When read as a theory that is supposed to mirror, represent or fit some collection of historical data, critics argue that Kuhn’s theory of paradigm shift in Structure of Scientific Revolutions fails by cherry-picking and underdetermination. When read as the ground for a socio-epistemological conception of rationality, critics argue that Kuhn’s theory fails by either the naturalistic fallacy or underarticulation. This paper suggests that we need not view Structure as a historian’s attempt to accurately depict scientific theory change or a (...) philosopher’s attempt to suggest, more normatively, the factors we ought to consider in theory choice. Instead, we might use Kuhn’s theory as a metaphilosophical frame through which to better understand the limits of otherwise intractable philosophical debates. We can focus on Kuhn’s theory not as a proposition or model to confirm, but as something we might use as a tool for understanding. Philosophers have discussed the justice and care orientations in ethics as two theories for which there will be some common, constraining set of intuitions to confirm one theory over the other, to demonstrate that protecting rights is fundamentally more valuable that fulfilling needs or that fulfilling needs is fundamentally more valuable that protecting rights. Instead of conceptualizing this conversation as a choice between two theories, this paper looks to Ian Hacking’s interpretation of Kuhn’s paradigm concept to suggest that working in the world of justice is very different than working in the world of care, as each orientation is a paradigm with its own cognitive and contextual standards of theory assessment. To start, after Larry Laudan, each has its own ontology, methodology, aims and values. But moreover, after Ian Hacking, each has an even larger, entrenched collection of projectible predicates. Though Carol Gilligan herself uses the metaphor of gestalt shift in a few places to characterize the move from the justice to the care perspective, the insight—that what many assume to be a standard exercise in theory choice is really more of a paradigm shift—has been under theorized by ethicists and ignored by philosophers of science. This paper brings the full resources of Structure and its secondary literature to this metaethical issue, while making the larger point that Structure has an important pragmatic role to play, when it comes to the understanding philosophical debates, even if we cannot secure the truth of Kuhn’s theory. (shrink)

When read as a theory that is supposed to mirror, represent or fit some collection of historical data, critics argue that Kuhn’s theory of paradigm shift in Structure of Scientific Revolutions fails by cherry-picking and underdetermination. When read as the ground for a socio-epistemological conception of rationality, critics argue that Kuhn’s theory fails by either the naturalistic fallacy or underarticulation. This paper suggests that we need not view Structure as a historian’s attempt to accurately depict scientific theory change or a (...) philosopher’s attempt to suggest, more normatively, the factors we ought to consider in theory choice. Instead, we might use Kuhn’s theory as a metaphilosophical frame through which to better understand the limits of otherwise intractable philosophical debates. We can focus on Kuhn’s theory not as a proposition or model to confirm, but as something we might use as a tool for understanding. Philosophers have discussed the justice and care orientations in ethics as two theories for which there will be some common, constraining set of intuitions to confirm one theory over the other, to demonstrate that protecting rights is fundamentally more valuable that fulfilling needs or that fulfilling needs is fundamentally more valuable that protecting rights. Instead of conceptualizing this conversation as a choice between two theories, this paper looks to Ian Hacking’s interpretation of Kuhn’s paradigm concept to suggest that working in the world of justice is very different than working in the world of care, as each orientation is a paradigm with its own cognitive and contextual standards of theory assessment. To start, after Larry Laudan, each has its own ontology, methodology, aims and values. But moreover, after Ian Hacking, each has an even larger, entrenched collection of projectible predicates. Though Carol Gilligan herself uses the metaphor of gestalt shift in a few places to characterize the move from the justice to the care perspective, the insight—that what many assume to be a standard exercise in theory choice is really more of a paradigm shift—has been under theorized by ethicists and ignored by philosophers of science. This paper brings the full resources of Structure and its secondary literature to this metaethical issue, while making the larger point that Structure has an important pragmatic role to play, when it comes to the understanding philosophical debates, even if we cannot secure the truth of Kuhn’s theory. (shrink)

Nanotechnology presents significant challenges in terms of developing a regulatory framework. This is due to a lack of scientific knowledge about the behaviour of the technology in its interactions with biological and ecological processes, the environment and other technologies. Crucially, there is a great deal of uncertainty surrounding the potential environmental and human health and safety impacts of NT. Consequently, the development of NT is a potential test case for framing new models of ‘soft law’ voluntary governance as a substitute (...) for traditional command and control type regulation. Driven by ‘new science governance,’ an approach based on a combination of ideas in anticipatory ethics, future-oriented responsibility, upstream public engagement and deliberation and theories of justice may offer a solution. The uniqueness of the approach can be found in the incorporation of anticipatory approaches via public participation and deliberation as the input into procedural justice approaches with distributional justice as the output. The overarching objective of this work is to contribute to the discussion in relation to the internalisation of responsibility and the building of intellectual and societal capacity to anticipate negative consequences before they arise in the hope that such an approach could be the antithesis of the retrospective imposition of responsibility and liability after the harm is done, which is the outcome of traditional regulatory and ethical approaches. Ultimately, the purpose is to contribute to the long-term sustainability of NT. (shrink)

In this paper, I urge that the very real lessons Carol Gilligan's work in moral psychology offer to moral philosophy can best be appreciated if we take seriously the gap between the two disciplines. The care and justice perspectives Gilligan explores are psychological orientations, and orientations are defined as much by matters of emphasis, selectivity of interpretation, and gestalt as they are by propositional commitment. As such, I argue, their contribution to moral theory is best seen as (...) stances from which to do theory, rather than as constituting ready-made theories themselves. In pursuing this train of thought, I examine how Gilligan's work has developed over time and how, in the end, we should understand the juxtaposition between the two orientations. (shrink)

