Care theorists have made significant gains over the past twenty-five years in establishing caring as a viable moral and political concept. Nonetheless, the concept of caring remains underdeveloped as a basis for a moral and political philosophy, and there is no fully developed account of our moral obligation to care. This article advances thinking about caring by developing a definition of caring and a theory of obligation to care sufficient to ground a general moral and (...) political philosophy. (shrink)

: Care theorists have made significant gains over the past twenty-five years in establishing caring as a viable moral and political concept. Nonetheless, the concept of caring remains underdeveloped as a basis for a moral and political philosophy, and there is no fully developed account of our moral obligation to care. This article advances thinking about caring by developing a definition of caring and a theory of obligation to care sufficient to ground a general moral (...) and political philosophy. (shrink)

A continuing need for care for elderly, combined with looser family structures prompt the question what filial obligations are. Do adult children of elderly have a duty to care? Several theories of filial obligation are reviewed. The reciprocity argument is not sensitive to the parent–child relationship after childhood. A theory of friendship does not offer a correct parallel for the relationship between adult child and elderly parent. Arguments based on need or vulnerability run the risk of being (...) unjust to those on whom a needs-based claim is laid. To compare filial obligations with promises makes too much of parents’ expectations, however reasonable they may be. The good of being in an unchosen relationship seems the best basis for filial obligations, with an according duty to maintain the relationship when possible. We suggest this relationship should be maintained even if one of the parties is no longer capable of consciously contributing to it. We argue that this entails a duty to care about one’s parents, not for one’s parents. This implies that care for the elderly is not in the first place a task for adult children. (shrink)

A continuing need for care for elderly, combined with looser family structures prompt the question what filial obligations are. Do adult children of elderly have a duty to care? Several theories of filial obligation are reviewed. The reciprocity argument is not sensitive to the parent–child relationship after childhood. A theory of friendship does not offer a correct parallel for the relationship between adult child and elderly parent. Arguments based on need or vulnerability run the risk of being (...) unjust to those on whom a needs-based claim is laid. To compare filial obligations with promises makes too much of parents’ expectations, however reasonable they may be. The good of being in an unchosen relationship seems the best basis for filial obligations, with an according duty to maintain the relationship when possible. We suggest this relationship should be maintained even if one of the parties is no longer capable of consciously contributing to it. We argue that this entails a duty to care about one’s parents, not for one’s parents. This implies that care for the elderly is not in the first place a task for adult children. (shrink)

It has often been argued that Foucault’s turn to antique and early Christian care of the self, spiritual self-.practices and truth-telling (parrhesia) results from inquiries into the confession practices and pastoral power structures in the context of a genealogy of the desiring subject. This line of reasoning is in itself not incorrect, but – this article claims – needs to be complemented with an account of Foucault’s philosophical quest for freedom and for conditions, possibilities and modes of thinking and (...) acting differently vis-à-vis the normalizing regimes of power in science and, hence, in philosophy as an academic discipline. In this context a first turn to antique philosophy seen as a ‘way of life’ constructed through ascetic practices can be detected already writings from the late 1960s and early 1970s. Although indeed the project of the history of sexuality moved in a direction than Foucault had foreseen in the first volume published in 1976, earlier reflections on the need for free and critical philosophical thought relative to scientific ‘disciplines’ already prelude the later inquiries into care of the self, self-practices and parrhesia as productive for a critical philosophical attitude. (shrink)

Growing interest in embedded research approaches—where research is incorporated into clinical care—has spurred numerous studies to generate knowledge relevant to the real-world needs of patients and other stakeholders. However, it also has presented ethical challenges. An emerging challenge is how to understand the nature and extent of investigators’ obligations to patient-subjects. Prior scholarship on investigator duties has generally been grounded upon the premise that research and clinical care are distinct activities, bearing distinct duties. Yet this premise—and its corresponding (...) implications—are challenged when research and clinical care are deliberately integrated. After presenting three case studies from recent pragmatic clinical trials, we identify six differences between explanatory trials and embedded research that limit the application of existing scholarship for ascertaining investigator duties. We suggest that these limitations indicate a need to account for the implications of usual care and to move beyond a narrow focus on the investigator-subject dyad, one that better reflects the team- and institution-based nature of contemporary health systems. (shrink)

