist ethic-of-care, and a justice-based ethic. A Parentalist ethic-of-care could support teachers yet recognize the context of the contemporary neo-liberal environment, where most children need to attain formal qualifications in a marketized world, and where such measures of success are highly valued. (shrink)

<b>Objectives:</b> To gather empirical data on how gender and educational level influence bioethical reasoning among medical students by analyzing their use of care versus justice arguments for reconciling a bioethical dilemma. <b>Setting:</b> University Departments of Medical Ethics, Social and Communication Psychology in Germany. Participants: First and fifth year medical students. Design and method: Multidisciplinary, empirical, 2-segment study of ethics in action: In intrapersonal Segment 1, the students were presented with a bioethical dilemma and then administered a 13-item questionnaire (...) to survey their individual preferences for care versus justice arguments in resolving the conflict. The survey questioned 6 justice, 6 care-related items and 1 socially critical item. Data were analysed by gender and year of medical school. In interpersonal Segment 2, the bioethical dilemma from Segment 1 was discussed in gender-mixed and gender-homogeneous groups. Coded transcripts were evaluated to identify prevalences in care versus justice reasoning. <b>Results:</b> Data on 462 medical students were evaluable (n=338 in Segment 1, n=168 in Segment 2, n=44 overlap). Gender and level of education had no effect on moral reasoning in intrapersonal Segment 1, but significantly affected reasoning in interpersonal Segment 2, where women significantly tended to use more care-orientated arguments. Justice arguments predominated the group discussions. <b>Conclusion:</b> Interpersonal contexts affect moral reasoning in medical students, probably by amplifying the socialisation relating to gender and educational level. Care orientation is associated with the female gender. Professional socialisation tends to reduce the diversity and richness of moral reasoning towards a more justice-weighted orientation. Medical ethics should teach both justice and care reasoning modes in order to broaden physicians' ability to reconcile bioethical dilemmas. (shrink)

Although gender differences in attitudes toward animal research have been reported in the literature for some time, exploration into the nature of these differences has received less attention. This article examines gender differences in responses to a survey of attitudes toward the use of animals in research. The survey was completed by college students and consisted of items intended to tap different issues related to the animal research debate. Results indicated that women were more likely than (...) men to support tenets of the animal protection movement. Likewise, women were more likely than men to favor increased restrictions on animal use and were more concerned than men about the suffering of research animals. Analysis of item contents suggested that women endorsed items reflecting a general caring for animals, were more willing than men to make personal sacrifices such as giving up meat and medical benefits in an effort to protect animals, and were more likely than men to question the use of animals in research on scientific grounds. Men, on the other hand, tended to emphasize the potential benefits arising from the use of animals in research. (shrink)

Carol Gilligan heard a ‘distinct moral language’ in the voices of women who were subjects in her studies of moral reasoning. Though herself a developmental psychologist, Gilligan has put her mark on contemporary feminist moral philosophy by daring to claim the competence of this voice and the worth of its message. Her book, In a Different Voice, which one theorist has aptly described as a best-seller, explored the concern with care and relationships which Gilligan discerned in the moral reasoning of (...) women and contrasted it with the orientation toward justice and rights which she found to typify the moral reasoning of men. (shrink)

My purpose in this paper is to set forth a case for inclusion, without any restriction whatsoever, of gays and lesbians in the legal definition of marriage within the various jurisdictions within the United States of America. Historical and cross cultural definitions of marriage are usually based on two basic premises or components, structure and function. Structural definitions of marriage, with which most people and jurisdictions identify, are based on exclusion and inclusion, i.e. on who is eligible for inclusion and (...) who must be excluded. Ordinarily the restrictions exclude those not having reached the age of majority, those who are not judged mentally competent, and those of the same gender. Functional definitions of marriage are based on the willingness of the partners to engage in the duties and responsibilities to each other and to all offspring regardless of their physical or mental fitness. I intend to defend the proposition that legal marriage for gays and lesbians is better defined and defended when based on function rather than structure. Specifically, this means that marriage is the union of those who 1.) without mental equivocation embrace their mutual commitment to support and care for each other; 2.) are of legal age; 3.) are of sound mind; and 4.) affirm their commitment to fulfill, to the best of their ability, the following functions as they pertain to the natural birth, legal adoption, or foster care of any and all children included in the marital union: These functions include but are not limited to: protection , economic, affect-giving, socialization, acculturation, education, and sexual access between the conjugal partners. Historically, there is no record throughout the history of humankind, of any state or body politic that does not profess a vested interest in the mate selection patterns of its young. This is not generally for the edification of the married, but rather for the assurance of the socialization and acculturation of the ascending generation. (shrink)

The COVID-19 crisis illustrates the fragility of supply chains. Countries with excellent health systems struggled to ensure essential supplies of food, medicines, and personal protective equipment which were vital to a fast and effective response. Using geo-legality, which maps the constitutive relations between law and space, we argue that the failure of supply chains in many western countries during the crisis reveals a fundamental tension between their role as facilitators of care and caring, and the logistic logics by which they (...) operate. While supply chains link the intimate, domestic concerns of providing medical care with the globalised geographical concerns of moving goods across different jurisdictions at the right time, their contemporary organisation and regulation does not reflect the caring relations and public goods they are meant to support. Drawing on analysis of examples from Canada, the United Kingdom, and the United States, this article argues that a reconfiguration of supply chains in accordance with feminist approaches that place care at the centre of supply chain operation and organisation will be important to amendments of both domestic and global health law. (shrink)

Increasingly, palliative care is being referred to as an essential programme and in some cases as a human right. Once it is recognized as such, it becomes part of the lexicon of social justice in that it can be argued that all members of society should have access to such care. However, this begs the question of how that care should be enacted, particularly in rural and remote areas. This question illustrates some of Friedrich Hayek's critiques of social (...) class='Hi'>justice. Hayek has likened social justice to a ‘moral stone’ arguing that social justice is meaningless to the extent that society is impersonal and as such cannot be just, only those individuals who make up that society can be just. When responsibility for justice is assigned to an impersonal society, ideas of social justice can become a clarion call for whom no one is directly accountable. This opens the door for questionable macro‐level political agendas that have no capacity to enact the ideal, and worse, may suppress individual moral acts towards the desired end. Further, acts of interference at the macro level with the ideal of equal opportunity run the risk of disadvantaging other members of society. Instead, he has argued that a better approach lies in finding ways to induce and support individual moral acts that promote the human good. Hayek's arguments are particularly compelling for rural palliative care. In this paper we draw upon data from an ethnographic study in rural palliative care to illustrate the potential misfit between the ethical ideal of palliative care as expressed by rural participants and the narratives of social justice. (shrink)