This paper examines how expertise is treated as a separable domain of epistemics by looking at simulated intensive care shift-handovers between resident physicians. In these handovers, medical information about a patient is transferred from an outgoing physician to an incoming physician. These handovers contain different interactional activities, such as discussing the patient identifiers, giving a clinical impression, and discussing tasks and focus points. We found that with respect to knowledge about the patient, the OPs display an orientation to (...) a knowledge imbalance, but with respect to procedures, reasoning, and activities, they display an orientation to a knowledge balance. We use ‘expertise’ to refer to this latter type of knowledge. ‘Expertise’ differs from, and adds to, how knowledge is often treated in epistemics in that it is concerned with professional competence or ‘knowing how’. In terms of epistemics, the participants in the handovers orient to a steep epistemic or knowledge gradient when it concerns the patient, while simultaneously displaying an orientation to a horizontal expertise gradient. (shrink)

In this paper we aim to discuss a theoretical explanation for the positive relationship between patients’ knowledge and their trust in healthcare personnel. Our approach is based on John Dewey’s notion of continuity. This notion entails that the individual’s experiences are interpreted as interrelated to each other, and that knowledge is related to future experience, not merely a record of the past. Furthermore, we apply Niklas Luhmann’s theory on trust as a way of reducing complexity and enabling action. Anthony Giddens’ (...) description and analysis of the high modern society provides a frame for discussing the preconditions for patient-healthcare personnel interaction. High modernity is dominated by expert systems and demands trust in these. We conclude that patient knowledge and trust in healthcare personnel is related because both knowledge and trust are future- and action-oriented concepts. The traits of high modernity provides opportunities and challenges as the personnel can and must perform discretion. This discretion must be made in a context where knowledge is considered uncertain and preliminary. (shrink)

Since Carol Gilligan's In a Different Voice (1982) the ethics of care has developed as a movement of allied thinkers, in different continents, who have a shared concern and who reflect on similar topics. This shared concern is that care can only be revalued and take its societal place if existing asymmetrical power relations are unveiled, and if the dignity of care givers and care receivers is better guaranteed, socially, politically and personally. In this first (...) volume of a new series leading care ethicists from Europe and the United States focus on the moral significance of two concepts in the debate that ask for further reflection. In discussion with the work of Axel Honneth on recognition and the work of Emmanuel Housset on compassion a contribution is made to a reconsideration of recognition and compassion from an ethics of care perspective. This volume contains contributions by Andries Baart, Estelle Ferrarese, Chris Gastmans, Mieke Grypdonck, Emmanuel Housset, Carlo Leget, Hilde Lindemann, Axel Liegeois, Christa Schnabl, Joan C. Tronto, Annelies van Heijst, Linus Vanlaere, Frans Vosman and Margaret Urban Walker. (shrink)

Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons (n = 20) in order to explore and describe their moral orientation based on the paradigms of justice (Kohlberg) and care (Gilligan). The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men’s moral reasoning was dominated by caring, (...) but justice dominated the reasoning of four women. The implications for ethical decision-making and future research are discussed. (shrink)

This study presents the Italian adaptation of the Measure of Moral Orientation, second revision. Based on Carol Gilligan’s theory of the Ethics of Care, the MMO-2 was designed to measure two complementary moral stances, namely, Care and Justice. For this study, questionnaire responses from 683 university students were assessed against an Italian-adapted MMO-2 scale. Data were analyzed through exploratory structural equation modeling first as separate scenarios and then as a single model. The final model comprises 4 (...) intercorrelated pairs of latent variables and shows highly satisfactory goodness of fit indices with moderate construct validity and reliability. Strengths, limitations, and directions for the future developments of the MMO-2 are discussed. (shrink)

The main aim of this paper is to shed light on two somewhat underappreciated theories, which, by drawing attention to the embodied and relational nature of the self, both went beyond the disembodied and individualist paradigm long before most current leading approaches in the field. The paper first considers the routes out of the crisis of this paradigm proposed by care ethics. The first part focuses mainly on Carol Gilligan’s relational account of subjectivity, which served as an inspiration (...) for the development of care ethics as a moral theory, and discusses the strengths and weaknesses of her account. In the next step, the paper sets out to compare the view of the self deployed by care ethics with Donald Winnicott’s account of the transitional area of play. The paper argues that both care ethics and Winnicott’s theory make it possible to understand human subjectivity as at the same time dependent and mature, ambivalent and integrated, vulnerable and responsible, relational and non-arbitrary. Winnicott and care ethicists jointly demonstrate that it is neither an absolute symbiosis with others, nor a total separation from them, that is decisive for the well-being of an individual and a social field. Rather, it is beneficial and morally desirable to cultivate concrete interpersonal relationships in the area of complex relationality. The paper concludes that the crisis of the disembodied and individualistic paradigm of the self cannot be overcome by an uncritical emphasis on the positive function of relational, embodied and supra-individual aspects of human existence. Though essential, these aspects are at the same time complex and developmentally conditioned. (shrink)

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

Carol Gilligan heard a ‘distinct moral language’ in the voices of women who were subjects in her studies of moral reasoning. Though herself a developmental psychologist, Gilligan has put her mark on contemporary feminist moral philosophy by daring to claim the competence of this voice and the worth of its message. Her book, In a Different Voice, which one theorist has aptly described as a best-seller, explored the concern with care and relationships which Gilligan discerned in (...) the moral reasoning of women and contrasted it with the orientation toward justice and rights which she found to typify the moral reasoning of men. (shrink)

In this paper, I discuss the ethics of care as a response to impartialist ethical theories. In section 1, I contrast Gilligan’s critique of impartial ethical theories with other objections to impartialism. In section 2, I analyze some of the ways in which impartialists have attempted to understand the ethics of care since the publication of Gilligan’s text. In section 3, I argue against proponents of impartialism and show that care constitutes an ethical theory in (...) its own right, not one which is dependent or parasitic upon impartialism. In section 4, I contrast care ethic’s conception of the self with that offered by traditional ethical theories, and argue that the most important distinction between the care and impartialist accounts of morality lies in the conception of the moral self which informs each of these approaches. (shrink)

Institutional ethics committees (IECs) in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed IECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan (...) and Nel Noddings, is an unacknowledged basis for IEC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for IECs. (shrink)