On 11 March 2011, Japan experienced a major disaster brought about by a 9.0-magnitude earthquake and a massive tsunami that followed. This disaster caused extensive damage to the Fukushima Daiichi nuclear power plant with the release of a large amount of radiation, leading to a crisis level 7 on the International Atomic Energy Agency scale. In this report, we discuss the obligations of physicians to provide care during the initial weeks after the disaster. We appeal to the obligation (...) of general beneficence and argue that physicians should go to disaster zones only if there is no significant risk, cost or burden associated with doing so. We conclude that physicians were not obligated to go to Fukushima given the high risk of radiation exposure and physical and psychological harm. However, we must acknowledge that there were serious epistemic difficulties in accurately assessing the risks or benefits of travelling to Fukushima at the time. The discussion that follows is highly pertinent to all countries that rely on nuclear energy. (shrink)

Objectives: To report the attitudes and opinions of subjects in US clinical trials about whether or not, and why, they should receive post-trial access (PTA) to the trial drug, care and information. Design: Focus groups, short self-administered questionnaires. Setting: Boston, Dallas, Detroit, Oklahoma City. Participants: Current and recent subjects in clinical trials, primarily for chronic diseases. Results: 93 individuals participated in 10 focus groups. Many thought researchers, sponsors, health insurers and others share obligations to facilitate PTA to the trial (...) drug, if it benefited the subject, or to a therapeutic equivalent. Some thought PTA obligations include providing transition care (referrals to non-trial physicians or other trials, limited follow-up, short-term drug supply) or care for long-term adverse events. Others held, in contrast, that there are no PTA obligations regarding drugs or care. However, there was agreement that former subjects should receive information (drug name, dosage received, market approval date, long-term adverse effects, trial results). Participants frequently appealed to health need, cost, relationships, reciprocity, free choice and sponsor self-interest to support their views. Many of their reasons overlapped with those commonly discussed by bioethicists. Conclusion: Many participants in US trials for chronic conditions thought there are obligations to facilitate PTA to the trial drug at a “fair” price; these views were less demanding than those of non-US subjects in other studies. However, our participants’ views about informational obligations were broader than those of other subjects and many bioethicists. Our results suggest that the PTA debate should expand beyond the trial drug and aggregate results. (shrink)

A dominant area of inquiry within intergenerational ethics concerns how goods ought to be justly distributed between noncontemporaries. Contractualist theories of justice that have broached these discussions have often centered on the concepts of mutual advantage and reciprocal cooperation between rational, self‐interested beings. However, another prominent reason that many in the present feel that they have obligations toward future generations is not due to self‐interested reciprocity, but simply because they care about what happens to them. Care ethics promises (...) to be conceptually well‐suited for articulating this latter reason: given that future generations are in a perpetual condition of dependency on present‐day people's actions, this is precisely the kind of relational structure that care theorists should be interested in morally evaluating. Unfortunately, the care literature has been largely silent on intergenerational ethics. This article aims to advance this literature, offering the blueprints of what a care ethic concerning future generations—a “future care ethic”—should look like. The resultant ethic defends a sufficientarian theory of obligation: people in the present ought to ensure the conditions needed to encourage and sustain a world that enables good caring relations to flourish. (shrink)

Some moral philosophers in the West hold that adult children have no more moral obligation to support their elderly parents than does any other person in the society, no matter how much sacrifice their parents made for them or what misery their parents are presently suffering. This is because children do not ask to be brought into the world or to be adopted. Therefore, there is a "basic asymmetry between parental and the filial obligations." I argue against the Daniels/English (...) thesis by employing the traditional Confucian view of the nature of filial obligation. On the basis of a distinction between 'moral duty' and 'moral responsibility' and the Confucian concept of justice, I argue that the filial obligation of adult children to care respectfully for their aged parents is not necessarily self-imposed. I conclude that due to the naturalistic character of the family, the nature of our familial obligations cannot be consensual, contractarian and voluntarist, but instead existential, communal and historical. (shrink)

