This article builds on existing feminist literature on obstetric violence in the context of childbirth to argue that there is a continuum of obstetric violence that also includes that perpetuated in relation to pregnancy prevention and termination, as well as antenatal healthcare and birth. This structural violence is highlighted in relation to conscientious objection, the reporting of people suspected of illegal abortions by their healthcare providers, and contraceptive coercion. Recognizing the limitations of criminal and human rights approaches to (...) obstetric violence, this article takes Martha Fineman’s vulnerability theory as the foundation for the transformative structural change of healthcare institutions. (shrink)

At its core, nonideal theory is an attempt not only to address issues of justice, but it also provides us a lens through which we can articulate our limitations as knowers and reasoners, the ways in which we are relational in our autonomy needs, and the ways in which we are deeply dependent upon institutions and social supports for our agency and identities. Bringing this lens into bioethics means shifting our orientation in our scholarship and our practice. This (...) shift will have implications in how bioethical evaluations are taken up and played out in policies, institutional structures that inform the clinical encounter, and avenues for protection and redress for marginalized and vulnerable populations. It will also allow theorists and researchers to interrogate the status quo, revealing how many standard policies and practices are embedded in social and institutional arrangements that privilege the few or are built on exclusionary norms. The path forward, and the aim of this volume, is to extend the scholarship of nonideal approaches to bioethics. The volume is divided into two main parts. The first is focused on philosophically unpacking nonideal theory as an approach in bioethics. The second offers applications of nonideal theory in environmental ethics, healthcare ethics, public heath ethics, and genetic ethics. Our collective aim is to expand what has been considered nonideal bioethics. The history of nonideal theory has as its point of reference a turn away from Rawlsian justice, but the future of nonideal theory is ripe with possibilities. (shrink)

The paper summarizes recently published data and recommendations about healthcare disparities experienced by African Americans who have Medicare or other healthcare coverage. Against this background the paper addresses the ethics of such disparities and how disadvantages of vulnerable populations like African Americans are typically maintained indecision making about how to respond to such disparities. Considering how to respond to disparities reveals much that vulnerable populations would bring to the policy-making table, if they can also be heard when they (...) get there. The paper argues that vulnerable populations like African Americans need fair representation in bodies deciding what to do about such disparities and that fairness requires proportional representation at all levels of decisions that affect healthcare – a radical change. In this decision setting, howto provide adequate protection of minorities needs much further attention. The most attractive decision-making model is deliberative democracy. The paper shows that in deliberation, fair representation requires not only having a voice in decisions, but a fair hearing of those voices. Achieving a fair hearing requires changes in norms of communication and training of all to give importance to greetings and other measures of civility and trust building, and to be open to diverse forms of expression. Decisions about how to respond to healthcare disparities would include what programs to initiate for whom, howto evaluate the programs, and what to do in response to such evaluations. Conclusions are that achieving such goals will take a sea change in how healthcare institutions and providers do their business, and that social activism at every level will be needed to effect these changes. The discussion highlights many ethical issues that need much greater attention. (shrink)

Phenomenological interviews with queer women in rural Nova Scotia reveal significant forms of trauma experienced during labour and birth. Situating the accounts of participants within both phenomenological and intersectional analyses reveals harms enabled by structurally embedded heteronormative and homophobic healthcare practices and policies. Our account illustrates the breadth and depth of harm experienced and outlines how these violate core ethical principles and values in healthcare.

This book offers new essays exploring concepts and applications of nonideal theory in bioethics. Nonideal theory refers to an analytic approach to moral and political philosophy (especially in relation to justice), according to which we should not assume that there will be perfect compliance with principles, that there will be favorable circumstances for just institutions and right action, or that reasoners are capable of being impartial. Nonideal theory takes the world as it actually is, in all (...) of its imperfections. Bioethicists have called for greater attention to how nonideal theory can serve as a guide in the messy realities they face daily. Although many bioethicists implicitly assume nonideal theory in their work, there is the need for more explicit engagement with this theoretical outlook. A nonideal approach to bioethics would start by examining the sociopolitical realities of healthcare and the embeddedness of moral actors in those realities. How are bioethicists to navigate systemic injustices when completing research, giving guidance for patient care, and contributing to medical and public health policies? When there are no good options and when moral agents are enmeshed in their sociopolitical viewpoints, how should moral theorizing proceed? What do bioethical issues and principles look like from the perspective of historically marginalized persons? These are just a few of the questions that motivate nonideal theory within bioethics. This book begins in Part I with an overview of the foundational tenets of nonideal theory, what nonideal theory can offer bioethics, and why it may be preferable to ideal theory in addressing moral dilemmas in the clinic and beyond. In Part II, authors discuss applications of nonideal theory in many areas of bioethics, including reflections on environmental harms, racism and minority health, healthcare injustices during incarceration and detention, and other vulnerabilities experienced by patients from clinical and public health perspectives. The chapters within each section demonstrate the breadth in scope that nonideal theory encompasses, bringing together diverse theorists and approaches into one collection. (shrink)

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of (...) epistemic injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

The goal of this paper is to propose a relational turn in healthcare professionalism, to improve the responsiveness of both healthcare professionals and organizations towards care of patients, but also professionals. To this end, it is important to stress the way in which difficult situations and vulnerability faced by professionals can have an impact on their performance of work. This article pursue two objectives. First, I focus on understanding and making visible shared vulnerability that arises in (...) clinical settings from a triple perspective: patient and family, health professionals, and institutions. Second, to address this challenge for professionalism, in this paper I articulate the term "relational centered-patient professionalism", which has two main axes. The relational approach means taking into account how the relationships among professionals, patients and institutions determine the constitution and evolution of those professional values. The focus on patient centered care is indispensable, because it is the ultimate goal pursued by the development of these professional values, and must always be at the center. (shrink)

