In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment (...) to both distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision‐making related to their interests, including in crisis planning before, during, and after a pandemic like Covid‐19. (shrink)

The healthcare system—the assemblage of hospitals, insurers, professional associations, policymakers, patients, caregivers, and other entities oriented toward health in the United States—does more than cure illness. It is, and in some cases ought to be but falls short, attentive to endpoints other than cure, such as comfort, participation in desired activities, and the creation of families—things that may broadly be understood as promoting well-being. In the United States, health care utilization is prohibitively expensive. As a result, most people can (...) only access care through insurance. While the care available within the broad U.S. healthcare system may be oriented toward a wide variety of endpoints, insurance... (shrink)

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

Volume 19, Issue 6, June 2019, Page W3-W4.

The intensity of the opposition to health reform in the United States continues to shock and perplex proponents of the Patient Protection and Affordable Care Act. The emotion and the apocalyptic rhetoric, render civil and evidence-based debate over the implications and alternatives to specific provisions in the law difficult if not problematic. The public debate has largely barreled down two non-parallel yet non-intersecting paths: opponents focus on their fear of government expansion in the future if PPACA is implemented now, (...) while proponents focus on the urgency and specifics of our health care market problems and the limited number of tools we have to address them. Frustration on both sides has led opponents to deny the seriousness of our health system’s problems and proponents to ignore the risk of governmental overreach. These non-intersecting lines of argument are not moving us closer to a desired and necessary resolution. (shrink)

According to HealthCare.gov, by improving access to quality health for all Americans, the Affordable Care Act (ACA) will reduce disparities in health insurance coverage. One way this will happen under the provisions of the ACA is by creating a new health insurance marketplace (a health insurance exchange) by 2014 in which “all people will have a choice for quality, affordable health insurance even if a job loss, job switch, move or illness occurs”. This does not mean that everyone will (...) have whatever insurance coverage he or she wants. The provisions of the ACA require that each of the four benefit categories of plans (known as bronze, silver, gold and platinum) provides no less than the benefits available in an “essential health benefits package”. However, without a clear understanding of what criteria must be satisfied for health care to be essential, the ACA’s requirement is much too vague and open to multiple, potentially conflicting interpretations. Indeed, without such understanding, in the rush to provide health insurance coverage to as many people as is economically feasible, we may replace one kind of disparity (lack of health insurance) with another kind of disparity (lack of adequate health insurance). Thus, this paper explores the concept of “essential benefits”, arguing that the “essential health benefits package” in the ACA should be one that optimally satisfies the basic needs of the people covered. (shrink)

This article explores the feasibility of using an appeal to the virtues in bioethical analyses, and the difficulties posed by the fact that most virtues and especially hope, are embedded in particular traditions. Whose virtues, then, shall focus our analyses ? A brief description of Christian hope is used to argue that hope does play a major role in various health care venues and to suggest that the common elements in a secular account of the virtues can be found (...) in an unbiased sharing of one's religious background or way of life. (shrink)

This essay makes the affirmative case for health reform by expounding on three fundamental points: one moral case for expanding access to coverage and care to all is grounded in scriptural concepts of community and mutual obligation which continue to inform the American pursuit of justice; the structure of PPACA springs from an appreciation of and approach to channeling market forces that was developed and proposed by a coalition of moderate and conservative Republican U.S. senators almost 20 years ago; (...) the most humane path to a better and more sustainable health system lies in implementing PPACA as fast and fully as we can. The purpose of this essay is to articulate why it is not possible to make our health system better, sustainable and serve us all without government playing specific and limited but absolutely crucial catalytic roles. (shrink)

Newcomers and more experienced feminist theorists will welcome this even-handed survey of the care/justice debate within feminist ethics. Grace Clement clarifies the key terms, examines the arguments and assumptions of all sides to the debate, and explores the broader implications for both practical and applied ethics. Readers will appreciate her generous treatment of the feminine, feminist, and justice-based perspectives that have dominated the debate.Clement also goes well beyond description and criticism, advancing the discussion through the incorporation of a broad (...) range of insights into a new integration of the values of care and justice. Care, Autonomy, and Justice marks a major step forward in our understanding of feminist ethics. It is both direct and helpful enough to work as an introduction for students and insightful and original enough to make it necessary reading for scholars. (shrink)

Bioethics as a branch of professional ethics has rapidly expanded in recent years. The growth of interest in bioethics is the result of its focus on life, its value, as well as the questions about health, medicine and problems which are involved. Bioethics is included within the lessons of ethical education in primary and secondary schools in Slovakia. As an independent subject it creates part of the compulsory curriculum in the study programme of ethics at university. It is noteworthy that (...) bioethics also keeps an important place in the education of future doctors at Medical Faculties. It gives rise to an interesting question; what about doctors’ long-term performance in their profession? Do they need knowledge of medical ethics when performing their job? This article tries to answer these questions. It points out that teaching medical ethics is relevant/necessary at primary schools, secondary schools, for students of ethics, medical students and other health care professionals as well as for practising physicians. (shrink)

