The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What’s more, given the stage of their development and lack of (...) standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future. (shrink)

Background:In the face of scarcity, nurses may inevitably delay or omit some nursing interventions and give priority to others. This increases the risk of adverse patient outcomes and threatens safety, quality, and dignity in care. However, it is not clear if there is an ethical element in nursing care rationing and how nurses experience the phenomenon in its ethical perspective.Objectives:The purpose was to synthesize studies that relate care rationing with the ethical perspectives of nursing, and find the deeper, moral meaning (...) of this phenomenon.Research design:A systematic review and thematic synthesis of qualitative studies was used. Searching was based on guidelines suggested by Joana Brigs Institute, while the synthesis has drawn from the methodology described. Primary studies were sought from nine electronic databases and manual searches. The explicitness of reporting was assed using consolidated criteria for reporting qualitative research. Nine studies involving 167 nurse participants were included. Synthesis resulted in 35 preliminary themes, 14 descriptive themes, and four analytical themes. Discussion of relationships between themes revealed a new thematic framework.Ethical consideration:Every effort has been taken, for the thoroughness in searching and retrieving the primary studies of this synthesis, and in order for them to be treated accurately, fairly and honestly and without intentional misinterpretations of their findings.Discussion:Within limitations of scarcity, nurses face moral challenges and their decisions may jeopardize professional values, leading to role conflict, feelings of guilt, distress and difficulty in fulfilling a morally acceptable role. However, more research is needed to support certain relationships.Conclusions:Related literature is limited. The few studies found highlighted the essence of justice, equality in care and in values when prioritizing care—with little support to the ethical effects of rationing on nurses. Further research on ethical dimension of care rationing may illuminate other important aspects of this phenomenon. (shrink)

In recent decades, care has played an increasingly crucial role in the self-understanding of the human being in the West. Nevertheless, there is a great deal of confusion and uncertainty surrounding the notion of care. One of the focal points of critics is the normativity of care. To what extent does care have an obligatory character? Only when the objective normative basis of care is sufficiently clarified, care practices can be evaluated and optimised from an ethical perspective. In this contribution (...) we explain how the anthropology of personalism could bring us closer to the normative core of care. The paper starts with a general overview of the contribution of care ethics in healthcare and the problems in relation to the normativity of care. Thereafter, we set the viewpoints of the Louvain tradition of personalism apart en show that this view on the human person is in keeping with a few basic principles of care ethics. Next, we describe how a personalist approach to care ethics can indeed indicate in which direction action must be taken so that human action may be considered ethically sound. (shrink)

It should not be a surprise in the near future to encounter either a personal or a professional service robot in our homes and/or our work places: according to the International Federation for Robots, there will be approx 35 million service robots at work by 2018. Given that individuals will interact and even cooperate with these service robots, their design and development demand ethical attention. With this in mind I suggest the use of an approach for incorporating ethics into the (...) design process of robots known as Care Centered Value Sensitive Design. Although this approach was originally and intentionally designed for the healthcare domain, the aim of this paper is to present a preliminary study of how personal and professional service robots might also be evaluated using the CCVSD approach. The normative foundations for CCVSD come from its reliance on the care ethics tradition and in particular the use of care practices for: structuring the analysis and, determining the values of ethical import. To apply CCVSD outside of healthcare one must show that the robot has been integrated into a care practice. Accordingly, the practice into which the robot is to be used must be assessed and shown to meet the conditions of a care practice. By investigating the foundations of the approach I hope to show why it may be applicable for service robots and further to give examples of current robot prototypes that can and cannot be evaluated using CCVSD. (shrink)

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What’s more, given the stage of their development and lack of (...) standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future. (shrink)

Notwithstanding the fact that care ethics has received increased attention, it has also faced much criticism. One of the focal points of critics is the normativity of care. Only when the objective normative basis of care is sufficiently clarified can care practices be evaluated and optimized from an ethical point of view. We emphasize that two levels of normativity can be identified: the context level and the foundational anthropology level. The personalist approach to care ethics is normatively stronger, at least (...) on one level, namely the foundational anthropology level. This personalist approach to care ethics indicates in which direction action must be taken so that human action may be considered ethically sound. (shrink)

