People with cognitive disabilities are equal citizens, and law ought to show respect for them as full equals. To do so, law must provide such people with equal entitlements to medical care, housing, and other economic needs. But law must also go further, providing people with disabilities truly equal access to education, even when that is costly and involves considerable change in current methods of instruction. The central theme of this essay (...) is what is required in order to give such people political and civil rights on a basis of genuine equality. (shrink)

Liberalism welcomes diversity in substantive ideas of the good but not in the process whereby these ideas are formed. Ideas of the good acquire weight on the presumption that each is a person's own, formed independently. But people differ in their capacities to conceptualize. Some, appropriately characterized as cerebral, are proficient in and profoundly involved with conceptualizing. Others, labeled cognitively disabled, range from individuals with mild limitations to those so unable to express themselves that we (...) cannot be sure whether their behavior is mediated by concepts at all. Constricted cognitive capacities have been thought to prevent participation in the prescribed process for forming personalized ideas of the good. So liberal theory, when formulating principles and practices of justice, often disregards cognitively disabled peoples' perspectives. We put aside metaphysically driven notions about personhood and show how interpersonal processes of “prosthetic” thinking (different from surrogacy) can satisfy liberalism's standards, positioning cognitively disabled individuals as fully participating subjects of justice. (shrink)

This chapter contains sections titled: Why Philosophy and Cognitive Disability? Historical Overview Discussion of Themes and the Chapters Concluding Remarks References.

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a (...) procedural checklist to guide this process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. (shrink)

This article asks how people come to interpret themselves and others as autonomous given their multiple dependencies. We draw on a cross-case comparison of ethnographic studies with two populations for whom autonomy is both central and problematic: elderly patients in post-acute care, and young adults with disabilities in an independent living program. Analyzing the institutional efforts to make their clients “as independent as possible,” we find that staff members at each organization formulate autonomy as (...) a temporal project through an ongoing calibration of open futures, ideal pasts, and situational competence. Constantly adjusting and fine-tuning where in time autonomy “really” is, workers arrange present dependence so that the contours of the future remain open for their clients. In other words, they make use of temporal markers to produce recognizable autonomous subjects whose dependencies are momentary. Theorizing this temporal project enables us to see more clearly how all of us engage in the constant business of “doing” autonomy, and to better understand the role of institutions in producing autonomous selves. (shrink)

The social and cultural model of disability has challenged the historically powerful perception of disability as a deficiency. Disability is no longer conceived of solely in terms of an individual lack of capacities but also considered as a structural effect of disabling social institutions and normalizing thinking. The UN Convention on the Rights of Persons with Disabilities (CRPD) from 2006 marks a decisive step towards the recognition of humans with (cognitive) disabilities as legal subjects who (...) are entitled to enjoy all human rights on equal terms with others. A central claim of the CRPD refers to full political participation of persons with (cognitive) disabilities. This paper argues for strengthening the political participation of persons with severe cognitive disabilities. The normative starting point is the claim that they are our equals, both morally and socially. In spelling out this status equality for the realm of the political, I focus on what political equality and inclusivity means concerning franchise. I will argue that the disenfranchisement of persons with cognitive disabilities, as practiced in many countries, cannot be justified. Furthermore, enfranchising persons with cognitive disabilities is deemed a central expression of their recognition as equals. Thus, it marks a crucial moment of emancipatory transformation towards a more inclusive political system. In cases where severely cognitive disabled persons cannot exercise the right to vote themselves, forms of assisted voting and supported decision-making must be available. (shrink)

I argue that capabilities approaches are useful in formulating a political theory that takes seriously the needs of persons with severe cognitive disabilities (PSCD). I establish three adequacy criteria for theories of justice that take seriously the needs of PSCD: A) understanding PSCD as oppressed, B) positing a single standard of what is owed to PSCD abled individuals, and C) concern with flourishing as well as political liberty. I claim that conceiving valued capabilities as the end (...) of social distribution may help a political theory to meet these criteria.I posit three further adequacy criteria: D) refusing to see PSCD as less than human, E) valuing moral powers other than practical reason, and F) securing space for care and dependency relationships. I show that how well Elizabeth Anderson and Martha Nussbaum’s capabilities approaches meet these criteria depends on their divergent conceptions of what capabilities are for. I sketch another capabilities approach that might better meet the three latter criteria (inspired by Lawrence Becker and Eva Kittay’s work), that conceives capabilities as for agency and relationship. (shrink)

A feminist ethics that bases morality on dependence or vulnerability challenges the moral priority of uniform over disparate treatment. Persons with disabilities resist equality's homogenization of moral personhood. But displacing equality in favor of caring or trust reprises the repression of those already marginalized. The ethics of difference proves an ineffective remedy for the negative consequences attendant on how historically marginalized groups are different. An historicized conception of equality resolves the dilemma.

Does life have meaning? What is flourishing? How do we attain the good life? Philosophers, and many others of us, have explored these questions for centuries. As Eva Feder Kittay points out, however, there is a flaw in the essential premise of these questions: they seem oblivious to the very nature of the ways in which humans live, omitting a world of co-dependency, and of the fact that we live in and through our bodies, whether they are fully abled (...) or disabled. Our dependent, vulnerable, messy, changeable, and embodied experience colors everything about our lives both on the surface and when it comes to deeper concepts, but we tend to leave aside the body for the mind when it comes to philosophical matters. Disability offers a powerful challenge to long-held philosophical views about the nature of the good life, what provides meaning in our lives, and the centrality of reason, as well as questions of justice, dignity, and personhood. These concepts need not be distant and idealized; the answers are right before us, in the way humans interact with one another, care for one another, and need one another--whether they possess full mental capacities or have cognitive limitations. We need to revise our concepts of things like dignity and personhood in light of this important correction, Kittay argues. This is the first of two books in which Kittay will grapple with just how we need to revisit core philosophical ideas in light of disabled people's experience and way of being in the world. Kittay, an award-winning philosopher who is also the mother to a multiply-disabled daughter, interweaves the personal voice with the philosophical as a critical method of philosophical investigation. Here, she addresses why cognitive disability can reorient us to what truly matters, and questions the centrality of normalcy as part of a good life. With profound sensitivity and insight, Kittay examines other difficult topics: How can we look at the ethical questions regarding prenatal testing in light of a new appreciation of the personhood of disabled people? What do new possibilities in genetic testing imply for understanding disability, the family, and bioethics? How can we reconsider the importance of care, and how does it work best? In the process of pursuing these questions, Kittay articulates an ethic of care, which is the ethical theory most useful for claiming full rights for disabled people and providing the opportunities for everyone to live joyful and fulfilling lives. She applies the lessons of care to the controversial alteration of severely cognitively disabled children known as the Ashley Treatment, whereby a child's growth is halted with extensive estrogen treatment and related bodily interventions are justified. This book both imparts lessons that advocate on behalf of those with significant disabilities, and constructs a moral theory grounded on our ability to give, receive, and share care and love. Above all, it aims to adjust social attitudes and misconceptions about life with disability. (shrink)

ABSTRACT People who are paid to provide basic care for others are frequently undervalued, exploited and expected to reach often unrealistic standards of care. I argue that appropriate social recognition, support and fair pay for people who provide care for those who are disabled, frail and aged, or suffering ill health that impedes their capacity to negotiate daily activities without support, depends on a reconsideration of the paradigm of the citizen or and moral agent. I argue that (...) by drawing on the ideas of human vulnerability and dependency as central to our personhood, a more realistic conception of selves, citizens and persons can be developed that better recognises the inevitability of human dependency and the social value of care work. I also indicate the significance of this vulnerability‐focussed view for ethical evaluation of the emotional aspects of care relationships. (shrink)

This chapter contains sections titled: Introduction: Liberalism and Inclusiveness Liberalism: Political and Metaphysical Collaborating on Ideas of the Good Powers of Self‐Control Conclusion References.

