The concept of missed care refers to an irrefragable truth that required nursing care, which is left undone, occurs in the delivery of health care. As a technical concept, missed care offers nurses the opportunity to articulate a problematic experience. But what are we to make of missed care from an ethical perspective? Can nurses be held morally responsible for missed care? Ethically speaking, it is generally accepted that if a (...) person has a moral obligation to do something, s/he needs to have the capacity to do it. If a person does not have the capacity to fulfil a moral obligation, then s/he cannot be held responsible for failing to do so. This is captured by the “ought implies can” (OIC) principle. This paper brings the OIC principle to the forefront of the discussion on missed care. It is contended that nurses – qua moral agents – may be discharged from a moral obligation to carry out a required caring act because of some inability that is not of their making and therefore may not be morally responsible for missed care. However, the OIC principle may not be applied to all situations of missed care depending on their causes. In addition, following in the thought of Sapontzis (The Southern Journal of Philosophy, 1991, XXIX, 383–393) it is contended that when an original obligation to deliver a required act of care cannot be fulfilled, other obligations may be generated as summed up in the “Principle of Making Amends” and the “Principle of Appropriate Feeling.” It is the view of this paper that these further principles could prevent the OIC principle from being used to simply excuse omissions of care from a normative standard and could support the view that nurses continue to have alternative obligations to make amends and to respond with appropriate feelings to missed care. (shrink)

Stimulated by our conversations at the 2018 International Philosophy of Nursing Society Conference and our shared interests, the coauthors present an argument for augmenting the broader discussion of “missed care” with our synthesized concept called structural missingness. We take the problem of missed care to be largely grounded on a particular economic construction of the healthcare system within an era of what some are calling the Capitalocene, capturing the pervasive influence of capitalism on nature, humanity and (...) the world order. Our perspective is that of the United States, however, extrapolations can be made to the social and healthcare systems in other countries. We are concerned with the underlying conditions that structurally reify inequality and ultimately undermine nursing practice. To situate the discussion, we briefly review existing literature on the contextualization of missed care. We understand contemporary circumstances of missed care as a function of the neoliberalization of healthcare, including the idea of nursing as a commodity. From this, we discuss the implications of missed care, which forms the basis of our critique. Synthesizing the term “structural missingness, we locate a moral imperative in the professional and disciplinary commitments of nursing to consider who and what have been left out. This moral imperative for the nursing profession, along with other social and health related professions, underscores our obligation to be involved in uncovering inequities and conceptualizing upstream solutions for structural missingness. (shrink)

This article draws on the free‐text commentaries from trans‐Tasman studies that used the MISSCARE questionnaire to explore the reasons why nurses miss care. In this paper, we examine the idea that nurses perpetuate a self‐effacing approach to care, at the expense of patient care and professional accountability, using what they describe as the art of nursing to frame their claims of both nursing care and missed nursing care. We use historical dialogue alongside a paradigmatic (...) analysis to examine why nurses allow themselves to continue working within settings that put their professional/personal selves aside in an attempt to deliver care within constraints that make completing care an impossible task. The findings suggest an ambivalence and conflict confront nurses attempting to provide care within the New Public Management environment. This can be seen in the tensions that draw a line between care as an art, and care as a financial target, juxtaposed with the inherent clash of values arising from the way nursing care is conceptualised within two contradictory paradigms. (shrink)

Background: Determination of the factors affecting missed nursing care and the impact of ethical leadership is important in improving the quality of care. Aim: This study aims to determine the missed nursing care and its relationship with perceived ethical leadership. Research design: A cross-sectional study. Participants and research context: The sample consisted of 233 nurses, of whom 92.7% were staff nurses and 7.3% were charge nurses, who work in three different hospitals in Turkey. The study (...) data were collected using a personal and professional characteristics data form, the Missed Nursing Care Survey, and the Ethical Leadership Scale. Ethical considerations: The study was approved by the non-interventional ethics committee of Dokuz Eylül University Ethics Committee for Noninvasive Clinical Studies. All participants’ written and verbal consents were obtained. Findings: The most missed nursing care practices were ambulation, attending interdisciplinary care conferences, and discharge planning. According to the logistic regression analysis, sex, the number of patients that the nurse is in charge of giving care, the number of patients discharged in the last shift, and satisfaction with the team were determined as factors affecting missed care. No significant relationship was found between ethical leadership and missed nursing care, and a weak but significant relationship was found between the clarification of duties/roles subscale and missed nursing care. Discussion: Ethical leaders should collaborate with policy-makers at an institutional level to particularly achieve teamwork that is effective in the provision of care, to control missed basic nursing care, and to organize working hours and at the country level to determine roles and to increase the workforce. Conclusion: The results of this study contribute to the international literature on the most common type of missed nursing care, its reasons, and the relationship between the missed care and ethical leadership in a different cultural context. (shrink)

Background:Previous research has linked missed nursing care to nurses’ work environment. Ethical climate is a part of work environment, but the relationship of missed care to different types of ethical climate is unknown.Research objectives:To describe the types of ethical climate in adult in-patient cancer care settings, and their relationship to missed nursing care.Research design:A descriptive correlation design was used. Data were collected using the Ethical Climate Questionnaire and the MISSCARE survey tool, and analyzed (...) with descriptive statistics, Pearson’s correlation and analysis of variance.Participants and research context:All nurses from relevant units in the Republic of Cyprus were invited to participate.Ethical considerations:The research protocol has been approved according to national legislation, all licenses have been obtained, and respondents participated voluntarily after they have received all necessary information.Findings:Response rate was 91.8%. Five types identified were as follows: caring ; law and code ; rules ; instrumental ; and independence. Reported overall missed care was M = 2.51, and this was positively related to instrumental and independence types and negatively related to caring, rules, and law and code.Discussion:The reported levels of missed care and the types of ethical climates present similarities and differences with the relevant literature. All types of ethical climate were related to the reported missed care.Conclusion:Efforts to reduce the influence of instrumental and independence types and fostering caring, law and code, and rules types might decrease missed nursing care. However, more robust evidence is needed. (shrink)