Institutional ethics committees in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed lECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan and (...) Nel Noddings, is an unacknowledged basis for /EC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for lECs. (shrink)

There is a curious asymmetry in cases where the use of religious language involves a breakdown in communication and leads to a seemingly intractable dispute. Why does the use of religious language in such cases almost always arise on the side of patients and their families, rather than on the side of clinicians or others who work in healthcare settings? I suggest that the intractable disputes arise when patients and their families use religious language to frame their problem and the (...) possibilities of solution. Unlike clinicians, they are not bilingual and thus lack the capacity to understand and negotiate differences in terms that are responsive to those who work in healthcare settings. After considering a representative case, I explore whether an ethics consultant or chaplain can function as a translator and suggest that, at best, such efforts at mediation depend on contingent aspects of a case and will only be partially successful. To appreciate limits on the role for bilingual translators, I consider a futility dispute where a parent using religious language demands that everything be done for a permanently unconscious child. I challenge the traditional interpretation that says the parent values “mere duration of biological life irrespective of quality.” From a religious perspective, human life is never “merely biological.” This effort to slot the dispute into standard philosophical schemas misses what is crucial in the dispute. I suggest that a better interpretation views the dispute at a meta-level as one about whether withholding and withdrawing care is morally distinguishable from killing. Curiously, this interpretation makes the advocate of futile care into an ally of those “quality of life” advocates who also challenge this distinction. The crux of their dispute now rests on the normative ethics of killing. While I think my interpretation comes much closer to the views of many who demand ‘futile care,’ I suggest that it still falls short because of the way it reconstructs the religious concerns in nonreligious terms. I close by considering an analogy between the language of suffering and the language of faith, suggesting that both require a much richer understanding of the narratives that orient the lives of patients and their families. (shrink)

This chapter contains sections titled: Caring About Caring A Face Only a Mother Could Love? Tough Love: Paternalism as a Form of Caring Paternalism is Not Justice by Another Name Can My Dad Care Too Much? The Importance of Tough Love Notes.

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

In lieu of an abstract, here is a brief excerpt of the content:158 Feminist Studies 46, no. 1. © 2020 by Feminist Studies, Inc. María Fernanda Olarte-Sierra and Tania Pérez-Bustos Careful Speculations: Toward a Caring Science of Forensic Genetics in Colombia Feminist Science and Technology Studies (STS) has recently opened up the question of care as a set of practices related to the sustainability of life.1 The field of feminist studies more broadly has extensively 1. This literature mostly comes (...) from Northern contexts and started to flourish with the seminal work of María Puig de la Bellacasa, “Matters of Care in Technoscience: Assembling Neglected Things,” Social Studies of Science 41, no. 1 (2010): 85–106. This essay gathers scattered feminist STS reflections on these issues and looks at them through the lens of care, including authors such as Susan Leigh Star, Donna Haraway, Isabelle Stengers, Hilary Rose, and Annemarie Mol. The concept of care orienting this exercise of rereading these authors is proposed by Berenice Fisher and Joan Tronto, “Toward a Feminist Theory of Caring,” in Circles of Care: Work and Identity in Women’s Lives, ed. Emily K. Abel and Margaret K. Nelson (Albany: State University of New York Press, 1990), 35–62. Before and after that essay came out, Puig de la Bellacasa published several other papers related to this issue, including “Touching Technologies, Touching Visions. The Reclaiming of Sensorial Experience and the Politics of Speculative Thinking,” Subjectivity 28, no. 1 (2009): 297–315; “‘Nothing Comes without Its World’: Thinking with Care,” The Sociological Review 60, no. 2 (2012): 197– 216; “Ethical Doings in Naturecultures,” Ethics, Place & Environment 13, no. 2 (2010): 151–69; “Making Time for Soil: Technoscientific Futurity and the Pace of Care,” Social Studies of Science 45, no. 5 (2015): 691–716; and Matters of Care: Speculative Ethics in More than Human Worlds (Minneapolis: University of Minnesota Press, 2017). All these publications have been widely cited by other authors, particularly in a special issue of Social Studies of Science on the politics of care published in 2015 (volume 45, issue 5). Other examples María Fernanda Olarte-Sierra and Tania Pérez-Bustos 159 studied how care, and associated practices such as transnational care chains, are feminized and precarious—involving an ethos embodied by those who actively work to maintain or preserve another’s life. Feminists have focused on the politics of care embedded in invisible jobs related to aesthetics, domestic work, child and elder care, and sexual activities and see all these tasks as related to the reproduction of life and culture.2 Central to this conceptualization of care is the understanding that these jobs are typically women’s work. There is a common association between this care and notions of “motherhood” as it relates to values such as compassion, love, and respect, which have been constructed as universally feminine. However, the main goal of feminist studies of care has been to deconstruct this association, particularly because it is imbued with the white, wealthy, heteronormative ideal of femininity that underlies a gendered division of labor. The reality is that class, race, nation, and gender determine who cares for whom, whether or not labor is paid, and to what extent care is exploitative. One strand of recent research problematizes both valorizing and criticizing care practices on the grounds that they are based on a rather homogeneous understanding of the feminine. Instead, these scholars seek to resurrect valuable feminist work without relying on essentialism of authors contributing to this discussion on care as an ethos for science include Ruth Müller and Martha Kenney, “Agential Conversations: Interviewing Postdoctoral Life Scientists and the Politics of Mundane Research Practices,” Science as Culture 24, no. 4 (2014): 537–59; Charis Thompson, Good Science: The Ethical Choreography of Stem Cell Research (Cambridge, MA: MIT Press, 2013); and Carrie Friese, “Realizing Potential in Translational Medicine: The Uncanny Emergence of Care as Science,” Current Anthropology 54 (S7): S129-S138. 2. From Latin America, see, for example, Luz Gabriela Arango Gaviria, Adira Amaya Urquijo, Tania Pérez-Bustos, and Javier Pineda Duque, eds., Género y cuidado: teorías, escenarios y políticas (Bogotá: Universidad Nacional de Colombia, 2018); Pascale Molinier and Luz Grabriela Arango Gaviria, eds., El trabajo y... (shrink)