Care exploitation pervades our lives. Consider the public school teachers who care about helping children achieve their goals by providing them with a proper education and are expected to do so by parents, administrators, or legislators—even with abysmal pay and little appreciation. Perhaps the most common case of care exploitation is the expectation of a mother to make great (and disproportionate) sacrifices in her life for the well-being of her child, which mothers often meet because they bear (...) a caring orientation toward their child. Despite their willingly assenting, there is something morally problematic about their treatment. I argue that an injustice has been perpetrated against them, drawing on interpersonal accounts of exploitation to highlight that the unique wrong of care exploitation is the failure to respect one’s dignity by taking advantage of their vulnerability of caring about. Following this, I articulate the necessary and jointly sufficient conditions of care exploitation and their relationships to one another. (shrink)

Policies that determine whether someone is allowed access to reproductive healthcare or not vary widely among countries, especially in their age requirements. This raises the suspicion of arbitrariness, especially because often no underlying justification is provided. In this article, we pose the question—under which circumstances is it morally acceptable to use age for policy and legislation in the first place? We start from the notion that everyone has a _conditional positive_ right to fertility treatment. Subsequently, we set off to formulate (...) a framework that helps to determine who should be excluded from treatment nonetheless. The framework’s three core elements are: choosing and ethically justifying exclusion criteria (target), determining the actual limit between in- and exclusion (cut-off), and selecting variables that help to predict the exclusion criteria via correlation (as they are not directly measurable) (proxy). This framework allows us to show that referring to age in policy and legislation is only ethically justifiable if there is a sufficiently strong correlation with a non-directly measurable exclusion criterion. Moreover, since age is only one of many predicting variables, it should therefore not be ascribed any special status. Finally, our framework may be used as an argumentative scheme to critically assess the ethical legitimacy of policies that regulate access to (fertility) treatments in general. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Caring for Landscapes of Justice in Perilous Settler EnvironmentsMishuana Goemanindians are the "singing remnants" or "graffiti," in the words of Leanne Betasamosake Simpson ("i am graffiti"). The forms this graffiti takes, our inscriptions on the landscape, are as numerous as our Nations, abundant as our ancestors who loved, lived, and passed down knowledge of our lands and histories. "You are the result of the love of thousands," writes Linda (...) Hogan, who beseeches us to listen to the environment surrounding us (159). Deborah Miranda (Coastal Esselen and Chumash) reminds us that we are also the result of violent histories, in her tribal memoir Bad Indians, a book that relishes the tales of her ancestors who resist and act out to survive. This harm, genocide, and settler mapping of worlds also must be attuned to in our surroundings and in "our bodies [that are] bridges over which our descendants cross, spanning unimaginable landscapes of loss" (Miranda 74). Visual cartographic mapping has been part and parcel of the erasure of California Indians, relegated to the small, contained, and past temporal space of a romanticized mission.This paper centers on the NDN Collective's work and the photography of Cara Romero's project Tongvaland and the works of Gabrielino Tongva artist Mercedes Dorame. The setting of these projects is in the sprawling landscape of Los Angeles, or the homelands of the Gabrielino Tongva people, who call it Tovaangar. I will examine the anti-colonial aesthetics and care practices mapped out in the work rather than presenting a "true" Indigenous map or alternative map. Mapping a history of the landscape by creating a "new" narrative or "true" narrative is not enough. As Maori scholar Linda Tuhwi Smith states, "[w]e believe that history is also about justice, that understanding history will enlighten our decisions about the future. Wrong. History is also about power. In fact, history is mostly about power. … [A] thousand accounts of the truth will not alter the fact that indigenous peoples are still marginal [End Page 50] and do not possess the power to transform history into justice" (34). The Gabrielino Tongva, who comprise an estimated 2,300 people, do not possess the population power and cannot access the form of voting or democracy to make the changes needed just by telling their truth. Across California, people know about the raw deal, the embezzlement, the genocide, and the so-called lost treaties. In fact, under Eisenhower, recompense was paid out in small amounts to Tongva families of the dispossessed. Instead, to continue with the words of Smith, "[i]t is also about reconciling and reprioritizing what is really important about the past with what is important about the present" (111). What Romero and the NDN Collective—made up of numerous tribal leaders, scholars, and other artists—did was relay and prioritize how they wanted to be seen in their homelands. These billboards invite us in, in a gift of sharing, or what tribal cultural leader Craig Torres related to me as a spirit of Maxxa, a sharing, gifting, or swapping of knowledge. Dorame's beautiful and critical installations in public art spaces reflect Maxxa—they invite the viewers to think through land from her curious arrangements. As artists, part of their practice is not that of a Western version of a tortured genius but instead is energized by pulling in community and creating a collective practice. They undo settler space together and with us. The cartographic practices of these California Indians' creative arts exemplify communities of care that must be considered when we think through the unmapping of settler terrains. This question requires an approach of radical care. As Hi'ilei Hobart and Tamara Kneese make clear, the notion of care is "inseparable from systemic inequalities and power systems" (Hobart and Kneese 1).The work of the NDN Collective and Dorame counters a settler-based, commercial map of Los Angeles. Indigenous people, relegated by the settler state as expendable and erasable graffiti, confront capitalist and state ordinances at various scales. Rather than understand this as a subjugated positionality, I posit that graffiti is the critique necessary and valuable to understanding interlocking structures of oppression. In the following words of Leanne... (shrink)