As physicians, we have seen patients with substance use disorders leave the hospital against medical advice, slipping through the cracks of our health care system. In fact, despite a high burden of life‐threatening illnesses, patients with SUDs are at a nearly threefold increased risk of leaving the hospital against medical advice. Leaving against medical advice is associated with an increased thirty‐day mortality rate as well as an increased rate of hospital readmission. When a patient leaves in this way, the (...) health care system loses the opportunity to engage with someone who is struggling with an SUD and whose health is at imminent risk. Fortunately, there are ways to address some of these challenges within existing organizational frameworks. Addiction consult teams and supervised injection facilities are two interventions that have proven successful. (shrink)

A longitudinal perspective on motherhood that spans the experience of gestation, birthing, the care of young children, and the mother’s relation to her grown children makes way for a conception of the mother as essentially plural. It shall be argued in this paper that maternity is necessarily tied to surrogacy, that it is divided into a multiplicity of tasks inevitably parceled out to multiple agents. In this essay, the analysis of maternal surrogacy is focused on the phenomenon of mothering (...) from a distance, a maternal practice engendered by the feminization and globalization of labor markets. By both affirming the value of maternal surrogates and questioning the limits of surrogacy, this analysis of motherhood challenges both the economic exploitation that engenders and sustains distant mothering and the gendered division of care labor that supports the global economy of care. (shrink)

We agree with Alfandre and colleagues that ethics guidance for contingency conditions in public health emergencies is urgently needed. The Minnesota COVID Ethics Collabora...

Care left undone, interchangeably referred to as missed care, unfinished nursing care and task incompletion, is pervasive in contemporary healthcare systems. Care left undone can result in adverse outcomes for the patient, nurse and organization. The rhetoric that surrounds care left undone infers it is a contemporary nursing phenomenon; however, a seventeenth‐century Spanish nursing treatise, Instruccion de Enfermeros (Instructions for Nurses), challenges this assumption. Instruccion de Enfermeros was an instructional guide that was written for (...) members of the Congregation of Bernardino de Obregon who worked as nurses at the Madrid General Hospital. The treatise provides a historical commentary on the daily roles, responsibilities and working conditions of the Obregonian nurses. Its content and context suggest the Obregonian nursing resource was consistently time poor due to a confluence of internal and external stressors. Consequently, the Obregonians were under considerable role strain resulting in inferior patient care. This article explores the antecedents of care left undone through a historical lens using exemplars from the 1625 edition of Instruccion de Enfermeros. Factors contributing to care left undone in Obregonian nursing will then be examined to offer insights into the similarities between what a nurse suffered 400 years ago and what exists in contemporary nursing practice. (shrink)

Midwives and nurses play a critical role in safeguarding the lives of women in resource-constrained African countries. Working within the context of scarce resources may undermine their moral agency and hinder their ability to care. The purpose of this paper is to understand the influence of resource scarcity on midwifery and nursing care and practice. A critical ethnography was conducted in the obstetric department of three tertiary-level facilities in Ghana. Purposive sampling was used to recruit 30 midwives and (...) nurses and semistructured interviews, field notes and documentary materials were used to generate in-depth understanding. Ethical approval was granted from Canada and Ghana and written, and ongoing informed consent was obtained from the participants. Five conceptual themes depicting the impact of scarce resources on midwifery and nursing care were discovered: compromised care, constrained care, dehumanized care, missed care and disengaged care. Improving the maternal health of women and averting avoidable maternal morbidity and mortality require governments and institutions to invest in health infrastructure that will support the delivery of ethical and safe midwifery care for women in their most vulnerable period. (shrink)

Equipoise is widely regarded to be an essential prerequisite for the ethical conduct of a randomised controlled trial. There are some circumstances however, under which it is acceptable to conduct a randomised controlled trial in the absence of equipoise. Limited access to the preferred intervention is one such circumstance. In this paper we present an example of a randomised trial in which access to the preferred intervention, preschool education, was severely limited by resource constraints. The ethical issues that arise when (...) conducting randomised trials in health care are considered in the context of trials of social interventions. In health, education and social welfare, effective interventions are frequently limited due to budgetary constraints. Explicit acknowledgement of the need to ration interventions, and the use of random allocation to do this even in the absence of equipoise, would facilitate learning more about the effects of these interventions. (shrink)

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants (...) identified four strategies associated with NPM which add to workload after‐hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care. (shrink)