Trust is central to the therapeutic relationship, but the epistemic asymmetries between the expert healthcare provider and the patient make the patient, the trustor, vulnerable to the provider, the trustee. The narratives of pain sufferers provide helpful insights into the experience of pain at the juncture of trust, expert knowledge, and the therapeutic relationship. While stories of pain sufferers having their testimonies dismissed are well documented, pain sufferers continue to experience their testimonies as being epistemically downgraded. This kind of (...) epistemic injustice has received limited treatment in bioethics. In this paper, we examine how a climate of distrust in pain management may facilitate what Fricker calls epistemic injustice. We critically interrogate the processes through which pain sufferers are vulnerable to specific kinds of epistemic injustice, such as testimonial injustice. We also examine how healthcare institutions and practices privilege some kinds of evidence and ways of knowing while excluding certain patient testimonies from epistemic consideration. We argue that providers ought to avoid epistemic injustice in pain management by striving toward epistemic humility. Epistemic humility, as a form of epistemic justice, may be the kind disposition required to correct the harmful prejudices that may arise through testimonial exchange in chronic pain management. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.4 (2004) 411-425 [Access article in PDF] Vulnerability, Vulnerable Populations, and Policy Mary C. Ruof "Special justification is required for inviting vulnerable individuals to serve as research subjects and, if they are selected, the means of protecting their rights and welfare must be strictly applied."Guideline 13: Research Involving Vulnerable Persons International Ethical Guidelines for Biomedical Research Involving Human Subjects Council for International Organizations (...) of Medical Sciences (CIOMS) and World Health Organization (WHO) Geneva, Switzerland, 2002 Within medical research and healthcare certain groups are afforded special protections and services because of their designation as vulnerable. The vulnerable require special justification to participate in human subject research in order to eliminate potential human rights abuses. The Nuremberg Code of 1947 was written in response to the extreme human subject abuses that occurred under the Nazi regime, and, although the intent of the 1947 Code was to protect human rights, rigid voluntary consent requirements deprived some individuals of the right to participate in clinical trials. Recent human research guidelines, such as the CIOMS/WHO guidelines referenced above and the guidelines referenced in Section V of this Scope Note, attempt to balance both protection from abuse in research and access to new, experimental treatments for the vulnerable.Although various protective guidelines stipulate special protections for vulnerable populations, the concept of vulnerability and consequently the criteria designating vulnerable populations remain vague. Precisely who are the vulnerable? The word "vulnerability" stems from the Latin vulnerare, "to wound." (Oxford Encyclopedic English Dictionary 1995). In clinical research, the term [End Page 411] vulnerable generally is applied to individuals who are unable to give informed consent or who are susceptible to coercion. The Common Rule (45 CFR 46, Subpart A) includes as vulnerable research subjects: children, prisoners, pregnant women, and persons who are handicapped, mentally disabled, economically disadvantaged, or educationally disadvantaged. Although the Common Rule specifies certain vulnerable categories, the guidelines were not intended to be exclusive, leaving open the interpretation of vulnerability.In medical research and health policy, vulnerability is an abstract concept that has concrete effects both for those labeled vulnerable and for those not. Clinical researchers, healthcare workers, ethical reviewers, and policymakers must be able to identify vulnerable subjects to establish how healthcare resources will be allocated and who will qualify for special protections and socialized benefits. Attempts to quantify vulnerability in clear, measurable ways have met little if any consensus. As Alexander Morawa (II, 2003, p. 150) states, "There is no single approach to definition of vulnerability. In fact, there is no purposeful categorisation at all."Difficulties in defining vulnerability have prompted discourse surrounding its utility as a qualifying factor in the allocation of health resources and its appropriateness as a guiding principle in bioethics. Some of the authors cited in this Scope Note argue against the labeling and categorization of vulnerable individuals and populations. "Labeling individuals as 'vulnerable' risks viewing vulnerable individuals as 'others' worthy of pity, a view rarely appreciated" (III, Danis and Patrick 2002, p. 320). The categories of vulnerable groups listed under the Common Rule have been the source of controversy, "for example, many find the suggestion that pregnant women are vulnerable to be quite sexist" (IV, DeBruin 2001, p. 7). Instead of creating categories of vulnerable populations, would it not be better to derive an account of just treatment from a just social policy at large that encompasses human vulnerabilities (II, Brock 2002, p. 283).For some of the authors listed here, the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them. In contrast to the four American principles of biomedical ethics—autonomy, nonmaleficence, beneficence, and justice—the four principles of European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity. According to, Jacob Dahl Rendtorff and Peter Kemp (I, 2000, p. 274) "the principle of vulnerability is ontologically prior to the other [European] principles, it expresses better than all of the other ethical principles... the finitude of the human condition."Some of the... (shrink)

Much of the debate around temporary foreign worker programs in recent years has focused on full or partial access to rights, and, in particular, on the extent to which liberal democratic states may be justified in restricting rights of membership to those who come and work on their territory. Many accounts of the situation of temporary foreign workers assume that a full set of rights will remedy moral inequities that they suffer in their new homes. I aim to show two (...) things: first, and based on experiences reported by former Live-in-Caregivers in Canada who now have access to the full set of citizenship rights, and German citizens who are descendants of Kurdish guestworkers in Germany, I have proposed that even after gaining citizenship, many of them experience social stigma and a sense of exclusion. Second, I have argued that this neglects a basic need that individuals have, which is to have access to relational resources within society in order to be protected against social deprivation. This need is seemingly immune to be effectively protected through the known catalogue of social, civic and political rights. Instead, I argue that social deprivation needs to be analyzed through the lens of institutional vulnerability to yield an analysis of the moral obligations of liberal democratic states. (shrink)

Contemporary feminist theory by and large agrees on criticizing the traditional, autonomous subject and instead maintains a relational, dependent self, but the vocabulary used to describe the latter remains contested. These contestations are seen in comparing the approach of some feminist legal theory, as demonstrated by Martha Fineman, to the approach of some feminist theory that draws on continental philosophy, as demonstrated by Judith Butler. Fineman's concept of vulnerability emphasizes the universality of vulnerability in the (...) human condition, arguing that a “responsive state” is most conducive to producing subjects who are “resilient” in the face of neoliberal pressures. We argue that vulnerability, as an existential as opposed to a political description, is a limited rubric under which to organize against neoliberal forces. Further, we contend that Fineman's rhetoric of resilience risks reiterating a neoliberal logic of individualized self-management. In response, we look to Butler's concept of precarity, which underscores particular social conditions, as opposed to universal ontological vulnerabilities, that debilitate certain subjects. At stake is how we respond to neoliberal forces today: a vocabulary of precarity poses a more effective challenge than one of vulnerability, for it opens onto not merely individual or institutional resilience but grounded, communal resistance. (shrink)