The factions debating health care reform in the United States have gravitated toward one of two positions: that just health care is an individual responsibility or that it must be regarded as a national concern. Both arguments overlook a third possibility: that justice in health care is multilayered and requires the participation of multiple and diverse communities. _Communities of Health Care Justice_ makes a powerful ethical argument for treating communities as critical moral actors that play key roles in (...) defining and upholding just health policy. Drawing together the key community dimensions of health care, and demonstrating their neglect in most prominent theories of health care justice, Charlene Galarneau postulates the ethical norms of community justice. In the process, she proposes that while the subnational communities of health care justice are defined by shared place, including those bound by culture, religion, gender, and race that together they define justice. As she constructs her innovative theorization of health care justice, Galarneau also reveals its firm grounding in the work of real-world health policy and community advocates. _Communities of Health Care Justice_ not only strives to imagine a new framework of just health care, but also to show how elements of this framework exist in current health policy, and to outline the systemic, conceptual, and structural changes required to put these justice norms into fuller practice. (shrink)

There are kinds of dialogue that support social justice and others that do the reverse. The kinds of dialogue that support social justice require that anger be bracketed and that hiding in safe spaces be eschewed. All illegitimate ad hominem/ad feminem attacks are ruled out from the get-go. No dialogical contribution can be down-graded on account of the communicator’s gender, race, or religion. As well, this communicative approach unapologetically privileges reason in full view of theories and strategies (...) that might seek to undermine reasoning as just another illegitimate form of power. On the more positive side, it is argued in this paper that social justice dialogue will be enhanced by a kind of “communicative upgrading,” which amplifies “person perception,” foregrounds the impersonal forces within our common social spaces rather than the “baddies” within, and orients the dialogical trajectory toward the future rather than the past. Finally, it is argued in this paper that educators have a pressing responsibility to guide their students through social justice dialogue so that their speech contributes to the amelioration of injustice, rather than rendering the terrain more treacherous. (shrink)

There are kinds of dialogue that support social justice and others that do the reverse. The kinds of dialogue that supports social justice requires that anger be bracketed and that hiding in safe spaces be eschewed. All illegitimate ad hominem/ad feminem attacks are ruled out from the get-go. No dialogical contribution can be down-graded on account of the communicator’s gender, race, or religion. As well, this social justice communicative approach unapologetically privileges reason in full view of (...) theories and strategies that might seek to undermine reasoning as just another illegitimate form of power. -/- On the more positive side, we will argue that social justice dialogue will enhanced by a kind of “communicative upgrading” that amplifies “person perception,” foregrounds the impersonal forces within our common social spaces rather than the “baddies” within, and orients the dialogical trajectory toward the future rather than the past. Finally, we will argue that educators have a pressing responsibility to guide their students through social justice dialogue so that their contributions contribute to the amelioration of injustice, rather than rendering the terrain more treacherous. (shrink)

We discuss the role of prior authorization (PA) in supporting patient-centered care (PCC) by directing health system resources and thus the ability to better meet the needs of individual patients. We begin with an account of PCC as a standard that should be aimed for in patient care. In order to achieve widespread PCC, appropriate resource management is essential in a healthcare system. This brings us to PA, and we present an idealized view of PA in order to argue (...) how at its best, it can contribute to the provision of PCC. PA is a means of cost saving and as such it has mixed success. The example of the US demonstrates how implementation of PA has increased health inequalities whereas best practice has the potential to reduce them. In contrast, systems of universal coverage, like those in Europe, may use the cost savings of PA to better address individuals' care and PCC. The conclusion we offer therefore is an optimistic one, pointing towards areas of supportive overlap between PCC and PA where usually the incongruities are most evident. (shrink)

The gendered division of labour in combination with the feminisation of international migration contribute to shortages of care, a phenomenon often called ‘care drain’. I argue that this phenomenon is an issue of global gender justice. I look at two methodological challenges and favourably analyse the suggestions that care drain studies should include the effects of fathers’ and other male caregivers’ migration and, in some cases, the effects of migration within national borders. I also explain why care drain (...) is a problem of distributive justice, by looking at the background conditions that result in much of the care-givers’ migration. (shrink)

In all western countries health care budgets are under considerable constraint and therefore a reflection process has started on how to gain the most health benefit for the population within limited resource boundaries. The field of ethics of resource allocation has evolved only recently in order to bring some objectivity and rationality in the discussion. In this article it is argued that priority setting is the prerequisite of ethical resource allocation and that for purposes of operationalization, instruments such as need (...) assessment and health technology assessment (HTA) are essential worktools for making more rational decisions. Thresholds (deduced from the need assessment and HTA) are - within this context - guiding but not binding principles. -/- Discussion of theoretical concepts of not only priority setting, need assessment and HTA complemented by practical examples for showing the challenges and the need, but also the chances of a more explicit and transparent policy of resource allocation in health care. Results: Priority setting in health care is based on the values of equity, justice and solidarity. Health packages decisions are determined from medical need (the severity of the condition) and/or the appropriateness of medical interventions (their cost-effectiveness). With growing awareness that originally effective and cost-effective services and programmes are eventually provided inappropriately, the focus is shifting towards the organisational aspects of provision and application. Therefore, need assessment is based on the distinction of health care needs from demand, supply, or actual care. Additionally HTA provides the evidence on health care interventions in a way that it becomes obvious who benefits from an intervention and who definitely does not benefit, but eventually is harmed. -/- Health services research on effective and cost-effective interventions and research/monitoring of performance that the effective and cost-effective services are provided appropriately are of increasing importance for guiding the decision-making process on priority setting and need assessment. Effective healthcare for all is sustainable, if we start to put expenditures in perspective and focus health policies and research strategies on managing expectations through patient information and a more realistic notion of medical advancements and, on the other hand, on encouraging need-based and cost-effective innovations. (shrink)

Critiques of Western feminists’ attempts to extend claims about gender injustice to the global context highlighted a dilemma facing Western feminists, what I call the global gender justice dilemma. In response to this dilemma, Alison M. Jaggar argues that Western feminists should turn our attention away from trying to resolve it and, instead, toward examination of our own complicity in the processes that produce injustice. I suggest that this kind of approach is helpful in responding to (...) an additional dilemma that confronts the Western feminist, namely the epistemic dilemma. Western feminists can speak for women of the global South and run the risk of distorting those women’s experience and further silencing their voices, or we can refuse to speak and abdicate our responsibilities to address injustice. I argue that we should address this dilemma not by trying to resolve it but by examining our role in the reproduction of epistemically unjust practices. To explain this response, I offer a preliminary account of epistemic injustice as epistemic oppression. I conclude by claiming that our own epistemic complicity in epistemically oppressive social practices is a weighty reason for us to work to transform those practices. (shrink)