Our survey of literature on moral dilemmas in teaching reveals that scholars declare the need to unequivocally resolve them yet refrain from doing so. This phenomenon is rooted in falure to distinguish between the different moral conflicts. The methods of resolving abstract hypothetical dilemmas, advocated but not implemented by the scholars, are poorly suited to deal with conflicts involving social pressure and high-stakes consequences for the parties involved, like most of the conflicts that teachers report. Thus, textbooks invite teachers to (...) resolve dilemmas on their own through reflection and dialogue, beyond the limits which Habermasian ethics of dialogue allows. The scholarship licenses lax attitudes towards commitment to professional and ethical standards by appealing to the ethics of care. It appeals to outdated versions of ethics of care that posit care in opposition to the ethics of duties, no longer employed in ethics of nursing and other caring professions. (shrink)

The concept of paternalism is intricately tied to the concept of autonomy. It is commonly assumed that when paternalistic interventions are wrong, they are wrong because they impede individuals’ autonomy. Our aim in this paper is to show that the recent shift towards conceiving of autonomy relationally highlights a separate conceptual space for a nonpaternalistic kind of interpersonal intervention termed maternalism. We argue that maternalism makes a twofold contribution to the debate over the ethics of interpersonal action and decision-making. Descriptively, (...) it captures common experiences that, while not unusual in everyday life, are largely absent from the present discussion. Normatively, it describes a type of intervention with justification conditions distinct from the standard framework of paternalism. We explicate these contributions by describing six key differences between maternalism and paternalism, and conclude by anticipating and responding to potential objections. (shrink)

The perspectives of the dominant Western ethical theories, have dominated the concepts of autonomy and informed consent for many years. Recently this dominant understanding has been challenged by ethics of care which, although, also emanates from the West presents a more nuanced concept: relational autonomy, which is more faithful to our human experience. By paying particular attention to relational autonomy, particularity and Process approach to ethical deliberations in ethics of care, this paper seeks to construct a concept of informed consent (...) from the perspective of ethics of care which is here called relational autonomy-in-informed consent. Thus, providing a broader theoretical basis for informed consent beyond the usual theoretical perspectives that are particularly Western. Care ethics provides such a broader basis because it appeals to a global perspective that encompasses lessons from other cultures, and this will help to enrich the current ideas of bioethics principles of autonomy and informed consent. This objective will be achieved by exploring the ethics of care emphasis on relationships based on a universal experience of caring; and by contrasting its concept of autonomy as relational with the understanding of autonomy in the approaches of the dominant moral theories that reflect rational, individualistic, and rights-oriented autonomy of the American liberalism. (shrink)

In this article I wish to show how care ethics puts forward a fundamental critique on the ideal of independency in human life without thereby discounting autonomy as a moral value altogether. In care ethics, a relational account of autonomy is developed instead. Because care ethics is sometimes criticized in the literature as hopelessly vague and ambiguous, I shall begin by elaborating on how care ethics and its place in ethical theory can be understood. I shall stipulate a definition of (...) care ethics as a moral perspective or orientation from which ethical theorizing can take place. This will mean that care ethics is more a stance from which we can theorize ethically, than ready-made theory in itself. In conceiving care ethics in this way, it becomes possible to make clear that, for instance, a moral concept of autonomy is not abandoned, but instead is given a particular place and interpretation. In the final part of this article I will show how ‘relational autonomy’ can be applied fruitfully in the practice of psychiatric care. (shrink)

If I do you a good turn, you may respond with gratitude and express that gratitude by saying “Thank you.” Similarly, if I insult you, you may react with resentment which you express by shouting, “Screw you!” or something of the sort. Broadly put, when confronted with another’s morally significant conduct, we are inclined to respond with a reactive attitude and to express that reactive attitude in speech. A number of familiar speech acts have a call-and-response structure. Questions, demands and (...) hails are all call-types, and each seeks a defining response. Questions seek answers, demands seek compliance, and a hail, for example, “Hi Coleen” seeks a “Hi” in return. Many theorists claim that expressions of the reactive attitudes also have this structure. Yet, this insight raises a number of questions. There are, after all, many familiar call-types, not only questions, demands and hails, but also requests, invitations, recommendations and entreaties. Given this, it is natural to wonder whether the expressed reactive attitudes are a sui generis call-type or whether they can be properly assimilated to one of the better-known forms. Further, we might wonder about the response component. It is utterly familiar that the response suited to a demand is compliance, and that the response sought by a question is an answer, but what response do the expressed reactive attitudes seek? The answer to this question is not similarly ready to hand. In this paper, I provide a recognition-based theory of the call-and-response structure of the expressed reactive attitudes. On my account, both the positive and negative expressed reactive attitudes are modes of recognition that seek for their target to give expression to her recognition of having been appropriately recognized. In the negative case, the target does this by feeling and expressing guilt or remorse, and in the positive case, by feeling and expressing self-approbation. (shrink)