In this article, I apply the concept of solidarity to collective knowledge practices in healthcare. Generally, solidarity acknowledges that people are dependent on each other in many respects, and it captures those support practices that people engage in out of concern for others in whom they recognise a relevant similarity. Drawing on the rich literature on solidarity in bioethics and beyond, this article specifically discusses the role that epistemic solidarity can play in healthcare. It thus focuses, in particular, (...) on solidarity’s relationship with justice and injustice. In this regard, it is argued (1) that justice and solidarity are two equally important and complementary values that should both be considered in healthcare practices and institutions and (2) that solidarity often arises in unjust situations and can be a means to bring about justice. I transfer these ‘general’ insights about solidarity to knowledge practices in healthcare and link them to the discussion about epistemic injustices in healthcare and how to overcome them. I argue that epistemic solidarity can play an important role in overcoming epistemic injustices as well as—and independently from its contribution to justice—in knowledge production in medicine more generally. To demonstrate how epistemic solidarity can add to our understanding of collective knowledge practices, I discuss two examples: patients sharing their medical data for research purposes and healthcare professionals’ engagement with patients to better understand their afflictions. (shrink)

It is widely acknowledged that trust plays an important role for the acceptability of data sharing practices in research and healthcare, and for the adoption of new health technologies such as AI. Yet there is reported distrust in this domain. Although in the UK, the NHS is one of the most trusted public institutions, public trust does not appear to accompany its data sharing practices for research and innovation, specifically with the private sector, that have been introduced in (...) recent years. In this paper, we examine the question of, what is it about sharing NHS data for research and innovation with for-profit companies that challenges public trust? To address this question, we draw from political theory to provide an account of public trust that helps better understand the relationship between the public and the NHS within a democratic context, as well as, the kind of obligations and expectations that govern this relationship. Then we examine whether the way in which the NHS is managing patient data and its collaboration with the private sector fit under this trust-based relationship. We argue that the datafication of healthcare and the broader ‘health and wealth’ agenda adopted by consecutive UK governments represent a major shift in the institutional character of the NHS, which brings into question the meaning of public good the NHS is expected to provide, challenging public trust. We conclude by suggesting that to address the problem of public trust, a theoretical and empirical examination of the benefits but also the costs associated with this shift needs to take place, as well as an open conversation at public level to determine what values should be promoted by a public institution like the NHS. (shrink)

In this important collection of essays Dennis Thompson argues for a more robust conception of responsibility in public life than prevails in contemporary democracies. He suggests that we should stop thinking so much about public ethics in terms of individual vices and start thinking about it more in terms of institutional vices. Combining theory and practice with many concrete examples and proposals for reform, these essays could be used in courses in applied ethics or political theory and will (...) be read by professionals and graduate students in schools of political science, public policy, law, public health, journalism and business. (shrink)

Despite decades of activism, resistance, and education, both feminists and gender rebels continue to experience personal, political, institutional, and cultural resistance to rights, recognition, and respect. In the face of these inequalities and disparities, Transgressing Feminist Theory and Discourse seeks to engage with, and disrupt the long-standing debates, unquestioned conceptual formations, and taboo topics in contemporary feminist studies. The first half of the book challenges key concepts and theories related to feminist scholarship by advocating new approaches for theorizing interdisciplinarity, (...) intersectionality, critical race theory, trans studies, and genetics. The second half of the book offers feminist critiques or explorations of timely topics such as the 2017 Women's March and Donald Trump's election as well as non-Western perspectives of family and the absence of women's perspectives in healthcare. Contributors comprise of leading scholars and activists from disciplines including gender and sexuality studies, African American studies, communication studies, sociology, political science, and media. Transgressing Feminist Theory and Discourse is a compelling examination of some of the most high-profile feminist issues today. It hopes to infuse future and current debates and conversations around feminism and feminist theory with intersectional, imaginative, provocative, and evocative ideas, inspiring bold cross-fertilizations of concepts, principles, and practices. (shrink)

Despite broad agreement that the vulnerable have a claim to special protection, defining vulnerable persons or populations has proved more difficult than we would like. This is a theoretical as well as a practical problem, as it hinders both convincing justifications for this claim and the practical application of required protections. In this paper, I review consent-based, harm-based, and comprehensive definitions of vulnerability in healthcare and research with human subjects. Although current definitions are subject to critique, their underlying (...) assumptions may be complementary. I propose that we should define vulnerability in research and healthcare as an identifiably increased likelihood of incurring additional or greater wrong. In order to identify the vulnerable, as well as the type of protection that they need, this definition requires that we start from the sorts of wrongs likely to occur and from identifiable increments in the likelihood, or to the likely degree, that these wrongs will occur. It is limited but appropriately so, as it only applies to special protection, not to any protection to which we have a valid claim. Using this definition would clarify that the normative force of claims for special protection does not rest with vulnerability itself, but with pre-existing claims when these are more likely to be denied. Such a clarification could help those who carry responsibility for the protection of vulnerable populations, such as Institutional Review Boards, to define the sort of protection required in a more targeted and effective manner. (shrink)

Vulnerability and politics are among the relevant and key topics of discussion in the Ethiopian healthcare context. Attempts by the formal bioethics structure in Ethiopia to deliberate on ethical issues relating to vulnerability and politics in healthcare have been limited, even though the informal analysis of bioethical issues has been present in traditional Ethiopian communities. This is reflected in religion, social values, and local moral underpinnings. Thus, the aim of this paper is to discuss the bioethical (...) implications of vulnerability and politics for healthcare in Ethiopia and to suggest possible ways forward. First, we will briefly introduce what has been done to develop bioethics as a field in Ethiopia and what gaps remain concerning its implementation in healthcare practice. This will give a context for our second and main task – analyzing the healthcare challenges in relation to vulnerability and politics and discussing their bioethical implications. In doing so, and since these two concepts are intrinsically broad, we demarcate their scope by focusing on specific issues such as poverty, gender, health governance, and armed conflicts. Lastly, we provide suggestions for the ways forward. (shrink)

This paper discusses the ethical implications of racism and some of the various costs associated with racism occurring at the institutional level. We argue that, in many ways, the laws, social structures, and institutions in Western society have operated to perpetuate the continuation of historical legacies of racial inequities with or without the intention of individuals and groups in society. By merely maintaining existing structures, laws, and social norms, society can impose social, economic, and health costs on racial minorities (...) that impinge on their well-being and human dignity. Based on a review of multidisciplinary research on racism, particularly focusing on healthcare, we demonstrate how institutional racism leads to social and economic inequalities in society. By positing institutional racism as the inherent cause of avoidable disparities in healthcare, this paper draws attention to the ethical significance of racism, which remains a relatively neglected issue in bioethics research. (shrink)

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, (...) class='Hi'>healthcare professionals bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)

