Abstract In the last few decades, a growing number of commentators have questioned the appropriateness of the 'justice view' of ethics as a suitable approach in health care ethics, and most certainly in nursing. Essentially, in their ethical deliberations, it is argued that nurses do not readily adopt the high degree of impartiality and objectivity that is associated with a justice view; instead their moral practices are more accurately reflected through the use of alternative approaches such as relational or care-based (...) ethics. Yet, it has also been argued that this viewpoint does not necessarily 'do justice' to the broader moral responsibilities of nurses towards humanity in general, i.e. to the wider socio-cultural and socio-political issues in society, and to the concept of social justice in particular. This criticism has triggered a much closer examination of relational and care-based ethics in nursing at levels beyond individual responsiveness within relationships and brought into the spotlight the need for a more ethically refined nursing response to an increasingly complex set of socio-cultural inequalities. This article explores a relational ethic within nursing practices with contemporary ideas regarding social justice. In particular, it is argued that the synergy between the two actually produces an ethic that is capable of not only challenging the continuing predominance of justice-based ethics within health care, but of replacing it. Subsequently, in the discussion that follows, it is suggested that a combined social justice and relational care-based approach, as a social ethic, should guide the moral deliberations and actions of nurses. It is maintained that such an approach is not only possible, but crucial if nurses are to realize their full potential as ethical agents for individual and social good. © 2011 Blackwell Publishing Ltd. (shrink)

Much of feminist theory takes issue with traditional, liberal theories of consent and obligation. Though none have proposed abandoning obligation outright, there has been a general shift among feminists towards a responsibility paradigm. Responsibility models acknowledge given relationships and interdependence, and so posit responsibilities as given, regardless of whether they are voluntary. But in theories that take freedom as a principal value, a move from a socially unembedded voluntarism to socially embedded responsibility leaves something missing. Constructive accounts of and prescriptions (...) for freedom must consider the reality of social life; yet acknowledging that relations are given need not require subordinating the role of voluntarism and consent in most relationships. In this paper I offer a commitment framework that seeks to supplant obligation while also reconciling relational given-ness and voluntarism. I propose an analysis of commitment that takes relations as the starting point and then show how the concept can: 1. guide actions 2. account for responsibilities 3. enhance freedom and 4. avoid a large share of coercive forces that are believed as necessary for reinforcing obligation and responsibility fulfillment. (shrink)

How ethics in human services is a political activity, shaping social relationships, is explored through the examination of two opposing discourses, a principle-based and a situated/relational narrative. Factors such as neo-liberalism, managerialism, and the risk-aversive society give a context for the reasons that the principle-based discourse has been the predominant influence, and what interests are served by this trope taking center stage. A delineation and critique of both perspectives are provided, including an explanation of the epistemological underpinnings of these discourses. (...) The piece ends with what needs to be done to strengthen ethics. (shrink)

In the social sciences, the iconic definition of privilege is that of unearned advantage. Consequently, professionals in the social services may devote less attention to the examination of their own professional privilege since it has been earned. This article addresses ethical concerns about the earned privilege that accrues to professionals in the caring fields and the potential effects on service users. This paper will focus particularly on some of the pedagogical dimensions. The inherent paradox in socializing students into professional roles, (...) which enhance privilege, while attempting to reduce the power differentials with service users, requires attention by teachers. How one might lessen the hierarchy that is created between the helper and service user as a result of that privilege will be explored. The paper will detail professional privilege and both constructive and problematic impacts on the helping relationship. The ‘uneven’ advantage of being able to set the standards of health and morality are also discussed. In the process, ethical trespass may result. We will explore this concept and its implications. Because, privilege contributes to social stratification between helpers and recipients, the final segment offers one educational strategy that can be used to potentially lessen the ‘we–they’ duality. (shrink)