Euthanasia and assisted suicide have been legally possible in the Netherlands since 2001, provided that statutory due care criteria are met, including: voluntary and well-considered request; unbearable suffering without prospect of improvement; informing the patient; lack of a reasonable alternative; independent second physician’s opinion. ‘Unbearable suffering’ must have a medical basis, either somatic or psychiatric, but there is no requirement of limited life expectancy. All EAS cases must be reported and are scrutinised by regional review committees. The purpose of this (...) study was to investigate whether any particular difficulties arise when the EAS due care criteria are applied to patients with an intellectual disability and/or autism spectrum disorder. The 416 case summaries available on the RTE website were searched for intellectual disability and autism spectrum disorder. Direct content analysis was used on these nine cases. Assessment of decisional capacity was mentioned in eight cases, but few details given; in two cases, there had been uncertainty or disagreement about capacity. Two patients had progressive somatic conditions. For most, suffering was due to an inability to cope with changing circumstances or increasing dependency; in several cases, suffering was described in terms of characteristics of living with an autism spectrum disorder, rather than an acquired medical condition. Some physicians struggled to understand the patient’s perspective. Treatment refusal was a common theme, leading physicians to conclude that EAS was the only remaining option. There was a lack of detail on social circumstances and how patients were informed about their prognosis. Autonomy and decisional capacity are highly complex for patients with intellectual disabilities and difficult to assess; capacity tests in these cases did not appear sufficiently stringent. Assessment of suffering is particularly difficult for patients who have experienced life-long disability. The sometimes brief time frames and limited number of physician-patient meetings may not be sufficient to make a decision as serious as EAS. The Dutch EAS due care criteria are not easily applied to people with intellectual disabilities and/or autism spectrum disorder, and do not appear to act as adequate safeguards. (shrink)

SCHOFIELD I, TOLSON D and FLEMING V. Nursing Inquiry 2012; 19: 165–176 [Epub ahead of print]How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse AnalysisDelirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease‐based classification systems and clinical guidelines. (...) There is little systematic study of nurses’ day‐to‐day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses’ care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses’ language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person‐centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion. (shrink)

As a form of functional diversity, spinal cord injury expressed by tetraplegia is one of the most serious events that can impact people, affecting their family and socioeconomic life. The type of care relationship established in these cases will be essential for preserving autonomy. The objective of this study was to understand how care relationships influence the autonomy of people with tetraplegia and the dynamics that trigger practices of autonomy violation, maintenance and promotion. This research is inspired (...) by problematization as a methodology using the Arch of Maguerez as an analytical approach strategy that enables an engagement between empirical and theoretical data. Some models of care relationships identified in this study either promote or violate autonomy: the protectionist model, based on the biomedical interpretation model of disability and the bodily impediments caused by spinal cord injury; the participatory model, involving the patient's interest in adapting to their new condition of family and community life, seeking to understand the practical aspects of daily life; the sharing model, in which the complicity and understanding of new forms of bodily expression allow the caregiver to be almost an extension of the tetraplegic person's body; the delegate model, which occurs in relationships with professional caregivers; and the emancipatory model, which seeks to empower the patient, highlight potentialities, and encourage autonomy. The key components of these conceptual care models guided the elaboration of hypotheses for intervention with the objective of maintaining and promoting the autonomy of people with tetraplegia through supported care. (shrink)

Care staff in Norway usually work in the private homes of people with intellectual disabilities. Staff experience ethical challenges daily in their interactions with their clients. The aim of this paper is to introduce a vignette validation procedure for selection of practice-close vignettes that can be used to elicit and explore staff reflections on ethical challenges in their work. Staff participants were recruited from different municipalities in one county of Norway. To develop vignettes with good (...) internal validity, the validation process consisted of (1) a field study to identify situations to be included as vignettes, (2) a six-step categorization process to select vignettes with good internal validity, (3) transforming the situations into vignettes, including removal of elements that were too leading or constricting, (4) testing the familiarity and relevance of the preliminary sample of vignettes (external validation), (5) final selection of four vignettes to be included in the investigation, and (6) a validation of the four vignettes? familiarity and practical relevance as ethical challenges by the final sample of interviewees. Our preliminary experience indicates that the validation procedure enhanced the selection of vignettes to elicit staff perceptions and reflections on daily ethical challenges. (shrink)

It is commonly held that there are both cases in which there is a strong moral reason not to cause the existence of a disabled person and cases in which, although it would be permissible to cause a disabled person to exist, it would be better not to. Yet many disabled people are affronted by the idea that it is sometimes better to prevent people like themselves from existing, precisely because these people would be disabled. One (...) of their grounds for concern, which will be my particular focus in this paper, is that claiming that there are reasons to prevent the existence of disabled people may be expressive of a demeaning and hurtful view of the status of existing disabled people, a view that may encourage discriminatory attitudes towards and treatment of the disabled. I will contend that there can indeed be moral and prudential reasons for preventing the existence of a disabled person. But I will argue that it is less obvious than many people assume what, if anything, the recognition of these reasons expresses about disabled people. And I will contend that, even if the recognition of these reasons does express a perception of disabled people that is potentially hurtful, this effect could be offset by the social expression of a contrary view that I will claim is in fact compatible with and equally valid as the potentially hurtful view. Whether it may be morally objectionable to cause a disabled person to exist depends, in part, on whether the person’s life would be worth living. If it is ever objectionable to cause a disabled person to exist, the objections are surely strongest when the person’s life would be “worth not living” – that is, would have aspects or features that would be bad for the person and that would decisively outweigh those, if any, that would be good. Such cases are, however, quite rare. Indeed, some people question whether there are any disabilities so severe as to cause life to be worth not living. It can be argued that disability involves only the absence of certain abilities and that mere deficits.... (shrink)

According to Bayertz the core meaning of solidarity is the perception of mutual obligations between the members of a community. This definition leaves open the various ways solidarity is perceived by individuals in different communities and how it manifests itself in a particular community. This paper explores solidarity as manifested in the context of families in respect of caregiving for a family member who has become dependent because of disease or illness. Though family caregiving is based on the same (...) perception of mutual obligation as the solidarity that supports welfare arrangements in society, the manifestation of solidarity in families is different. Solidarity that underpins welfare arrangements is based on a perception of mutual obligation towards an anonymous dependent other and is enforced by the government. Solidarity in families is directed towards a concrete other and is based on free choice, albeit often accompanied by a strong sense of personal duty. In this paper we try to distinguish between solidarity as a sociological concept and as a moral concept. An important moral element of solidarity, as expressed in families, is the need for recognition of family caregivers, not only of their concrete practical efforts, but also of their own identity as caregivers and as individuals. We illustrate this argument by referring to examples in the Nuffield Council on Bioethics report Dementia : ethical issues, about the experiences of family caregivers in dementia care and the importance for them of recognition of their role. (shrink)

Background:Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy.Objective:To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy.Setting:Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people with intellectual (...) class='Hi'>disabilities.Methods:Ethnographic field study.Ethical considerations:The boards representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee.Findings:Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.”Conclusion:Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. (shrink)

BackgroundAs moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research.MethodsA multiple-case study was conducted in a care organization for people (...) with intellectual disabilities and/or acquired brain injury, by observing MCD sessions as ‘cases’, followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client’s quality of care and life; (6) the organizational and policy level.ResultsAccording to interviewees, their moral awareness and their collaboration, both among colleagues and with clients’ relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients’ relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up.ConclusionsConcretizing and conceptualizing the ‘impact’ of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider ‘impact’ in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients’ and relatives’ experiences. (shrink)

Disabled people frequently find themselves in situations where their quality of life and wellbeing is being measured or judged by others, whether in decisions about health care provision or assessments for social supports. Recent debates about wellbeing and how it might be assessed (through subjective and/or objective measures) have prompted a renewed focus on disabled people’s wellbeing because of its seemingly ‘anomalous’ nature; that is, whilst to external (objective) observers the wellbeing of disabled people appears (...) poor, based on subjective assessments, people with disabilities report a good quality of life. In this paper, I examine an article by the philosopher Dan Moller in which he seeks to explain this ‘disability paradox’. Despite agreeing with his analysis that there is more to what people value than happiness, his explanation reflects some of the difficulties presented in philosophical accounts which seek to understand the lives of disabled people: this includes an analysis which fails to problematise definitions of wellbeing and who has the ‘voice’ to do the defining; which negates the multiple identities and subject positions that disabled people occupy; and which lacks recognition of the social contexts which mediate disabled people’s lives. I suggest that there is a need to incorporate disabled people’s voices into research which deepens our empirical knowledge about the relationship between impairment and wellbeing, including the social circumstances that shape disabled people’s agency. (shrink)