Vulnerability theory as developed in the Vulnerability and Human Condition Initiative is an alternative to a rights-based or social contract paradigm for thinking about foundation concepts of state responsibility. One fundamental premise of the theory is that the individuals and groups currently described as “vulnerable populations” should not be labelled vulnerable, nor should they be sequestered in discreet categories for the purposes of law and policy. This plea for their inclusion in a larger whole is not (...) to deny that discrimination, harm, and relative disadvantage arising from all sorts of circumstances and situations exist. Nor is it to suggest that particular instances of harm should not be addressed by appropriate state action. Rather, it is an argument that “vulnerability” is the wrong concept to use to define and isolate these groups, or any other specific group, from the whole of humanity. Human vulnerability is universal and constant, inherent in the human condition. Recognizing the theoretical mandates of accepting the universal, vulnerability theory presents a “vulnerable subject” as the only appropriate object of law and policy. This inclusive, universal legal subject incorporates the realities of the ontological body and its life-long dependence on social institutions and relationships, building a theory of essential social cohesion and reciprocity in which the state has the responsibility to see that these vital social institutions and relationships operate justly. (shrink)

The concept of solidarity has recently come to prominence in the healthcare literature, addressing the motivation for taking seriously the shared vulnerabilities and medical needs of compatriots and for acting to help them meet these needs. In a recent book, Prainsack and Buyx take solidarity as a commitment to bear costs to assist others regarded as similar, with implications for governing health databases, personalized medicine, and organ donation. More broadly, solidarity has been understood normatively to call for ‘standing with’ (...) or assisting fellow community members and possibly also distant others in regard to their needs, whether for its own sake or in order to realize the demands of justice. I argue here that the understanding of solidarity in the existing bioethics literature is unduly restricted by not sufficiently theorizing the notion of structural (or systemic) injustice and its import for understanding solidarity. Extending traditional conceptions of labor and social movement solidarity, I contrast unitary solidarity within a given group with ‘networking solidarities’ across groups. I analyze the meaning of structural injustice and its significance for solidarity, including countering institutionally entrenched inequalities and economic exploitation. I then apply this broadened conception to healthcare, discussing structural problems with the U.S. insurance system and the solidarity movements addressing its deficiencies. I analyze some natural disasters and global health challenges that were aggravated by structural injustices, along with the solidarity movements they engendered. Finally, I revisit the questions of governing health databases and of personalized medicine with the enlarged conception of solidarity in view. (shrink)

One of the most prevalent rationales for public healthcare policies is a human right to healthcare. Governments are the typical duty-bearers, but they differ vastly in their capacity to help those vulnerable to serious health problems and those with severe disabilities. A right to healthcare is out of the reach of many developing economies that struggle to provide the most basic services to their citizens. If human rights to provision of such goods exist, then governments would be (...) violating rights without doing anything wrong. I argue that such variable ability to provide healthcare depends not only on financial resources, but on institutional capacity, and that the latter represents a more fundamental challenge to the existence of a human right to healthcare than previously recognized. This challenge does not imply that government has no obligations to protect and improve the health of their citizens, but that it is best to think of such obligations as generated by conventional rights, namely rights arising from local legal and social conventions, which require governments to pursue health-related moral goals such as reducing suffering, closing opportunity gaps for the disadvantaged, and preventing the spread of contagious diseases. We need not think of such moral goals in terms of human rights. (shrink)

Bribing doctors for preferential treatment is rampant in the healthcare system of developing countries like Vietnam. Although bribery raises the out-of-pocket expenditures of patients, it is so common to be deemed an “envelope culture.” Given the little understanding of the underlying mechanism of the culture, this study employed the mindsponge theory for reasoning the mental processes of both patients and doctors for why they embrace the “envelope culture” and used the Bayesian Mindsponge Framework (BMF) analytics to validate our (...) reasoning. Analyzing responses from 1042 Vietnamese patients, we discovered that bribing doctors can help patients reduce the destitution risk induced by treatment. Such effect of doctor bribery remains consistent among patients that have to pay high daily costs (e.g., accommodation and subsistence fees) regardless of their employment status. Nevertheless, for patients with no or unstable jobs, their risks of destitution increase if they have to pay more thank-you money. These findings suggest that doctor bribery is an adaptive strategy for patients in an environment where the healthcare supply cannot meet the actual demand. Moreover, healthcare equity is greatly exacerbated due to the envelope culture, as vulnerable individuals are exposed to a greater threat of poverty. At the same time, those with good economic conditions get preferential treatment by paying a higher amount of thank-you money. Healthcare workers’ ethics must be the top priority for an equitable and proper healthcare system. (shrink)

The objective of the paper is to explore the issue that despite the absence of adequate formal and systematic ways for the poor and disadvantaged people to get access to health benefit like in a rich liberal society, there are active social customs, feelings and individual and collective responsibilities among the people that help the disadvantaged and poor people to have access to the minimum health care facility in both liberal and non-liberal poor countries. In order to explain the importance (...) and functional contribution of the social norms in this respect, some examples will be illustrated from Bangladesh which is a poor liberal country. There will be two sections of the paper. In the first section, it will be exhibited how the naturally and socially disadvantaged people in a liberal society get benefit following Rawls‟ theory of distributive justice. In the second section, it will be showed that in a poor country where there are less resources of the government to provide enough services to the poor and disadvantaged people, the communal feelings and the informal social institutions play a vital role that helps the disadvantaged and poor people to get access to the health benefit. The traditional social norms impose indirect sanction on its people to come forward to help the worse off people of the country. It is depicted that Rawlsian theory of distribution does not work properly in these countries, rather the communitarian feelings is more welcomed for the benefit of the overall welfare of the society and this will be shown in the conclusion of the paper. (shrink)