Die forensische Psychiatrie und insbesondere ihr klinischer Bereich, der Maßregelvollzug, sind im Hinblick auf Forschung noch weitgehend eine terra incognita. Steigende Unterbringungszahlen und Gesetzesreformen belasten die klinische Arbeit des Maßregelvollzugs. Zugleich hat der Fall Mollath Fragen an der Zuverlässigkeit forensisch-psychiatrischer Prognosen aufgeworfen. Gerade im zentralen Arbeitsbereich der Kriminal- und Gefährlichkeitsprognose fehlen epidemiologische und Verlaufsdaten. Auch zur Effizienz der Therapieprogramme und der Frage, welche Maßnahmen letztlich zu einer Verbesserung der Prognose bei Maßregelvollzugspatienten führen, gibt es keine einheitlichen Daten. Vor dem Hintergrund (...) des Doppelmandates der Besserung und Sicherung und des Anspruchs der Gesellschaft, vor gefährlichen, psychisch kranken Straftätern geschützt zu werden, ist es sowohl fachlich wie ethisch geboten, über die Frage der Effizienz der forensisch-psychiatrischen Arbeit zu forschen. Hiermit will sich die vorliegende Arbeit auseinandersetzen und die fachlichen sowie ethischen Aspekte diskutieren. Ansätze aus der Sozialethik können hier Argumente für eine ethisch verantwortbare Forschung auf diesem Gebiet liefern. (shrink)

One widely accepted way of justifying universal access to health care is to argue that access to health care is necessary to ensure health, which is necessary to provide equality of opportunity. But the evidence on the social determinants of health undermines this argument.

The aim of this paper is to get from a phenomenology of birth towards an ethics of obstetric care: Human rights violations in obstetrics are currently a globally debated phenomenon. Research suggests that maltreatment is widespread and a global phenomenon. However, the prevalence cannot yet be clearly quantified. In view of this problem, it is necessary to take the subjective perspective of those affected seriously. Narrative and phenomenological accounts of birth experiences could help to foster the dialogue between (...) persons giving birth and health professionals. First, I will present narrative accounts of birth experiences recorded by feminist phenomenologists. Second, I will interpret these narrative accounts within a feminist phenomenological framework in order to contribute to a phenomenology of birth, which, in a third step, shall help to develop an ethics of obstetric care. In engaging with the phenomenology of care outlined by feminist care ethicists, I will analyze the elements and conditions of good care, and draw conclusions for an ethic of obstetric and midwifery care. Drawing additionally on the theory of relational autonomy, my paper argues for a relational implementation of self-determination in childbirth. Lastly, I will discuss to what extent the ethical ideal of care has an affinity to the midwifery model of childbirth, and how the current situation of obstetrics prevents a women-centered birth culture. (shrink)

This book presents the first systematic account of dependency care in a liberal theory of justice. Despite the fact that receiving dependency care is necessary for human survival, the practices with which we meet society’s care needs are seldom recognized for their functional role. Instead, norms about gender and race obscure and shape expectations about whose needs for care are legitimate as well as about whose caregiving labor more advantaged members of society will receive. These (...) opaque arrangements must be made visible if we are to remedy skewed intuitions and judgements about care. Freedom to Care develops a modified form of social contract theory with which to evaluate society’s caregiving arrangements. Building on work by feminist liberals and care ethicists, it reframes debates about care to move beyond gender with an inequality-tracking framework that can be employed in any culture. Because care provision has been enmeshed in the subordination of women and people of color, eliminating the invisibility of these forms of labor yields a critical liberal theory of justice with feminist and anti-racist aims. (shrink)