This chapter provides a roadmap of ongoing conversations about cognitive disability and moral status. Its aim is to highlight the political stakes of these conversations for advocates for the cognitively disabled while at the same time bringing out how a fundamental point of divergence within the conversations has to do with what count as appropriate methods of ethics. The main divide is between thinkers who take ethical neutrality to be a regulative ideal for doing empirical justice to the (...) lives of people with cognitive disabilities and those who reject this methodological precept as unduly restrictive. What results is a debate between, on the one hand, fans of various familiar forms of moral individualism and Kantian approaches in ethics and, on the other, a range of disability scholars and activists who implicitly or explicitly make use of philosophically more radical methods. (shrink)

We present a cross-cultural analysis showing that the presence of an active or moral High God in societies varies generally along a continuum from lesser to greater technological complexity and subsistence productivity. Foragers are least likely to have High Gods. Horticulturalists and agriculturalists are more likely. Pastoralists are most likely, though they are less easily positioned along the productivity continuum. We suggest that belief in moral High Gods was fostered by emerging leaders in societies dependent on resources that were (...) difficult to manage and defend without group cooperation. These leaders used the concept of a supernatural moral enforcer to manipulate others into cooperating, which resulted in greater productivity. Reproductive success would accrue most to such leaders, but the average reproductive success of all individuals in the society would also increase with greater productivity. Supernatural enforcement of moral codes maintained social cohesion and allowed for further population growth, giving one society an advantage in competition with others. (shrink)

Participatory action research (PAR) is a form of community-driven qualitative research which aims to collaboratively take action to improve participants’ lives. This is generally achieved through cognitive, reflexive learning cycles, whereby people ultimately enhance their wellbeing. This approach builds on two assumptions: (1) participants are able to reflect on and prioritize difficulties they face; (2) collective impetus and action are progressively achieved, ultimately leading to increased wellbeing. This article complicates these assumptions by analyzing a two-year PAR project (...) class='Hi'>with mothers of disabled children from a South African urban settlement. Participant observation notes, interviews, and a group discussion served as primary data. We found that mothers’ severe psychological stress and the strong intersectionality of their daily challenges hampered participation. Consequently, mothers considered the project ‘inactionable’. Yet, many women quickly started expressing important individual and collective wellbeing transformations. To understand these ‘unlikely’ transformations, a feminist relational account, in particular, that of relational wellbeing, proves essential. We reflect on the consequences of these findings for the dominant PAR methodology and operationalization, and propose to sensitize future PAR with marginalized women by employing relational wellbeing as an overarching ontological awareness. (shrink)

What is it like to live with the label “Disability?” NIB editorial staff and narrative symposium editors, Jeffery Bishop and Naomi Sunderland developed a call for stories, which was sent to several list serves, shared with the 1000 Voices Project community and posted on Narrative Inquiry in Bioethics ’ website. The request for personal stories from people who identify with the label “disabled” asked them to: consider how the label “disability” interacts with other aspects of (...) their life in health care settings; does the term “disability” reflect their actual embodied experiences of impairment or does it fail to do justice to their particular experience of impairment; describe the kind of experiences that are possible because of the impairment(s); discuss how the label has affected their “authentic voice”; and many other concepts about what effects the label has on their lives. These authors share deeply personal experiences that will help readers understand their world, challenges, and joys. Thirteen stories are found in the print version of the journal and an additional five supplemental stories are published online only through Project MUSE. The stories are complemented by four commentary articles by Elizabeth R. Schiltz; Lorna Hallahan; Nicole Matthews, Kathleen Ellem, and Lesley Chenoweth; and Jeffery Bishop, Rachelle Barina, and Devan Stahl. These scholars come from the disciplines of law, social work, media studies, medicine, and bioethics from Australia and the United States. Together, the symposium’s storytellers and commentators offer striking and informative insights into the everydayness of living with disabilities. (shrink)