We argue that individuals who have access to vaccines and for whom vaccination is not medically contraindicated have a moral obligation to contribute to the realisation of herd immunity by being vaccinated. Contrary to what some have claimed, we argue that this individual moral obligation exists in spite of the fact that each individual vaccination does not significantly affect vaccination coverage rates and therefore does not significantly contribute to herd immunity. Establishing the existence of a moral obligation (...) to be vaccinated despite the negligible contribution each vaccination can make to the realisation of herd immunity is important because such moral obligation would strengthen the justification for coercive vaccination policies. We show that two types of arguments—namely a utilitarian argument based on Parfit’s Principle of Group Beneficence and a contractualist argument—can ground an individual moral obligation to be vaccinated, in spite of the imperceptible contribution that any single vaccination makes to vaccine coverage rates. We add a further argument for a moral obligation to be vaccinated that does not require embracing problematic comprehensive moral theories such as utilitarianism or contractualism. The argument is based on a “duty of easy rescue” applied to collectives, which grounds a collective moral obligation to realise herd immunity, and on a principle of fairness in the distribution of the burdens that must be borne to realise herd immunity. (shrink)

The rapid growth of next-generation genetic sequencing has prompted debate about the responsibilities of researchers toward genetic incidental findings. Assuming there is a duty to disclose significant incidental findings, might there be an obligation for researchers to actively look for these findings? We present an ethical framework for analyzing whether there is a positive duty to look for genetic incidental findings. Using the ancillary care framework as a guide, we identify three main criteria that must be present to (...) give rise to an obligation to look: high benefit to participants, lack of alternative access for participants, and reasonable burden on researchers. Our analysis indicates that there is no obligation to look for incidental findings today, but during the ongoing translation of genomic analysis from research to clinical care, this obligation may arise. (shrink)

In the United States, disease screening is offered to the public as a consumer service. It has been proposed that the act of “consumption” is a manifestation of agency and that the decision to consume is an exercise of autonomy. The enthusiasm of the American public for disease screening and the expansion in the demand for all sorts of disease screening in recent years can be viewed as an expression of such autonomy. Here, we argue that the enthusiasm for disease (...) screening witnessed in the American public today may be more a reflection of the constraint on autonomy than its facilitation. It is our opinion that the articulation of socio-historical processes has contributed to a moral imperative which is reflected in the decision making of individuals around disease screening. We suggest medical and health professionals have a responsibility to facilitate the exercise of individual autonomy in health care decision making as an integral component of professional obligation. These professionals need to problematise healthcare activities that constrain individual autonomy. (shrink)

Clinicians at quaternary centers see part of their mission as providing hope when others cannot. They tend to see sicker patients with more complex disease processes. Part of this mission is offering longshot treatment modalities that are unlikely to achieve their stated goal, but conceivably could. When patients embark on such a treatment plan, it may fail. Often treatment toward an initial goal continues beyond the point at which such a goal is feasible. We explore the progression of care (...) from longshot to fantasy using two pediatric cases. This progression may be differentiated into four distinct stages of care related to the potential of achieving the initial goals of care. Physicians are often ill prepared for the progression of treatments from a longshot hope to an unfeasible and, therefore, typically unjustified intervention. We present a structured approach to guide clinicians at referral institutions where these situations may be common. The transition of care from “longshot” to “fantasy” is an inherent part of quaternary care for the sickest of patients that has been underexplored. Physicians are often poorly equipped to approach that transition. We advocate this approach to the shift from longshot to fantasy with the belief that such a structured method will have multiple benefits, including: reduced suffering for the patient; decreased emotional burden on patient and family; decreased provider moral distress; increased likelihood of seeking high quality palliative care earlier; and provision of honest and straightforward information to patients and their families. (shrink)