For the past several years patients have been expected to play a key role in their recovery. Self management and disease management have reached a hype status. Considering these recent trends what does this mean for the division of responsibilities between doctors and patients? What kind of role should healthcare providers play? With findings based on a qualitative research project of an innovative practice for people with Chronic Obstructive Pulmonary Disease (COPD) we reflect on these questions. In-depth interviews conducted with (...) people with COPD, physiotherapists and a pulmonologist show that shifting responsibilities require a supportive attitude from healthcare providers and a dialogical communication between patients and professionals. Our findings show more is needed in order to motivate people with COPD to take responsibility and become co-owners in a process of recovery. The case example illustrates that people with COPD need support from fellow patients to learn to accept their disabilities. Awareness that COPD is more than just a lack of air, that mind and body interact, is a first step to investigate other potential problems and to enhance one’s quality of life. (shrink)

This essay focuses on the value of self-doubt in moral inquiry and in moral education. Using John Patrick Shanley’s play, Doubt: A parable, as illustration, it shows how self-doubt initiates and extends moral inquiry, highlights one’s epistemic fallibility and connects the inquirer to the virtue of humility. The essay draws on the work of Charles Sanders Peirce, Hullett, Nussbaum, Thayer-Bacon and Elbow to support the idea that the question ‘Am I wrong?’ is important for moral inquiry and for moral education.

Socially Assistive Robots are increasingly conceived as applicable tools to be used in aged care. However, the use carries many negative and positive connotations. Negative connotations come forth out of romanticized views of care practices, disregarding their already established technological nature. Positive connotations are formulated out of techno-deterministic views on SAR use, presenting it as an inevitable and necessary next step in technological development to guarantee aged care. Ethical guidance of SAR use inspired by negative connotations tends to be over-restrictive (...) whereas positive connotations tend to provide over-permissive guidance. To avoid these extremes, we report on the development and content of 21 ethical orientations regarding SAR use in aged care. These orientations resulted from a multi-phased project, which consisted of empirical-ethical research focusing on older adults’ intuitions regarding SAR use and philosophical-ethical research focusing on philosophical-ethical argumentations regarding SAR use. This project led to the Socio-historical contextualization of the ethics of SAR use, in which the ethical impact of SAR use is localized on three interrelated analysis levels: societal, organizational, and individual-relational. The 21 novel orientations regarding SAR use are structured according to these levels and further categorized into foundational and applied orientations. The first category leads to critical reflection on SAR use while the latter category inspires decision-making processes regarding this use. While going beyond the care-romantic and techno-deterministic gaze of SAR use in aged care, the described orientations balance themselves between their over-restrictiveness and over-permissiveness. (shrink)

Different embodiments of technology permeate all layers of public and private domains in society. In the public domain of aged care, attention is increasingly focused on the use of socially assistive robots supporting caregivers and older adults to guarantee that older adults receive care. The introduction of SARs in aged-care contexts is joint by intensive empirical and philosophical research. Although these efforts merit praise, current empirical and philosophical research are still too far separated. Strengthening the connection between these two fields (...) is crucial to have a full understanding of the ethical impact of these technological artefacts. To bridge this gap, we propose a philosophical-ethical framework for SAR use, one that is grounded in the dialogue between empirical-ethical knowledge about and philosophical-ethical reflection on SAR use. We highlight the importance of considering the intuitions of older adults and their caregivers in this framework. Grounding philosophical-ethical reflection in these intuitions opens the ethics of SAR use in aged care to its own socio-historical contextualisation. Referring to the work of Margaret Urban Walker, Joan Tronto and Andrew Feenberg, it is argued that this socio-historical contextualisation of the ethics of SAR use already has strong philosophical underpinnings. Moreover, this contextualisation enables us to formulate a rudimentary decision-making process about SAR use in aged care which rests on three pillars: stakeholders’ intuitions about SAR use as sources of knowledge; interpretative dialogues as democratic spaces to discuss the ethics of SAR use; the concretisation of ethics in SAR use. (shrink)