Events such as industrialization, population growth and old age have made the disability more visible. We think that the disabled people's attitude towards being disabled and religion is an important issue to be investigated in terms of formation of the social sensitivity about the learning of the thoughts of disabled people. In this context, it is aimed to investigate the function of the religion in terms of how the disabled identify, understand and overcome the problems related to being (...) disabled. The sample of the study consisted of 58 people, 20 (34.5%) female and 38 (65.5%) male. Semi-structured interview technique was used as the research qualitative research method and descriptive analysis technique was used in the analysis of the data. In the article, the relation between disability and religion has been tried to be understood in terms of sociology of religion in the context of functionalist approach. In general, disabled people evaluate disability (81.1%) as "examination", (10.3%) as "problem" and (8.6%) as "difference”. It is concluded that religion affects the thoughts of disabled person in a positive way to understand and accept the disability. It has been seen that the disabled people have applied to the state, social support systems and spiritual values ​​to overcome their problems. However, it is the duty of all social institutions to increase the social sensitivity to the disabled people.Summary: Events such as industrialization, population growth and old age have further increased disability. It is important that the social sensitivity towards disabled people and disabled people’s thoughts about disability should be learned. We think that the disabled people's attitude towards being disabled and towards religion is an important issue to be investigated. In this study, the functions of religion to overcome the problems related to the disability and the way how the disabled people define and understand the disability will be investigated. In this context, we think that an individual's overcoming the problems related to disability is an important issue that should be examined in terms of religion-referenced behavior.The sample of the study consisted of 58 people, 20 (34.5 %) female and 38 (65.5 %) male. Semi-structured interview technique was used as the research qualitative research method and descriptive analysis technique was used in the analysis of the data. In the article, the relation between disability and religion has been tried to be perceived in terms of sociology of religion in the context of functionalist approach.It is a fact that various approaches to disability in various societies have been made during the historical process. These approaches are known as moral, medicinal/medical, social, human rights and limitative models. Each of these approaches points to a specific direction and problems of disability. In other words, each model handles and predicts a different dimension of the subject.According to the Qur’ân, disability means not to be in a bodily sense, but to stay away from the truth and expressed in the way of not seeing the truth, not grasping and not hearing, that is, figuratively meaningful. Again from the point of view of the Qur’ân, the first cause of disability comes to people through the divine will and test. The others are due to people's own mistakes.The changing paradigm shift with the enlightenment process has changed the way people view each other. In this context, with the thought and modernization of enlightenment, people's view of human beings and environment has changed. The body which is thought as the trust of God has turned into a body in which one is his proprietor. Therefore, this situation brought the contest, the debate, the comparison and the alienation together.Today, people with disabilities face many financial, spiritual, social and cultural problems. Poverty arising from unemployment, livelihood, accommodation constitute financial problems that are the first to come to mind; access to places of worship, instruction of worship, fulfillment of worship, lack of spiritual care and support constitute spiritual problems; education, health, access and social exclusion constitute social and cultural problems.Disabled people ask themselves these questions related to disability: Why did it happen to me? If it is a test, why do not I start the test on equal conditions with healthy people? Here the disabled person consults the religion to understand and find an answer to the situation that he is in. Because religion is an important factor that responds to the search for meaning, it reduces the feeling of deprivation, and fulfills the task of compensation mechanism. In addition to this, religion gives life a goal and power to the person to overcome the problems he encounters with.In our research on the relationship between disability and religion, religion as in many subjects has contributed positively to the individual’s view towards the fact of disability and to overcome some problems. For example, as a result of the research, the participants evaluated "disability" (81.1 %) as ‘test’ (10.3%) as ‘problem’ and (8.6 %) as ‘difference’.They answered the question ‘How has the disability affected your religious thoughts?’, 71% of the participants expressed that it has affected in a positive way (as a test, made me closer to God, increased my loyalty to God, a motivation source). Besides, 23 % of the participants expressed that it hasn't caused any changes (already believed, fate, disability isn't an obstruct to worship) and 6 % of the participants expressed that it has affected in a negative way (my life is upside down, I am questioning this situation).In addition to those who answered the question ‘Has the disability affected your life?’ in a ‘positive’ way, there is a considerable amount of people who said that the entrances of the mosques are not suitable for the disabled people. In addition, the disabled people stated that they have problems with the way of worshipping (orthopedically disabled), listening to the Qur’ân, hearing the azan (hearing impaired), and cannot go to the mosques and cannot fast because of the health problems, all of which have affected their religious life in a ‘negative’ way. We can gather the answers given to the question in three categories about what kind of behaviors the disabled people do to overcome/eliminate problems. The first is that they receive a variety of services and assistance by applying to the state for material support in order to overcome the problems related to disability and the second is that the social support services are mainly given within the family and friends, and the third is they worship, pray and fast, which are must of Islam, to eliminate the spiritual distress.The rate of people, whose answers are ‘positive’ to this question ‘Does your religious belief have an effect to deal with the disability?’ because they believe the afterlife and who say they feel relieved by praying and worshipping, is very high (95%). Moreover, it is remarkable that the ones say they are ‘not positive’ still explain this with religious concepts such as test and examination which require patience. In short, religion relieves disabled people by fulfilling the task of compensation mechanism with understanding disability and overcoming problems.Almost half of the participants (45%) said no to the following question: Is there any kind of material/spiritual support given to you by the religious officials or religious people in your community? Some factors affecting this situation are that religious officials have no knowledge and education about how to treat disabled people and how to help them.As a result, disabled people face various financial and spiritual problems. They consult religion to solve some of these problems. The vast majority of the disabled consider disability as a test and a fate. Therefore, religion plays an important role for disabled people to understand disability and cope with it. Besides, disabled people have stated that they face various problems in fulfilling their worship and in accessing the places of worship. In this context, physically disabled people also need the supportive power of religion just like other disabled people. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reifying Relevance in Mild Cognitive Impairment:An Appeal for Care and CautionJanice E. Graham (bio) and Karen Ritchie (bio)KeywordsAlzheimer’s disease, construction, dementia, market forces, mild cognitive impairmentWe thank the reviewers for their thoughtful comments that probe shadowy areas in our argument, and we welcome this opportunity to elucidate our position. First, we are not repudiating the natural and social facts of pathologic brain degeneration and the physical and (...) cognitive impairments that manifest in people affected by dementia disorders. We are, however, questioning the epistemology, politics, and persistence by some to harden the construct of mild cognitive impairment (MCI) prematurely as a "natural" precursor to dementia. We suggested insufficiencies in viewing MCI as prodromal to Alzheimer's disease (AD; Graham and Ritchie 2006, 36), and pointed to evidence for the prognostic irrelevance of some MCI subcategories (35). The commentators have read our manuscript as suggesting that AD and MCI are different kinds, and that a diagnosis of AD is more "real" than that of MCI. But AD is also fraught with classification issues, as we describe in the section of our paper that deals with consensus committees, published practice guidelines, and the determination of treatment efficacy. Like MCI, AD is a heterogeneous condition, but unlike MCI, AD is a constructed practical kind that does some "work" beyond essentialist (neural degeneration, brain atrophy) claims. Its criteria identify people with well-defined dementia symptoms and multiple cognitive and functional impairments who are in need of, and benefit from, support. Even with these criteria, however, there have been great attempts to achieve definitional accuracy in dementia diagnoses. Practical refinements to the differential diagnosis of dementia based on solid research evidence have made way for more specific recognitions of vascular dementias, dementia of the Lewy body type, and other subtypes beyond AD. So AD too has been subject to more careful, more cautious operationalization in recent years, with research supporting multiple factors and the comorbidity of several types (kinds) of dementia in any one individual.Our paper takes up concerns that are not resolved for dementia and suggests that the nascent category of MCI is still so insufficiently defined as to be ambiguous, and as such, is in danger of identifying individuals with what will be, and has [End Page 57] already been, linked to a debilitating and deeply stigmatizing and fatal disorder (AD). We are not contesting the reality that some people begin to display early signs of cognitive loss, nor are we suggesting that symptoms be ignored; as researchers, we stand behind the careful tracking of symptoms and signs in patients and research participants as an essential clinical and research practice. In a era where the public has been made wary of the potentially fatal effects of new treatments whose more careful scrutiny in specific populations would have saved lives (e.g., Fontanarosa, Rennie, and DeAngelis 2004; Psaty and Furberg 2005), and made all the more popular by what Kramer coined "diagnostic bracket creep" (1993, 15), we are questioning the drivers and value of a premature diagnostic classification whose definitional accuracy is neither sufficient nor effective for specific identification of individuals.That matters of fact are constructed does not take away from their natural fact. Some people have subjective reports or show objective evidence of cognitive decline while having preserved activities of daily living—the construction of this evidence indicates they are not normal and they are not demented. Based on such evidence, where then does the balance of probability for MCI lie? A multidisciplinary international group of experts gathered in Stockholm in 2003 to discuss MCI concepts (Winblad et al. 2004). They acknowledged that the heterogeneous etiology of MCI contributes to "some confusion concerning the specific boundaries of the condition", stating that this "not normal, not demented" condition is nonetheless "useful both clinically and as a research entity" (p. 241). Importantly, they concluded that MCI needs "better definition" (p. 246). It was at this stage that we first wrote our manuscript, and in the subsequent two years we have eagerly awaited new studies, and the recognition of flexible, practical subtypes to evolve.We state "that MCI cannot be considered to be a separate clinical entity" (Graham and... (shrink)

As people living with Alzheimer ’s disease experience their lifetime of memories slowly slipping away, they become dependent on society’s independent practical reasoners - family, health care professionals and society. Many people grow accustomed to the cognitive decline and begin to view the person with dementia as less than a person. In Dependent rational animals, Alasdair MacIntyre emphasized a moral framework that encompasses two sets of virtues needed for human beings to flourish in (...) society and to achieve genuine common goods - the virtues of independent practical reasoners and the virtues of acknowledged dependence. Virtues of acknowledged dependence are discussed ethically in terms of benevolence towards those who are disabled or dependent upon people who are strong and independent. The authors propose that using MacIntyre’s perspective of the two sets of virtues is valuable in the care of persons with Alzheimer ’s disease. According to MacIntyre, independent reasoners who understand and practice these two sets of virtues will help those people in communities who are dependent and vulnerable, and, subsequently, human flourishing can occur. (shrink)

Eva Feder Kittay's Learning from My Daughter: The Value and Care of Disabled Minds is poised to make a major contribution to the disability literature and is likely to spark controversy among disability scholars. The book's central contribution is the articulation of an ethics of care for meeting the “genuine needs” and “legitimate wants” of people with disabilities or chronic illnesses. We applaud Kittay, who is the mother of a woman with cerebral palsy who has multiple (...) physical and intellectual impairments, for sharing her story in such an eloquent, accessible, and personal manner. The question remains, however, as to whether Kittay's normative theory of care captures the ethical obligations that should exist between the carer and the cared‐for. In demanding that the cared‐for include the carer as a participant in all their interactions with others, Kittay conceptualizes what paid caregiving relationships should look like in a way we find misguided. (shrink)

In this article, we sought reconciliation between the “body‐as‐representation” and the “body‐as‐experience,” that is, how the body is represented in discourse and how the body of older people with cognitive impairment is experienced. We identified four contemporary “technologies” and gave examples of these to show how they influence how older people with cognitive impairment are often represented in acute care settings. We argued that these technologies may be mediated further by discourses of ageism and (...) ableism which can potentiate either the repressive or productive tendencies of these technologies resulting in either positive or negative care experiences for the older person and/or their carer, including nurses. We then provided examples from research of embodied experiences of older people with dementia and of how nurses and other professionals utilized their inter‐bodily experiences to inform acts of caring. The specificity and individuality of these experiences were more conducive to positive care experiences. We conclude the article by proposing that the act of caring is one way nurses seek to reconcile the “body‐as‐representation” with the “body‐as‐experience” to mitigate the repressive effects of negative ageism and ableism. The act of caring, we argue, is the essence of caring enacted through the provision of person‐centred care which evokes nurses to respond appropriately to the older person's “otherness,” their “variation of being” while enabling them to enact a continuation of themselves and their own version of normality. (shrink)