Some feminist philosophers criticize the idea of human rights because, they allege, it encapsulates male bias; it is therefore misguided, in their view, to extend moral rights to non-human animals. I argue that the feminist criticism is misguided. Ideas are not biased in favour of men simply because they originate with men, nor are ideas themselves biased in favour of men because men have used them prejudicially. As for the position that women should abandon theories of rights and embrace an (...) ethic that emphasizes care: women who made this choice would not so much liberate themselves from the patriarchy as they would conform to its representation of women as emotional, subjective and irrational. There is, then, no good reason to withhold ascribing rights to non-human animals, based on the criticisms of rights made by some feminists. (shrink)

I offer a very qualified argument to the effect that rights are grounded in a certain sort of prejudice that privileges individualistic and perhaps masculinist ways of thinking about moral life. I also propose that we look carefully at other conceptions of social ontology and moral life, including the much discussed care conception.

Hastings Center Report, Volume 52, Issue 3, Page 29-31, May–June 2022.

Henry Richardson has recently published the first book ever devoted to ancillary care obligations, which roughly concern what medical researchers are morally required to provide to participants beyond what safety requires. In it Richardson notes that he has presented the ‘only fully elaborated view out there’ on this topic, which he calls the ‘partial-entrustment model’. In this article, I provide a new theory of ancillary care obligations, one that is grounded on ideals of communion salient in the African (...) philosophical tradition and is intended to rival and surpass Richardson’s model, which is a function of Western considerations of autonomy. I argue that the relational approach of the former has several virtues in comparison to the basic individualism of the latter. (shrink)

The paper is an attempt to review the basis for the claim that physicians have a professional obligation to treat AIDS patients. Considered are the historical record, two professional codes of ethics, and several recent articles. The paper concludes that the arguments considered, which attempt to support the claim that physicians have an obligation to treat, fail. It is suggested, rather, that common humanity, which physicians share with those who suffer from AIDS, ought to be the basis for (...) engaging in the care of AIDS patients. (shrink)

The HIV/AIDS epidemic is increasingly a diseaseof the disadvantaged, a destroyer of nations,and a threat to global security and well-being.But this need not be so: the world has thescientific knowledge, technologicalinnovations, and financial resources tosignificantly reduce the spread and sufferingcaused by the disease. This paper argues thatthe wealthy nations of the world, led by theUnited States, have a moral obligation to offermuch greater assistance to developing countrieswhere the epidemic is most severe. UsingZimbabwe as a case study, this essay examinesthe (...) immediate and underlying factors behind theepidemic in order to make realistic andaffordable policy recommendations that includenew investments in global health care, debtrelief, and long-term economic development. Bydemonstrating our ability to dramaticallyaffect the future course and consequences ofthis unprecedented epidemic, the paperconcludes that greater action is not only inthe interest of public health, but is also amoral imperative. By investing the necessaryresources to improve public health and toreduce global poverty, we promote and extendthe fundamental rights and values that weprofess to hold dear. (shrink)

This paper gives a review of the academic literature on the duty to care during epidemics and the question of how much risk has to be accepted by medical personnel during their work. It will then address ask to what extent military personnel have this duty in the same way as their civilian counterparts or whether military health care personnel might act under a different moral obligation – with more or less encompassing or at least different duties.

As a result of the coronavirus (COVID‐19) pandemic, health professionals are faced with situations they have not previously encountered and are being forced to make difficult ethical decisions. As the first group to experience challenges of caring for patients with coronavirus, Chinese nurses endure heartbreak and face stressful moral dilemmas. In this opinion piece, we examine three related critical questions: Whether society has the right to require health professionals to risk their lives caring for patients; whether health professionals have the (...) right to refuse to care for patients during the coronavirus pandemic; and what obligations there are to protect health professionals? Value of care, community expectations, legal obligations, professional and codes of practice may compel health professionals to put themselves at risks in emergency situations. The bioethical principles of autonomy, justice, beneficence and non‐maleficence, as well as public health ethics, guide nurses to justify their decisions as to whether they are entitled to refuse to treat COVID‐19 patients during the pandemic. We hope that the open discussion would support the international society in addressing similar ethical challenges in their respective situations during this public health crisis. (shrink)