Some Romanian feminist scholars argue that welfare policies of post-communist states are deeply unjust to women and preclude them from reaching economic autonomy. The upshot of this argument is that liberal economic policy would advance feminist goals better than the welfare state. How should we read this dissonance between Western and some Eastern feminist scholarship concerning distributive justice? I identify the problem of dependency at the core of a possible debate about feminism and welfare. Worries about how decades of (...) communism have shaped citizenry feed feminists' suspicion of the welfare state and fears of paternalist policies. I criticize the arguments in favour of neoliberal policies and I suggest a crucial distinction between legitimate, universal forms of human dependency and dependencies that result from particular social arrangements. (shrink)

Gender equality is something that the human race has been struggling with since time immemorial. No country has achieved gender equality despite the legislative, social, and economic gains for women. Therefore, modern society likes to blame certain groups, such as religion for the gender inequalities which are faced, more than others. The main focus of this study is to evaluate the role of religious leaders in promoting gender equality through the legislation and religious texts in Zimbabwe. (...) The study further explores how certain religious norms and practices can be modified through religious texts to accommodate women in achieving gender equality. The paper acknowledges that religious leaders have a greater responsibility to standup, speak and act with and on behalf of those with less power, such as the marginalized and discriminated against, including exploited planet Earth. The paper seeks to foreground how certain traditional religious practices and norms have exacerbated gender inequality in Zimbabwe, despite the laws that have been enacted by the government of Zimbabwe to promote gender equality. The data for the paper was gathered through observations and semi-structured interviews conducted with both religious leaders and women to establish how religious norms and practices directly or indirectly affect women and how they can be modified to achieve gender equality in Zimbabwe. The data gathered was analysed through descriptive data analysis. The paper concludes by recommending that religious leaders should be thoroughly trained on how to promote gender equality through religious texts and legislation. Contribution: The article evaluated the role of religious leaders in promoting gender equality through legislation and religious texts in Zimbabwe. It argued that religious leaders have a higher need to support, advocate and act on behalf of individuals who are marginalised and subjected to discrimination on planet Earth. Hence, its contribution was in promoting gender equality through religious texts and legislation in Zimbabwe for sustainable development. (shrink)

In activist circles feminist political thought is often viewed as abstract because it does not help activists make the kinds of arguments that are generally effective with donors and policy makers. The feminist political philosopher's focus on how we know and what counts as knowledge is a large step away from the terrain in which activists make their arguments to donors. Yet, philosophical reflection on the relations between power and knowledge can make a significant contribution to women's human rights work (...) in the area of evaluation. Feminist political philosophy can offer guidelines for how to evaluate the work of women's human rights organizations and their funders in light of the social, political, and economic conditions that render their work necessary and difficult. This article offers 1) an account of the difficulty in showing the impact of social change activism using conventional modes of measurement, particularly those that focus on first order effects, 2) feminist theoretical insights into the interrelatedness of global gender injustices that may help us develop better benchmarks of evaluation for women's human rights programming, and 3) a sketch of how to approach the evaluation of organizations and donors who seek to support global gender justice. (shrink)

I develop the foundation for cosmopolitan care, an underexplored variety of moral cosmopolitanism. I begin by offering a characterization of contemporary cosmopolitanism from the justice tradition. Rather than discussing the political, economic or cultural aspects of cosmopolitanism, I instead address its moral dimensions. I then employ a feminist philosophical perspective to provide a critical evaluation of the moral foundations of cosmopolitan justice, with an eye toward demonstrating the need for an alternative account of moral cosmopolitanism as cosmopolitan (...) care. After providing an explanation of how care ethics in connection with Kantian ethics generates a duty to care, I consider one main feature of cosmopolitan care, namely the theory of obligation it endorses. In developing this account, I place special emphasis on the practical ramifications of the theory by using it to analyze gender violence in conflict zones. (shrink)

This study explores company support for men's participation in child care in Sweden, where the government promotes gender equality. The authors investigate the influence of two ideologies about gender, the doctrine of separate spheres and masculine hegemony, on the responsiveness to fathers shown by Sweden's largest corporations. Father-friendly companies had adopted values associated with the private sphere and prioritized entrance of women into the public sphere. Companies with less masculine hegemony provided some informal but no formal support to (...) fathers. Following social justice theory, future research could focus on how fathers come to perceive the lack of corporate responsiveness as unfair. (shrink)

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is (...) essential. We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)

How does so much gender inequality endure in an era when many laws and policies endorse principles of gender equality? This essay examines this dilemma by considering Susan Moller Okin's criticism of “false gender neutrality,” research on implicit bias, and the shifting relation of gender bias to American law. I argue that these are crucial elements of the modern cycle of gender inequality, enabling it to operate through a perverse “invisible-hand” mechanism. This framework helps convey (...) how underlying gender bias influences individual behaviors that generate, legitimate, and mask broad patterns of inequality. Contemporary legal conflicts reflect many of these dynamics, which appear in controversies over gender-based violence, gender discrimination in pay and promotion, and women's reproductive health care benefits. This analysis advances our understanding of how the contemporary cycle of gender inequality operates, the complex links between individual behavior and structural bias, and the difficulty of pursuing gender justice through prevailing frameworks of law and liberalism. It also underscores the continued importance of feminists' collective work to address “invisible” as well as visible biases. (shrink)

Women continue to be in charge of most childrearing; men continue to be responsible for most breadwinning. There is no consensus on whether this state of affairs, and the informal norms that encourage it, are matters of justice to be tackled by state action. Feminists have criticized political liberalism for its alleged inability to embrace a full feminist agenda, inability explained by political liberals’ commitment to the ideal of state neutrality. The debate continues on whether neutral states can accommodate (...) two feminist demands: to enact policies aimed at dismantling the feminization of caregiving, especially childrearing, and to compensate women for some of the disadvantages they incur by being primary care-givers. I contribute to this debate with three arguments in support of policies meant to de-gender care-giving and compensate care-givers. The first appeals to equality of opportunity to positions of advantage and justifies policies that prevent or mitigate statistical discrimination and implicit biases. The second draws attention to a possible causal relationship between the specialization of women in early childcare and misogyny; since the latter is incompatible with political liberal justice, it yields the conclusion that political liberals ought to further investigate the causal hypothesis with the aim of establishing or refuting it. The third argument concludes that legitimate childrearing prohibits adults from socializing children or, at least girls, into gender norms; it justifies duties of justice on the side of parents, educators, and economic agents, and state policies meant to offset foreseeable breaches of some of these duties. (shrink)