Various traditions in mental health care, such as phenomenological, and existential and cognitive-behavioral psychotherapy, implicitly or explicitly acknowledge that a disruption of the self, or the person, or the agent is among the common denominators of different mental disorders. They often emphasize the importance of understanding patients as reasonsresponsive, in their full mental health relevant complexity, if their mental disorder is to be treated successfully. The centrality of the concept of the self is not mirrored in the mainstream scientific (...) approaches in psychiatry however; the self has rarely been considered as the object of scientific research, the empirical investigation of which might yield successful explanations of and interventions in mental disorders. Thus, even though self-related phenomena are clinically relevant in so far as they give important information about a mental disorder to the clinician and help the development of effective interventions, they are not considered among the scientifically relevant properties of mental disorders. Leaving the self-related phenomena out of the scientific research on mental disorders can be attributed to the presupposition that the self is not empirically tractable and its use will hinder psychiatry’s goal to be scientific. In this paper, taking issue with this, I argue the self is empirically tractable, and its use as a target of research will not hinder psychiatry’s scientific commitments. (shrink)

Background The fourth section of the 1967 Abortion Act states that individuals (including health care practitioners) do not have to participate in an abortion if they have a conscientious objection. A conscientious objection is a refusal to participate in abortion on the grounds of conscience. This may be informed by religious, moral, philosophical, ethical, or personal beliefs. Currently, there is very little investigation into the impact of conscientious objection on service users in Britain. The perspectives of service users are (...) imperative in understanding the real-world consequences and potential impact of conscientious objection and should be considered when creating and reviewing policies and guidelines. This research provided a platform for women and those who can become pregnant to share their experiences and opinions at a time when these voices are largely excluded in the great tradition of Western political philosophy and law-making processes. Method Five service users were interviewed using a narrative interview approach to uncover their abortion journeys and experiences of conscientious objection. Findings The findings were presented as found poems and uncovered that doctors are not always: informing service users that they have a conscientious objection to abortion, giving service users enough information to access abortion (indirect referral), treating them non-judgmentally, and providing medically correct information. Service users did not experience burdens such as long waiting times and were still able to access legal abortion. However, service users did experience negative emotional effects, as they were often left feeling scared, angry, and hopeless when they were not referred and/or were mistreated. Conclusions Findings indicate that conscientious objection could work in practice. However, it is currently failing some individuals on an emotional level, as not all doctors are adhering to guidelines. Conscientious objection in Britain needs to be addressed, to ensure service users receive fair, impartial, non-judgmental care. (shrink)

This paper argues that the missing voice in clinical ethics is that of informal caregivers. Despite their substantial contribution to care provided to individuals with disabilities, chronic illness or dementia, informal caregivers are rarely thought of as members of the healthcare team and their narratives are rarely listened to and included in clinical and ethical decisions. Addressing this gap, this paper discusses the reasons for the systemic misrecognition of informal caregivers in healthcare systems and argues for their greater narrative (...) inclusion on the clinical, legal and social planes. (shrink)

This essay argues that post-analytic philosophy finds its origins not only in an invented tradition—that of ‘analytic philosophy’—but also in an invented dilemma: namely, the response to the allegedly overweening dominance of ‘positivism’ in American philosophy. I begin by surveying the problems with the folk wisdom about positivism and analytic philosophy. This pervasive narrative locates the emergence of post-analytic philosophy after a period of hegemony for logical positivism and cognate philosophical subfields. Taking seriously evidence indicating a distinct overlap in the (...) construction of the analytic and post-analytic traditions, I return to the founding moment of American analytic philosophy in the years immediately following World War II. What we see, I suggest, is not a reaction against a clearly defined and powerful logical positivist mainstream, but the careful, piecewise co-ordination of what would become characteristic ‘analytic’ modes of argument, problematics, and tool kits. Willard Van Orman Quine played a central role in this process, and for this reason I focus on the circumstances in which his field-defining 1951 article, ‘Two Dogmas of Empiricism’ was written and received. I conclude with the claim that both analytic and post-analytic philosophers relied on a peculiar image of the failure of logical positivism, and of the opportunities that failure presented. (shrink)

Thomas Twiss has written a careful, well-documented study of the evolution of Trotsky’s ideas on theUSSRbureaucracy until 1936. He also traces Trotsky’s assessments of the causes and meaning of the Moscow Trials and the Terror in 1936–8; but essentially the detailed study stops in 1936. In fact, Trotsky’s thinking continued to develop in response to new developments after 1936. The puzzle which Trotsky grappled with – the ‘workers’ state’ which is simultaneously the instrument of fascistic terror against the workers by (...) ‘the sole privileged and commanding stratum’ – was connected to puzzles in the more general Marxist theory of the state, which Twiss explores usefully in his opening chapter. (shrink)

There is no agreed minimum standard with regard to what is considered safe, competent nursing care. Limited resources and organizational constraints make it challenging to develop a minimum standard. As part of their everyday practice, nurses have to ration nursing care and prioritize what care to postpone, leave out, and/or omit. In developed countries where public healthcare is tax-funded, a minimum level of healthcare is a patient right; however, what this entails in a given patient’s actual situation (...) is unclear. Thus, both patients and nurses would benefit from the development of a minimum standard of nursing care. Clarity on this matter is also of ethical and legal concern. In this article, we explore the case for developing a minimum standard to ensure safe and competent nursing care services. Any such standard must encompass knowledge of basic principles of clinical nursing and preservation of moral values, as well as managerial issues, such as manpower planning, skill-mix, and time to care. In order for such standards to aid in providing safe and competent nursing care, they should be in compliance with accepted evidence-based nursing knowledge, based on patients’ needs and legal rights to healthcare and on nurses’ codes of ethics. That is, a minimum standard must uphold a satisfactory level of quality in terms of both professionalism and ethics. Rather than being fixed, the minimum standard should be adjusted according to patients’ needs in different settings and may thus be different in different contexts and countries. (shrink)