The operating assumption in mostdiscussions of health policy is that governmenthas some responsibility for the health of itscitizens and that it may legitimately tax,subsidize, and regulate its citizens in theexercise of that responsibility. On thisassumption, public obligations to HIV/AIDSpatients are a function of their needs inrelationship to other health needs. This paperchallenges the operating assumption by arguingthat it cannot be grounded in the obligationsthat individuals have to each other.The paper rests on its own assumption: themoral theory of individualism. On this (...) theory,individuals are ends in themselves who have theright to choose their own actions and uses oftheir resources; they do not have unchosenobligations to help others. In regard toHIV/AIDS patients, consequently, individualshave no duty to help, nor any other obligationbeyond that of respecting their rights; andthere is no valid basis for governmentregulations or subsidies on their behalf.The paper argues against the two approachescommonly used to defend a more expansive viewof individual obligations and the role ofgovernment. The first is the assumption ofwelfare rights to goods and services; thesecond is the assumption that distributivejustice requires some redistribution of healthcare resources. (shrink)

In this paper, we argue that providers who conscientiously refuse to provide legal and professionally accepted medical care are not always morally required to refer their patients to willing providers. Indeed, we will argue that refusing to refer is morally admirable in certain instances. In making the case, we show that belief in a sweeping moral duty to refer depends on an implicit assumption that the procedures sanctioned by legal and professional norms are ethically permissible. Focusing on examples of (...) female genital cutting, clitoridectomy and ‘normalizing’ surgery for children with intersex traits, we argue that this assumption is untenable and that providers are not morally required to refer when refusing to perform genuinely unethical procedures. The fact that acceptance of our thesis would force us to face the challenge of distinguishing between ethical and unethical medical practices is a virtue. This is the central task of medical ethics, and we must confront it rather than evade it. There are no data in this work. (shrink)

Contemporary ethical and political discourses frequently refer to the moral force of needs as justifying access to resources and rights to goods. Can needs make normative claims on anyone, and if so, how? What obligations do moral agents have to respond to the needs of other people? As finite creatures, humans inevitably experience need. Certain kinds of needs, namely fundamental needs, must be met if individuals are to avoid the harm of compromised agency. Fundamental needs involve agency-threatening events or circumstances (...) to which another must respond in order to cultivate, sustain or restore the agency of the one in need. I establish that fundamental needs have moral significance through an argument demonstrating the good of agency. I develop a robust account of agency, one that moves beyond the traditional identification of agency with rational capacities, to incorporate both emotional and relational abilities. Following the Kantian duty of beneficence, I then argue that our mutual and inevitable interdependence gives rise to a duty to care for the fundamental needs of others. Next, drawing upon care ethics, I suggest that moral agents are obligated not only to meet fundamental needs present in others, but also to do so in a manner indebted to forms of dignifying care. It is not enough that we meet the needs of others. How we do so carries with it the conferral or denial of dignity and inclusion in a moral community. Finally, I demonstrate the applied ethical import of the foregoing theoretical account by discussing practices of caring for the fundamental needs of elderly individuals, who are often relegated to the margins of agency. Specifically, I consider two cases: recommended rationing of healthcare resources for the elderly and filial obligation. (shrink)

Solnica et al argue that “Jewish law and modern secular approaches based on professional responsibilities obligate physicians to care for all patients even those with communicable diseases”. The authors base their viewpoint on the opinion of Rabbi Eliezer Waldenberg and apply it to suggest that physicians are obligated to endanger themselves during epidemics, such as COVID-19. It is argued that Solnica et al’s analysis of Rabbi Waldenberg’s text and their conclusion that healthcare workers are obligated to endanger themselves while (...) treating patient who suffer from contagious illness during epidemics according to Jewish law suffer from various shortcomings. Indeed, Jewish law looks favourably on healthcare workers who take a reasonable risk in treating their patients in the context of epidemics. However, it is considered a voluntary supererogatory act—not obligatory. Solnica et al may express a legitimate ethical viewpoint. However, it does not seem to represent the mainstream approach of what Jewish law would demand as obligatory from its practitioners. (shrink)