Having encountered landmines in offering a critique of philosophy based on my experience as the mother of a cognitively disabled daughter, I ask, “Should I continue?” I defend the idea that pursuing this project is of a piece with the invisible care labor that is done by people with disabilities and their families. The value of attempting to influence philosophical conceptions of cognitive disability by virtue of this experience is justified by an inextricable relationship between (...) the personal, the political, and the philosophical. If one grants that the “special relationship” between mother and child requires moral recognition, then I need first to make vivid the case that this relationship in the case of a child who lacks some “normal capacities” is indistinguishable from any mother‐child relationship. If this is so, then I believe I can make a case that has as its conclusion that the moral personhood of even the severely cognitively disabled must be granted. Moreover, such recognition, I argue, necessitates the recognition of others who bear no special relationships to the child. (shrink)

The label Body Integrity Dysphoria (BID) refers to a heterogeneous class of conditions whose sufferers desire a particular type of physical impairment. Variants of the desire for disability share the experiential “friction” elicited by the mismatch between the physical body and the subjective body. Perceived from childhood, body integrity dysphoria intensifies progressively throughout life, often leading sufferers to simulate disability and attempt to engage in self-injury. The contemporary scientific community agrees on the assumption that BID is a complex phenomenon that (...) involves biological, social, and psychological dimensions. The present work aims to provide a preliminary qualitative overview of the desire for permanent visual impairment through novel descriptions from a recent narrative interview we conducted. The desire for blindness appears to be extremely rare. To date, there have been very few studies investigating this phenomenon. Despite these limitations, this paper aims to describe the subjective aspect of visual dysphoria, considering its similarities and differences with other variants grouped under the label of BID. (shrink)

1施莱尔玛赫 contribution to the development施莱尔玛赫for hermeneutics in the development of Historically hermeneutics In order to make a decisive turn when he made ​​the future "general hermeneutics" , hermeneutics will be applied to all text interpretation. When the traditional hermeneutics contains In order to understand, description and application,施莱尔玛赫the attention is hermeneutics as "the art of understanding." 施莱尔玛赫also introduced the interpretation of psychology, can penetrate the text by means of its author's individuality and flexibility soul. He wanted to become a systematic hermeneutics, (...) and criticism of previous hermeneutics is "the rules of the merger," and the lack of coherence. Wu Ning speaking, they deal with different issues is a combination of methods. 施莱尔玛赫hermeneutics points to avoid misunderstanding of the text. This part is up to the final discussion of施莱尔玛赫criticism of the United States. 2. Dilthey contribution to the philosophical hermeneutics of Dilthey on施莱尔玛赫In order to write the thesis, including In order to Protestant hermeneutics history, from the Reformation to the future as a second reference books. He was a learned scholar and has been on many topics regardless above. For our purposes, Dilthey is a philosopher with a passion for life, he was placed In order to humanities and social sciences and natural sciences in an established full equality of points, by the foundation on the hermeneutics In order to develop a basic methodology. But in the science competition, he was seeking "Allgemeingultigkeit", a universal validity, to do so In order to give him too much towards the foundation to the scientific methods of thought. He is still a major development of the character of philosophical hermeneutics. 3 Heidegger before and on philosophical hermeneutics, "and there is time" contribution to the development of philosophical hermeneutics is the decisive shift in Heidegger, born with the future, there are original philosopher The early works. He Freiburg Hu plugs Seoul assistant, and in the phenomenological Hu stopper Seoul In order to create a useful set up beyond the traditional methods of philosophy, but he is still too dependent on science Hu stopper Marco effectiveness. Part I: description of the evolution of the early Heidegger: "ontology - the fact of hermeneutics," the book published after the death of Heidegger was published in 1999, English translation, Heidegger in this series by the fact that the ontology of hermeneutics In order to give us a hermeneutic understanding of his meaning. In order to avoid the traditional hermeneutics of his meaning, In order to return to the ancient hope臘hermeneueinc and hermeneia idiom. He attempts to go beyond the limits of contemporary objects, through the period of return to the ancient hope臘general language idioms. Hermeneutic encounter with the interpretation of Homer's description of the mouth, publish, translate and interpret. His description of historical hermeneutics in the pull-down maps and sub ​​Lane Park after a groundbreaking Aristotle hope臘idioms in the loss of richness and decline. But the hermeneutics of Heidegger speaking the method is close to something, such as early speech hermeneutics In order to approach closer to the truth of it is understandable the former interpretation of this domain as there face life. For this last hermeneutics as the method of self-understanding, but in a letter to his students Engelbert Kerbs letter, Heidegger also emphasizes the history In order to recognize the character. Us from our understanding of historical context, our understanding of the structure is formed by shaping the concept of history and even our language. In Dilthey's hermeneutics, he also stressed that understanding the historical basis. From Dilthey to Heidegger this view. Heidegger in his speech defines hermeneutics as "the fact of participation, close, and descriptions of the same interrogation methods." Hermeneutics is the interpretation of not only understanding knowledge as a negative process, but active participation, interrogation and close. Fact of itself is interpreted, it is through understanding the questions and answers something. Heidegger back to the necessary conditions for our understanding of factors, understanding of "the former structure." He describes some part of the former, is awareness and understanding of nature, we understand something "to" something, and we understand it in a specific historical context. Further more, we expect to understand it in the presence of a sight, not a determining sexual arousal by the sight, by the basic problems of the future horizon, it is "the possibility of there," the sight, for there is a special special possible time horizon. These early works of Heidegger has been found there the possibility of meaning. We all都leadership to a new concept of the humanities. In addition, as a rational animal, as Aristotle said sub-Lane, who is of a future there may not be included, including the timing of there. People are looking to understand their own there. Instructions to Heidegger, hermeneutics offers a new concept for the person's point of view. Part II: there and time hermeneutics is first mentioned in the "there and the time," Section VII, Heidegger phenomenology has been interpreted as if it is. In order that he found "the meaning of phenomenological description as a way to rely on hermeneutics, phenomenology of this and some of the logos have hermeneuein the characteristics of this phenomenology is to use some basic meaning of the word hermeneutics, it indicates the work In order to interpret . "In the second sense, Heidegger found in hermeneutics裡are there for the meaning of this method of exposing the shield. The third meaning is the interpretation of this promising continuous manner so that its future is possible, it's future there. Section 31 of hermeneutics is important, because there is some understanding that is. Understanding the process is the center of human existence, in Section 32 entitled "interpretation and understanding," understanding the interpretation built on. Visit the world around it and understand things as this or that, always never as pure consciousness. As Heidegger said, "always had to watch as the ability to understand and interpret", in other words, there is no precedence in the interpretation of pure consciousness, there is always ask questions and interpretation of the visual field. Section 44, regardless Heidegger also true about management, in its modern form as a true statement, is always carried a deeper understanding and interpretation of the export process. But the really right is defined as the management there has been an associate of knot, so it access to basic ontology of sight. It is obvious that there's open, this hole is to guide him toward the police point of view of the artistic part of the next lecture will be discussed. This lecture primarily presents the two early works of Heidegger in which hermeneutics plays a definitive role. As background, the contributions of Schleiermacher and Dilthey are presented briefly before going into Heidegger's contribution. Ⅰ. Schleiermacher's Contribution to the Development of a Philosophical Hermeneutics Schleiermacher made a decisive turn in the history of hermeneutics when he proposed a "Universal Hermeneutics," a hermeneutics that would apply to all kinds of text interpretation. While traditional hermeneutics included moments of understanding, explication and application, Schleiermacher focused on hermeneutics as the "art of understanding . "Schleiermacher also introduced psychological interpretation whereby one tried to penetrate the individuality and soul of the author of a text. He wanted hermeneutics to be systematic, and he criticized previous hermeneutics for being only an" amalgam of rules "and lacking systematic coherence. Rather , they were methods for dealing with an array of different kinds of problems. Schleiermacher's hermeneutics was directed at avoiding misunderstanding of the text. At the end of this section Gadamer's criticisms of Schleiermacher will be discussed. Ⅱ. Dilthey's Contribution to Philosophical Hermeneutics Dilthey wrote his dissertation on Schleiermacher and included a history of Protestant hermeneutics since the Reformation as a second companion volume. He was a broadly educated professor and wrote on many topics. For our purposes, Dilthey was a life-philosopher with a passion for placing the Humanities and Social Sciences on an equal footing with the Natural Sciences by developing a basic methodology for them based on hermeneutics. But in competing with the sciences, he sought an "Allgemeingultigkeit," a universal validity, and in doing so he tended to give too much ground to the way of thinking in the sciences. Still, he is a major figure in the development of philosophical hermeneutics. Ⅲ. The Contribution of Martin Heidegger to Philosophical Hermeneutics before and in Being and Time The decisive turn in the development of a philosophical hermeneutics came in the early writings of Martin Heidegger, a radical and original philosopher. He was in Freiburg an assistant to Husserl and found in Husserl's phenomenology a useful way of overcoming traditional philosophy, but he still found Husserl too preoccupied with scientific validity. Part Ⅰ: Heidegger's Early Lectures: Ontology-the Hermeneutics of Facticity A posthumously published and translated set of Heidegger's lectures on ontology in terms of a hermeneutics of facticity gives us a sense of his understanding of hermeneutics. He bypassed the traditional sense of hermeneutics and went back to the Greek usage of hermeneuein and hermeneia. He attempted to overcome the limitations of modern objectivity by returning to the usages current in ordinary language in ancient Greece. There hermeneutics meant orally interpreting Homer, announcing, translating, and explaining. His account of the history of hermeneutics after Plato and Aristotle is a history of decline and loss of the richness found in Greek usage. But hermeneutics for Heidegger meant a means of access to something, and in these early lectures hermeneutics became an interpretive means of access to facticity, to the realm of pre-interpretive understanding as Dasein faces life. Ultimately hermeneutics became a means for the self-understanding for Dasein. But in a letter to his student, Engelbert Krebs, Heidegger also emphasizes the historical character of cognition. We understand from our situation in history, and our understanding is structured by historically shaped concepts and even our language. Dilthey, too, emphasized the historical matrix for understanding in his hermeneutics, and Heidegger took this up from Dilthey. Heidegger defined hermeneutics in the opening lines of the lectures as "the unified manner of the engaging, approaching, accessing, interrogating, and explication of facticity." Hermeneutics as interpretation is not just understanding as a passive process of cognition but an active engaging, interrogating, and accessing. Facticity itself is interpretive in that it sees what something is through question and answer. Heidegger is stepping back into the factors that precondition our understanding, the "forestructure" of understanding. This forehaving, he says, belongs to the very nature of knowing and understanding. We see something "as "something, and we see it in a specific historical situation. Furthermore, we see it in an existential horizon of expectation, a horizon haunted by uncertainty, by the" fundamental questionability of the future, that is of "possible being," of what is possible for this particular being at this particular time and place. Already in these early works Heidegger finds in the sense of what is possible being, a sense of "ontic questionability, care, restlessness, anxiety, temporality." All of this leads to a new conception of humanity. Instead of being an animal endowed with reason, as in Aristotle, a human being is a being with a possible future, a being with temporality. Humans are beings seeking to know themselves. Hermeneutics, Heidegger says, offers the standpoint for a new conception of the human being. Part Ⅱ: Being and Time The first mention of hermeneutics is in section 7 of Being and Time, where Heidegger is already interpreting phenomenology as letting what is show itself. He finds that " the meaning of phenomenological description as a method lies in interpretation. The logos of the phenomenology of Dasein has the character of hermēneúein. The phenomenology of Dasein is a hermeneutic in the original signification of the word, where it designates the work of interpreting. "In a second sense, Heidegger finds in hermeneutics a means of uncovering the meaning of being for Dasein. And the third sense is the interpretation Dasein as continually making its future possibilities, its future being. Section 31 is important to hermeneutics because there the being of Dasein is said to be understanding. Understanding is the central process of an existing human being. In section 32, titled "Understanding and Interpretation," interpretation builds on understanding. It looks around at the surrounding world and sees things as this or that, always already , never as pure perception. As Heidegger puts it, "The seeing of this sight is always already understanding and interpreting." In other words, there is no pure perception prior to interpretation; there is always the horizon of questioning and interpreting. In section 44, Heidegger argues that truth, too, in its modern forms as statements which are true, is derivative from the deeper processes of understanding and interpreting that are always already going on. But when truth is rightfully defined in connection with being, then it moves into the horizon of fundamental ontology. It is the disclosure of being. This insight is part of what leads him to his view of art, which we will discuss in the next lectur. (shrink)