The present paper considers the possible sense of “nonsensical” caring—caring (1) which for various reasons apparently cannot help the cared-for, and (2) in which the carer, though convinced that it will not be effective, whole-heartedly engages. The project is inspired by the fiction of Ali Smith, which offers varied, vivid and memorable examples of such caring: worried that her dead sister misses life experience, Clare in Hotel World makes sure her sensations are doubly intense and rich though she knows her (...) sister, being dead, will not benefit from them; in Summer Hannah and Daniel write to each other tender letters which they immediately burn for safety’s sake so that the addressee has not even the slightest chance of ever reading them; in “Virtual” a bed-ridden girl diligently takes care of her virtual pet, well aware that it is not alive, let alone sentient. Smith’s examples of “nonsensical” caring are strangely compelling, yet in real life such caring—predictably ineffective (as regards helping the other) and costly—is rare. Why? Under what metaphysical assumptions, if any, could “nonsensical” caring make sense? The paper considers these questions, taking Søren Kierkegaard’s extensive discussion of agape love in Works of Love (1847) as its primary point of reference. (shrink)

BackgroundRationing of care in nursing is nurses' inability to complete all care activities for patients because of scarcity in time and resource. Literature suggests that rationing of care is closely related to patient safety and quality of care. The phenomena have been defined and studied from varied perspectives and contexts. A systematic review of studies related to the concept was aimed at identifying and synthesizing the finding.MethodsThe review followed Preferred Reporting Items for Systematic Reviews and Meta‐analysis (...) guidelines, and literature searches were conducted in MEDLINE, CINAHL, PsycInfo, Web of Science and EMBASE databases. Fifty‐seven quantitative studies were included in the review.FindingsThe review observed that nursing activities addressing the emotional, educational, mobility and hygiene needs of the patients were commonly rationed. Antecedents of rationing included resource inadequacy and organizational work environment. Rationing influenced patient satisfaction, mortality and a number of adverse events and was associated with decreased job satisfaction, increased intention to leave and high turnover among nurses.DiscussionsThis review concludes that rationing in nursing is ubiquitous, embedded in the work environment and poses a threat to the professional health and philosophical base of nursing in addition to having serious implications on patients' safety. Strategies to reframe and reconsider organizational traits, and open discussion with other healthcare stakeholders can reduce rationing of nursing care. The review suggests future researchers adopt different methodological layout to study rationing. (shrink)

In this article, we report findings from a qualitative study that explored how the relatives of intensive care unit patients experienced the nurses’ role and relationship with them in the end-of-life decision-making processes. In all, 27 relatives of 21 deceased patients were interviewed about their experiences in this challenging ethical issue. The findings reveal that despite bedside experiences of care, compassion and comfort, the nurses were perceived as vague and evasive in their communication, and the relatives missed (...) a long-term perspective in the dialogue. Few experienced that nurses participated in meetings with doctors and relatives. The ethical consequences imply increased loneliness and uncertainty, and the experience that the relatives themselves have the responsibility of obtaining information and understanding their role in the decision-making process. The relatives therefore felt that the nurses could have been more involved in the process. (shrink)

Miss Telfer offers a new analysis, classifying health care into four systems, only one of which, the 'laissez-faire' type, is unlikely to be acceptable today. The other three systems are defined here as 'liberal humanitarian', 'liberal socialist' and 'pure socialist'. Each is analysed for its content and for the views of its protagonists and antagonists. On these issues no dogma is proclaimed as the author says she has sought to 'bring out some of the principles at issue in any (...) discussion of the rights and wrongs of socialized medicine'. This journal is surely the proper place for such a discussion as the worlds of the politician, of the economist, of the doctor and of the patient come to a point in the philosophies behind the aspect of medical ethics exemplified in the provision of medical services by the state. Miss Telfer also glances down the byways of the medicine of the market place. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Providing Care to a Potential Aggressor: An Ethical DilemmaHandreen Mohammed SaeedFollowing the abrupt fall of almost a third of its territory in 2014 to armed militias, Iraq fell into civil war turmoil. As a direct result of the armed conflicts, hundreds of thousands of Iraqis were displaced or subjected to atrocious human rights violations with physical, sexual, and psychosocial abuse. While the scenes on the TV provided only (...) a glimpse of what was happening on the ground, the true stories circulating about people’s suffering left me personally in absolute shock. Among those who suffered the most from the offences were marginalized religious and ethnic minority groups, who were viewed and treated as infidels by the aggressor militants. Those marginalized communities not only endured displacement due to the armed conflicts but they were also mass-exterminated, sexually abused, and underwent massive destruction of their towns and villages.In 2016, I was working for Ministry of Health as a primary care physician in a small town in Iraqi Kurdistan, which hosted tens of thousands of internally displaced people (IDPs) from one of those marginalized minority communities. I had the opportunity to hear their tragic stories firsthand as they fled for their lives in 2014. Working in those communities as a primary care physician allowed me to truly understand their feelings and emotions and reflect on their experiences while providing healthcare services. This experience sparked an interest in humanitarian work, in which I could be close to areas of need and involved in providing physical health first-aid and also psychological and social first-aid; all crucial in addressing the future health consequences experienced by people going through humanitarian crises. In the same year, 2016, I joined an international medical organization and started working in remote and low-resource settings in northern Iraq as a humanitarian physician. Our projects included a variety of primary care, psychosocial, and urgent care services targeting refugees, IDPs, and vulnerable host communities in areas near conflict zones. The projects were designed and implemented with the hope that the most vulnerable populations have access to our services.In October 2016, the Iraqi authorities launched a massive military operation known as the “Battle of Mosul” to regain control of Mosul, the second-largest city in Iraq. As an emergency medical humanitarian organization, we had to be near the battlefield and respond to the unfolding humanitarian crisis on a daily basis. As the official security forces backed by the international alliance started to advance, tens of thousands of people, including some militants and their families, fled Mosul and headed towards areas controlled by the Kurdistan Regional Government’s forces in the north, where our organization was operational. Some of them sought refuge in one of our medical facilities in northern Iraq, which was operated by local staff, [End Page 172] including members from some of the minority communities that had suffered the most from the militants’ aggression in 2014. The patients entering our facilities were mainly older adults, women, and children, but we were also visited by a small group of potential militants who were either injured, malnourished, or just seeking help and refuge. As a neutral, impartial, independent, humanitarian organization compliant with medical ethics, we were committed to providing healthcare services to anybody in need without discrimination or judgment.As we responded to the humanitarian crisis unfolding before our eyes, some of our staff members came forward and raised valid questions about the ethics of treating patients potentially involved in serious human rights violations. With tears in her eyes, one nurse approached me and stated, “Seeing these people reminds me of all the girls and women who went missing from my village and are now being sold as sex slaves in Syria”. The staff expressed serious concerns about their ability to provide care to patients who may have been involved in mass killing, torture, and the destruction of their own towns, as well as sexual abuse against their family members, friends, and people in their communities. Due to the psychological and physical trauma caused by the militants’ conquest, the staff was reluctant to provide medical care to these patients, as seeing and hearing them brought back... (shrink)