It has been 40 years since the seminal papers on pharmacy's status as a profession sparked debate about the pharmacist's role in health care, yet the questions they raised are just as poignant today as they were then. Questions about whether pharmacists are the experts when it comes to drug therapy information can be answered practically by assessing the perception of pharmacists' obligations to patients as being dependent on or independent of physicians' responsibilities. Both options have important implications for (...) pharmacy's status as a profession, the value that pharmacists can add to health care, and a pharmacist's right to deny a patient emergency contraception. (shrink)

The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C (...) transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration. (shrink)

Some authors argue that the ethics of medical care and the ethics of research differ, and that it is a mistake to conflate the two. They propose “that medical research and medical treatment are two distinct forms of activities, governed by different ethical principles.” This raises the question of whether physicians who are also clinical investigators may separate their role as physician from that of researcher when they are involved in clinical trials, thereby avoiding the obligations required in the (...) physician-patient relationship. Miller and Brody suggest that medical training is to blame for what they believe is the physicians’ tendency to confound the obligations of research and practice. “Physician-investigators, after all, went to medical school” they explain. They believe that considering research with patients outside the ethical framework of the physician-patient relationship may be “difficult and threatening” to physicians who have “psychological needs” to consider the ethical obligations flowing from their relationship with their patients. (shrink)

Some authors argue that the ethics of medical care and the ethics of research differ, and that it is a mistake to conflate the two. They propose “that medical research and medical treatment are two distinct forms of activities, governed by different ethical principles.” This raises the question of whether physicians who are also clinical investigators may separate their role as physician from that of researcher when they are involved in clinical trials, thereby avoiding the obligations required in the (...) physician-patient relationship. Miller and Brody suggest that medical training is to blame for what they believe is the physicians’ tendency to confound the obligations of research and practice. “Physician-investigators, after all, went to medical school” they explain. They believe that considering research with patients outside the ethical framework of the physician-patient relationship may be “difficult and threatening” to physicians who have “psychological needs” to consider the ethical obligations flowing from their relationship with their patients. (shrink)

Reprint of an article that first appeared in Theoretical Medicine and Bioethics (2017).

The preventative paradigm of preconception care is receiving increasing attention, yet its boundaries remain vague in three respects: temporally; agentially; and instrumentally. Crucially, it remains unclear just who is to be considered a ‘potential parent’, how soon they should take up preconception responsibilities, and how weighty their responsibilities should be.

One might think that parental obligation to children ends with the end of childhood. I argue that if we consider why parents are obligated to their children, we will see that this view is false. Creating children exposes them to life’s risks. When we expose others to risks, we are often obligated to minimize damages and compensate for harms. Life’s risks last a lifetime, therefore parental obligation to one’s children does too. Grown children’s autonomy, and grown children’s independent (...) responsibility for some of their own problems, can sometimes limit what parental responsibility demands of parents but it doesn’t do away with the responsibility. I argue that my conclusions are not as counterintuitive as they might initially seem. I also consider the implications that parental obligation to grown children might have on the oft assumed obligation that grown children have to care for their parents. (shrink)