Making better choices about future technologies that are being researched or developed is an important motivator behind lay ethics interventions. However, in practice, they do not always succeed to serve that goal. Especially authors who have noted that lay ethicists sometimes take recourse to well-known themes which stem from old, even ‘archetypical’ stories, have been criticized for making too little room for agency and decision-making in their approach. This paper aims to contribute to a reflection on how lay ethics can (...) acquire more practical relevance. It will use resources in narrative ethics to suggest that in order to be relevant for action, facilitators of lay ethics interventions need to invite participants to engage in a narrative quest. As part of a quest, lay ethicists should be asked to reflect on a specific question or choice, use diverse input which is informative about the heterogeneity of viewpoints that are defended in society and argue for their standpoints. (shrink)

A standard view in ethics is that ethical issues concern a different range of human concerns than does politics. This essay goes beyond the long-standing dispute about the extent to which applied ethics needs a commitment to ethical theory. It argues that regardless of the outcome of that dispute, applied ethics, because it presumes something about the nature of authority, rests upon and is implicated in political theory. After internalist and externalist accounts of applied ethics are described, “mixed” approaches are (...) considered that contain inevitable political dimensions. A feminist alternative, Walker’s metaethic of responsibility, shows that authority is best understood as relational and that situations of unequal power are therefore often the places where applied ethics arises. Furthermore, in a democratic society, commitments to democracy should shape the account of authority, and, thus, the nature of applied ethics as well. (shrink)

This paper investigates reasons for practices and policies that are designed to promote higher levels of enrolment by women in scientific disciplines. It challenges the assumptions and problematic arguments of a recent article questioning their legitimacy. Considering the motivations for and merits of such programs suggests a practical response to the question of whether there should be programs to attract female science and engineering students.

: Drawing from work in feminist moral philosophy, Tobin argues that the most common methodology used in practical ethics is a questionable methodology for addressing practical problems across diverse cultural contexts because the kind of impartiality it requires is neither feasible nor desirable. She then defends an alternative methodology for practical ethics in a global context and uses her proposed methodology to evaluate a problem that confronts many Sunni Muslim women around the world.

Drawing from work in feminist moral philosophy, Tobin argues that the most common methodology used in practical ethics is a questionable methodology for addressing practical problems across diverse cultural contexts because the kind of impartiality it requires is neither feasible nor desirable. She then defends an alternative methodology for practical ethics in a global context and uses her proposed methodology to evaluate a problem that confronts many Sunni Muslim women around the world.

Drawing from work in feminist moral philosophy, Tobin argues that the most common methodology used in practical ethics is a questionable methodology for addressing practical problems across diverse cultural contexts because the kind of impartiality it requires is neither feasible nor desirable. She then defends an alternative methodology for practical ethics in a global context and uses her proposed methodology to evaluate a problem that confronts many Sunni Muslim women around the world.

The Covid-19 pandemic is a tragedy for those who have been hard hit worldwide. At the same time, it is also a test of concepts and practices of what good care is and requires, and how quality of care can be accounted for. In this paper, we present our Care-Ethical Model of Quality Enquiry and apply it to the case of residential care for older people in the Netherlands during the Covid-19 pandemic. Instead of thinking about care in healthcare and (...) social welfare as a set of separate care acts, we think about care as a complex practice of relational caring, crossed by other practices. Instead of thinking about professional caregivers as functionaries obeying external rules, we think about them as practically wise professionals. Instead of thinking about developing external quality criteria and systems, we think about cultivating reflective quality awareness. Instead of abstracting from societal forces that make care possible but also limit it, we acknowledge them and find ways to deal with them. Based on these critical insights, the CEMQUE model can be helpful to describe, interrogate, evaluate, and improve existing care practices. It has four entries: the care receiver considered from their humanness, the caregiver considered from their solicitude, the care facility considered from its habitability and the societal, institutional and scholarly context considered from the perspective of the good life, justice and decency. The crux is enabling all these different entries with all their different aspects to be taken into account. In Corona times this turns out to be more crucial than ever. (shrink)