This paper discusses obligations of international distributive justice-specifically, obligations rich countries have to transfer resources to poor countries. It argues that the major seven OECD countries each have an obligation to transfer at least one percent of their GDP to developing countries. -/- The strategy of the paper is to defend this position without having to resolve the many debates that attend questions of international distributive justice. In this respect, it belongs to the neglected category of nonideal theory. (...) The key to the strategy is to show that a significant amount of good would be accomplished by a one percent transfer, despite the fact that one percent is quite a small amount. -/- To make this showing, the paper takes health as a fundamental measure of individual well-being and examines the improvement in life expectancy that would likely result from devoting the one percent transfer to the major determinants of health. It adduces data indicating that substantial progress towards raising life expectancy in developing countries to the global average of 64.5 years can be expected from expenditures of $125 per capita, divided between health care, education, and basic nutrition and income support. A one percent transfer from the major seven is enough to cover expenditures on that scale for the poorest fifth of the world's population. (shrink)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for (...) class='Hi'>gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

Proponents of the ethic of care regard it as a personal ethic created by women which reveals the deficiencies of the male-defined ethic of justice. In contrast, feminist critics of the ethic of care hold that the ethic of care is parochial and renounces justice and therefore inconsistent with feminist goals. In my dissertation I resolve this debate by examining the concepts of care, justice, autonomy, and public and private spheres. ;Care and autonomy are often thought to (...) be mutually exclusive because care is based on a social conception of the self, while autonomy is based on an individualistic conception of the self. I challenge this dichotomy by showing that autonomy presupposes that we are socially constituted, and that care requires that we be able to individuate ourselves from others. I also examine the symbolic and institutional structures that construct care and autonomy in opposition to each other in our society. ;Moral theorists usually understand care and justice as having different domains, with their boundaries drawn along public-private lines. I challenge the traditional boundaries of care, showing that the expansion of care need not come at the expense of justice, but instead can serve to enrich our conception of justice. I also explore some of the moral issues that arise in attempts to apply the ethic of care to public questions of pacifism and welfare policy. ;The conflicts between the ethic of care and the ethic of justice need not lead us to accept one at the expense of the other, but can help us distinguish between better and worse versions of each ethic, providing the groundwork for a feminist ethic of care. However, despite the theoretical compatibility of the two ethics, I argue that given their present social contexts, integrating them into a comprehensive ethic brings the danger that the ethic of care will be subsumed by the ethic of justice. (shrink)