Since Oregon implemented its Death with Dignity Act, many additional states have followed suit demonstrating a growing understanding and acceptance of aid in dying processes. Traditionally, the patient has been the one to request and seek this option out. However, as Death with Dignity acts continue to expand, it will impact the role of physicians and bring up questions over whether physicians have the ethical obligation to facilitate a conversation about AID with patients during end of life discussions. Patients (...) have the right to make informed decisions about their health, which implies that physicians have an obligation to discuss with and inform patients of the options that will accomplish the patients’ goals of care. We will argue that physicians have an ethical obligation to inform certain patients about AID during end of life care discussions. We will also address what this obligation encompasses and explore guidelines of when and how these conversations should occur and proceed. Earlier guidelines, presented by various palliative care and ethics experts, for proceeding with such conversations have mostly agreed that the discussion of hospice and end of life care with patients should be initiated early and that the individual goals of a patient during the remaining duration of life should be thoroughly examined before discussion of appropriate options. In discussing AID, physicians should never recommend but inform patients about the basics so that they can make an informed decision. If patients express further interest in AID, the physician should open up the dialogue to address the reasoning behind this decision versus other possible treatments to ensure that patients clearly comprehend the process and implications of their decision. Ultimately, any end of life choice should be made by patients with the full capacity to express what they envision for the remaining duration of life and to comprehend the advantages and disadvantages of all the possible options. (shrink)

Undocumented and undomiciled, Gustavo Jiménez had been in the United States for several years. He knew his leg wasn’t right when it began to swell and redden. After the cellulitis spread to his bloodstream, he was found unconscious on the street and admitted to the intensive care unit. He improved quickly and was soon able to tell a social worker his name and that he had family in Quito. Then his health took a turn for the worse, and he (...) developed multisystem organ failure. His doctors believed his prognosis grave and further care futile. They wanted to invoke a provision under their state’s law that allows, at the discretion of at least two physicians, for the withdrawal of life‐sustaining therapy for isolated and decisionally incapacitated patients, but the social worker had ethical concerns about the doctors’ desire to make such a momentous decision without family input. She asked for a “time‐out to locate his family,” but one of the doctors asserted, “His family isn’t here, and you’ll never find them. Besides we need the bed. The ER is full of patients we can help.” What is owed a patient and family in such a situation? (shrink)

The relationship between dementia and criminal behavior perplexes legal and health care systems. Dementia is a progressive clinical syndrome defined by impairment in at least two cognitive domains that interferes with one's activities of daily. Dementia symptoms have been associated with behaviors that violate social norms and constitute criminal actions. A failure to address a gap in policies that support appropriate management of individuals with dementia reflects a failure in our social obligation to care for those who (...) are most vulnerable amongst us. Categorical protections, informed by precedent models applied to juveniles and individuals with psychiatric illness, could help meet a social obligation to provide protections to individuals with dementia. We propose an approach that integrates affirmative defenses to mitigate criminal liability and sentencing restrictions to prevent cruel and unusual punishment. (shrink)

An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children are likely to (...) become involved in the caring process and informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care and the subsequent impact on the care recipient and formal- and informal care providers. (shrink)

End-of-life medical decision making presents a major challenge to patients and physicians alike. In order to determine whether it is ethically justifiable to forgo medical treatment in such scenarios, clinical data must be interpreted alongside patient values, as well as in light of the physician's ethical commitments. Though much has been written about this ethical issue from religious perspectives , little work has been done from an Islamic point of view. To fill the gap in the literature around Islamic bioethical (...) perspectives on the matter, we derive a theologically rooted rubric for goals of care. We use the Islamic obligation for Muslims to seek medical treatment as the foundation for determining the clinical conditions under which Muslim physicians have a duty to treat. We next link the theological concept of accountability before God to quality-of-life assessment. Using this construct, we suggest that a Muslim physician is not obligated to maintain or conti.. (shrink)

The contention of this article is that parents do have obligations to care for their children, but for reasons that are not typically offered. I argue that this obligation to care for one’s children is unfair to parents but not unjust. I do not provide a detailed account of what our obligations are to our children. Rather, I focus on providing a justification for any obligation to care for them at all.

Reprint of an article that appeared in Theoretical Medicine and Bioethics (2017).