This article examines how the EU gender mainstreaming approach has addressed work and family reconciliation across Southern Italian regions, to foster a more egalitarian and socially inclusive development. Drawing upon a survey of women of different socioeconomic backgrounds and in-depth interviewing of regional policy-makers, this article assesses what gender equality policies do and don’t do for work–family reconciliation within the Italian Mezzogiorno. Findings show that while poor women may be stigmatized as inadequate mothers, middle-class women are pushed to join men (...) in employment and civic sphere at the expense of caring. As both public and private caring supply is underdeveloped and unevenly guaranteed between protected and unprotected workers, women may be constrained to reduce their participation in the labour market. Traditional gendered family roles and power relations within the household may further discourage women to work, form and maintain a family. (shrink)

_ Source: _Volume 38, Issue 1, pp 55 - 63 The paper gives an account of the relation between the Croatian humanist Franciscus Tranquillus Andronicus Parthenius and Desiderius Erasmus. The main source is Erasmus’ letter to Tranquillus of 28 June 1519; another document is Erasmus’ _Convivium poeticum_, first printed in 1523, in which a character named Parthenius appears. An analysis of Erasmus’ letter and of the context in which it was written reveals that Tranquillus’ visit to Louvain happened at a (...) very inconvenient time for Erasmus, especially because he had to carefully deal with the conservative theologians, who were trying to extinguish the recently established Collegium Trilingue in Louvain. As for the identity of Parthenius in the _Convivium poeticum_, a new hint is given for his identification with Tranquillus. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Health Care Ethics: A Comprehensive Christian Resource by James R. ThobabenPaul D. SimmonsHealth Care Ethics: A Comprehensive Christian Resource by James R. Thobaben Downers Grove, IL: Intervarsity Press, 2009. 429pp. $28.00In recent years, a stir has been created by the vocal and aggressive involvement of evangelicals in such issues as abortion, homosexuality, and end-of-life decisions. James Thobaben, the dean of Asbury Seminary, provides what he calls (...) a [End Page 203] “comprehensive resource” for evangelicals, and promises better understandings of their perspectives and commitments for those who are baffled or frustrated by the actions and claims of those on the religious right.Thobaben casts a wide net when defining those he includes as “evangelicals”—Southern Baptists, members of Campus Crusade, Pentecostals, the Holiness movement, neoevangelicals, charismatics, and Anabaptists. These diverse groups are evangelicals because of their “consistency on moral choices,” doctrinal orientation, and styles of social advocacy (24). Although they differ in a number of ways, they all share having been influenced in some way by John and Charles Wesley, Jonathan Edwards, and the Reformation. All stress conversion in that “one must say yes to the divine Jesus Christ” and become identified with the community of faithful believers (57). And in recent decades, they have become a potent political force with regard to the issues of abortion and homosexuality.Thobaben covers a wide range of topics in this book: from a general discussion of theodicy and healing to bioethics, disability, sickness, family and congregational care, professional truthfulness, managing care, end-of-life decisions, assisted reproduction, organ donation, and death. Yet, although he claims to provide a “comprehensive resource” on evangelical Christian health care ethics, he fails to provide a thorough examination of his subject matter. For example, Thobaben pays little attention to the historic beginnings of the religious right. One misses any mention of political action groups or the coalitions formed with or by conservative Christian groups to pursue social reforms, or of why such disparate groups have cooperated for political or social goals under the same umbrella. He focuses solely on identifying and articulating the consensus among those who embrace certain moral values on the current scene. Thobaben’s uncritical approach to his subject matter leaves the impression that this book is essentially an apology for evangelical, right-wing Christian social thought. One searches in vain for any critical discussion of the beliefs and values he presents or any thoughtful engagement with those who might view the stances he presents as an assault against women’s rights or an attack on the rights of gays, lesbians, and transsexuals.Moreover, in a book like this, one would have expected a more careful assessment of biblical passages and historical precedents. Thobaben does not provide much rationale for his method for moving from the Bible to current social issues. For example, no prohibition against abortion is found in the Bible and the few passages about homosexual practices hardly add up to the fierce opposition to gays found among strident evangelicals. Moreover, Thobaben does not mention that in 1965 laws against contraceptives were declared unconstitutional by the Griswold vs. Connecticut decision, the Supreme Court’s rejection of a ban supported by an evangelical crusade led by Anthony Comstock. [End Page 204]It is interesting to note that Thobaben holds a strongly qualified commitment to religious liberty and only a “thin” version of the social contract basic to the Bill of Rights (37). He argues that in at least some situations “intolerance is not only morally understandable but strongly preferable,” as in the examples of the “abolition of slavery and prolife/antiabortion advocacy” (29) or, in another context—where he distinguishes between tolerance toward those outside the church and intolerance toward those within it—with regard to homosexuality and alcohol intoxication (30).The task of Christian ethics is to enlighten believers and the general citizenry by a careful exposition of the sources of wisdom available to those who want to think and think morally about issues of importance to human flourishing. That task is especially important in an age of demagogic hostility toward unpopular groups. Sadly, this book does not engage such critical questions. It may prove... (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, (...) while internationally studies highlight instances of covert rationing/missed care/care left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