This paper addresses Peter Singer's claim that cognitive ability can function as a universal criterion for measuring moral worth. I argue that Singer fails to adequately represent cognitive capacity as the object of moral knowledge at stake in his theory. He thus fails to put forth credible knowledge claims, which undermines both the trustworthiness of his moral theories and the morality of the actions called for by these theories. I situate Singer's methods within feminist critiques of moral reasoning and moral (...) epistemology, and argue that Singer's methods are problematic for moral reasoning because they abstract from their object valuable contextual features. I further develop this claim by showing the importance of embodiment for the construal of objects of moral knowledge. Finally, I develop the moral and scholarly implications of this critique. By showing that the abstract, universal methods of reasoning Singer employs cannot credibly construe the objects of ethical inquiry, I call into question the validity of these methods as a means to moral knowledge in general. Furthermore, since moral reasoning takes place within an embodied moral landscape, it is itself a moral enterprise. Singer's moral reasoning, and ours, must be held accountable for its knowledge claims as well as its concrete effects in the world. (shrink)

Tessman responds to her three critics’ comments on Burdened Virtues, focusing on their concerns with her stipulation of an “inclusivity requirement,” according to which one cannot be said to flourish without contributing to the flourishing of an inclusive collectivity. Tessman identifies a naturalized approach to ethics—which she distinguishes from the naturalism she implicitly endorsed in Burdened Virtues—that illuminates how a conception of flourishing that meets the inclusivity requirement could carry moral authority.

Tessman responds to her three critics’ comments on Burdened Virtues, focusing on their concerns with her stipulation of an “inclusivity requirement,” according to which one cannot be said to flourish without contributing to the flourishing of an inclusive collectivity. Tessman identifies a naturalized approach to ethics—which she distinguishes from the naturalism she implicitly endorsed in Burdened Virtues—that illuminates how a conception of flourishing that meets the inclusivity requirement could carry moral authority.

I briefly introduce Moral Failure as a book that brings together philosophical and empirical work in moral psychology to examine moral requirements that are non-negotiable and that contravene the principle that “ought implies can.” I respond to Rivera by arguing that the process of construction that imbues normative requirements with authority need not systematize or eliminate conflicts between normative requirements. My response to Schwartzman clarifies what is problematic about nonideal theorizing that limits itself to offering action-guidance. In response to Kittay, (...) I defend my rejection of “ought implies can,” and consider the implications of the concept of unfair moral requirements. (shrink)

This paper draws on Claudia Card’s discussions of moral luck to consider the complicated moral life of people—described as pessimists—who accept the heavy knowledge of the predictability of the bad moral luck of oppression. The potential threat to ethics posed by this knowledge can be overcome by the pessimist whose resistance to oppression, even in the absence of hope, expresses a sense of still having a ‘‘claim’’ on flourishing despite its unattainability under oppression.

The theory and practise of care is defined and enacted differently in different national as well as cultural contexts, illuminating how differently constructed the personal and societal structures in Europe are. A common trait is however that care work paid or non-paid, private or public is identified with women. To navigate in the landscape of care and ethics requires taking into account the constitutive relation between one’s identity, embodiment and position. The author suggests conceiving care as an existential condition of (...) life demanded from all human beings. This will free care from the identification with women and pave a way towards a more gender equal and just society with less gender segregation in the labour market and at the arena of education. (shrink)

In this article the relevance of the feminist ethic of care for current Dutch social policies is elaborated. It starts from the observation that Dutch society is witnessing two intertwined processes: the relocation of politics and the relocation of care. Together these processes result in the need for new normative frameworks for social policy. Care has to become part of the practices of active citizenship, which should be based on notions of relationality and interdependence. Basic moral concepts of the ethic (...) of care, like attentiveness, responsibility, competence, responsiveness, trust and asymmetrical reciprocity are introduced. In the final part, the ethic of care is applied to two topical issues: policies on combining paid labour and care and generation-sensitive policies. Finally some norms are proposed to guide social policymaking. (shrink)