I propose to study one problem for epistemic dependence on experts: how to locate experts on what I will call cognitive islands. Cognitive islands are those domains for knowledge in which expertise is required to evaluate other experts. They exist under two conditions: first, that there is no test for expertise available to the inexpert; and second, that the domain is not linked to another domain with such a test. Cognitive islands are the places where we (...) have the fewest resources for evaluating experts, which makes our expert dependences particularly risky. -/- Some have argued that cognitive islands lead to the complete unusability of expert testimony: that anybody who needs expert advice on a cognitive island will be entirely unable to find it. I argue against this radical form of pessimism, but propose a more moderate alternative. I demonstrate that we have some resources for finding experts on cognitive islands, but that cognitive islands leave us vulnerable to an epistemic trap which I will call runaway echo chambers. In a runaway echo chamber, our inexpertise may lead us to pick out bad experts, which will simply reinforce our mistaken beliefs and sensibilities. (shrink)

Key commentators on person‐centred care have described it as a “new ethic of care” which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person‐centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person‐centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to (...) comply more often with prevailing norms than those championed by person‐centred care. We draw on elements of work by moral philosopher Løgstrup and Foucault to provide insight into nurses’ ethical conduct and ask why nurses would want to act otherwise, when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand, sovereign expressions of life and parrhêsia. We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person‐centred care. We argue that nurses’ responses to the ethical demand by way of parrhêsia can be an important feature of intra‐organizational reflexivity and its transformation towards the delivery care that is more person‐centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research. (shrink)

In recent years in Turkey, it has been attempted to ensure that students who need special education are educated through inclusion. In the meanwhile, it became important to reveal scientifically the educational theories on which the inclusive education is based and the approach of Islam towards inclusive education that somehow has an influence on our national education policy. This study aims to examine the educational theories on which the inclusive education is based and the Islamic approach towards inclusive education. The (...) data of the study was collected by literature review. As a result, it is possible to say that the underlying theories of inclusive education are integrated education theory, cognitive democrative theory and dysontogenesis theories. In addition, although there are no specific verses for inclusive education in the Qurʾān and the Sunnah, it can be said that Islam has an positive approach to the inclusive education in general. Depending on this result, formal education should be conducted in the context of the principle of “least restricted education environment”.Summary: It is a matter of controversy about how education that increases the potential of human beings can be given to people who differ from their peers and who need special education. In recent years, there have been two prominent views in literature on this issue: The first is the ‘discriminatory’ view, which advocates that individuals with special needs should receive education in special spaces with similar students. The second is the ‘integrative view’, which states that these students should receive inclusive education with their peers. This view defends that students with special needs should be educated in separate boarding/day special education schools and special education classes within the normal schools. Recently in Turkey it is aimed to provide education to the students who need special education mostly by means of inclusion as an alternative to the first group. For this education, which is held with the claim of a less restricted environment, the conditions of the students are constantly improved with new regulations.This study aims to reveal the theories that can be the basis of inclusive education and Islam's approach to inclusive education. In this study, I will try to find answers to the following questions.1. What are the educational theories and claims that can be the basis of inclusive education?2. What are the principles of inclusive education in the Qur’an and Sunnah?This study is important in terms of revealing general opinions that may be the basis of theoretical foundations of inclusive education and examining Islam’s approach to inclusive education. The study, which was prepared by examining the English and Turkish literature available within the scope of the possibilities, was designed with theoretical analysis method. Although ‘accessibility’, which is considered among the shortcomings of theoretical studies in literature, is an important limitation for this study, the fact that it constitutes a theoretical ground for future studies and fills an important gap in the literature determines the importance of the study.Integrated education theory, cognitive democratic theory and dyontogenesis theories can be regarded as the establishing theoretical foundations of inclusive education. Integrated education theory is based on Whitehead’s philosophy of education. This philosophy sees the individual as a whole. It does not intend to make people have a profession or make money by simply using their intelligence. Instead, it helps to ensure that both the individual and society as a whole are happy by helping them to make the most of their potential. This model is based on developing emotion, mind, body, and spirituality as a whole. The distinctness and sacredness of human life and the need to know about this sacredness are the main pillars of integrated education theory. In this model all people are seen equal. According to this theory, the “natural” as well as the “beautiful” is appreciated. Therefore, no one feels bad in such an environment because of its differences. Because of the value given to them, each individual’s love of learning and ideals remain alive. The individual makes use of his/her mind to make a connection between the meaning of life and the school.Cognitive democratic theory asserts that educational arrangements should be made to prevent any feelings of alienation, oppression, and insignificance by considering different groups in education. This theory, which emphasizes the phenomenon of democracy and citizenship, aims at social cohesion in the light of epistemological principles. The theory is based on the fact that social change and change in education support each other. According to the theory, the formation of democratic citizenship is only possible if the school environment is a place where students can internalize democratic values. This is achieved by equal consideration of each segment at different levels. According to this theory, elements such as classroom environment, discipline, program, rights, participation in decisions, educational activities should be organized according to democratic values. In such an environment, different special education students find a place for themselves.Vygotsky's dysontogenesis thesis is based on his theory of social learning. His theory provides a methodological framework for inclusion in special education. The theory states that information is obtained through social communication. In this theory, knowledge is an element that is acquired together with other people rather than something that happens in the human mind. According to this theory, instead of focusing on the brain (head), where social knowledge is formed, self, mind, emotion should be included in education. Also, disability is a social deviation rather than a biological disease. Social relations and the environment mostly shape this deviation. Therefore, the abnormal child approach that has become a place in the society should be abandoned. The theory opposes the concept of mental retardation. Because mental disability should be explained by the differences in mental development. According to this theory, mental retardation is a social problem; education should be provided with appropriate methods over the examples that can be experienced in a commonplace with their peers. Distracting the student from his/her normal peers due to his/her differences, creates negative social conditions and harms his/herself.As far as I have examined, there is no direct Qur’anic verse or phrase about inclusive education for the disabled. However, there are verses regarding the integration and solidarity of the society on righteousness. Principles for inclusive education can be drawn from these verses. The Prophet valued the disabled and settled the principles on how society should treat them. He frequently visited them, enabled them to employ appropriate jobs, determined the conditions of the economic order by considering them, and dignified them with honor. In other words, he tried to make provisions to prevent the disabled from being separated from society. For example he urged Zahir bin Itban to continue trade, asked Abdullah Ibn Umm Mektum to come to community prayers, thus he sought different ways to integrate disabled people into society. These practices can be seen as a positive outlook towards the mainstreaming education of today. In the period of the four great caliphs, practices for mainstreaming education continued. (shrink)