The claim that, in some nontrivial sense, nursing can be identified with caring has prompted a search for the philosophical foundations of care in the nursing literature. Although the ethics of care was initially associated with Gilligan's ‘different voice’, there has more recently been an attempt – led principally by Benner – to displace the gender perspective with a Heideggerian one, even if Kant is the figure to whom both Gilligan and Benner appear most irretrievably opposed. (...) This paper represents the first half of a double-edged project: initially, to point out that Heidegger explicitly disowns any ethical implications for his ontological thinking, and to argue that no ethical theory (including an ethics of care) can be derived from Being and Time; and then to argue that Kant's categorical imperative is not only compatible with the ethics of care but actively entails it. In this, Heideggerian, part of the argument, I consider three attempts to wrest an ethics from Being and Time– those of Benner, Olafson and Guignon – suggesting that, for different reasons, they all fail. Benner systematically confuses the ontological with the ontic, not recognizing that care, concern and solicitude have ‘deficient’ modes as well as positive ones, and that Heidegger's ontology retrieves the possibility of an ethics-in-general without at any point implying an ethics-in-particular (whether of care or justice). Olafson does recognize this, and to that extent admits his failure, but his efforts to amplify Heidegger's thought in such a way as to generate an ethical theory involve both the importing of Kantian premises, and an appeal to some rather doubtful empirical observations. Guignon resorts to Heidegger's discussion of authenticity, and the idea that authentic Dasein ‘may choose its hero’, suggesting a morally reassuring list of heroes who might fit the bill. However, there is nothing in Heidegger's account of this choice that justifies his confidence, and I conclude by proposing that we should take Heidegger at his word when he says that ontology has ‘no result, no effect’. (shrink)

Carol Gilligan's In a Different Voice, which appeared in 1982, argued that men tend to conceive morality in terms of rights, justice, and autonomy, whereas women more frequently think in terms of caring, responsibility, and interrelation with others. At about the same time, Nel Noddings in Caring: A Feminine Approach to Ethics and Moral Education sought to articulate and defend in its own right a “feminine” morality centered specifically around the ideal of caring. Since then, there has been a (...) heated debate about the reality of the distinction Gilligan drew and about its potential implications for ethical theory. Discussions of the morality of caring have questioned, in particular, whether any such morality can really provide a total framework for moral thought and action. For in order to deal with our obligations to people we are not acquainted with and address large-scale issues of social morality, any morality of caring seems to require supplementation by typically “masculine” thinking in terms of rights and justice, with the result that caring turns out to be but one part of morality, rather than anything women, or more enlightened men, could find attractive as a total and self-sufficient way of approaching ethical issues. (shrink)

The crisis resilience of vital social systems is currently the target of constant development efforts in Finland, as their drifting into crisis would weaken societies’ functional abilities, safety, and security. This is also the case regarding the Finnish health care system. In an attempt to move beyond existing frameworks of crisis imagination, this article takes an unconventional stance by elucidating endogenous crisis dynamics present in the Finnish health care system. Delphi process was conducted for top experts in Finnish (...) health care and crisis management. With a dissensus-seeking orientation, our aim was to fertilize disagreements among panelists to reveal key vulnerabilities in the health system. Despite our efforts to evoke dissensus, the panelists ended up generating a consensus that aims to protect the underlying assumptions of the health system’s knowledge structure. Through inductive analysis of expert discourses, the data was analyzed through our research question “what constitutes a crisis-proof health system and a crisis-prone health system”. What is framed as a strength of the system by our panelists, namely the ability to maintain legitimacy, improve efficiency, and guarantee continuity, can still have questionable implications that are left ungrasped. A system’s theory approach illustrates how such effects can develop and escalate beyond the reach of social interventions, and thus be predisposed to cause objectionable yet concealed social crises. The discussion illustrates how these endogenous crisis dynamics could be seen to materialize in real-life cases. (shrink)

The aim of this research was to explore the elements that configure the quality of care among three Mexican same-sex planned families: two female-parented families (through donor insemination) and a male-parented one (through adoption). The first family consisted of two mothers and a 3-year-old daughter; the second one had two mothers and a 1.5-year-old set of boy twins and the third family consisted of two fathers and a 2-year-old girl. It was assumed that Ainsworth’s notions of quality of (...) class='Hi'>care organization are useful in order to understand caregiver-child attachment relationships, regardless of the parents’ sexual orientation. A collective case study was selected due to the fact that these families shared their “unconventionality” (i.e. parents were not heterosexual) and the fact that they were planned, but each one constituted a particular case with a unique configuration. Four trained independent observers used the q-sort methodology (Maternal Behavior Q-Sort and Attachment Q-Sort) to describe parents’ and children’s behavior, respectively. The findings showed that parents were highly sensitive and all children used them as a secure base. To provide an in-depth examination of which elements configure the quality of care, a semi-structured interview with each parent was carried out. Through a thematic analysis, an over-arching theme named Affections and Emotions was identified, together with six subthemes: 1) Creating an affective environment; 2) Being available; 3) Acknowledging and expressing emotions; 4) Perceiving, interpreting and responding adequately to the child’s real self; 5) Taking the child’s perspective into account; and 6) Agreeing on roles and dividing the tasks. In order to showcase the particular configuration of gay parenting, the male-headed family narrative is reported in detail, because gay parents have been perceived as violating traditional gender roles as well as the hegemonic model of masculinity. The findings were consistent with the notion of quality of care as proposed by Ainsworth and her collaborators. The implications of the methodological device and research regarding same-sex planned families are discussed so as to understand the organization of the caregiving environment. (shrink)