In November 2004, the Swiss population voted to accept a law on research using human embryonic stem cells. In this paper, we use Switzerland as a case study of the shaping of the ostensibly ethical debate on the use of embryos in embryonic stem cell research by legal, political and social constraints. We describe how the national and international context affected the content and wording of the law. We discuss the consequences of the revised law's separation of stem cell research (...) from other forms of embryo research, its definitions of embryo and of spare embryos, and the introduction of donorship into the Swiss ethical debate on IVF. We focus on the exclusion of the potential embryo donors' voices and perspectives from the debate, and consider the effects of this exclusion on ethical discourse and the political process. (shrink)

Despite the fact that most of us value integrity, and despite the fact that we readily understand one another when we talk and argue about it, integrity remains elusive to understand. Considerable scholarly attention has left troubling disagreement on fundamental issues: Is integrity in fact a virtue? If it is, what is it a virtue of? Why exactly should we value integrity? What is the appropriate way to have concern for one’s own integrity? Is having integrity compatible with having significant (...) moral flaws? After an overview of common ‘data points’ or platitudes concerning integrity, this article outlines six distinct views of integrity that have been defended and draws attention to problems each has accommodating these data points. (shrink)

Abstract 1 This paper makes a preliminary case for a central and radical claim. I begin with Bernard Williams? seldom-faced argument that integrity cannot be a moral virtue because it lacks two key ingredients of moral virtues, namely a characteristic thought and motivation. Whereas, for example, generosity involves the thought that another could use assistance, and the motivation to actually give assistance, integrity lacks these two things essential to morally excellent responses. I show that several maneuvers aimed at avoiding Williams? (...) challenge fail and that others are likely to remain unpersuasive. The paper concludes by offering an argument to the best explanation: Williams? important insight is best explained by the supposition that integrity is an epistemic virtue, and an epistemic virtue of a practical sort. (shrink)

In this methodological reflection, I describe the multidisciplinary hermeneutic process of philosophizing about teacher dissatisfaction. I discuss how philosophy serves as a starting point for interpretive work based on interviews with former teachers and readings of qualitative and quantitative research on teacher attrition and dissatisfaction. The result has been a project that enabled me to offer new descriptions of phenomena and to develop concepts that can be used to interpret the moral dimensions of teacher dissatisfaction. The fact that I return (...) to language and concepts as my research outcomes is why, despite my multidisciplinary approach, I continue to describe my work as philosophical. I suggest that philosophical enquiry pursued through empirical research has the potential to inform larger empirical studies, serve as a “sensitizing instrument” for empirical analysis, and to open discursive spaces where common understandings limit interpretive possibilities. (shrink)

This article surveys recent feminist contributions to moral philosophy with an emphasis on those works which engage with debates within mainstream ethics. The article begins by examining a tension said to arise from the two criteria a theory must meet if it is to count as feminist moral theory: the women's experience requirement and the feminist conclusion requirement. Subsequent sections deal with feminist relational theories of rights, feminist work on responsibility and feminist contractarian approaches to ethics. A final section looks (...) at the application of some feminist moral theories to the problem of abortion. (shrink)

Not all those who write philosophy are recognized as philosophers. In this paper I argue that Dutch writer Isabelle de Charrière, usually known as a novelist, is actually engaged in doing moral philosophy. In the second half of the eighteenth century, Charrière wrote novels about characters who endorsed moral theories and commitments. Her novels track the dilemmas that these characters face in trying to live according their moral theories and commitments. I consider the case for treating fiction as philosophically valuable, (...) and argue that Charrière's novels fall into the category of philosophically valuable fiction. (shrink)

This paper argues that human rights-based approaches to human security overlook the importance of caring values, relations of care, and care work in the achievement and long-term maintenance of human security. It outlines an alternative approach to the ethics of human security which combines a feminist ontological and normative position on the centrality of caring values and practices in sustaining life with a feminist account of the gendered political economy of contemporary globalisation. Moreover, it argues that a critical, feminist ethics (...) of care can provide a comprehensive ontological and normative framework for integrating economic exclusion with violence, and thus for understanding and conceptualising human security in a way that is sensitive to the role played by gender identities and other types of power relations. This, I argue, can be achieved through an interrogation of the relationship between neoliberal globalisation and hegemonic forms masculinity in the context of contemporary global governance. (shrink)