On July 2021, the UK High Court of Justice heard the Case CO/2066/2020 on the application of Heidi Crowter who lives with Down’s syndrome, and Máire Lea-Wilson whose son Aidan has Down’s syndrome. Crowter and Lea-Wilson, with the support of the disability rights campaign, ‘Don’t Screen Us Out’, have been taking legal action against the Secretary of State for Health and Social Care (the UK Government) for a review of the 1967 Abortion Act: the removal of section 1(1)(d) (...) making termination of pregnancy lawful for ‘severe’ fetal indications detected after 24 weeks' gestation. On 23 September 2021, the High Court dismissed the claim. This action came at a time when non-invasive prenatal testing (NIPT) was introduced into the NHS England Fetal Anomaly Screening Programme for the trisomies 21, 13 and 18. The implementation of NIPT has been heavily criticised, in particular by ‘Don’t Screen Us Out’ campaigners, for increasing fetal selection and discrimination of people living with disabilities. The case of Crowter and Lea-Wilson echoes debates in other European countries such as in France and Germany, where the introduction of NIPT in the public healthcare system has provoked equally vehement public reactions and discussions. The comparison between these three countries allows contextualising the public discourses around NIPT and the ground for termination of pregnancy in relation to different socio-cultural and political contexts. We examine how each country, and particularly England, deals with the conflict between the principles of promoting the rights of people living with disabilities and preserving women’s reproductive autonomy. (shrink)

Definition of the problemThe concept of privacy has been astonishingly absent in the discussion about dementia care. In general, questions of privacy receive a lot of attention in nursing ethics; however, when it comes to dementia care, hardly any systematic ethical debate on the topic can be found. It almost seems as though people with dementia had lost any comprehensible interest in privacy and no longer had any private sphere that needed to be considered or protected. However, this (...) not only contradicts widespread moral intuitions but also ignores the views and needs of those affected.ArgumentsWe first outline the origins and dimensions of the concept of privacy and point out problems and limitations in the context of dementia. Especially the prevalent liberal conceptions’ dependence on the idea of autonomy poses significant challenges to an adequate conceptualization of the moral significance of privacy for people with dementia. Therefore, we subsequently explore alternative ways of conceptualizing the “value of privacy” in the context of dementia care.ConclusionAutonomy-based concepts of privacy may still be valid in the early stages of dementia. However, in the further course of the syndrome, the relevance of other normative aspects comes to the fore, especially respect for remaining personal preferences as well as objective criteria of dignity and well-being. Thus, we outline in a differentiated manner how and to what extent privacy can be of normative importance beyond the purview of autonomy and should consequently be taken into consideration in dementia care. (shrink)

The dominant idea in debates on social inclusion of people with intellectual disabilities is that social inclusion requires recognition of their ‘sameness’. As a result, most care providers try to enable people with intellectual disabilities to live and participate in ‘normal’ society, ‘in the community’. In this paper, we draw on (Pols, Medicine Health Care and Philosophy 18:81–90, 2015) empirical ethics of care approach to give an in-depth picture of places that have a radically (...) different take on what social inclusion for people with intellectual disabilities looks like: places known as ‘sheltered living institutions’. We argue these places can be seen as ‘communities of difference’ catered to the specific needs and capacities of the residents. We then contend that these communities raise questions about what a good life for people with intellectual disabilities looks like and where and how it ought to be realised; questions not posed very often, as they get muzzled by the dominant rhetoric of normalisation and the emphasis on sameness. (shrink)