Dance, as a mode of physical interaction, offers opportunities to care and be cared for, but this does not mean that dancers will, in fact, care. There may be no moral motivation underlying a lift, dip or intricate sequence of coordinated action. Choreographic scores may (knowingly or not) encourage merely perfunctory movements that are a poor simulacrum to care. Moreover, the caring that is expressed through dance need not transfer to other walks of life. I am not (...) alone in knowing spectacularly talented dancers whose behaviour off the dance floor is far from ethical – from the arrogant and petty to the flagrant abuse that plagues institutions of art and culture. This article considers how dance can illuminate both the acts and sentiments of care, conveying particular ethical orientations that trouble straightforward, absolute moral reasoning. The article frames an enquiry into the relation between ethics and aesthetics of care, drawn from feminist epistemologists Joan Tronto, Maurice Hamington, and Nel Noddings, as well as my own performance research on partnering. I frame a zone between technique and competence, foregrounding care in dance as both a technical and ethical issue. I will consider the necessary conditions by which dancing together can manifest care, rather than suggest blanketly that it always does or even that it should. To make this argument, I will describe and analyse Considered Care, a duet I created in the autumn of 2021 in collaboration with Boston Ballet. This performance research project provided the material from which to consider the concept of need, a condition of care in a dancing situation. I will conclude by considering the relationship between needs and trust in conceptualizing care within partnering. (shrink)

Inequalities in expectations to receive care permeate social structures, reinforcing racialized and gendered hierarchies. Harming the people who are overburdened and disadvantaged as caregivers, these inequalities also shape the subjectivities and corporeal habits of the class of people who expect to receive care from others. With three examples, I illustrate a series of justificatory asymmetries across gender and racial lines that illustrate asymmetries in deference and attendance to the needs of others as well as assertions of the rightful (...) occupation of space. These justificatory asymmetries are cogent reasons to evaluate the justice of caregiving arrangements in a way that tracks data about who cares for whom, which can be understood by the concept of the arrow of care map. I suggest, therefore, that the arrow of care map is a necessary component of any critical care theory. In addition, employing a method called living counterfactually, I show that when women of color assert full claimant status, we are reversing arrows of care, which then elicits resistance and violence from varied actors in the real world. These considerations together contribute to further defense of the theory of liberal dependency care’s constructivism, which combines hypothetical acceptability with autonomy skills in the real world. Each level, in turn, relies on the transparency of care practices in the real world as enabled by the arrow of care map. (shrink)

In their strife for designing a moral system where everyone is given equal consideration, cosmopolitan theorists have merely tolerated partiality as a necessary evil (insofar it means that we give priority to our kin opposite the distant needy). As a result, the cosmopolitan ideal has long departed from our moral psychologies and our social realities. Here I put forward partial cosmopolitanism as an alternative to save that obstacle. Instead of demanding impartial universal action, it requires from us that we (...) are equally responsive in all the relationships we stand in. That goes from the local to the cosmopolitan sphere, since I defend that we are related with strangers as co-members of the global community. Thus, partiality not only is accommodated by cosmopolitanism, but actually supports it: only by having meaningful personal relationships we become able to care for distant strangers. (shrink)

What if the work of a nurse, physio or homecare worker was designated an art, so that the qualities of the experiences they create became understood as aesthetic qualities? What if the interactions and physical connections created by artists, directors, dancers, or workshop facilitators was understood as a work of care? Care Aesthetics is the first full length book to explore these questions and examine the work of carer artists and artist carers to make the case for the (...) importance of valuing and supporting aesthetically caring relations across multiple aspects of our lives. Theoretically and practically the book outlines the implications of care aesthetics for the socially engaged arts field and health and social care, and for acts of aesthetic care in the everyday. Part One of the book outlines the approaches to aesthetics and to care theory that are necessary to make and defend the concept of care aesthetics. Part Two then tests this through practice, examining socially engaged arts and health and social care through its lens. It makes the case for careful art exploring the implications of care aesthetics for participatory or applied arts. Then it argues for artful care and how an aesthetic orientation to care practices might challenge some of the inadequacies of contemporary care. This is a vital, paradigm-shifting book for anyone engaged with socially engaged arts or social and health care practices, on an academic or professional level. (shrink)

This article examines the barriers to quality health care for transgender, nonbinary, and gender-expansive people (TGE) who become pregnant and give birth, identifying three central themes that emerge from the literature. These insights suggest that significant reform will be necessary to ensure access to safe, appropriate, gender-affirming care for childbearing TGE people. After illustrating the need for systemic changes that untether rigid gender norms from the provision of perinatal care, the article proposes that the Midwives Model (...) of Care offers a set of values and clinical practices that are well-suited to meet the needs of many TGE patients during pregnancy and childbirth and which should be incorporated into the healthcare system more broadly. (shrink)

This paper examines the relationship between strategies of cosmopolitan education intended to motivate citizens of affluent countries to care about distant others facing injustice, and injustices within the borders of these affluent countries. I argue that promoting justice within affluent countries and motivating citizens to act to address global injustices, are potentially complementary rather than competing projects. I make two claims. Injustices within national borders can undermine the development of cosmopolitan concern. National institutions delivering health and social care (...) play a vital role in developing and sustaining affective dispositions necessary to care about the fate of distant others. (shrink)

Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as (...) emergency medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values. (shrink)

This short essay seeks to identify and prevent a pitfall that attends less careful inquiries into “physiosemiosis.” It is emphasized that, in order to truly establish the presence of sign-action in the non-living world, all the components of a triadic sign - including the interpretant - would have to be abiotic (that is, not dependent on a living organism). Failure to heed this necessary condition can lead one to hastily confuse a natural sign (like smoke coming from fire) for (...) an instance of abiotic semiosis. A more rigorous and reserved approach to the topic is called for. (shrink)

The focus of AI ethics has recently shifted towards the question of whether and how the use of AI technologies can promote sustainability. This new research question involves discerning the sustainability of AI itself and evaluating AI as a tool to achieve sustainable objectives. This article aims to examine the justifications that one might employ to advocate for promoting sustainable AI. Specifically, it concentrates on a dimension of often disregarded reasons — reasons of “meaning” or “meaningfulness” — as discussed more (...) recently in the “meaning in life” literature of analytic ethics. To proceed, the article first elucidates the working definitions of “sustainable AI” and “meaning in life”, while also setting the criteria for evaluating the plausibility of these reasons. Subsequently, it presents and scrutinises three arguments for the claim that one has reasons to care about sustainable AI from a perspective of meaning: the Meaning-conferring-action Argument, the Afterlife Argument, and the Harm Argument. In conclusion, this article asserts that only the Harm Argument presents a viable line of reasoning. However, it also outlines the presuppositions of this argument and the additional steps necessary to make it compelling. (shrink)

Within a period of one year, two countries have enacted laws that articulate conditions under which euthanasia and physician assisted suicide are permitted. Belgium and the Netherlands thus distinguish themselves from all other countries of the world.In Belgium, palliative care organisations have been pro-actively involved in the debate on the contents of the law, highlighting that if euthanasia can ever be justified, it is necessary to provide good palliative care for all and to include in the euthanasia (...) law what has been called a palliative filter, i.e. a compulsory prior consultation with a specialised palliative care team. In the Netherlands, before the euthanasia law was enacted, there had been a policy of pragmatic tolerance for decades. The enactment itself did not give rise to intense debate. It can be questioned whether the new law would change anything at all since it only officially sanctioned an existing practice. This however does not mean that caregivers in palliative care, together with palliative care organisations, have not participated in the euthanasia debate.In the first part of this article the input of palliative care organisations in the Dutch euthanasia debate is described and explained by situating it in its broader context. First opinions on euthanasia of a variety of palliative care organisations are described. Secondly the Dutch debate on palliative care and euthanasia is analysed and evaluated. In a second part of this article a brief introduction to Belgian palliative care is given. This introduction is followed by an overview of the way organised palliative care has been active in the Belgian euthanasia debate. Attention too is given to the Belgian discussion on palliative sedation, sedation being presented by some as the palliative alternative to euthanasia but seen by others as nothing but euthanasia in disguise. (shrink)

The question ‘Why care about being an agent?’ asks for reasons to be something that appears to be non-optional. But perhaps it is closer to the question ‘Why be moral?’; or so I shall argue. Here the constitutivist answer—that we cannot help but have this aim—seems to be the best answer available. I suggest that, regardless of whether constitutivism is true, it is an incomplete answer. I argue that we should instead answer the question by looking at our evaluative (...) commitments to the exercise of our other capacities for which being a full-blown agent is a necessary condition. Thus, the only kind of reason available is hypothetical rather than categorical. The status of this reason may seem to undermine the importance of this answer. I show, however, that it both achieves much of what we want when we cite categorical reasons and highlights why agency is valuable. (shrink)

Philosophy Compass, Volume 17, Issue 4, April 2022. -/- In a moment where needs for care are acute and their provision precarious, feminist care ethics has gained new relevance as a framework for understanding and responding to necessary interdependence. This article reviews and evaluates two long-standing critiques of care ethics in light of this recent research. First, I assess what I call the pluralist feminist critique, or the dispute over the ability of care ethics to (...) address the needs and histories of a range of marginalized subjects. I identify two forms of this critique: the first disputes the biased starting points shaping the development of the theory, and the second concerns the weaponization of care in support of domination. Although these critiques are well-established, I draw attention to recent responses that move care theory in generative directions. I argue that the pluralist feminist critique demands both self-critical transformation in dialog with other feminist schools of thought and a robust account of care ethics' normative authority. I then take up critiques those levied by mainstream ethicists concerned with care theory's adequacy as an ethical approach. I show that recent work on normative authority, conceptual uniqueness, and the grounding of responsibility must be engaged before care theory can be dismissed as “under-theorized.” In articulating these two sets of critiques and evaluating recent rebuttals to them, I argue for a pluralist feminist theory of care within which strands informed by varying philosophical schools and methods can coexist. (shrink)