The urgent need to address climate change poses a range of complex moral and practical concerns, not least because rising to the challenge will require cooperation among countries that differ greatly in their wealth, the extent of their contributions to the problem, and their vulnerability to environmental and economic shocks. This thesis by publication in the field of climate ethics aims to characterise a range of national responsibilities associated with acting on climate change (Part I), and to identify proposals (...) for fulfilling those responsibilities through fair and feasible institutional arrangements (Part II). I aim not only to address substantive gaps in scholarly understanding of those responsibilities, but also to strengthen the ability of climate ethics to engage meaningfully with climate policy. Chapter 2 addresses the question of whether wealthy countries owe a “climate debt” to poor countries. It finds that even if climate debt (suitably interpreted) may provide a coherent and morally plausible concept, its political value as a discursive frame that can provide a basis for cooperation is limited. Chapter 3 investigates the role that equity may play in negotiations on a long-term climate change agreement. It argues that developed and developing countries may reach a “principled bargain” if both converge on a way of differentiating their responsibilities that places less emphasis on a rigid dichotomy between the two groups and more emphasis on objective criteria relating to their contribution to the problem and capacity to address it. Chapter 4 explores a question largely overlooked in climate ethics, namely whether wealthy countries owe compensation to those who are adversely affected by the climate policies which they enact. I find that enacting countries have responsibilities to compensate both domestic and foreign citizens who would suffer disproportionate losses from the effects of policies. Chapter 5 assesses whether wealthy countries may legitimately adopt unilateral (or “fragmented”) rather than multilaterally coordinated approaches to raising climate finance for developing countries. It finds that coordinated target-setting, effort sharing and oversight arrangements are essential, but that a mix of unilateral and coordinated approaches to raising funds will be necessary for securing legitimacy. In Chapter 6, through addressing the broader question of what should count as official aid, I consider whether wealthy countries may draw on aid budgets to support developing countries’ efforts to address climate change. I find that the current definition of official aid should be retained but supplemented by specified exclusions from eligibility in order to preserve the aid regime’s integrity. Nevertheless, some climate finance may justifiably be counted as aid provided that concerns relating to the diversion of aid funding are addressed. In addressing these research questions, the thesis seeks not only to make original theoretical contributions to climate ethics but also to strengthen broader scholarly understanding of the ways in which ethics and international public policy may inform one another, particularly by highlighting the role of framing considerations (Chapter 2), feasibility considerations (Chapter 3), and the ways in which principles of fairness and legitimacy map onto institutional functions (Chapters 4, 5 and 6). (shrink)

Applying Fineman’s vulnerability theory, this paper will explore the role of emotions within the legal profession and the specific vulnerabilities that arise from their traditional and contemporary treatment within law. It will consider how the notion of professionalism in law has traditionally disregarded or excluded emotions as irrelevant or even dangerous in a manner which is philosophically and psychologically flawed as well as damaging to mental health and wellbeing. This approach has created longstanding unacknowledged vulnerabilities for the profession (...) as a whole and individual practitioners. It will then explore how the shifting legal services landscape, and the resultant evolution of the profession, has led to a growing contemporary interest in the use of emotional competencies (often characterised as ‘soft skills’ or ‘emotional intelligence’). These are now increasingly exploited as tools to enhance profitability. However, this leads to a dichotomy as, despite their increasing utilisation, emotions are still not fully acknowledged or incorporated within law’s core professional values. This generates further individual and institutional vulnerabilities around mental health and wellbeing which require urgent attention to ensure the health of the contemporary profession. The paper concludes with suggestions for reforms to alleviate these vulnerabilities and promote greater future resilience within law. (shrink)

Vulnerability and empowerment are central concepts of contemporary development theory and ethics. Vulnerability associated with human interdependence is a wellspring of values in care ethics, while vulnerability arising from social problems demands remedy, of which empowerment is frequently the just form. Development planners and aid providers focus upon improving the wellbeing of the most vulnerable – especially women – by empowering them economically, socially and politically. -/- Both vulnerability and empowerment are considered in this volume. (...) Jay Drydyk argues that empowerment is necessarily relational, not simply a matter of expanding choices. Christine Koggel reviews Drydyk’s discussion through the lens of feminist relational theory, considering how norms, structures and institutions shape, delimit, and promote empowerment. Gail Presbey examines empowerment in East African women’s lives through the writings and biography of Wangari Maathai. Stacy Kosko considers indigenous self-governance and participation in shared governance. Serene Khader reflects upon postcolonial feminist criticism of the concept of adaptive preference. Vida Panitch discusses the economic vulnerability that surrounds the global market in surrogate birth. Anupam Pandey provides a review of third world eco-feminist activism and literature. Ann Cudd envisions international humanitarian intervention to support female autonomy against oppressive state and social institutions. (shrink)

The article addresses the implications of Prevent and Channel for epistemic justice. The first section outlines the background of Prevent. It draws upon Moira Gatens and Genevieve Lloyd’s concept of the collective imaginary, alongside Lorraine Code’s concept of epistemologies of mastery, in order to outline some of the images and imaginaries that inform and orient contemporary counter-terrorist preventative initiatives, in particular those affecting education. Of interest here is the way in which vulnerability is conceptualised in Prevent and Channel, in (...) particular the way in which those deemed ‘at risk of radicalisation’ are constituted as vulnerable and requiring intervention. The imaginary underpinning such preventative initiatives is, I argue, a therapeutic/epidemiological one. If attention is paid to the language associated with these interventions, one finds reference to terms such as contagion, immunity, resilience, grooming, virus, susceptibility, therapy, autonomy, vulnerability and risk—a constellation of images/concepts resonant with therapeutic and epidemiological theories and practices. I outline some of the implications of this therapeutic/epidemiological imaginary for epistemic injustice. If people, in this case, students, teachers and parents, feel that their voice will not be given credence, this leads to testimonial injustice. If one group is constituted as a suspect community, this risks hermeneutical injustice for that group—a situation facing Muslims at present. Given the requirements for educators and educational institutions to enact this particular iteration of preventative counter-terrorist legislation, the way in which vulnerability is understood and operationalised has direct bearing upon education and the educational experience of all stakeholders, in particular in relation to the conditions for epistemic justice. (shrink)

This paper aims to refute the idea whereby giving consideration to vulnerability can only lead to an ethics, or is only relative to a politics derived from morality. I first shed some light on the seeming impossibility experienced by a large number of contemporary theories of vulnerability to fully think the political. Second, I define what one overlooks in the political when one simply considers it as a sphere of implementation of moral principles. Finally, I interpret care theories (...) as an attempt to overcome the difficulty of thinking the political from the viewpoint of vulnerability, and I define the political as a movement of reengaging with and transforming what is already instituted. (shrink)

This article adds philosopher Judith Butler to the list of thinkers whose work underpins the interest in ethics and/in film that began in earnest in the 2000s. Beginning with Precarious Life: Powers of Mourning and Violence, Butler has published several volumes that blend ethical thinking with moral theory and political philosophy, focusing on the concepts of precariousness and vulnerability. This article suggests that two films directed by Abderrahmane Sissako, Bamako and Timbuktu, as dramas of precariousness and vulnerability (...) respectively, can inform thinking about cinematic ethics: the staging of a trial of global institutions in Bamako dramatizes the possible universalization of an ethic of precarity, while in Timbuktu the condemnation to death of a Tuareg shepherd by Ansar Dine, the militant Islamist group that occupied parts of Mali in 2012, allows Sissako to give full rein to his talent for filming the vulnerability of both victims and oppressors. (shrink)