Theorists have spent considerable time discussing the concept of responsibility. Their discussions, however, have generally focused on the question of who counts as responsible, and for what. But as Gary Watson has noted, “Responsibility is a triadic relationship: an individual (or group) is responsible to others for something” (Watson Agency and answerability: selected essays, 2004 , p. 7). Thus, theorizing about responsibility ought to involve theorizing not just about the actor and her conduct, but also about those the actor is (...) responsible to—and specifically about how these people hold the actor responsible for her conduct. In this paper, I give a topology of the terrain of holding others responsible. Over the course of the paper I disambiguate two very broad senses of holding responsible—regarding another as a responsible agent and holding another responsible for a particular piece of conduct. Next, I argue that the latter sense of holding responsible is a genus with two species—what I will call “holding responsible as deep moral appraisal” and “holding responsible as accountability.” Appreciating these distinctions, I argue, sheds considerable light on a number of questions concerning the scope and nature of our practices of holding others responsible. Finally, illuminating these distinct senses of holding responsible and highlighting their features reveals an awkwardness in the most carefully explicated and influential account of holding responsible, namely R. Jay Wallace’s account in Responsibility and the Moral Sentiments. (shrink)

Desert-realists maintain that those who do wrong without an excuse deserve blame. Desert-skeptics deny this, holding that though we may be responsible for our actions in some sense, we lack the kind of responsibility needed to deserve blame. In two recent papers, Randolph Clarke advances an innovative defense of desert-realism. He argues for deserved-guilt, the thesis that the guilty deserve to feel guilt. In his 2013 paper, Clarke suggests two strategies for defending deserved-guilt: the fitting-guilt strategy and the good-guilt strategy. (...) In his 2016 paper, Clarke issues a challenge to the desert-skeptic: he calls on them to provide a non-desert based account of guilt’s fittingness. In the first two thirds of the paper, I respond to Clarke’s challenge to the desert-skeptic, showing that guilt felt by the guilty is alethic-fitting, reason-fitting, and value-fitting. None of these notions of fittingness, I argue, are desert based. In the last third of the paper, I show how the work done in previous sections affords us the tools to finely diagnose the failures of both the fitting-guilt and the good-guilt strategies. Here, I draw on one of Clarke’s own insights—namely, that desert is intimately connected to the value of justice. I propose that showing that guilt is fitting, or again non-instrumentally good, fails to show that it is deserved because to show that it is deserved one must show that guilt is fitting or good in a sense that implicates justice. (shrink)

While the ethic of care has generally been regarded as an appropriate attitude for nurses, it has not received equal attention as a mode of ethical problem solving. The primary nursing model is exp...

Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities.

Conducting empirical research on gender in medical ethics is a challenge from a theoretical as well as a practical point of view. It still has to be clarified how gender aspects can be integrated without sustaining gender stereotypes. The developmental psychologist Carol Gilligan was among the first to question ethics from a gendered point of view. The notion of care introduced by her challenged conventional developmental psychology as well as moral philosophy. Gilligan was criticised, however, because her concept of ‘two (...) different voices’ may reinforce gender stereotypes. Moreover, although Gilligan stressed relatedness, this is not reflected in her own empirical approach, which still focuses on individual moral reflection. Concepts from social psychology can help overcome both problems. Social categories like gender shape moral identity and moral decisions. If morality is understood as being lived through actions of persons in social relationships, gender becomes a helpful category of moral analysis. Our findings will provide a conceptual basis for the question how empirical research in medical ethics can successfully embrace a gendered perspective. (shrink)