This article develops an approach to ethical globalization based on a feminist, political ethic of care; this is achieved, in part, through a comparison with, and critique of, Thomas Pogge's World Poverty and Human Rights. In his book, Pogge makes the valid and important argument that the global economic order is currently organized such that developed countries have a huge advantage in terms of power and expertise, and that decisions are reached purely and exclusively through self-interest. Pogge uses an institutional (...) rights framework to argue that direct responsibility for global poverty and inequality lies with the citizens of developed countries, since suffering and death are caused by global economic arrangements designed and imposed by our governments. While this argument is certainly compelling, I have argued that it tells us little about the actual effects of globalization on the real people of the South - including women, children and the elderly. As a result, it can offer little in the way of real alternatives or policy prescriptions. As a moral orientation, a care ethic relies on a relational moral ontology, and leads us to consider different values in terms of human flourishing. Moreover, it pushes us to consider the normative implications of aspects of the global political economy which are usually not 'seen' at all, including the global distribution of care work and the corresponding patterns of gender and racial inequality, the underprovision of care and resources for caring work in both the developed and developing world, and the ways in which unpaid or low-paid caring work helps to sustain a cycle of exploitation and inequality on a global scale. (shrink)

The priority that Tessman’s argument gives to phenomenological and neuropsychological explanations of moral requirements entails a fundamental shift in our understanding of these. Two central problems of normative theory come together in Tessman’s account. The first arises when an agent’s sense of requirement clashes with what a systematic theory prescribes. The second arises when neuropsychological accounts fail to fit the prescription. Tessman argues that no account successfully resolves moral dilemmas such that ought always implies can, and she argues that neuropsychology (...) explains our sense of impossible requirements. This explanation eliminates the role of a prescriptive theory in explaining an agent’s sense of requirement. (shrink)

There is no consensus about the ethical ideal of genetic counselling and decision making. This paper reviews and discusses some of the most prominent ethical arguments that have been brought forward against the non-directiveness principle (NDP), which has been the ethical gold standard for a long time. These arguments can be classed in four categories: (i) NDP can be against the best interests of the individuals concerned; (ii) NDP has ideological elements that do not adequately represent the counselling ethos; (iii) (...) NDP was historically a defensive tool that protected the interests of geneticists against social criticism and against litigation; (iv) NDP falsely assumes individual responsibility and hides the shared responsibility of other social actors. The paper argues that a serious understanding of moral space, which people need in order to make ‘their own’ decisions, leads to a necessarily relational concept of agency. The positive counterpart of NDP is to allow a space for agency. Allowing agency implies offering the kind of support that the decision-making person really needs. To make a good decision about personal genetics implies being empowered to act as a contextually sensitive person who is aware of relationships and corresponding responsibilities. (shrink)

For nursing, the idea of bearing witness is of utmost importance. Nurses are present with persons who experience changes in their health and quality of life and who live intense and profound moments of struggling, questioning, and finding meaning. Nurses are also with persons from moment to moment as their lives unfold, and when joy, serenity, contentment, vulnerability, sadness, fear, and suffering are experienced. In this paper, it is proposed that bearing witness is a moral way of engaging in the (...) nurse–person relationship. Based on Levinas’s ethics of the face, it is claimed that bearing witness is enacting one’s moral responsibility, which arises from the encounter with the other. Drawing on Parse’s human becoming theory, ways of witnessing and bearing witness are defined and discussed. It is suggested that bearing witness is a human‐to‐human way of being‐relating, a mode of human coexistence. Bearing witness is being present and attentive to the truth of another’s experiences. Moreover, in this paper, the ways nurses enact their moral agency and bear witness to others placed in their care, or turn away, are explored. Nurses’ moral agency is located in the constrained moral space of contemporary health care. Hence, the creation of a moral space, which allows nurses to enact their moral responsibility of bearing witness to other persons’ experiences of health and quality of life, is called for. In doing so, it is suggested that the act of bearing witness needs a specific nursing knowledge base and a recognition that being present and being with another is a valuable nursing practice that is utterly meaningful for persons who are living through difficult times. (shrink)

Grounding Knowledge is written partly out of a sense of celebration and partly out of a sense of consternation. The celebration is generated by the feeling that epistemology has started to explore...