In the face of environmental crises such as climate change, pollution and biodiversity loss—which all adversely impact on health—Gils-Schmidt and Salloch explore whether physicians can be justified in taking climate issues into account in clinical care.1 While their approach centres on the ‘climate-sensitive’ decisions, physicians can carry out on the micro-level of clinical decision-making, they encourage further discussions on how climate-related issues can be included across different levels of decision-making in healthcare. We propose a list of tasks and a (...) model to assist with navigating the range of factors and structural elements an environmentally sensitive ethics must address. Stephen Gardiner’s notion of a perfect moral storm is central to understanding these issues.2 Gardiner describes how a perfect moral storm occurs in the centre of three overlapping conditions for human action and policymaking in the face of climate change. This storm is driven by: (1) a lack of interest among current generations to meet global needs and accommodate the well-being of future generations, (2) a lack of ecological concerns for other parts of nature than humans and (3) weak ethical and political theories and institutions shaping policy decisions on issues with severe implications across borders and generations. Moreover, these conditions are embedded in the existing, complex world of ethically unjustified power imbalances and social injustice. The growing awareness of healthcare’s climate footprint has amplified and accelerated global, grassroots action to make healthcare more environmentally friendly. This includes incorporating environmental impacts into quality improvement methodologies, building communities of practice to explore how to make …. (shrink)

In recent years we may observe increasing interest in the development of social innovation both regarding theory as well as the practice of responding to social problems and challenges. One of the crucial challenges at the beginning of the 21st century is population ageing. Various new and innovative initiatives, programs, schemes, and projects to respond to negative consequences of this demographic process are emerging around the world. However, social theories related to ageing are still insufficiently combined with these new (...) practices, social movements, organisational models, and institutions. Many scholars are still using notions and tools from classical theories of social gerontology or the sociology of ageing such as disengagement theory, activity theory, and successful and productive ageing. Such theories do not sufficiently explain ageing in the context of, for example, a broad use of the information and communications technologies including robotics and automation, new healthcare and long-term care models, advancements in the development and governance of age-friendly environments, and public engagement of older adults into co-production of services delivered by public, private, non-governmental as well as non-formal entities. (shrink)

Over many years, different theories have been developed to guide the social practices and policies of institutions so that they demonstrate equal concern and respect for all, and satisfy the requirements of justice. Although the normative principles described in a theory may support just institutions, whether this results in just outcomes will depend on how the decisions that implement the principles are made and actioned. As a societal institution charged with caring for people, ensuring just outcomes is (...) a distinct concern in healthcare. Relationships within this institution are constitutive of human flourishing and are also important to justice. Yet, it is not possible to create, maintain or evaluate interpersonal relationships in the same manner as institutions because rather than being universal and impartial, they are particular and partial. Consequently, the link between theories of justice that guide decision-making in relation to structures or institutions, and the relationships that influence those with a proximate effect on individuals, is not explicit. To address this gap, this article argues that a focus on human flourishing provides a nexus between the decision-making for just institutions and just outcomes for individuals. (shrink)

Children’s and young persons’ rights have received increasing been focus in recent decades, due in a significant degree to the UN Convention on the Rights of the Child. In Sweden, compulsory care in the social-services system is disputed, not least for the forceful measures that facility personnel have at their disposal to control children in certain conflict situations. The general aim of this article is to examine how the increased emphasis in Sweden on children’s rights is promoting resilience for children (...) and youth in youth compulsory secure-care settings. A more general question is whether the child-rights discourse leads in practice to increased resilience for children and youth in this setting, or even in general. The empirical material shows that children and young people’s perceptions of care and treatment are strongly linked to their interactions with staff and how the staff use restrictive measures. Applying Martha Fineman’s vulnerability theory in this context means that achieving resilience demands an analysis of the institutional settings in which children and young persons live their day-to-day lives, including their relationships in this setting. Comparing the legal possibilities of physical constraint with interviews of children and personnel reveals that relevant legislative frameworks and children’s-rights discourse should serve as a protection mechanism for children and youths, but in real life, these seem to have limited effect. (shrink)

This is the first book to unpack the legal and ethical issues surrounding unauthorised intimate examinations during labour. The book uses feminist, socio-legal and philosophical tools to explore the issues of power, vulnerability and autonomy. The collection challenges the perception that the law adequately addresses different manifestations of unauthorised medical touch through the lens of women's experiences of unauthorised vaginal examinations during labour. The book unearths several broader themes that are of huge significance to lawyers and healthcare professionals (...) such as the legal status of women and their bodies. The book raises questions about women's experiences during childbirth in hospital settings. It explores the status of women's bodies during labour and childbirth where too easily they become objectified, and it raises important issues around consent. The book highlights links to the law on sexual offences and women's loss of power under the medical gaze. The book includes contributions from leading feminist philosophers, medical professionals, and academics in medicine and law, and offers pioneering analysis relevant to lawyers and healthcare professionals with an interest in medical law and ethics; feminist theory; criminal law; tort law; and human rights law. (shrink)

Chang-Rae Lee’s 2014 novel On Such a Full Sea uses the genre of speculative fiction to reflect on longstanding healthcare debates in the United States that have recently crystalized around the Affordable Care Act. The novel imagines the political economy of healthcare in a future America devastated by environmental illness. What kind of care is available and to whom? Who provides it? Who pays for it? What about distribution and access? The different healthcare systems governing each of (...) three geo-social zones in Lee's future society represent exaggerated versions of the scenarios participants in the ACA debate claim their opponents’ health policies would produce. The essay argues that Lee’s novel ultimately favors a version of universal government-funded care over a system based on supposed free-market principles, even as the novel also tries to make room for conservative Americans’ fears about the specter of so-called “socialized medicine.” More broadly, the essay contends that the health humanities should devote more attention to literary and artistic engagements with healthcare as a system: a complex set of financial models, public and private institutions, government policies, and actors whose roles range well beyond patient and care provider. (shrink)

Chang-Rae Lee’s 2014 novel On Such a Full Sea uses the genre of speculative fiction to reflect on longstanding healthcare debates in the United States that have recently crystalized around the Affordable Care Act. The novel imagines the political economy of healthcare in a future America devastated by environmental illness. What kind of care is available and to whom? Who provides it? Who pays for it? What about distribution and access? The different healthcare systems governing each of (...) three geo-social zones in Lee's future society represent exaggerated versions of the scenarios participants in the ACA debate claim their opponents’ health policies would produce. The essay argues that Lee’s novel ultimately favors a version of universal government-funded care over a system based on supposed free-market principles, even as the novel also tries to make room for conservative Americans’ fears about the specter of so-called “socialized medicine.” More broadly, the essay contends that the health humanities should devote more attention to literary and artistic engagements with healthcare as a system: a complex set of financial models, public and private institutions, government policies, and actors whose roles range well beyond patient and care provider. (shrink)