Introduction:In previous issues of this journal, Carol Gilligan’s original concept of mature care has been conceptualized by several (especially Norwegian) contributors. This has resulted in a dichotomous view of self and other, and of self-care and altruism, in which any form of self-sacrifice is rejected. Although this interpretation of Gilligan seems to be quite persistent in care-ethical theory, it does not seem to do justice to either Gilligan’s original work or the tensions experienced in (...) contemporary nursing practice.Discussion:A close reading of Gilligan’s concept of mature care leads to a view that differs radically from any dichotomy of self-care and altruism. Instead of a dichotomous view, a dialectical view on self and other is proposed that builds upon connectedness and might support a care-ethical view of nursing that is more consistent with Gilligan’s own critical insights such as relationality and a practice-based ethics. A concrete case taken from nursing practice shows the interconnectedness of professional and personal responsibility. This underpins a multilayered, complex view of self-realization that encompasses sacrifices as well.Conclusion:When mature care is characterized as a practice of a multilayered connectedness, caregivers can be acknowledged for their relational identity and nursing practices can be recognized as multilayered and interconnected. This view is better able to capture the tensions that are related to today’s nursing as a practice, which inevitably includes sacrifices of self. In conclusion, a further discussion on normative conceptualizations of care is proposed that starts with a non-normative scrutiny of caring practices. (shrink)

Recent literature portrays caring as a psychological, social, and ethical orientation associated with female gender identity. This essay focuses on Giliigan's influential view that “care” is a broad theme of moral development which is under-represented in dominant theories of human development such as Kohlberg's theory. An alternative hypothesis is proposed portraying care development as a set of circumscribed coping strategies tailored to dealingwith sexism. While these strategies are practically effective and partially “liberated,” from the moral point of (...) view, they also reflect the debilitating influences of sexist socialization even at the highest level. Gilligan and her colleagues seem to misidentify these inadequacies of mature care. This alternative hypothesis is briefly related to the critical and feminist tradition. Then it is supported with Gilligan's own research and interpretive text. (shrink)

The expansion of the older population suggests that there will be significant numbers in need of care and support in their own home environment. Yet, little is known about the kind of situations professionals are faced with and how they intervene in the living environment of older people. Qualitative data were collected over a period of 1.5 years from a multi-disciplinary community-based geriatric team in the Netherlands, and participant observations carried out. Forty-two cases discussed within the team meetings (...) were analysed. Results demonstrate that providing care to older people is a dynamic process and revolves around various paradoxes as experienced by professionals. This is illustrated by presenting three paradoxes that emerged within the data: respecting autonomy versus preserving safety; the care needs of the care recipients versus the capacity of their informal carers to cope; and holding a formal orientation versus a tailored orientation on tasks. Providing care in the home environment of older people requires from professionals a continuous anticipation of (un)expected evolutions in situations of their care recipients. In order to optimally support older people professionals need ‘professional discretion’. They must be supported to systematically reflect on and legitimize their intervention strategies. (shrink)

Background:The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought.Objectives:This study explored nurses’ care practices at the end of (...) life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity.Research Design and context:Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated.Ethical Considerations:Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals.Findings:A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting.Discussion:Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members.Conclusion:Despite the avoidance of death talk and nurses’ lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values. (shrink)

Recent research has found diat family caregivers do not discuss their caregiving in terms of tasks but instead describe their care as shaped by concerns, commitments and goals. The purpose of this paper is to challenge the ways in which nurses approach die family caregiving process and to explore possibilities for evolving nursing knowledge by questioning existing practice in die light of developing insight into die ways in which being a family caregiver is meaningful. A critique of die philosophical (...) orientations of rationalism and empiricism provides a platform to discuss the merits of a Heideggerian phe-nomenological approach in assisting nurses to better understand family caring experience. Such critique serves to support the notion of displacing die traditional scientific view as die prime means of disclosing trudi, acknowledging alternative ways of knowing. (shrink)

Research on doctor-patient communication has characterized such interactions as being asymmetrical. The present article tries to shift emphasis away from the different orientations individuals bring to the communicative setting and attempts to highlight the different orientations ("voices") within a given individual. We draw on an in-depth analysis of discourse between a 2 l-year-old man who can be ascribed the roles of both patient and potential research subject and an interviewer who acts in both the role of medical staff and researcher. (...) Focusing our analysis on a limited number of linguistic forms (pronouns and demonstratives), it is argued that the use of the same form for different referents signals a conflation of two voices - the voice of health care ("caring") and the voice of "research." Furthermore, we argue that the voice of research is most likely to be interpreted by the patient/research subject within the framework of curing. As such, the present article promotes a shift in emphasis from different institutional - and as such often assumed to be preexisting - orientations between the communicating parties to differing orientations within the individual that cannot help but be misconstrued in terms of the curing voice. Our conclusion focuses on the ethical and discourse analytic implications of analyzing voices in a discussion. (shrink)

Over the past two decades there has been a great deal of research conducted into the question of gender differences in ethical decision making in organisations. Much of this has been based on questionnaire surveys, typically asking respondents (often students, sometimes professionals) to judge the moral acceptability of actions as described in short cases or vignettes. Overall the results seem inconclusive, although what differences have been noted tend to show women as ‘more ethical’ than men. The authors of this paper (...) believe that attention should be paid to the insight, from Carol Gilligan and others, that women are more inclined than men to subscribe to an ‘ethic of care’, and that once this perspective is adopted a pattern is discernible. In a critical examination of previous research we pay particular attention to the detailed content of cases used in surveys, and the statistical analysis of findings. We advocate greater reflection on the results of quantitative surveys and sensitivity to different possible interpretations of findings. This we do with our own exploratory study, conducted with UK undergraduate students of accounting, the findings from which seem to support the original hypothesis that where a ‘care’ orientation is invited, women do indeed react differently to business ethics issues than do men. (shrink)