Care Ethics and Poetry is the first book to address the relationship between poetry and feminist care ethics. The authors argue that morality, and more specifically, moral progress, is a product of inquiry, imagination, and confronting new experiences. Engaging poetry, therefore, can contribute to the habits necessary for a robust moral life—specifically, caring. Each chapter offers poems that can provoke considerations of moral relations without explicitly moralizing. The book contributes to valorizing poetry and aesthetic experience as much (...) as it does to reassessing how we think about care ethics. (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)

In decisions about inclusion (or exclusion) of health care services in the benefit package, different interpretations of notions like health, health risk, disease, quality of life or necessary care often remain implicit. Yet they can lead to different benefit package decisions. After a brief discussion of these concepts in definitions of the goals of medicine, the various value-judgements implicit in interpretations of key notions in health care are analysed and conclusions are drawn with regard to the (...) composition of decision making bodies at various levels. It is further argued that such a body needs to discuss the various interpretations of key-notions explicitly in the various phases of a priority-setting procedure so that more consistent choices can be made in health care priority setting. (shrink)

Solidarity is a contested concept whose definition needs to be clarified, especially in the context of the recent pandemic and in a world in permanent crisis. It is necessary to review certain stages of how solidarity develops and to relate the stages to the current status of solidarity in this post-pandemic period, with the aim of establishing some lines of approach to proposals for viable bioethics in the context of a post-foundational philosophy as the present one.

Background: Neglect and abuse of elders in care institutions is a recurring issue in the media. Elders in care institutions are vulnerable due to their physical, cognitive, and verbal limitations. Such vulnerabilities may make them more susceptible to mistreatment by caregivers on whom they are heavily dependent. Objectives: The goal was to understand caregivers’ concerns about ensuring correct and proper treatment, as well as their experiences with neglect and abuse of older patients. This article examines resources and challenges (...) of professional ethics within the care setting. Research design: A study was conducted to explore the quality of care provided to older patients in nursing homes, geriatrics institutions, and ambulant care in the northwest region of Switzerland. Participants and research context: A total of 23 semi-structured interviews were conducted with nursing staff of varying experience levels. Ethical considerations: Ethical approval was granted by the competent regional ethics commission, Ethikkomission Nordwest-und Zentralschweiz EKNZ [Ethics Commission Northwest and Central Switzerland]. Findings: Three themes emerged from our data analysis: professional identity, professional context, and professional relationships. Our findings indicate mutual vulnerabilities within these three themes, characterizing the interactions between nursing staff and older patients. Study participants believe that incidences of error, neglect, and abuse are consequences of their own vulnerability since they are not able to meet the demands of an overstraining work situation. Discussion: Different aspects of this mutual vulnerability are described and critically discussed as challenges for professional ethics. Conclusion: Early education, continuous training as well as better management and response from the institution are necessary to maintain professionalism while handling mutual vulnerabilities. (shrink)

:In a recent paper in Cambridge Quarterly of Healthcare Ethics on the necessary conditions for morally responsible animal research David DeGrazia and Jeff Sebo claim that the key requirements for morally responsible animal research are an assertion of sufficient net benefit, a worthwhile-life condition, and a no-unnecessary-harm condition. With regards to the assertion of sufficient net benefit, the authors claim that morally responsible research offers unique benefits to humans that outweigh the costs and harms to humans and animals. In (...) this commentary we will raise epistemic, practical, and ethical challenges to DeGrazia and Sebo’s emphasis on benefits in the prospective assessment of research studies involving animals. We do not disagree with DeGrazia and Sebo that, at the theoretical level, the benefits of research justify our using animals. Our contribution intends to clarify, at the practical level, how we should understand benefits in the prospective assessment and moral justification of animal research. We argue that ASNB should be understood as an assessment of Expectation of Knowledge Production in the prospective assessment and justification of animal research. EKP breaks down into two further claims: that morally responsible research generates knowledge worth having and that morally responsible research is designed and executed to produce generalizable knowledge. We understand the condition called knowledge worth having as scientists’ testing a hypothesis that, whether verified or falsified, advances an important interest, and production of generalizable knowledge in terms of scientific integrity. Generalizable knowledge refers to experimental results that generalize to a larger population beyond the animals studied. Generalizable scientific knowledge is reliable, replicable, and accurately descriptive. In sum, morally responsible research will be designed and carefully executed to successfully test a hypothesis that, whether verified or falsified, advances important interests. Our formulation of EKP, crucially, does not require further showing that an experiment involving animals will produce societal benefits. (shrink)