Despite the role of public health interventions in controlling disease transmission and protecting the public during the COVID-19 emergency, the implementation of quarantine restrictions has raised serious ethical concerns, especially in relation to the well-being of vulnerable populations. Drawing on the lived experiences of rural Chinese migrants who are subject to pandemic control, the authors highlight their inadequate capacities to manage the risks associated with the pandemic and adjust to quarantine restrictions. Informed by an ethical discourse of vulnerability, we (...) show that underpinning this group’s deficient coping strategies is a range of detrimental social structures and institutions that have developed under the persistent rural–urban divide in China. These structural constraints and pathologies expose rural migrants to serious risks and uncertainties while depriving them of the means and resources necessary to protect their own interests in the process of complying with quarantine restrictions. Understanding the plight of rural Chinese migrants as a structural problem also has implications for the global response to the COVID-19 pandemic. We further suggest a need for state intervention to mitigate structural deficiencies and empower the vulnerable during the COVID-19 era. (shrink)

All people are vulnerable to having their self-concepts shaped by others. This article investigates that vulnerability using a theory of narrative self-constitution. According to narrative self-constitution, people depend on others to develop and maintain skills of self-narration and they are vulnerable to having the content of their self-narratives co-authored by others. This theoretical framework highlights how vulnerability to co-authoring is essential to developing a self-narrative and, thus, the possibility of autonomy. However, this vulnerability equally entails that (...) co-authors can undermine autonomy by contributing disvalued content to the agent’s self-narrative and undermining her authorial skills. I illustrate these processes with the first-hand reports of several women who survived sexual abuse as children. Their narratives of survival and healing reveal the challenges involved in developing the skills required to manage vulnerability to co-authoring and how others can help in this process. Finally, I discuss some of the implications of co-authoring for the healthcare professional and the therapeutic relationship. (shrink)

Organizational ethics—defined as the alignment of an institution’s practices with its mission, vision, and values—is a growing field in health care not well characterized in empirical literature. To capture the scope and context of organizational ethics work in United States healthcare institutions, we conducted a nationwide convenience survey of ethicists regarding the scope of organizational ethics work, common challenges faced, and the organizational context in which this work is done. In this article, we report substantial variability in the (...) structure of organizational ethics programs and the settings in which it is conducted. Notable findings included disagreement about the activities that comprise organizational ethics and a lack of common metrics used to assess organizational ethics activities. A frequently cited barrier to full engagement in these activities was poor institution-wide understanding about the role and function of organizational ethics resources. These data suggest a tension in the trajectory of organizational ethics’ professionalization: while some variability is appropriate to the field’s relative youth, inadequate attention to definitions of organizational ethics practice and metrics for success can impede discussions about appropriate institutional support, leadership context, and training for practitioners. (shrink)

This thesis is a philosophical contribution to the theories on risk communication. The topic of risk communication is approached from several different angles, but with a normative focus on equality and vulnerability. Essay I is a comment on risk perception theory and the psychometric model in particular. In risk perception research individual risk taking is described as either a result of valuing the benefits from risk taking or a failure of comprehending the severity or probability of risks. The (...) essay argues that sometimes individuals take risks simply because they are in a vulnerable position and have no other choice. Four factors are identified as crucial in risks from vulnerability: poor outset conditions, lack of reasonable options, hope and liability to disinformation. Essay II addresses the democratic approach to risk communication and the ideal of risk communication as a dialogue between more or less equal stakeholders. The Essay argues that even the more innovative and dialogue oriented approaches to risk communication are unequal. This is often blurred by the confusion between the described ideal and the description of these newer approaches. This inequality is analysed in a three-fold way: influence over the communication process; influence over and access to information; and influence over risk decisions. The Essay develops a typology of different risk communication practices and influence distributions and concludes that the form of risk communication most commonly referred in the literature is the most imbalanced kind where all three types of influence falls to the same party. Essay III explores the concept of trust, an often-mentioned objective for risk communication. The concept of trust is analyzed from previous philosophical approaches, and the idea of trust as comfortable defocusing is introduced. It is argued that not only the gains for the trustee but also the gains and risks for the truster, generally and in the case from risk communication, can be explained by this notion. It is concluded that public trust for institutions or organizations need not be framed on an individual level. Instead, the vulnerability of trusting can be counter-acted by a delegation of different stances, including both control and trust, among different individuals and institutions in society. (shrink)

The central claim of this book is that the dichotomy between economic dependence and economic independence is completely inadequate for describing the political challenges faced by contemporary capitalist welfare states. The simplistic contrast between markets and states as sources of income renders invisible the relations of dependence established in our basic economic institutions such as the family, property, and money. This book is a work of political theory that attacks narrow conceptions of dependence and identifies distinct senses of (...) dependence that might allow political communities to make clearer decisions about the justice of our economic institutions and practices. Inheritance, for example, is as much a form of dependence as support by a welfare state, but these are never compared in debates about economic justice. This book begins the work of comparing forms of economic dependence, and argues that economic dependence is always an issue of both vulnerability and parasitism. It builds bridges between political theory and social science, and is of relevance to those concerned with social and economic justice in and beyond contemporary capitalist welfare states. (shrink)

In this paper, we offer some compelling reasons to think that issues relating to vulnerability play a significant – albeit thus far underacknowledged – role in Jürgen Habermas’s notions of communicative action and discourse. We shall argue that the basic notions of discourse and communicative action presuppose a robust conception of vulnerability and that recognising vulnerability is essential for making sense of the social character of knowledge, on the epistemic side of things, and for making sense of (...) the possibility of deliberative democracy, on the political side of things. Our paper is divided into four principal sections. In Section 1, we provide a basic outline of Habermas on communicative action and discourse. In Section 2, we develop an account of vulnerability and communication in the context of speaker/hearer relations. We specifically focus on distorted communication, vulnerability and speech. In Section 3, we focus on elaborating epistemic pathologies in the context of epistemic oppression and testimonial injustice. In Section 4, we focus on explaining how Habermasian resources contribute to vulnerability theory, and how introducing vulnerability theory to Habermas broadens or deepens his theory of communication action and his discourse ethics theory. (shrink)