This article attends to an unnamed and often missing element of the cosmopolitanism discourse: care ethics. Developed out of feminist theory in the 1980s, care ethics privileges the relational, contextual, and affective aspects of morality. It is my suggestion that contemporary discussions of cosmopolitanism would benefit from integrating the moral commitments of care ethics. First, a definition of care ethics is offered followed by a delineation of themes of care in the cosmopolitan theorizing of an (...) historical figure, Jane Addams, and a contemporary theorist, Kwame Anthony Appiah. Ultimately, the contention here is that cosmopolitan societies envisioned by Addams and Appiah cannot be exclusively founded on systems of justice (i.e., rights, principles, laws) but needs caring to provide the social cohesion necessary for organic international justice, as well as lasting peace. (shrink)

Managed care poses a challenge to the traditional conceptualization of medicine and of the physician-patient relationship. People have evaluated the merits of managed care by focusing upon the way its incentives alter the relationship between physician and patient. However, this misses the key to rightly evaluating MCOs. To address the ethics of MCOs one should focus on the institution-patient relationship, and this has not been sufficiently addressed in the literature. I will address this relationship here and show how (...) the institution-patient relationship has evolved, why it has become increasingly prominent, and why we must move beyond business ethics for rightly understanding it. (shrink)

The metaphor of “care drain” has been created as a womanly parallel to the “brain drain” idea. Just as “brain drain” suggests that the skilled migrants are an economic loss for the sending country, “care drain” describes the migrant women hired as care workers as a loss of care for their children left behind. This paper criticizes the construction of migrant women as “care drain” for three reasons: 1) it is built on sexist stereotypes, 2) (...) it misrepresents and devalues care work, and 3) it misses the opportunity for a theoretical change about how skills in migration contexts can be understood. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Gaining a Heart But Missing MyselfLeilani R. GrahamI gathered it in my hands as it fell from my hair-brush, too saturated to hold anymore. It felt as if I were inside a movie and waiting for someone to yell “Cut!” but no call came. It continued to fall, feather-like onto the ground, individual strands glinting in the light of the bathroom window. My hair, nearly all of it, was (...) gone.Between the time of my heart transplant and the moment my hair began to fall out, I arguably had suffered enough. Transplant brought four open-heart surgeries, ten days on ECMO, an intra-aortic balloon pump, delirium, necrotizing pneumonia, and so much muscular atrophy that I had to re-learn how to walk. CPR, broken ribs, and the scar of a tricuspid clip from a botched biopsy: it was not the miracle I was hoping for.The internal trauma had certainly taken its toll. I no longer knew how I really felt, thanks to copious pain meds that altered my mind and body. Each limb was foreign as I re-acclimated to how one grabs hold of a cup, signs their name, touches their legs. Externally, I was a mess: covered in deep purple bruises across my torso from the diabetes treatments, dead skin pooling in unwashed pores, my ankles swollen and indiscernible from my legs. But lacking a good mirror (or the desire to find one), I still felt like “myself” during my forty-five day hospital stay. I could feel my cheekbones protruding from thinning skin, saw through unfocused eyes from the tempestuous blood sugars, and my hair sat in a rat’s nest atop my head; but I was still me.Arriving home, I felt like a newborn being brought into the real world for the first time. I needed help with everything—showers, sitting up, putting on shoes, even going to the bathroom. At age twenty-four, I felt I had regressed to the point of no return as I relied on others to do the simplest tasks. In addition, I was quarantined inside for three months, due to the risk of obtaining a fungal infection from the outside. Caged, and alone in my body, I a trapped and wounded tiger: angry, hurting, and scared. [End Page 109]When I had been prepared for transplant—and I use “prepared” loosely because the information packet I was handed was insulting at best—I knew to expect the scars. I had no issue with that, having been cut open at my throat and chest for previous surgeries. I knew to expect a 12-inch line from neck to navel: the most evident sign I would now carry that I was disabled.What I did not expect were the bullet holes— the sealed entrances of thick chest tubes that now dotted my lower torso. I did not anticipate the bruises on my arms and groin from arterial pokes. I felt violated as if I had walked into some kind of abduction and was rolled out, beaten, bruised, and, worst, touched.But it wasn’t the physical trauma that hurt the most. It was that no one seemed surprised.Immediately after transplant, the team’s focus is purely on survival. Survive the 30 days post-surgery. Survive the year. Metrics, uncomfortably tied to transplant center success statistics, funding, and clout have little to do with the patients themselves. What did I care to only survive a year? I wanted years. I wanted decades. It felt I wanted more than anyone was willing to pay attention to.The conversation was narrowed to high-risk issues: infection, rejection, or other life-threatening conditions. While this makes sense on a clinical level, what constitutes a major event for a clinician may not be of the same emotional value to the patient. In my case, I was less occupied by how the steroids were working and more obsessed with their side effects, such as how much weight I was rapidly gaining. I walked into the clinic one day with the beginnings of stretch marks and a week later had claw-like ripples down my sides. My mood swings were explosive... (shrink)