Photo ID 72893750 © Rawpixelimages|Dreamstime.com ABSTRACT Solidarity is a concept increasingly employed in bioethics whose application merits further clarity and explanation. Given how vital cooperation and community-level care are to mitigating communicable disease transmission, we use lessons from the COVID-19 pandemic to reveal how solidarity is a useful descriptive and analytical tool for public health scholars, practitioners, and policymakers. Drawing upon an influential framework of solidarity that highlights how solidarity arises from the ground up, we reveal how structural forces can (...) impact the cultivation of solidarity from the top down, particularly through ensuring robust access to important social determinants of health. Public health institutions can support solidarity movements among individuals and communities by adopting a lens of social justice when considering public health priorities and, in turn, promote health equity. INTRODUCTION Over the past two decades, scholars have invoked the concept of solidarity when assessing a wide range of topics in bioethics, from CRISPR-Cas9 technology to organ donation to structural racism.[1] However, the growing literature on solidarity has not fully examined the roles and responsibilities of institutions and governments in fostering solidarity, especially regarding public health measures that implicate entire populations. We argue that it remains unclear how public health institutions should engage with solidarity and how their engagement will affect public health and its ethics. We first take Prainsack and Buyx’ three-tiered framework as an analytical starting point.[2] We then explore how public health institutions can foster solidarity by carefully considering factors that may bolster it on an interpersonal, community, and national scale. We conclude that public health institutions should adopt a lens of social justice to promote solidarity at the interpersonal and community levels, thereby promoting equity in future public health efforts. BACKGROUND Calls for solidarity in bioethics raise longstanding normative questions about the nature and limits of our duties to one another and how to weigh autonomy over considerations of justice.[3] Though the term is diversely applied, Prainsack and Buyx propose a potentially unifying definition in the 2011 Nuffield Council report, “Solidarity: Reflections On An Emerging Concept in Bioethics.” The report defines solidarity as an activity involving “shared practices reflecting a collective commitment to carry financial, social, emotional, and or other ‘costs’ to assist others.” Their conceptualization also includes important features that distinguish solidarity from other values like empathy or altruism: solidarity emphasizes action rather than mere internal feeling and recognition of connection as motivation.[4] Bioethicists have since applied this conceptualization when analyzing issues in public and global health, given that population-level efforts need cooperation from individuals and communities. Prainsack and Buyx further note that solidarity is relevant in bioethics discourses about justice and equity, in support of providing aid to low- and middle-income countries, and as a value exemplified by European welfare states.[5] Other bioethicists have argued that promoting solidarity can contribute to community engagement, partnership with Tribal communities, and global health equity.[6] Most recently, scholars have applied solidarity as a lens to assess the COVID-19 pandemic, highlighting the pitfalls of national mitigation efforts and global disparities in disease outcomes.[7] I. Solidarity at Three Levels It seems impossible to foster solidarity in public health if we cannot identify it in general contexts. Prainsack and Buyx articulate three levels of solidarity: interpersonal solidarity, group solidarity, and legal or contractual codifications of solidarity.[8] They argue that each level inherently informs the one ‘above’ it in a unilateral direction. In other words, solidarity is fundamentally a bottom-up phenomenon. Solidarity among individuals influences group norms, which then have the potential to shape policy and institutional practice.[9] Within the Prainsack and Buyx framework, it would seem nonsensical to posit how solidarity might be expressed vertically or from the “top down.” It appears intuitively odd to imagine how a government entity might ‘be’ in solidarity with a person or group if solidarity requires some cognition about their condition per Prainsack and Buyx’ definition. Some have argued that solidarity does not seem like something that one can impose, as instances of it arise from agents recognizing and acting upon some bond rather than in response to a command. Indeed, people may be rightfully hesitant to engage in solidarity if the official messaging is overly paternalistic or coercive.[10] However, some authors have countered that governments can express solidarity through enacting structural and policy changes, though it is ambiguous how these actions are distinct from a justice-driven approach.[11] If a bottom-up approach is thus the most practical means of achieving policy that reflects solidarity, then it does not add much to public health. Institutions would be ineffective without the population’s initiation of the corresponding social norms. However, we find this conclusion overly pessimistic. Fostering a culture of solidarity to improve public health has potential merit. Prainsack and Buyx’ framework overlooks how public health actors can influence solidarity between individuals and across communities. To clarify, we agree with the view that solidarity is a bottom-up phenomenon. Solidarity may not be able to originate in a top-down fashion, but we suggest that public health institutions can take a more active role in providing the public with accurate information, promoting social justice, and intervening in the social determinants of health. II. The COVID-19 Pandemic as a Case Study Lessons learned from the ongoing COVID-19 pandemic support our argument. The pandemic deepened socioeconomic disparities in the US and hindered access to vital resources such as food, housing, and healthcare.[12] Prainsack recently noted: “[n]ext to the immediate health effects of the virus, poverty and grave inequalities have been the root causes of human suffering during the pandemic.”[13] Prior to the pandemic, many rural and low-income populations lacked reliable access to the internet and devices like laptops or smartphones. This continued lack of access restricts the flow of information and prevents people from accessing telemedicine services.[14] Preexisting social, political, and health inequities worsened health outcomes among many marginalized racial and ethnic groups. It is well-documented that communities of color, including Black, American Indian or Alaska Native, and Latinx populations, had greater COVID-related mortality and morbidity due to the effects of structural racism.[15] Although federal US agencies such as the Centers for Disease Control and Prevention enacted laws that provided safety nets (e.g., the Federal Eviction Moratorium), the majority of such programs have ended, leaving many with little assistance and the threat of further hardship.[16] These disparities are relevant because Prainsack, Buyx, and others note that solidarity arises from agents recognizing and acting on some perceived attainable collective goal(s). Income inequality and disparate access to food, education, and health care may lead people to consider public health goals unattainable. This could limit the desire to work toward those goals collectively.[17] The existing literature on collective action theory supports this intuition. It emphasizes that structural conditions, such as an absence of perceived hope for social change among a group, can lead to low ‘group efficacy’ and little willingness to cooperate, both within and across socioeconomic strata.[18] The pandemic spurred countless messages from public health agencies. The messaging did not recognize or attend to the different material realities and circumstances of the US population. How can people feel comfortable getting vaccinated if they deeply distrust the government, including public health institutions? How can people remain motivated to wear masks and distance themselves if they cannot afford basic necessities and work jobs without adequate pay and leave policies? We ask these questions to illustrate how socioeconomic disparities can marginalize people if they feel ignored, apathetic, or resentful of those better off or those in power whom they perceive to “not be doing enough.” This marginalization precludes the formation of solidarity. There are instances when a population has disparate access to resources and social capital, but solidarity may still emerge from a shared goal or vision for the future. For example, a heterogeneous population living in the same town may come together to protest an environmental injustice that impacts their water supply with the common goal of securing access to safe drinking water. However, many populations in the US failed to recognize shared goals of this kind during the COVID-19 pandemic. A significant minority of the US population was reluctant to acknowledge the severity of COVID-19 infection and thus refused to participate in efforts to mitigate its spread. Even between groups who shared the goal of slowing COVID-19 transmission, the methods were widely debated. Approximately 20 percent of the adult population eligible for vaccination remains unvaccinated.[19] Governmental bodies responsible for disseminating information, coordinating the allocation of resources, and establishing guidelines have a large role in mediating these disagreements and intervening in socioeconomic conditions that impact people's ability and willingness to engage in solidarity. III. Solidarity, Social Justice, and the Role of Public Health Institutions Adopting a lens of social justice provides further insights into how public health actors impact solidarity. Powers and Faden argue that the “foundational moral justification for the social institution of public health is social justice.”[20] Their theory of social justice has two aims. First, it ensures that everyone has a sufficient amount of the six core elements of well-being and that public health institutions are responsible for “adopting policies and creating environments” where all can flourish.