How do we care well for a human being: ourselves or another? Non-Kantian scholars rarely identify the philosophy of Kant as a particularly useful resource with which to understand the full complexity of human care. Kant’s philosophy is often taken to presuppose that a philosophical analysis of good human life needs to attend only to how autonomous, rational agents—sprung up like mushrooms out of nowhere, without a childhood, never sick, always independent—ought to act respectfully, and how they can be (...) forced to interact rightfully. Questions involving aspects of human life captured by what Eva Kittay aptly phrased “the fact of dependency” (1999) —such as our vulnerable, fragile, and embodied social natures, asymmetrical care relations, and deep systemic injustices—are therefore commonly thought to be beyond the grasp of Kant and of Kantian philosophy. Against this historically prominent understanding of Kant’s practical philosophy, below I engage and draw upon recent Kant scholarship which shows both the inadequacy of such rationalist readings and the fruitfulness of using Kant’s practical philosophy to enhance our understanding of human care relations. After situating my approach in the existing, relevant secondary literature on Kant’s human agent, I explore key features of Kant’s accounts of human nature and the highest good. I pay special attention to his proposal that our human nature comprises reflective and unreflective aspects and patterns that we (ought to) strive to develop, transform, and integrate in wise ways through our faculty of desire. In addition, I emphasize the dangers that our ineradicable propensity to do bad things (evil) poses for our projects of self- and other- care. I proceed by outlining how Kant’s account of moral (ethical and legal) responsibility for self and others is developed through his theories of freedom, that is, through his theory of virtue (virtuous internal freedom with its account of perfect and imperfect duties) and his theory of right (rightful external freedom with its account of innate, private, and public right). On the conception I am advancing, we are pretty messy, fragile, and vulnerable beings whose projects of caring are difficult, ongoing, and complex. On the one hand, we (should) strive to care for ourselves (by striving to manage and heal badly functioning parts and by developing, transforming, and integrating immature or distinct parts of ourselves into good wholes) and for others (assisting them in their projects of management and healing and of developing, transforming, and integrating themselves into good wholes) in ways that are both respectful and attentive to the particular people we are—people with lives of our own to live—and the kinds of relationships we share. On the other hand, we should, and can, be forced to interact rightfully, meaning interaction consistent with one another’s basic (innate, private, and public) rights and, hence, contribute to reform projects that improve our inherited, imperfect legal-political systems with regard to care relations. Bringing Kant’s philosophy into dialogue with care theorists, I conclude, advances the insights of both traditions by showing one way to arrive at a multifaceted, yet unified account of human care relations where our embodied, social as well as our rational natures are given due consideration. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Underplayed Ethics and the Dilemmas of Psychiatric CareChong Siow Ann and Tamra LysaghtThe practice of psychiatry is fraught with uncertainty. The exact causes and the biological substrates underlying mental disorders remain to be elucidated; even the diagnosis of these disorders is descriptive and not based on an etiological understanding and no biological diagnostic markers have been validated. The manifestation of almost all mental disorders results from a complex (...) interaction of biological and environmental factors which encompasses the patient’s unique life history, experiences and relationship with others and the community. In the face of such uncertainties — at times extending to the types of treatment (psychiatry is generally acknowledged not be an exact science) — it has been argued that adopting a pragmatic approach is necessary.1 Accordingly, this approach necessitates high ethical standards among mental health practitioners.Some mental illnesses are associated with varying degrees and types of cognitive impairments. Others have certain symptoms like auditory hallucinations and delusions that might severely compromise the patients’ autonomy, distort their sense of reality, increase the risk of harm to themselves or others and render them incapable of making informed decisions in their treatment and participation in research.Consequently, there are issues that are particular to the provision of mental healthcare. These include the need for enforced involuntary treatment with the corollary of depriving a patient of his personal liberty even [End Page 173] though it is often justified on the grounds that it is in the patient’s best interests. However, at times, it is the legal and societal obligation of mental health practitioners to protect those who might be harmed from the patient’s action that might seem to be more pressing. In this situation of double agency, lies the tension of providing confidential care for patients and acting as “an agent of the state” where that patient’s confidentiality might be breached and his liberty infringed upon. This situation is further aggravated by the stigma that clings ever so tenaciously to those who suffer from mental disorders and where it is the norm to stereotype them as dangerous and unpredictable.Consideration of a patient’s autonomy is also challenged by characteristics that are unique to the practice of psychiatry. The prescription of certain psychotropic medications can alter how people think and feel, while psychotherapy works towards changing the patient’s views and values. The philosopher, Jennifer Radden, describes this process as “re-forming the patient’s whole self or character … akin to the responsibilities of raising children”.2 The psychotherapeutic relationship is thus particularly personal and intimate because patients are asked to provide information that often reveals their innermost feelings, fears and fantasies. This information is provided on the basis of trust and assurance of confidentiality, and with expectation of being helped.Jeremy Holmes and Gwen Adshead have elaborated on the vulnerability of patients seeking psychotherapy: they might be particularly susceptible to exploitation because their past experiences of being exploited have led to their distress and help seeking — their dependency and the extreme privacy of the therapeutic relationship make any transgression difficult to be uncovered.3 There is a calamitous combination of the “unconscious wish in the patient to be used” with the complicity of an unethical therapist seeking to fulfil his own interests.4As in any other doctor-patient relationship, the relationship between the mental healthcare practitioner and the patient is one of unequal power where the former is ascendant. While that power should be exercised to heal and to relieve suffering, it also gives the practitioner tremendous power “to harm, reject, misunderstand, or exploit patients who struggle with the experience of mental illness, which itself may generate helplessness, despair, distress, and exceptional dependence on the clinician”.5 Given the potential of doing good and harm coupled with the likelihood of being so significant in the life of the patient,6 providing care for those with mental disorders and distress is necessarily ethically exacting — arguably more so than in other medical practice settings. [End Page 174]This precariousness has led to the suggestion that ethics in psychiatry should have a special status and that the more general principles of biomedical ethics are too limited in scope to... (shrink)

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

Special volume of "Thaumàzein - Rivista di Filosofia" dedicated to the theme of Socratic Eudaimonia and care for others. It is a multilingual volume comprising twenty papers divided into six sections with an introduction by Linda Napolitano. Edited by Santiago Chame, Donald Morrison, and Linda Napolitano. -/- Despite the appearances given by certain texts, the moral psychology of Socrates needs not imply selfishness. On the contrary, a close look at passages in Plato and Xenophon (see Plato, Meno 77-78; (...) Protagoras 358; Gorgias 466-468; Euthydemus 278; Lysis 219; Xenophon, Memorabilia III 9, 4-5) suggests that the “egoist”’s welfare depends upon the welfare of others (i.e. family, friends or the whole city). Since the welfare of his family, friends and city is part of his own eudaimonìa, the “egoist” (phìlautos) has a direct and intrinsic motive to promote the welfare of these others. -/- This multilingual issue explores the role that other peoples’ welfare plays in Socratic ethics. Special attention is paid to test-cases in which the principle that moral action is always good only for the agent seems to have no validity. I.e., under which circumstances is the self-sacrifice for the sake of others (such as the soldier’s self-sacrifice on the battlefield) good for the agent (as in Alcibiades I 115a-116d)? Essays deal with contradictions or tensions of this sort, and relate them to more general views on eudaimonìa held within Socratic literature. Comparison between different Socratic authors is used as a means to identify the distinctive features of Socratic eudaimonìa if compared to other Greek theories of happiness, such as the Aristotelian theory of philautìa (NE IX, 1166a-1166b; 1168a-1169b). (shrink)

This paper uses themes from Catholic social teaching to challenge Church and society to prioritize a group that is left behind by social injustice: people with intellectual disabilities. It provides background information on intellectual disability, summarizes moral principles of Catholic social doctrine, describes sociological facts about how people with intellectual disabilities are left behind by social factors, and prescribes actionable solutions for treating them as equal members of society. The goal is to identify how (...) to shape a society at all socio-ecological levels in ways that better protect the dignity, solidarity, and participation of people with intellectual disabilities. Although the analysis references the US and is limited to intellectual disabilities, its lessons apply to other countries and disabilities as well. (shrink)

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood (...) as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context. (shrink)

In this book, David Levine explores the unknown self. The unknown self is the self existing as a potential to become something yet to be determined. The shape our personalities and life experiences take depends on a process. At the outset of this process, the self is, in a sense, a stranger; both to us and to others. The more this is the case, the greater the openness of the process of self-formation to a kind of freedom, which is (...) the freedom from predetermination of its outcome. In exploring this process, the book considers such topics as: the nature of inner freedom and its relationship to deliberation and choice; stranger anxiety and its connection to group dynamics and social connection; the internal factors that enable us to make the decisions that shape our lives and through our actions realise the ends embedded in our decisions; how our memories shape our choices and the lives we lead that result from them; what makes it possible for us to live comfortably with and depend on people we do not know; concern for the welfare of strangers and how our welfare can be secure in a world where others do not care about us or us about them. (shrink)

This article examines the unique disadvantages experienced by Black people and other people of color with substance use disorder in health care, and argues that an intersectional approach to enforcing disability rights laws offer an opportunity to ameliorate some of the harms of oppression to this population.

Caring for Liberalism brings together chapters that explore how liberal political theory, in its many guises, might be modified or transformed to take the fact of dependency on board. In addressing the place of care in liberalism, this collection advances the idea that care ethics can help respond to legitimate criticisms from feminists who argue that liberalism ignores issues of race, class, and ethnicity. The chapters do not simply add care to existing liberal political frameworks; rather, they explore how (...) integrating dependency might leave core components of the traditional liberal philosophical apparatus intact, while transforming other aspects of it. Additionally, the contributors address the design of social and political institutions through which care is given and received, with special attention paid to non-Western care practices. This book will appeal to scholars working on liberalism in philosophy, political science, law, and public policy, and it is a must-read for feminist political philosophers. (shrink)

There are opportunities in practice for practitioners to sustain the citizenship of the people with whom they work. These opportunities arise as a matter of everyday decision-making, in the ways that service users and their families are facilitated to participate in decisions affecting their lives. Citizenship also hinges on the organisation of services to meet the needs of service users and carers. In this article, a care situation which fails to meet the needs of one family is examined (...) using an ethics of care. A social worker reflects on her role in the decision-making and the eventual lack of commitment from a wider team to provide good care. To answer yes to the question of whether others matter, we need to consider whether the moral acheivement has been accomplished; that is to show in practice, that others do matter. (shrink)