This paper examines the role of vulnerability in the basis of business ethics by criticizing its role in giving a moral substantial character to fiduciary duties to shareholders. The target is Marcoux’s (Bus Ethics Q 13(1):1–24, 2003) argument for morally substantial fiduciary duties vis-à-vis the multifiduciary stakeholder theory. Rather than proceed to support the stakeholder paradigm, a conception of vulnerability is combined with Heath’s 2004) “market failure” view of the ethical obligations of managers as falling out of (...) their roles as professionals involved in the institution of the market. The result is the core of a theoretically defensible and managerially motivating and deployable ethic. (shrink)

One of the most important goals of out of home placements is to reduce vulnerability and to enable well-being in the long term. This article hermeneutically reconstructs biographies decades after leaving-care to understand the impact of residential care experiences on selected dimensions of care-leavers’ well-being, that were discovered in the data material. For this article three analytic areas were selected from the core of the narratives of former care leavers: Social networks, parenthood and state interventions. The selected findings on (...) long-term outcomes presented here are based on a qualitative research project funded by the Swiss National Science Foundation on life trajectories after residential care. The authors have conducted 37 biographical narrative interviews with former children placed in residential care between 1950 and 1990 in the Canton of Zurich, Switzerland. The analysis of these narrative interviews was structured by the inductive procedures of Grounded Theory. Its foundation is the conceptualisation and dimensionalisation of data through inductive coding within the narratives. Research question: We mainly were interested in aspects of transitions exclusively relevant from the actors’ point of view. The objective of this paper is to learn for the future by taking biographical experiences and long-term outcome in account. As we know residential care facilities have changed in last decades, but structurally some key figures are still continuing. They still interrupt the life course two times: when you start to the live in the institution and when you leave. One main question is how young people manage to integrate residential experiences through their life course and where they keep on struggling until the end of their lives. From a life-course perspective, the impact of social service intention on individual life courses, behind sending the individuals to such facilities, are important to investigate. They implicate relevant information concerning current practice and impact of placing children in residential care. Social networks and experiences of parenthood show why we must frame and accompany transitions out of care. (shrink)

Catholic healthcare institutions live amidst tension between three intersecting primary values, namely, a commitment of service to the poor and vulnerable, promoting the common good for all, and financially sustainability. Within this tension, the question sometimes arises as to whether it is ever justifiable, i.e., consistent with Catholic identity, to place limits on charity care. In this article we will argue that the health reform measures of the Affordable Care Act do not eliminate this tension but actually increase (...) the urgency of addressing it. Moreover, we will conclude that the question of limiting charity care in a manner that is consistent with the obligations of Catholic identity around serving the poor and vulnerable, promoting the common good, and remaining financially sustainable is not a question of if, but of how such limits are established. Such limits, however, cannot be established in light of one overriding moral consideration or principle, but must be established in light of a multitude of principles guiding us to a holistic understanding of the interrelatedness of the moral dimensions of Catholic identity. (shrink)

Whistleblowers are a vital means of protecting society because they provide information about serious wrongdoing. And yet, people who speak up can suffer. Even so, debates on whistleblowing focus on compelling employees to come forward, often overlooking the risk involved. Theoretical understanding of whistleblowers’ post-disclosure experience is weak because tangible and material impacts are poorly understood due partly to a lack of empirical detail on the financial costs of speaking out. To address this, we present findings from a novel empirical (...) study surveying whistleblowers. We demonstrate how whistleblowers who leave their role as a result of speaking out can lose both the financial and temporal resources necessary to redevelop their livelihoods post-disclosure. We also show how associated costs involving significant legal and health expenditure can rise. Based on these insights, our first contribution is to present a new conceptual framing of post-disclosure experiences, drawing on feminist theory, that emphasizes the bodily vulnerability of whistleblowers and their families. Our second contribution repositions whistleblowing as a form of labour defending against precarity, which involves new expenses, takes significant time, and often must be carried out with depleted income. Bringing forth the intersubjective aspect of the whistleblowing experience, our study shows how both the post-disclosure survival of whistleblowers, and their capacity to speak, depend on institutional supports or, in their absence, on personal networks. By reconceptualizing post-disclosure experiences in this way—as material, embodied and intersubjective—practical implications for whistleblower advocacy and policy emerge, alongside contributions to theoretical debates. Reversing typical formulations in business ethics, we turn extant debates on the ethical duty of employees to speak up against wrongdoing on their heads. We argue instead for a responsibility to protect whistleblowers exposed to vulnerability, a duty owed by those upon whose behalf they speak. (shrink)

Worldwide, vulnerable neighbourhoods of large cities are often the scene of collective violent conflicts linked with migration and ethnic minorities’ struggles for social justice. However, urban conflicts of this kind have not taken place in Spanish cities with high immigration rates, even though the country has been deeply affected by two recent socioeconomic crises (2009 and 2020). This article reports findings of a study aimed at understanding what lies behind this apparent social peace. The research methodology was based on an (...) analysis of secondary socio-economic and socio-relational data from the Spanish Institute of Statistics and from key national surveys and reports. Results confirmed that immigrant population living in the country are strongly segregated in the lower strata of the labour and socioeconomic structure and have been disproportionately affected by the crises. However, research findings also pointed to the existence of strong closed support networks where social capital has been effective at palliating members’ disadvantage and unrest. Drawing on the Theory of Rupture Frames, we argue that this is a fragile and unsustainable social peace, rooted in social injustice, and anticipate that unless actively prevented, uncontrolled conflict will eventually emerge in main cities’ neighbourhoods in Spain. (shrink)

Background:In China, the conventional family-based ageing care model is under pressure from social transitions, raising the question of whether and to what extent families are still capable of dealing with the care of the aged.Objective:This article examines the vulnerability and inadequacy of families to bear responsibility for the care of the aged against a backdrop of socioeconomic transformation and diminishing institutional support in rural China.Research design:This article adopts an empirical ethical approach that integrates empirical investigation with ethical inquiry.Participants and (...) research context:The empirical component of this article focuses on the lived experiences of caring for a wife and mother with dementia in one rural Chinese family, collected from a 6-month fieldwork study conducted at one primary hospital.Ethical considerations:Approval was obtained from the university ethics committee.Findings:The empirical study highlights a conflicted family process of managing and negotiating care that indicates the inadequacies and limited ability of families to deal with aged care tasks. In addition, inadequate structures and institutional deficiencies exacerbate the vulnerability of rural families and their inability to offer adequate care.Conclusion:Acknowledging the vulnerability of families as ageing care providers, this article calls for a socially supported family care model for rural older people in China and also proposes policy recommendations. (shrink)