[21] Second, public health institutions should distribute resources meant to promote well-being and focus on the “needs of those who are the most disadvantaged.”[22] Public health institutions should enact policies that address injustice. In doing so, public health institutions can seed the opportunity to build solidarity from the bottom up. Equipping individuals and communities with resources will foster cooperation and adherence to policies that require solidarity, such as masking and vaccination. This is consistent with arguments illustrating how institutions such as Tribal governments promote the conditions needed for their group, and especially its most vulnerable members, to flourish.[23] Addressing social determinants of health with a social justice lens will create the circumstances under which more individuals and groups can find common causes and foster solidarity. In the long run, such efforts may result in the establishment of values and practices from the bottom up. There are societal and public health preconditions required before institutions can expect their audience to act in solidarity with one another. Through their great influence over information and resources, public institutions do have the power to impact what values are most widespread. Furthermore, public health may foster trust and hope, which are important psychosocial factors that influence collective action,[24] if policies increase access to resources that promote well-being. Messaging efficacy also depends on the context of public trust, education, and whether the institutions meet one’s basic needs. Disparate messaging across different public institutions may confuse or disillusion individuals. To apply our theory of solidarity to the decision to vaccinate, a policy would be to foster conditions that facilitate access to vaccines and information about vaccine efficacy instead of imposing a top-down mandate without first eliciting public trust. IV. Counterargument Some argue that discordant public health messaging, ineffective government, and inadequate social programs can also bring people together under pressure and foster solidarity. One may argue that the most powerful motivators towards solidarity are strife and disparity, as evidenced throughout history. During the pandemic alone, political struggle and personal hardship inspired solidarity in the US, from individual neighbors helping each other to mutual aid groups forming across communities. We thus do not claim that solidarity is possible only when our government programs and public health institutions are most effective. We instead point out that solidarity can be further hindered when people feel alienated, hopeless, and pitted against each other. CONCLUSION Many competing conceptualizations of solidarity persist in the bioethics literature, and Prainsack and Buyx offer one compelling framework that public health ethicists continue to draw upon.[25] However, their framework fails to acknowledge how public health institutions impact interpersonal and group solidarity. Public health institutions can foster solidarity through actions other than mere messaging, invoking catchphrases like “we are all in this together.” Efforts to address socioeconomic preconditions and alleviate health disparities can cultivate group solidarity. As we saw during the pandemic, cooperation and solidarity go hand-in-hand with disease mitigation efforts; solidarity has clear intrinsic value.[26] As this relationship becomes more apparent, we will continue to see attempts from public health institutions to foster or invoke solidarity. Therefore, public health institutions would be remiss to ignore their role in addressing the social determinants of health. Adopting a social justice lens when planning public health interventions will clarify and strengthen their role in facilitating solidarity. Ultimately, if health disparities continue to persist or widen, it is very hard to imagine how group solidarity can ever be achieved. The widescale adoption of many public health measures needed to promote health and well-being would be conducive to solidarity. - Disclaimer: The opinions expressed are the authors’ and do not represent the views of the NIH, DHHS, or the U.S. government. Funding Disclosure: This work was supported in part by the Intramural Program of the National Institutes of Health Clinical Center. - [1] John J Mulvihill et al., “Ethical Issues of CRISPR Technology and Gene Editing through the Lens of Solidarity,” British Medical Bulletin 122 (2017): 17–29, https://doi.org/10.1093/bmb/ldx002; Ben Saunders, “Altruism or Solidarity? The Motives for Organ Donation and Two Proposals,” Bioethics 26, no. 7 (September 2012): 376–81, https://doi.org/10.1111/j.1467-8519.2012.01989.x; -Vanessa Y Hiratsuka, “SPECIAL REPORT: A Critical Moment in Bioethics: Reckoning with Anti-Black Racism through Intergenerational Dialogue A Call for Solidarity in Bioethics: Confronting Anti-Black Racism Together,” 2022, https://doi.org/10.1002/hast.1380. [2] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [3] Bob Simpson, “A ‘We’ Problem for Bioethics and the Social Sciences: A Response to Barbara Prainsack,” Science, Technology, & Human Values 43, no. 1 (January 12, 2018): 45–55, https://doi.org/10.1177/0162243917735899. [4] Barbara Prainsack and Alena Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics (London: Nuffield Council on Bioethics, 2011). [5] Barbara Prainsack and Alena Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach,” Bioethics 26, no. 7 (September 2012): 343–50, https://doi.org/10.1111/J.1467-8519.2012.01987.X. [6] Bridget Pratt, Phaik Yeong Cheah, and Vicki Marsh, “Solidarity and Community Engagement in Global Health Research,” The American Journal of Bioethics : AJOB 20, no. 5 (May 3, 2020): 43–56, https://doi.org/10.1080/15265161.2020.1745930; Sara Chandros Hull, F. Leah Nez (Diné), and Juliana M. Blome, “Solidarity as an Aspirational Basis for Partnership with Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 14–17, https://doi.org/10.1080/15265161.2021.1965258; Mbih J. Tosam et al., “Global Health Inequalities and the Need for Solidarity: A View from the Global South,” Developing World Bioethics 18, no. 3 (September 1, 2018): 241–49, https://doi.org/10.1111/DEWB.12182. [7] Peter West-Oram, “Solidarity Is for Other People: Identifying Derelictions of Solidarity in Responses to COVID-19,” Journal of Medical Ethics 47, no. 2 (February 1, 2021): 65–68, https://doi.org/10.1136/MEDETHICS-2020-106522; Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215; F. Marijn Stok et al., “Social Inequality and Solidarity in Times of COVID-19,” International Journal of Environmental Research and Public Health 18, no. 12 (June 2, 2021), https://doi.org/10.3390/IJERPH18126339; Ming Jui Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics,” American Journal of Public Health 112, no. 2 (February 1, 2022): 255–61, https://doi.org/10.2105/AJPH.2021.306578; Barbara Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.,” Am J Public Health 112, no. 2 (February 1, 2022): 232–33, https://doi.org/10.2105/AJPH.2021.306619. [8] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [9] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [10] Yeh, “Solidarity in Pandemics, Mandatory Vaccination, and Public Health Ethics”; Prainsack, “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” [11] Ho, Anita, and Iulia Dascalu. "Relational solidarity and COVID-19: an ethical approach to disrupt the global health disparity pathway." Global Bioethics 32, no. 1 (2021): 34-50; West-Oram, Peter. "Solidarity is for other people: identifying derelictions of solidarity in responses to COVID-19." Journal of Medical Ethics 47, no. 2 (2021): 65-68. [12] Monica Webb Hooper, Anna María Nápoles, and Eliseo J. Pérez-Stable, “COVID-19 and Racial/Ethnic Disparities,” JAMA 323, no. 24 (June 23, 2020): 2466, https://doi.org/10.1001/jama.2020.8598. [13] Prainsack, Barbara. “Beyond Vaccination Mandates: Solidarity and Freedom During COVID-19.” Am J Public Health 112, no. 2 (February 1, 2022): 232–33. https://doi.org/10.2105/AJPH.2021.306619. [14] Camille A Clare, “Telehealth and the Digital Divide as a Social Determinant of Health during the COVID-19 Pandemic,” Network Modeling Analysis in Health Informatics and Bioinformatics 10 (2021): 26, https://doi.org/10.1007/s13721-021-00300-y. [15] Patrick Nana-Sinkam et al., “Health Disparities and Equity in the Era of COVID-19,” Journal of Clinical and Translational Science 5, no. 1 (March 16, 2021): e99, https://doi.org/10.1017/cts.2021.23. [16] Kathryn M Leifheit et al., “Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality,” American Journal of Epidemiology 190, no. 12 (December 1, 2021): 2503–10, https://doi.org/10.1093/aje/kwab196. [17] Barbara Prainsack, “Solidarity in Times of Pandemics,” Democratic Theory 7, no. 2 (December 1, 2020): 124–33, https://doi.org/10.3167/DT.2020.070215 [18] Maximilian Agostini and Martijn van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.,” Psychological Bulletin 147, no. 7 (July 2021): 667–700, https://doi.org/10.1037/bul0000256. [19] Department of Health and Human Services (HHS) Centers for Disease Control and Prevention (HHS/CDC), “COVID Data Tracker,” 2023, https://covid.cdc.gov/covid-data-tracker. [20] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 9 and Chapter 4 [21] Powers and Faden, Social Justice: The Moral Foundation of Public Health and Health Policy; Madison Powers and Ruth Faden, Structural Injustice: Power, Advantage, and Human Rights (New York: Oxford University Press, 2019). [22] Powers, Madison, and Ruth Faden. Social Justice: The Moral Foundation of Public Health and Health Policy. 1st editio. New York: Oxford Press, 2006, p. 10 [23] Bobby Saunkeah et al., “Extending Research Protections to Tribal Communities,” The American Journal of Bioethics 21, no. 10 (October 3, 2021): 5–12, https://doi.org/10.1080/15265161.2020.1865477. [24] Agostini and van Zomeren, “Toward a Comprehensive and Potentially Cross-Cultural Model of Why People Engage in Collective Action: A Quantitative Research Synthesis of Four Motivations and Structural Constraints.” [25] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics. [26] Ruth Chadwick, “COVID‐19 and the Possibility of Solidarity,” Bioethics 34, no. 7 (September 8, 2020): 637–637, https://doi.org/10.1111/bioe.12813. (shrink)