The issues are familiar to most in bioethics by now, through professional or personal experiences (or both). The rapidly expanding population of elderly persons who require care is raising critical...

BackgroundHumanitarian crises and emergencies, events often marked by high mortality, have until recently excluded palliative care—a specialty focusing on supporting people with serious or terminal illness or those nearing death. In the COVID-19 pandemic, palliative care has received unprecedented levels of societal attention. Unfortunately, this has not been enough to prevent patients dying alone, relatives not being able to say goodbye and palliative care being used instead of intensive care due to resource limitations. Yet global guidance (...) was available. In 2018, the WHO released a guide on‘Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises’—the first guidance on the topic by an international body.AimsThis paper argues that while a landmark document, the WHO guide took a narrowly clinical bioethics perspective and missed crucial moral dilemmas. We argue for adding a population-level bioethics lens, which draws forth complex moral dilemmas arising from the fact that groups having differential innate and acquired resources in the context of social and historical determinants of health. We discuss dilemmas concerning: limitations of material and human resources; patient prioritisation; euthanasia; and legacy inequalities, discrimination and power imbalances.ImplicationsIn parts of the world where opportunity for preparation still exists, and as countries emerge from COVID-19, planners must consider care for the dying. Immediate steps to support better resolutions to ethical dilemmas of the provision of palliative care in humanitarian and emergency contexts will require honest debate; concerted research effort; and international, national and local ethical guidance. (shrink)

This article attends to an unnamed and often missing element of the cosmopolitanism discourse: care ethics. Developed out of feminist theory in the 1980s, care ethics privileges the relational, contextual, and affective aspects of morality. It is my suggestion that contemporary discussions of cosmopolitanism would benefit from integrating the moral commitments of care ethics. First, a definition of care ethics is offered followed by a delineation of themes of care in the cosmopolitan theorizing of an (...) historical figure, Jane Addams, and a contemporary theorist, Kwame Anthony Appiah. Ultimately, the contention here is that cosmopolitan societies envisioned by Addams and Appiah cannot be exclusively founded on systems of justice (i.e., rights, principles, laws) but needs caring to provide the social cohesion necessary for organic international justice, as well as lasting peace. (shrink)

Alice Dunbar-Nelson is mostly remembered as a poet, activist, and ex-wife of Paul Laurence Dunbar. Her volume The Goodness of St. Rocque and Other Stories (1899) has been largely overshadowed as a result. Yet, the collection contains a portfolio of heroines analogous and contemporaneous to the famed New Woman figure of the fin de siècle. In this article, I consider Dunbar-Nelson’s heroines in light of their New Woman-esque agency and autonomy as they find remedies and power in objects and materials (...) steeped in New Orleans’s cultural heritage. Ceded neither social nor political self-governance nor domestic comfort, this article reads these transcendental, metaphysical objects as sources of self-care. With close analysis of “The Goodness of St. Rocque,” “Tony’s Wife,” and “Little Miss Sophie,” I argue that Dunbar-Nelson’s protagonists exert influence over their lives, specifically in the negotiation of romantic relationships, through voodoo charms, Catholic candles, tarot cards, sewing machines, and knitting needles. Covering courtship, break-ups, and unhappy marriages, I demonstrate the ways in which these empowering spiritual objects respond to health concerns, including malnutrition and domestic violence, in turn, situating them as alternatives to patriarchal and historically racist medical institutions. Valorizing the cultural milieu of New Orleans and the customs of the Caribbean and European heritage, and thereby conveying Dunbar-Nelson’s resistance to white and male supremacist ideologies in late-nineteenth-century Southern America, the article ultimately assesses the parallels with (predominantly white) New Woman fiction, through shared themes of fraught heterosexual dynamics and women’s declining health. (shrink)

This study explores child health care nurses’ pedagogical knowledge when supporting parents in their parenthood using various teaching practices, that is how to organise and process the content during parent education groups in primary health care. The aim is to identify teaching practices used by child health care nurses and to analyse such practices with regard to Aristotle's three forms of knowledge to comprehensively examine child health care nurses’ use of knowledge in practice. A qualitative methodological (...) design alongside the analysis of video‐recordings was used. The results showed that child health care nurses used four teaching practices: lecturing, demonstration, conversation and supervision. Their use of episteme was prominent, but they also seemed to master techne in combination with episteme during the first three teaching practices. During the conversation teaching practice, the child health nurses rarely succeeded. Consequently, they missed opportunities to identify mothers’ expressed concerns and to act in the best interests of both the mothers and their infants by the use of phronesis. In health care, however, theoretical episteme is superordinate to productive knowledge or phronesis, which also became evident in this study. Nevertheless, more interactive pedagogical practices are needed if more use of phronesis is to become a reality in parent education groups. (shrink)