Background Migrant live-in care workers are a main pillar of long-term care in many countries, including Germany. Several studies examining their working and living conditions reveal serious problems. However, a key element of live-in arrangements, namely the relationship between the individuals involved, has not yet been systematically investigated from an ethical perspective. Aim Building on previous socioempirical work that explored and set out the meaning of “care networks”, we start from the premise that live-ins are embedded in (...) a network of relationships which are essential for their employment and living situation. Methods The theoretical analysis draws on a network approach that takes care–ethical considerations into account. Using Joan Tronto’s four care–ethical phases, existing dependencies are described and reflected upon using the corresponding four care–ethical dimensions. The central questions are how dependencies in the live-in arrangement can be characterised based on the existing body of empirical studies and with a focus on the elements of power, dependency and trust in the ethical reflection on care. Results Based on this analysis, it becomes apparent that the ambivalence resulting from the simultaneity of different forms of asymmetry and mutual dependence is omnipresent in live-in arrangements and gives rise to seemingly contradictory forms of relationships and emotions. Responsibilities are vague and are constantly renegotiated on the basis of implicit assumptions and problematic role expectations and are also assigned without negotiation. Conclusions In the future, it will not only be necessary to better understand and clarify responsibilities at the micro level of the individual care arrangement from the various positions and roles and with a view to the changing processes of caring for another, but also to address the pressing ethical questions and problems in live-in arrangements at the meso and macro levels—enriched by care–ethical perspectives. (shrink)

While many western countries now have large Muslim communities, relatively little scholarly attention is given to the attitudes of Muslims regarding end-of-life issues. Meanwhile, we receive strong and significant signals from physicians and pastoral care teams on the difficulty of discussing pain treatment with Muslim patients. With this study of Islamic views on pain control and palliative sedation in English Sunni e-fatwas we wish to make a contribution from the field of religious studies to a better understanding of how (...) Muslim patients balance their personal needs for pain treatment with the Islamic normative background. Using Broeckaert’s conceptual framework on treatment decisions in advanced disease, we conducted an in-depth analysis of English Sunni e-fatwas on pain control and palliative sedation. The e-fatwas were selected using Bunt’s typology of Cyber Islamic Environments and Tyan’s definition of a fatwa. We found that references to the use of sedative medication to reduce the consciousness of the patient for pain treatment were very scarce in the texts we analysed. Although the idea of patiently enduring pain is present in the e-fatwas, it does not dominate the discussion, since the alleviation of pain is equally encouraged. When the pain medication used is addictive, alters the patient’s state of consciousness or contains alcohol making it problematic from an Islamic normative point of view, the use of this type of medication can be permitted on the basis of a principle in Islamic jurisprudence: necessity permits breaking the law. The possible danger of death after the administration of high doses of pain medicine is countered based on the intention of the treating physician: he or she aims to alleviate the pain and not kill the patient. The study of English Sunni e-fatwas on pain and symptom control indicates the absence of an insurmountable ethical problem connected to the use of heavy pain medication. (shrink)

Because of the gradual aging of the population, hospital facilities for socio-sanitary care of the elderly are quite scarce relative to the very high number of elderly people present in the country. This has pushed a high number of families to privately hire home-care workers. The scientific literature gives a picture of the psycho-physical risks that this type of profession is exposed to; however, there is still a need for a more systemic reflection with regard to representations about (...) their role and competences. The aim of the present study is to outline the representations of the role and the skills it requires from home-care workers’ point of view. We reconstructed how home-care workers perceive and define the profession, and understand the necessary skills required from their point of view. Our results show that the professional profile of home-care workers still remains poorly defined and that professionals themselves struggle to find value and recognition, and to articulate what the skill set they develop is formed of. (shrink)

Many different professionals play a key role in maintaining welfare in a welfare society. These professionals engage in moral judgements when using (new) technologies. In doing so, they achieve that radical responsibility towards the other that Levinas describes as being at the very core of ethics. Also, professionals try to assess the possible consequences of the involvement of specific technologies and adjust their actions in order to ensure ethical responsibility. Thus, ethics is necessary in order to obtain and sustain (...) one's professionalism. This presents care institutions with the challenge to design work processes and technology work in ways that include a sense of ‘the Other’ and make moral judgement an indispensable part of professional competence in technology. This article provides new understandings of the way ethics are involved in care institutions. Nurses’ moral judgements are sophisticated with regard to ethical perspectives. In hospitals, nurses combine Latour's notion of symmetry in human/technology relations with an ethics implying ethical priority to human beings over other beings. This combination of ethics is not only sophisticated; it is also paradoxical, as it puts together mutually contradictory ethics. Instead of causing moral confusion, this ethical paradox is employed to produce a particularly refined notion of care situations, allowing nurses’ care to include patients and technology alike. (shrink)

I develop two different epistemic roles for emotion and desire. Caring for moral ends and people plays a pivotal though contingent role in ensuring reliable awareness of morally salient details; possession of various emotions and motives is a necessary condition for autonomous understanding of moral concepts themselves. Those who believe such connections compromise the "objective" status of morality tend to assume rather than argue for the bifurcated conception of reason and affect this essay challenges.