This article examines the debate on whether to analyse ‘honour crimes’ as gender-based violence, or as cultural tradition, and the effects of either stance on protection from and prevention of these crimes. In particular, the article argues that the categorisation of honour-related violence as primarily cultural ignores its position within the wider spectrum of gender violence, and may result in a number of unfortunate side-effects, including lesser protection of the rights of women within minority communities, and the stigmatisation (...) of those communities. At the same time it is problematic to completely dismiss any cultural aspects of violence against women, and a nuanced approach is required which carefully balances the benefits and detriments of taking cultural factors into account. The article examines the issues within the context of the legal response to cases involving honour-related violence, arguing that although the judiciary has in a number of cases inclined towards viewing ‘honour’ as primarily cultural rather than patriarchal, in some cases they have begun to take a more gender-based or ‘mature multiculturalism’ approach. (shrink)

Medical-legal partnerships (MLPs) integrate knowledge and practices from law and health care in pursuit of health equity. However, the MLP movement has not reached its full potential to address racial health inequities, in part because its original framing was not explicitly race conscious.

This book proposes a cosmopolitan ethics that calls for analyzing how economic and political structures limit opportunities for different groups, distinguished by gender, race, and class. The author explores the implications of criticisms from the social sciences of Eurocentrism and of methodological nationalism for normative theories of mobility. These criticisms lend support to a cosmopolitan social science that rejects a principled distinction between international mobility and mobility within states and cities. This work has interdisciplinary appeal, integrating the social sciences, (...) political philosophy, and political theory. (shrink)

Efforts towards adaptation, dissemination, and implementation of culturally robust, evidence-informed mental health care rely on community-engaged research. Academic-community partnerships help bring science to service for vulnerable and historically disenfranchised populations. A growing literature supports the development of a framework of ethics for CEnR. This article examines ethical tensions in the context of the American Psychological Association Ethics Code General Principles – Beneficence and Nonmaleficence; Fidelity and Responsibility; Integrity; Justice; and Respect for People’s Rights and Dignity – and presents the (...) 4R action plan to support application of APA guidelines to academic-community partnership with youth-serving organizations. (shrink)

In this commentary on Eva Feder Kittay's Love's Labor: Essays on Women, Equality, and Dependency, I focus on Kittay's dependency theory. I apply this theory to an analysis of women's inadequate access to high-quality, cost-effective healthcare. I conclude that while quandaries remain unresolved, including getting men to do their share of dependency work, Kittay's book is an important and original contribution to feminist healthcare ethics and the development of a normative feminist ethic of care.

This book proposes a cosmopolitan ethics that calls for analyzing how economic and political structures limit opportunities for different groups, distinguished by gender, race, and class. The author explores the implications of criticisms from the social sciences of methodological nationalism for normative theories of mobility. These criticisms lend support to a cosmopolitan social science that rejects a principled distinction between international mobility and mobility within states and cities. This work has interdisciplinary appeal, integrating the social sciences, political philosophy, and (...) political theory. (shrink)

At the center of many critiques of liberalism is liberal neutrality, which is attacked on two fronts. First, it is argued that neutrality yields a restrictive sphere of public reason. Contentious views—like those endorsed by citizens with marginalized comprehensive doctrines—are outlawed from public consideration. Second, state policies must have neutral effects, lest they differentially impact those with unpopular views. Contentious state actions—like those endorsed by citizens with marginalized moral views—are outlawed from implementation. It is this combination of demands for neutrality (...) at the individual and state levels that produces the concern: if marginalized comprehensive doctrines cannot be discussed in the realm of public reason, and if marginalized moral views cannot be acted upon by the state, how will we ever achieve the goals of feminism, itself a marginalized moral view? Does liberal neutrality prohibit progress toward gender equality? In this paper, I argue to the contrary. Many objections regarding liberalism’s supposed failure to secure gender justice rely on a conception of neutrality as neutrality of effect. But at both the individual and state levels, liberalism’s demand for neutrality is about justification. Liberalism, specifically political liberalism, requires neither neutral content of public reasons nor neutral effects of state policies. (shrink)

Despite the prominence of person‐centred care (PCC) in nursing, there is no general agreement on the assumptions and the meaning of PCC. We sympathize with the work of others who rethink PCC towards relational, embedded, and temporal selfhood rather than individual personhood. Our perspective addresses criticism of humanist assumptions in PCC using critical posthumanism as a diffraction from dominant values We highlight the problematic realities that might be produced in healthcare, leading to some people being more likely to be disenfranchised (...) from healthcare than others. We point to the colonial, homo‐ and transphobic, racist, ableist, and ageist consequences of humanist traditions that have influenced the development of PCC. We describe the deep rooted conditions that structurally uphold inequality and undermine nursing practice that PCC reproduces. We advocate for the self‐determination of patients and emphasize that we support the fundamental mechanisms of PCC enabling patients' choice; however, without critical introspection, these are limited to a portion of humans. Last, we present limitations of our perspective based on our white*‐cisheteropatriarchy** positionality. We point to the fact that any reimagining of models such as PCC should be carefully done by listening, following, and ceding power to people with diversity dimensions*** and the lived experience or expertise that exists from diverse perspectives. We point towards Black, queer feminism, and critical disabilities studies to contextualize our point of critique with humanism and PCC to amplify equity for all people and communities. Theory and philosophy are useful to understand restrictive factors in healthcare delivery and to inform systematic strategies to improve the quality of care so as not to perpetuate the oppression of groups of people with diversity dimensions. *We purposely capitalize Black and use lower case for white to decentre whiteness and as an intentional act of antiracism (see White Homework a podcast series by Tori W. Douglas). **Cisheteropatriarchy describes people with intersecting identities of dominant social groups; cisgender is the gender identity that aligns with the gender you were assigned at birth, hetero means heterosexual, and patriarchy refers to structural systems of power based on maleness where women are often excluded and hold less power. ***With diversity dimensions, we refer to subjective lived experience and material realities of people that exist outside the ‘dominant minorities' of white‐cisheteropatriarchy, meaning groups of people in society who historically and currently hold more power and through this, structurally dominate the norms and possibilities of living for other people. (shrink)

Rationing health care by ordeals is likely to have different effects on women and men, and on distinct groups of women. I show how such putative effects of ordeals are relevant to achieving gender justice. I explain why some ordeals may disproportionately set back women’s interest in discretionary time, health and access to health care, and may undermine equality of opportunity for positions of advantage. Some ordeals protect the interests of the worse-off women yet set back the interests (...) of better-off women in equal opportunities. I suggest how we can use ordeal design to advance particular aims of gender justice. (shrink)