A particularly strong reason to vaccinate against transmittable diseases, based on considerations of harm, is to contribute to the realization of population-level herd immunity. We argue, however, that herd immunity alone is insufficient for deriving a strong harm-based moral obligation to vaccinate in all circumstances, since the obligation significantly weakens well above and well below the herd immunity threshold. The paper offers two additional harm-based arguments that, together with the herd immunity argument, consolidates our moral obligation. First, (...) we argue that individuals should themselves aim not to expose others to risk of harm, and that this consideration becomes stronger the more non-vaccinated people there are, i.e., the further we are below herd immunity. Second, we elaborate on two pragmatic reasons to vaccinate beyond the realization of herd immunity, pertaining to instability of vaccination rates and population heterogeneity, and argue that vaccinating above the threshold should serve as a precautionary measure for buttressing herd immunity. We also show that considerations of harm have normative primacy in establishing this obligation over considerations of fairness. Although perfectly sound, considerations of fairness are, at worst secondary, or at best complementary to considerations of harm. (shrink)

Healthcare workers carry a substantial risk of harm from infectious disease, particularly, but not exclusively, during outbreaks. More can be done by healthcare institutions to identify risks, quantify the current burden of preventable infectious disease amongst HCWs and identify opportunities for prevention. We suggest that institutional obligations should be clarified with respect to the mitigation of infectious disease risks to staff, and question the duty of HCWs to care while healthcare institutions persist with a reactive rather than proactive attitude (...) to infectious disease threats. (shrink)

The federal government has a generally unquestioned obligation to provide health care to veterans for diseases or disabilities acquired during military service. Much argued, however, is the government's obligation to offer care for nonservice‐connected disorders. The Reagan administration has sharpened the debate recently by attempting to impose a means test on veterans over sixty‐five who are seeking such care. But the controversy focuses on the wrong issue. Society has a moral obligation to provide adequate (...) health care to all citizens but has no special obligation to care for nonservice‐connected health problems of veterans. (shrink)

In this paper the authors address the recent argument that we have an obligation to seek or actively bring about our own death when we burden others too greatly. Some of the problems with this argument and some of the practical conseqeuences of adopting such a point of view are discussed in this paper. We argue that the argument rests on an individualistic approach which sees the family being burdened as standing alone instead of seeing it as embedded in (...) a burden-sharing community. (shrink)

After the typical theological and bioethical questions about in vitro fertilization (IVF) are vetted, there remains a three-dimensional understanding of responsibility that is not typically considered in Christian bioethics. This paper will explore responsibility to the spouses’ loving union, their bodies, and society in order to ascertain the morality of IVF. In a marriage partnership, the spouses’ primary responsibility is to each other. Although in matrimony physical union is essential to marriage, children are not. The second dimension of responsibility focuses (...) on the body—“the temple of God”—and on our responsibility to care for it. This concerns the woman, her husband, and even the newborn. Finally, the third understanding of responsibility leads us to address social concerns, with an emphasis on social dynamics, especially the cost of IVF procedures and how they siphon medical resources away from more urgent human needs in health care and within society. (shrink)

Background Duty to care is integral to nursing practice. Personal obligations that normally conflict with professional obligations are likely amplified during a public health emergency such as COVID-19. Organizations can facilitate a nurse’s ability to fulfill the duty to care without compromising on personal obligations. Research Aim The study aimed to explore the relationships among duty to care, perception of supportive environment, perceived stress, and COVID-19-specific anxieties in nurses working directly with COVID-19 patients. Research Design The study (...) design was a cross-sectional descriptive study using an online survey. It was conducted at an ANCC Magnet® designated 385-bed acute care teaching hospital located in a suburban area. Participants and Research Context Included in this study were 339 medical surgical nurses working directly with COVID-19 patients during the early phase of the pandemic. Ethical Considerations The study was reviewed by the institution’s clinical research committee and determined to be exempt. A survey invitation letter with a voluntary implied consent agreement was sent to participants with a description of the research study attached to the anonymous survey. Results Nurses with specific COVID-19-related anxieties were more likely to agree that it was ethical to abandon the workplace during a pandemic. Conclusions Organizations can and ought to mitigate the negative effects of COVID-19 on duty to care in future pandemics and healthcare emergencies by incorporating several recommendations derived from this study. (shrink)