“Intervention” is not synonymous with “care.” For an intervention to constitute care—which patients should have a right to access—it must be technically feasible and licit. Now these criteria do not prove sufficient; numerous archaic interventions remain feasible and legally permissible, yet are now bywords for spurious care. Therefore, we propound another necessary condition for an intervention to become care: the physician must rationally judge the intervention to be conducive to the patient’s good. Consequently, the right (...) of access-to-care relies on physicians being free to practice medicine in accord with their consciences, conscience being the rational faculty with which they judge the reasonableness of even mundane medical decisions. Since physicians operate as part of a community, it is further necessary to consider when central bodies may reasonably compel physicians to engage in interventions that the physician believes are not consistent with the patient’s good and/or are not congruent with the purposes of medicine. (shrink)

Nurse practitioners can ease increased pressure on primary care shortage while providing a cost-effective and high-quality alternative to certain physician services. However, scope-of-practice laws are restrictive and their modification remains a source of controversy. Clearly, there is a need for new thinking around the scope of practice debate. This article conducted a review of literature and laws concerning the nursing scope of practice, as well as the outcomes of nurse-led care coordination models. It also examined different manifestations of (...) the controversy that arises in scope of practice debates. We argue that improved care coordination is necessary to improve outcomes and “bend the cost curve downward.” Allowing nurse practitioners and other providers to practice to the full extent of their licenses will result in improved care coordination. This can be accomplished by expanding nursing and other providers' scopes of practice. But any health care reform strategy, particularly with respect to chronic care management, must also serve to activate the patient herself as the keystone in the coordinated care process. Focusing first on the patient's need for coordinated care may be what is necessary to move beyond the existing impasse between physicians and nurses on scope of practice expansion. (shrink)

In this short essay I express my own deep sympathy with Nel Noddings’s ethic of care and applaud her stubborn resistance in Happiness and Education to what John Dewey would have called false dualisms, such as those between intelligence and emotion, theory and practice, or vocation and academic studies.However, I question whether the sort of caring relation she depicts so beautifully in this and many other books is sufficiently robust to alone carry the weight of the moral life that (...) she supports, and whether her suspicion of community, while sounding important cautions, does not leave us with an ethical vision that is too thin to deliver the sort of education she prescribes. To this end, I argue that she judges Victor Frankl’s conception of freedom too harshly and his response to human suffering with an uncharacteristic lack of charity. Following well-known communitarian arguments of MichaelWalzer and CharlesTaylor I suggest that some account of a situated human agent who can choose freely to enter into relation is necessary to sustain the role of caring in education that has been Noddings most significant philosophical contribution. (shrink)

In a recent paper, Graf and Komatsu (1994) argued that the process dissociation procedure (Jacoby, 1991) is limited in its ability to separate and measure conscious and unconscious forms of memory and so should be "handIed with caution". Given that the study of unconscious influences has always posed a difficult problem for memory researchers, we agree with the general emphasis on caution. In this paper, we too advocate caution, especially as it applies to the use of indirect tests, assessing Graf (...) and Komatsu’s critique, and using the process dissociation procedure. We address the substantive issues raised by Graf and Komatsu and also point out the errors, both factual and logical, in their paper. Any method proposing to provide separate measures of conscious and unconscious influences requires judicious use and a careful examination of its underlying assumptions. The assumptions underlying the process dissociation framework are supported by a large number of experiments spanning a diverse range of.. (shrink)

Dependency care is an asymmetric good; everyone needs to receive it, but it is not the case that we all have to provide it. Despite ethicists’ of care’s theorizing about the importance of dependency care, it has yet to be theorized within a form of liberalism. This paper theorizes two components of a liberal theory of dependency care. First, it advances a liberal justification to include the receipt of dependency care among the benefits of social (...) cooperation. Then, it advances an autonomy-based principle to guide how care should be provided (“strong proceduralism”). Strong proceduralism is based on an account of autonomy that incorporates the significance of a person’s skills when he parses options. Strong proceduralism consequently requires educational efforts to teach care-giving skills to groups who have not previously possessed them. I hypothesize that strong proceduralism will secure adequate care provision as the outcome of autonomous choice, but if an inadequate number of people choose to provide care, then a secondary stage of deliberations will be necessary. If the outcome of those secondary deliberations is that people want to have their care needs met, then a fair process for distributing infringements on autonomy must be devised. (shrink)