This paper argues that the world-wide debate about physician assisted dying is missing a golden opportunity to focus on the orchestration of the end of life. Such a process consists of far more than adequate pain control and is a skill which, like all other skills, needs to be learned and taught. The debate offers an opportunity to press for the teaching of this skill. Beyond this, the desire to assure that all can have access to palliative care makes (...) sense only within the embrace of a universal health-care system and the desire that all can have a death with dignity is meaningful only within the embrace of a life with dignity. (shrink)

'Take care of the means and the ends will take care of themselves'By the time you are reading this instalment I will have been in my new position as Team Leader for a Community Conservation Project for more than one year. Why I left my previous position will perhaps become clear in this instalment. I may be unsuited to working in institutions that in theory value knowledge and analysis, but in practice become increasingly uncomfortable when the critical analysis (...) is turned inwards. I find I am not alone; witness the prominent case of the response of the World Bank to criticisms from their own former Chief Economist, the Nobel Economics laureate Joseph Stiglitz. His criticism of the International Financial Institutions after years of working with them could not be dismissed as the work of an uninformed outsider and were therefore treated with the disdain due to some one who had 'jumped ship'. (shrink)

This paper examines the few, but important legal and coronial cases concerning withdrawing or withholding life-sustaining treatment from severely disabled or critically impaired infants in Australia. Although sparse in number, the judgements should influence common clinical practices based on assessment of “best interests” but these have not yet been adopted. In particular, although courts have discounted assessment of “quality of life” as a legitimate component of determination of “best interests,” this remains a prominent component of clinical guidelines. In addition, this (...) paper highlights the lack of uniform clinical guidelines available to medical professionals and parents in Australia when making end-of-life decisions for severely ill infants. Thus, it is argued here that there is a need for an overarching prescriptive uniform framework or set of guidelines in end-of-life decision-making for impaired infants. This would encourage greater transparency, consistency, and some degree of objectivity in an area that often appears subjective. (shrink)

In perceptions of their landscapes the Latvians have denied the existence of the sublime, elevating rural and natural aspects as beautiful and good. While Latvian landscape aesthetics and ethics are based on the profound transformation of nature-landscape attitudes that occurred in Europe during the second half of the 18th century, when ideas of the beautiful, sublime, and the picturesque were debated, the existence of sublime characteristics within the borders of Latvia has not been recognized. In part the attitude derives from (...) the lack of dramatic topography in Latvia. Part of it is due to historic contrasts of sublime wonders in foreign lands with the simple rural beauties and virtues of Latvia. Travelers' observations of rural beauty in specific places reinforced such attitudes. But it is also bound up with the complex history of Latvians as an underclass during colonial rule that began during the 13th century and did not truly end until 1991. As during the 19th century, Latvians began to develop their own national traditions; they used a voluminous collection of rural folk songs on which to build subtle literary and other artistic interpretations of what is moral and beautiful in rural life, work, and landscapes. A particularly important motif in Latvian writing is earth. The ethics of work, social responsibility, and care for living things are a powerful theme. If the sublime is mentioned, it is brought into the compass of the rural and the tame. Sublime elements of nature occur as metaphors for human actions. Thoroughly imbued with the above traditions, the author, at first unselfconsciously, discovered sublime aspects in Latvian landscapes and nature during the course of the past 11 years. It is his belief that as Latvians distance themselves from past colonial rule, they will begin to see their land in a less narrow fashion and recognize its sublime characteristics. (shrink)

Several fields contributing to psychiatric advances, such as psychology, biology, and the humanities, have not yet met to produce a cohesive and integrated picture of human function and dysfunction, strength and vulnerability, etc., despite advances in their own areas. The failure may have its roots in a disagreement on what we mean by the human person and his or her relationship with the world, for which the incommensurate language of these disciplines may be partly to blame. Turns taken by western (...) philosophy over the past 400 years may help to explain this. Language is such an important tool for psychiatrists, that examination of it may afford an insight into the reasons for divisions in the field. This paper aims to examine and compare psychologies (and hence psychiatries) derived from modern western philosophy, with similar concepts in other cultures, through the study of developments in terminology, in terms of the simplest facts about what it means to be human. Terminology used in mental health in western cultures is examined, with particular consideration of the term “self” as it has come to be used in a technical sense. Analogous terms from non-English speaking European languages, and some non-western cultures are studied. Western philosophy and psychology have evolved a meaning for the term “self” which is quite different from equivalent terms in non-western cultures. It is a moot point whether or not the development in western psychiatry of what are now technical terms to describe normal human experience has become needlessly obscure and ambiguous. It is not evident that this “new” language represents a genuine advance in understanding; it distances mental health professionals from those who are not familiar with it; and it makes transcultural dialogue difficult. (shrink)

In 1989, Susan Wolf convincingly warned of a troublesome consequence that should discourage any movement in American society towards physician-assisted death—a legal backlash against the gains made for limiting life-sustaining treatment. The authors demonstrate that this dire consequence did not come to pass. As physician-assisted suicide gains a foothold in USA and elsewhere, many other slippery slope arguments are being put forward. Although many of these speculations should be taken seriously, they do not justify halting the new practice. Instead, our (...) courts, regulatory agencies, journalists, professional organisations and researchers should carefully monitor and study it as it unfolds, allowing continuous improvement just as our society has done in implementing the practice of limiting life-sustaining treatment. (shrink)