Stories told about violence, trauma, and loss inform knowledge of post-conflict societies. Stories have a context which is part of the story-teller’s life narrative. Reasons for silences are varied. This article affirms the importance of telling and listening to stories and notes the significance of silences within transitional justice’s narratives. It does this in three ways. First, it outlines a critical narrative theory of transitional justice which confirms the importance of narrative agency in telling or withholding stories. Relatedly, it affirms (...) the importance of story-telling as a way to explain differentiated gender requirements within transitional justice processes. Second, it examines gendered differences in the ways that women are silenced by shame, choose silence to retain self-respect, use silence as a strategy of survival, or an agential act. Third, it argues that compassionate listening requires gender-sensitive responses that recognize the narrator’s sense of self and needs. (shrink)

: On realist terms, politics is about power, security, and order, and the question of whether politics can practice compassion is irrelevant. The author argues that a politics of compassion is possible and necessary in order to address human security needs. She extend debates on care ethics to develop a politics of compassion, using the example of asylum seekers to demonstrate that politics can practice compassion with attentiveness to the needs of vulnerable people who are suffering, an active listening to (...) the voices of the vulnerable, and open, compassionate, and appropriate responses to particular needs. (shrink)

On realist terms, politics is about power, security, and order, and the question of whether politics can practice compassion is irrelevant. The author argues that a politics of compassion is possible and necessary in order to address human security needs. She extend debates on care ethics to develop a politics of compassion, using the example of asylum seekers to demonstrate that politics can practice compassion with attentiveness to the needs of vulnerable people who are suffering, an active listening to the (...) voices of the vulnerable, and open, compassionate, and appropriate responses to particular needs. (shrink)

Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values and (...) responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life. (shrink)

In “Conceptions of Care,” Tove Pettersen discusses and articulates select ways in which care can be comprehended. Several difficulties related to an altruistic understanding of care are examined before the author presents the case for a more favorable concept: mature care. Mature care is intended to take into account the interests of both parties to the caring relationship. This understanding of care facilitates the expression of the relational and reciprocal aspects of caring while emphasizing the equal worth of all involved. (...) Also attended to is the embeddedness of care in wider cultural and political contexts. (shrink)

: This project draws on scholarship of feminist and womanist scholars, and on results of interviews with scientists currently involved in molecular genetics. With reference to Margaret Urban Walker's "practices of moral responsibility," the social practices of molecular geneticists are explored, and strategies identified through which scientists negotiate their moral responsibilities. The implications of this work for scientists and for feminists are discussed.

Emotions play an important part in moral life. Within clinical ethics support (CES), one should take into account the crucial role of emotions in moral cases in clinical practice. In this paper, we present an Aristotelian approach to emotions. We argue that CES can help participants deal with emotions by fostering a joint process of investigation of the role of emotions in a case. This investigation goes beyond empathy with and moral judgment of the emotions of the case presenter. In (...) a moral case deliberation, the participants are invited to place themselves in the position of the case presenter and to investigate their own emotions in the situation. It is about critically assessing the facts in the case that cause the emotion and the related (moral) thoughts that accompany the emotion. It is also about finding the right emotion in a given situation and finding the right balance in dealing with that emotion. These steps in the moral inquiry give rise to group learning. It is a process of becoming open towards the perspectives of others, leading to new insights into what is an appropriate emotion in the specific situation. We show how this approach works in moral case deliberation. A physician presents a situation in which he is faced with a pregnant woman who is about to deliver multiple extremely premature infants at the threshold of viability. The moral deliberation of the case and the emotions therein leads to the participants’ conclusion that “compassion” is a more adequate emotion than “sadness”. The emotion “sadness” is pointed towards the tragedy that is happening to the woman. The emotion “compassion” is pointed towards the woman; it combines consideration and professional responsibility. Through the shift towards compassion, participants experienced more creativity and freedom to deal with the sad situation and to support the woman. The paper ends with an analysis and reflection on the deliberation process. In the conclusion we argue for more attention to emotions in clinical ethics support and offer some directions for doing this in the right way. (shrink)