Over the past two decades there has been a great deal of research conducted into the question of gender differences in ethical decision making in organisations. Much of this has been based on questionnaire surveys, typically asking respondents (often students, sometimes professionals) to judge the moral acceptability of actions as described in short cases or vignettes. Overall the results seem inconclusive, although what differences have been noted tend to show women as 'more ethical' than men. The authors of this paper (...) believe that attention should be paid to the insight, from Carol Gilligan and others, that women are more inclined than men to subscribe to an 'ethic of care', and that once this perspective is adopted a pattern is discernible. In a critical examination of previous research we pay particular attention to the detailed content of cases used in surveys, and the statistical analysis of findings. We advocate greater reflection on the results of quantitative surveys and sensitivity to different possible interpretations of findings. This we do with our own exploratory study, conducted with UK undergraduate students of accounting, the findings from which seem to support the original hypothesis that where a 'care' orientation is invited, women do indeed react differently to business ethics issues than do men. (shrink)

Social entrepreneurship orientation is a behavioral construct of social entrepreneurship ; therefore, we examined the influence of SEO of the organization on social and financial performance. A random sample of 810 employees was drawn from social enterprises of Pakistan during the COVID-19 pandemic. Although increasing research focuses on SE, the discipline continues to disintegrate, and this has led to appeals for a careful investigation of the associations of firms’ SE. In the recent decade, “social entrepreneurship” has earned its importance (...) as a segment of entrepreneurship. Instead of mixed activity, firms are more likely to engage in either for-profit or non-profit activities. The causes for and consequences of this conduct has been mainly studied using objective measures of SEO, social performance, and financial performance, with little attention paid to the subjective experiences of social enterprises. We rely on the theory of stakeholder and mixed structuring to postulate that social performance intermediates the SEO-financial performance relation. By assessing a sample of 810 employees from active enterprises, we discover that social performance mediates positively and partially between SEO and financial performance, and both direct and indirect paths are in the same direction and significant. Our findings exhibit that social performance variance explained 74% of the mediating role, and the remaining 26% of the effect is because of SEO. We consider the functions by which an SEO influences enterprise performance and delivers more prominent understanding into multiple spectrums of performance. We discuss the prospective suggestions of our research and foster an encouraging pathway for more enquiry on the SEO paradigm. The study adds contribution to the literature, which has not been testified before on hybrid firms. SEO is a newly defined construct and requires more prospective research. This research gives the researchers/scholars new directions to address related disciplines and further explore this domain. (shrink)

The purpose of this paper is not to provide an overall picture of care ethics, but, rather, to reflect upon the concept of care, which has gained significance in particular scientific contexts. Undoubtedly, the importance of the subject of care represents a challenge on the level of fundamental philosophical positions and a diversified look into the occurring forms of the psychological and social suffering, dependency, and vulnerability. I will shed light on tenets that are considered central to (...) the care ethics and that have led to the setting up of the relationship between care and democracy. By introducing the basic aspects of Carol Gilligan’s and Joan Tronto’s theories, I will emphasize their vocation to be politically relevant. A discussion on the relationship between care and justice on the one hand, and needs and rights on the other, will follow. Can hearing voices of care make democracy more just? How can care ethics provide a concrete support for democracy? On the political level, care ethics builds on the assumptions of the necessary relatedness and equality between individuals who are decisive in the light of the welfare state perspective. Upon closer examination, one may see that the setting up of these relationships is not new to the liberal perspective. Liberalism is historically rooted in the fundamental interconnection between freedom and equality. Virtues such as care and meekness can be formulated in the language of politics, but they still remain unpolitical. On the one hand, engaging in a critical reflection upon such virtues might be an indispensable measuring instrument for distinguishing a good democracy from a bad one. On the other hand, care ethics does not prove to be a real alternative to the ethics of justice. In this regard, care ethics seems to show its feet of clay. (shrink)

The idea behind this article is to discuss the importance and to develop the concept of reciprocity in asymmetric professional relationships. As an empirical starting point for an examination of the possible forms of reciprocity between patients and nurses in psychiatry, we chose two qualitative in-depth interviews with two different patients. The manners in which these two patients relate to medical personnel—one is dependent, the other is independent—show that this presents challenges to nurses. The theoretical context is provided by the (...) notion of mature care as it has been developed by feminist-oriented ethics of care, in contrast to the notion of altruistic care. In relation to the concept of mature care, we discuss how nursing can be perceived in demanding relationships with patients in psychiatry. Reciprocity implies that, in principle, the interests of the nurses also matter in a nurse-patient relationship. We show that reciprocity—in practice—is complicated and challenging in a number of different ways. Mature care—with its systematic inclusion of relationships and reciprocity—provides an alternative understanding of what takes place between patients and nurses compared with an altruistic notion of care. As such, mature care can be regarded as an useful paradigm for nurse-patient relationships in psychiatry. (shrink)

Put relationship-centered communication at the forefront of care Today, physicians face a hypercompetitive marketplace in which they must meet unique and complex patient needs as efficiently as possible. But in a culture prioritizing clinical outcomes above all, there can be a tendency to lose sight of one of the most critical aspects of providing effective care: the communication skills that build and foster physician-patient relationships. Studies have shown that good communication between doctors and patients and among all caregivers (...) who interface with patients directly results in better clinical outcomes, reduced costs, greater patient satisfaction, and lower rates of physician burnout. In Communication the Cleveland Clinic Way, Dr. Adrienne Boissy and her team tell the story of how Cleveland Clinic created and applied the R.E.D.E. to Communicate: Foundations of Healthcare program, making the world-renowned hospital system a leader in relationship-centered care. They provide a step-by-step guide for healthcare leaders and decision-makers to design, develop, and implement communication skills training in their own institutions. Learn how to: • Craft an effective, colleague-supported communication skills program to include veteran physicians, residents, and medical students • Leverage creative program design and data transparency to engage and facilitate staff physicians and advanced care providers • Identify common misperceptions and myths in healthcare communication and respond to them successfully • Cultivate a true sense of empathy—with patients and fellow caregivers alike—while maintaining professionalism In a field where difficult conversations and stressful relationships are commonplace, clinicians need a structured approach to enable them to deliver the best care possible. Communication the Cleveland Clinic Way is the blueprint for establishing a relationship-centered program that will improve patient experience, reinvigorate doctors’ passion for their work, and elevate any organization. (shrink)