I address the question of gender bias in ethical theorizing, in particular the claim that an "ethics of justice" is gender biased because it cannot logically accommodate an "ethics of care." I argue against the strong claim that an ethics of justice and an ethics of care are incompatible but suggest that theorizing that crystallizes into a tradition has non-logical as well as logical implications. In order to explain why ethical theorizing has focused on some content (...) and neglected others, one would have to suppose tacit general acceptance of a set of beliefs. It is in considering those beliefs that the charge of gender bias in ethical theorizing might be made to stick. (shrink)

In her provocative discussion of the challenge posed to the traditional impartialist, justice-focused conception of morality by the new-wave care perspective in ethics, Annette Baier calls for ‘a “marriage” of the old male and newly articulated female... moral wisdom,’ to produce a new ‘cooperative’ moral theory that ‘harmonize[s] justice and care.’ I want in this paper to play matchmaker, proposing one possible conjugal bonding: a union of two apparently dissimilar modes of what Nel Noddings calls ‘meeting the other (...) morally,’ a wedding of respect and care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Abortion to Abolition: Reproductive Health and Justice in Canada by Martha PaynterRebecca Simmons (bio)Abortion to Abolition: Reproductive Health and Justice in Canada by Martha Paynter Winnipeg, MB: Fernwood Publishing, 2022Martha Paynter's Abortion to Abolition: Reproductive Health and Justice in Canada is a bold, ambitious work that seeks to not only catalog Canada's meandering and often backtracking path toward reproductive justice, but to act (...) as a manifesto for Paynter's own ideas and goals for reproductive justice. The book takes the form of an anthology of stories, divided into chapters, that are grouped according to a certain right; for example, the right to bodily autonomy. This format effectively guides the reader from abortion to abolition. Paynter adroitly starts the book with white feminist favorites such as bodily autonomy and not having children. Then she logically progresses to more radical ideas such as parenting in prison and the total abolition of prisons. The stories in this book are accompanied by warm, colorful illustrations by Julia Hunt. These drawings help the reader visualize the person behind the story and the very real life that was affected by reproductive law and/or social norms. Paynter holds a PhD in nursing, and it is from this background that she writes, seeking to educate nurses and other healthcare professionals alongside a broader readership garnered through her clear, approachable writing style.Chapter 1 introduces the reader to many of the book's key themes by considering the right and need to have bodily autonomy, and the multiple ways this manifests itself in ordinary (and less-ordinary) life. Paynter considers the disparate stories of five women, all fighting in some way for bodily autonomy. The stories cover events of gender-based gun violence, sexual assault, transgender rights in prison, the legalization of sex work, police violence, and institutional racism. Each story recounted by Paynter catalogs tragedies and injustices with blunt and brutal honesty—perhaps to an unnecessary extent. Every horrific fact is laid bare for the readers as they uncover the intricacies of gender-based, imperialist, and racist violence. Paynter has chosen these stories to display the multitude of ways in which people—especially Black, Indigenous, people of color (BIPOC) and minoritized genders—can be willfully wronged by the state and [End Page 209] the criminal justice system, such that the reader must begin to confront the fact that these structures don't seem to exist to benefit or protect the most marginalized in society.Chapter 2 approaches the right not to have children through a number of stories related to contraception, abortion, and family planning. Paynter sketches some of the key points in Canada's journey toward the decriminalization of abortion, from paradoxical trailblazers, such as Dr. Emily Stowe in the 1800s, to the viral memefied content of art protestor iamkarats. While the unequivocal legality of abortion in Canada suggests incredible progressiveness and support for women's rights, Paynter paints a more complex picture through her chosen narratives. Crucially, the inequitable geographical access to abortion, in particular, throughout the huge landmass of Canada suggests that the right to not have children in Canada is not universal. Moreover, Paynter suggests that access is also bounded by financial constraints, finite public funding, and the limited availability of inclusive clinics that prioritize healthcare for LGBTQ2S+ people.Chapter 3 considers the topic of having children; in particular, the right to reproductive technologies and freedom from forced sterilization. Paynter quickly makes clear that while many white feminists might see having and not having children as diametrically opposed, they are two equally essential parts of reproductive justice. Paynter draws attention to the Sexual Sterilization Act of 1928 that was only overturned in 1972. She describes it as part of the "genocidal colonial project" (84), a collection of laws and policies aimed at fulfilling eugenicist, neoimperial ideals of increasing production of the white "race" and promoting the genocide of Indigenous peoples. Furthermore, Paynter argues that evidence of forced sterilization of Indigenous peoples, and other physical violence and neglect, persists to the present day and must be stopped and reparations made for previous harms. Paynter then considers the complex, often-debated case of commercialized surrogacy, which she defines... (shrink)

The United States is culturally oriented more toward individual rights and values than to communitarian values. That proclivity has made it hard to develop a common good, or solidarity-based, perspective on health care. Too many people believe they have no obligation to support the health care of others and resist a strong role for government, higher taxation, or reduced health benefits. I argue that we need to build a communitarian perspective on the concept of solidarity, which has been the (...) concept underlying European health care systems, by focusing not on individual needs, but rather, on those of different age groups—that is, what people need at different stages of life. (shrink)

A large and important part of social relations is gender relations between men and women. Over time, the manifestation of such relations has often been one of violence, particularly violence against women. Different approaches have been deployed to deal with the experience of gender-based violence (GBV). One popular approach is the human rights framework that suggest that GBV can be addressed by granting certain rights to women. We argue that while a human rights framework holds some promise in (...) resolving GBV, it is limited in some ways because it does not take the cultural perceptions of gender relations that envision gender duties into account. As part of our argument, we show that social relations in African communities ought to be primarily based on the principle of duty to the other, rather than an emphasis on rights. We conclude that there is a need to complement the rights-based approach with a duty-based approach to effectively address GBV. (shrink)

Many scholars think that women are sentenced more leniently than men because judges are paternalistic toward women. In this article, I suggest that paternalism is a multilayered concept and that it is important to distinguish between judicial concerns for protecting women and those for protecting children and families. To learn what factors judges consider in sentencing and whether these differ for men and women defendants, I interviewed 20 men and 3 women judges in two state criminal courts. I learned (...) that the primary objects of judicial protection were not women, but children, and men's and women's economic support or care for families. However, there was a labor hierarchy in the judges' minds in that they believed that care giving was more important than wage earning for the maintenance of families. Interactive influences among the defendant's gender, familial status, race or ethnicity, and the nature of the offense charged are discussed. (shrink)