This paper comes out of a panel honoring the work of Anne Donchin (1940-2014), which took place at the 2016 Congress of the International Network on Feminist Approaches to Bioethics (FAB) in Edinburgh. My general aim is to highlight the contributions Anne made to feminist bioethics, and to feminist reproductive ethics in particular. My more specific aim, however, is to have a kind of conversation with Anne, through her work, about whether reproductive justice could demand insurance coverage for in vitro (...) fertilization. I quote liberally from Anne’s work for this purpose, but also to shower the reader with her words, reminding those of us who knew her well what a wonderful colleague she was. (shrink)

This article briefly outlines some of the key problems with the way in which the moral realm has traditionally been understood and analysed. I propose two alternative views of what is morally interesting and applicable to nursing practice and I indicate that instability has its upsides. I begin with a moral tale – a 'Good Samaritan' story – which raises fairly usual questions about the nature of morality but also the more philosophically fundamental question about the relationship between subjectivity and (...) moral agency. I then consider this relationship from the perspectives of two twentieth century philosophers: Emmanuel Levinas and Michel Foucault. Levinas' basic point is that the experience of ethical subjectivity is made possible through others: the demand to respond to the existence of others is the basic social structure that precedes individual freedom. If Levinas posits intersubjectivity as a fundamental or primitive feature of the moral realm, Foucault poses an even more basic question: how have moral subjects and relations of obligation been constituted? The aim of ethical inquiry, for Foucault, is to describe the network of discourses, institutions, relations, and practices through which certain kinds of subjects are constituted and constitute themselves, e.g. as a kind of person who can act morally. Finally, I consider some recent research in philosophy of nursing which illustrates how Levinasian and/or Foucauldian perspectives can deepen understanding of nurses' moral practices, specifically, the work of Norwegian public health nurses, Canadian pediatric nurses, and Irish midwives. I suggest that in spite of the instability of morality in general and the particular ethical challenges that face nurses, there are grounds for hope and possible strategies for living in unstable times. (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)

I argue here that Beth Singer's analysis of rights as operative social norms allows us to make sense of the personal and political complexities of the abortion debate. In particular, I argue that it is only by means of Singer's analysis that we, as feminists, can reconcile our conviction that Carol Gilligan's celebration of empathy and partiality gestures toward something definitive of our moral experience with the need to avail ourselves of the politically efficacious language of rights.

A man with Alzheimer's who wanders around, a caregiver who disconnects the alarm, a daughter acting on het own, and a doctor who is not consulted set the stage for a feminist reflection on capacity/competence assessment. Feminist theory attempts to account for gender inequality in the political and in the epistemological realm. One of its tasks is to unravel the settings in which actual practices, i.c. capacity/competence assessment take place and offer an alternative. In this article the focus will be (...) on a feminist ethics of care in which relationality, care, vulnerability, and responsibility are privileged concepts and attitudes. The emphasis on these notions leads to a specific view of autonomy that has consequences for both carereceivers (patients, clients) and caregivers (professional and not professional). These concepts constitute a default setting that shapes the context for capacity/competence assessment. Whereas this notion is meant to distinguish between those who need to be taken care of and those who do not, reflection on what it means to say ‘those who need to be taken care of’ is also required. The feminist analysis presented here emphasizes the necessity of the contextualization of assessment of competence. It sketches the multifold and complex grid that comprehends capacity assessment. (shrink)