This article explores the contribution of the virtue of integrity to the concept of mature care. The virtue of integrity is understood as both a personal and a social virtue. The argument is that the virtue of integrity is a necessary condition for providing mature care. An example from a psychiatric acute ward illustrates that a nurse acting with the virtue of integrity displays clear self‐boundaries and self‐respect as well as respect towards the inherent integrity of the patient. (...) The article also addresses some problems related to lack of the virtue of integrity by discussing the problems connected to detachment and rigidity. (shrink)

This paper aims to bring together the appeal to the ordinary in the ethics of care and the ‘destruction’ or philosophical subversion which Wittgenstein references in his Philosophical Investigations: Where does our investigation get its importance from, since it seems to destroy everything interesting, all that is great and important? What we are destroying is nothing but houses of cards. The paper pursues a connection between the ethics of care and ordinary language philosophy as represented by Wittgenstein, Austin (...) and Cavell, in particular in a feminist perspective. The central point of Carol Gilligan’s In a Different Voice may not be the idea of a ‘feminine morality’ but a claim for an alternative form of morality. Gilligan’s essay seeks to capture a different, hitherto neglected yet universally present alternative ethical perspective, one easy to ignore because it relates to women and women’s activities. The ethics of care recalls a plea for ‘realism’; in the sense given to it in Cora Diamond’s The Realistic Spirit to mean the necessity of seeing what lies close at hand. Reflection on care brings ethics back to everyday practice much as Wittgenstein sought to bring language back from the metaphysical level to its everyday use. (shrink)

Literature on consumer ethics tends to focus on issues within the public sphere, such as the environment, and treats other drivers of consumption decisions, such as family, as non-moral concerns. Consequently, an attitude–behaviour gap is viewed as a straightforward failure by consumers to act ethically. We argue that this is based upon a view of consumer behaviour as linear and unproblematic, and an approach to moral reasoning, arising from a stereotypically masculine understanding of morality, which foregrounds abstract principles. By demonstrating (...) the importance of context to consumption decisions and articulating the impact of caring relationships, we highlight how such decisions are both complex and situated. This is particularly evident for decisions involving the needs of others, as occurs in family life. We argue that the incorporation of care ethics provides both theoretical insights and a more complete account of consumer ethics. This is explored empirically through an investigation of the ethical dilemmas arising from consumption decisions made by mothers of young children. Such decisions juxtapose an ethical consumption orientation with care for one’s child. Therefore, what has been previously considered a failure to act ethically may in fact be the outcome of complex decision making, which involves competing ethical considerations. We discuss the implications of our findings for theory and practice and how this approach to consumer ethics could be applied more widely. (shrink)

In the mid-nineteenth century, healthcare delivery began transitioning from an individual, private payment model to a third-party payment model, dominated by the insurance industry. During the same time, productivity shifted from a transformational model, centered on the provider-patient relationship, to a transactional model, based on the distribution of services. The emergence of medical insurance and other third-party payers removed providers and patients from discussions about treatment plans, payment, and risk. This resulted in a weakening, if not fracturing, of the provider-patient (...) relationship. All healthcare providers enter their profession to care for people, yet what has most frequently been lost in the transformed relationship over the past century is context, communication, and trust—all elements of a relational ethic, or what ethicist and psychologist Carol Gilligan first described as, “the ethics of care.” This loss of relationality has led to a model of healthcare delivery that is fractured, isolated, and uncoordinated, with an epidemic of medical errors that by some estimates results in the death of approximately 400,000 individuals per year. Thus far, isolated foci on patient quality, outcomes, and safety have been feckless and unimpressive. However, new advanced payment models, such as value-based purchasing and patient-centered medical homes, have the potential to reduce medical error by addressing its root cause. In linking payment to factors such as context, communication, and trust, they bring relationality back into the healthcare system. This essay traces the historic devolution of the provider-patient relationship and the promise of new payment models to restore it. (shrink)

Five registered nurses were interviewed as part of a comprehensive investigation by five researchers into the narratives of five enrolled nurses , five registered nurses and 10 patients describing their experiences in an acute care ward at one university hospital in Sweden. The project was developed at the Centre for Nursing Science at Ö rebro University Hospital. The ward in question was opened in 1997 and provides care for a period of up to three days, during which time (...) a decision has to be made regarding further care elsewhere or a return home. The registered nurses were interviewed concerning their experience of being in ethically difficult care situations in their work. Interpretation of the theme ‘ethical problems’ was left to the interviewees to reflect upon. A phenomenological hermeneutic method was used in all three studies. The most prominent feature revealed was the enormous responsibility present. When discussing their responsibility, their working environment and their own reactions such as stress and conscience, the registered nurses focused on the patients and the possible negative consequences for them, and showed what was at stake for the patients themselves. The nurses demonstrated both directly and indirectly what they consider to be good nursing practices. They therefore demand very high standards of themselves in their interactions with their patients. They create demands on themselves that they believe to be identical to those expected by patients. (shrink)

The paper takes its cue from the emergence in our society of a new view of the adolescent, which a branch of the psychological literature has spelled out in terms of a passage from Oedipus to Narcissus. It is argued that pre-college ethics education should engage with this passage by deploying educational strategies modelled according to the Care of the Self paradigm but revisiting it through Kierkegaard’s idea of repetition. The latter prevents that paradigm from fostering a sort of (...) aestheticization of ethical life and allows us to mobilize it in ethics education. Against this backdrop two pedagogical methods—autobiographical writing and essay writing—are discussed as possible tools for a Care-of-the-Self-oriented education. (shrink)