The ethics of care still appeals to many in spite of penetrating criticisms of it which have been presented over the past 15 years or so. This paper tries to offer an explanation for this, and then to critically engage with three versions of an ethics of care. The explanation consists firstly in the close affinities between nursing and care. The three versions identified below are by Gilligan (1982 ), a second by Tronto (1993 ), and a third by Gastmans (...) (2006 ), see also Little (1998 ). Each version is described and then subjected to criticism. It is concluded that where the ethics of care is presented in a distinctive way, it is at its least plausible; where it is stated in more plausible forms, it is not sufficiently distinct from nor superior to at least one other common approach to nursing ethics, namely the much-maligned 'four principles' approach. What is added by this paper to what is already known: as the article tries to explain, in spite of its being subjected to sustained criticism the ethics of care retains its appeal to many scholars. The paper tries to explain why, partly by distinguishing three different versions of an ethics of care. It is also shown that all three versions are beset with problems the least serious of which is distinctiveness from other approaches to moral problems in health care. (shrink)

Is it true that an ethics of care offers something distinct from other approaches to ethical problems in nursing, especially principlism? In this article an attempt is made to clarify an ethics of care and then to argue that there need be no substantial difference between principlism and an ethics of care when the latter is considered in the context of nursing. The article begins by considering the question of how one could in fact differentiate moral theories. As is explained, (...) this cannot be done merely in light of the moral judgements they defend, nor their ontological commitments (e.g. their view of the nature of persons). Following these methodological beginnings, care-based ethics is described and critically discussed. It is shown that ontological commitments embraced within care ethics do not themselves show that care ethics is distinct from other approaches. The idea of ‘psychological care’ is also discussed, which stems from the work of Margaret Little. Her claim that the ‘gestalts’ of justice and care cannot be combined is rejected in favour of an approach that does just that and which has been developed by Joan Tronto. It is then claimed that the moral commitments of principlism are certainly not incompatible with those of an ethics of care in the nursing context. A challenge to the idea that principlism and ethics of care might be compatible is anticipated in the work of Eva Feder Kittay. This challenge is responded to and it is concluded that care considered as a moral orientation and the moral values embedded in principlism are best combined in the nursing context. Care provides a moral orientation over which the obligations referred to in principlism can be laid. (shrink)

Morally contoured empathy is a form of reasonable partiality essential to the healthy care of dependents. It is critical as an epistemic aid in determining proper moral responsiveness; it is also, within certain richly normative roles and relationships, itself a crucial constitutive mode of moral connection. Yet the achievement of empathy is no easy feat. Patterns of incuriosity imperil connection, impeding empathic engagement; inappropriate empathic engagement, on the other hand, can result in self-effacement. Impartial moral principles and constraints offer at (...) best meager protection against these perils, and hence serve poorly in securing morally contoured empathy. More nuanced and practical guidance should be sought in normatively substantive conceptions of our roles and relationships and their defining moral stakes. These, joined with more abstract moral tools, can facilitate rich, narratively textured interpretations of moralitys demands. While the content of our normative conceptions must be continually debated, engaging in this debate is vital to the achievement of proper empathy, and thus to effective, respectful, morally healthy care of dependents. (shrink)

Just how care moves us is the subject of Katherine Gardiner’s thesis. Gardiner wants to know how care moves us – or in philosophical terms, how it motivates us. She describes caring as a morally ‘necessary’ activity, which means that we cannot escape responding to the care appeal. However, Gardiner uses the example of ‘Pim’, who cannot care and feels really bad about it - not because he is incapable of caring, but who just can’t. She reviews several versions of (...) care ethics that might persuade him to care, containing concepts like ‘engrossment’, ‘responsibility’, ‘solidarity’, ‘virtue’ and ‘reason’. According to Gardiner, none will do, because they are not compelling enough. She concludes that we need to understand how morality has effect, how it works. Christine Korsgaard’s concept of ‘normativity’ does just this. Korsgaard makes necessary links between making moral decisions and having an identity and being human and argues that acting contrary to any of these will make one “feel worse than death”. Caring for and about others is an important human activity and for some people is a crucial part of their practical identity. Without Korsgaard, we would have to reject Pim as a moral deviant (someone insensible to moral reason); with Korsgaard we can understand Pim’s pain, according to Gardiner. (shrink)