Three female physicians were interviewed as part of a comprehensive investigation into the narratives of female and male physicians and nurses, concerning their experience of being in ethically difficult care situations in the care of elderly people. The interviewees expressed great concern for the low status of care for elderly people, and the need to fight for the specialty and for the care and rights of their patients. All the interviewees’ narratives concerned problems relating to perspectives (...) of both action ethics and relational ethics. The main focus was on problems concerning the latter perspective, expressed as profound concern and respect for the individual patient. Secondary emphasis was placed on relationships with relatives and other professionals. The most common themes in an action ethics perspective were too little treatment and the lack of health services for older patients, together with overtreatment and death with dignity. These results were discussed in the light of Løgstrup’s ethics, which emphasize that human life means expressing oneself, in the expectation of being met by others. Both Ricoeur’s concept of an ethics of memory and Aristotle’s virtue ethics are presented in the discussion of too little and too much treatment. (shrink)

This introduction to the special issue on ‘Ricoeur and the ethics of care’ is not a standard editorial. It provides not only an explanation of the central questions and a first impression of the articles, but also a critical discussion of them by an expert in the field of care ethics, Joan Tronto. After explaining the reasons to bring Ricoeur into dialogue with the ethics of care, and analyzing how the four articles of this special issue shape (...) this dialogue, the authors give the floor to Tronto. She focuses on the central issue at stake: what may be the value of a more abstract, conceptual approach for the ethics of care as a radically practice-oriented way of thinking? She argues that the four contributions too easily frame this value in terms of Ricoeur’s relational anthropology. Instead she points out that if the ethics of care is a kind of practice, it makes sense to think of such practices as necessarily building upon one another, expanding constantly the context and relationships upon which practices are built. In the final section the authors respond to Tronto’s framing of ‘practices all the way up’ by arguing that this approach need not be at odds with one inspired by Ricoeur’s conceptual thinking. Rather the two can be seen as different movements—upwards and downwards—that both contribute constructively to the shaping of the important intermediary zone between the practices and the abstract ideals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:564 BOOK REVIEWS illuminating re-examination of the category of inwardness in Kierkegaard 's writings. The majority of the essays in the hook are similarly suggestive and will prove rewarding and interesting reading-they echo the aim and gift, share by Wittgenstein and Kierkegaard, of "making their readers thinkers" (xvi). University of Virginia Charlottesville, Virginia M. JAMIE FERREIRA Let the Future Come. By WILFRED DESAN. Washington, D.C.: Georgetown University Press, 1987. (...) Pp. 152. $9.95 (paper). Toward a lust Social Order. By DEREK L. PHILLIPS. Princeton: Princeton University Press, 1986. Pp. 434. $12.50. After several decades of doldrum thinking, social ethics, i.e., personal and political ethics done on the same canvas, is undergoing a welcome renewal. Perhaps spurred by the growing awareness of the massive problems of our tiny planet, thinkers from diverse areas are beginning to offer what the social sciences call "grand theory." Both Desan and Phillips make valuable contributions to this project and represent the best levels of refleotion from the teleological and deontological perspectives respectively. Desan's essay is the final volume of three, hut may be read independently of the earlier studies, discussed by this reviewer in 1973 in The Thomist (Vol. 37, pp. 249-255). If Desan has a core concept for his thinking it is planetary peace and the human individual as gardener and guardian of this admittedly future state of affairs. Phillips, critically inheriting the Anglo-American rights tradition, focuses on the person, not the planet, on the distinctiveness of the part, not on Desan's projeotion of a whole humanum composed of parts (each a member of the human community yet only a member). The metaphysical background here, then, is the whole-of-parts versus parts·of-awhole dialectic. Read together the two works would truly stimulate a graduate ethics seminar, for we see the renewal of ethical,thinking against some classical ontological themes. For Desan, the person is homo custos, self-aware becoming otheraware ; for Phillips, the person is the source and enactor of rights. He offers heavy criticism of the virtue/community school's orientation towards the common good of society, with subsidiary private rights located within that context. This is the weakest part of his massive survey of recent ethics. Phillips simply cannot see the reality of human community, which is exactly what Desan is determined to project as BOOK REVIEWS 565 our only possible future. Desan's combination of Thomism and Hegel stands to the far side of Phillips's Lockean stress on private rights as the base criterion for any future just public order. We will look first at Desan's final effort to summarize a notion of " planetary " existence that will be valid both individually and communally and then turn to Phillips's detailed, Rawls-like approach. Desan's argument against the primacy of the individual over the world community was carefully nuanced in his two earlier volumes; he has no intention of denigrating the person in order to celebrate the planet, and he is no partisan of the " deep ecology " effort to elevate nature above the sub-category human nature. His planet is social and political, a cosmic existent dependent upon specifically human activitynot individual activity at either the personal or national levels but activity at the level of the total earth population. He is not so much detailing yet another agenda for a New World Order as he is striving to raise modern individualized consciousness to a height where the reality of interdependency is rationally undeniable. Desan's appreciative critique of Husserl's individualized consciousness in his first volume, A Noetic Prelude to a United World, displayed the plight of personalized consciousness as against planetary awareness. In this final panel of his triptych, he synthesizes that critique: "Where the individual Observer is the magister, there are as many worlds as there are magistri." This privatized existence is not to be denied but rather seen for what it is: a limit instead of a secure startpoint for either ethical or epistemological theory. His second volume stressed that our very awareness of this limitation gives rise, perhaps in a Hegelian dialectic, to potential for participation in global existence. To resist this cooperative... (shrink)

The study discusses a new approach to parental agency in pediatric palliative care based on an active form of caregiving. It also explores the possibility of a positive conceptualization of parental agency in its relational context. The paper begins with an illustrative case study based on a clinical situation. This is followed by an analysis of various aspects of parental agency based on empirical studies that disclose the insufficiencies of the traditional approach to parental agency. In the next step, (...) parental agency is analyzed from a reality‐based perspective as an activity focused on relationships and the cognitive capacity of parents vis‐a‐vis their seriously ill children. The paper also considers the importance of the cultural and social contexts in which parental agency and decision‐making take place. This agency is addressed not as individualistic in form, and nor is it exercised in terms of fixed choices. Rather, the focus is on its dynamic and future‐oriented aspects. Consequently, parental agency should be comprehended not only as a form of proxy agency representing the child's best interests but also as a complex decision‐making process in which the parents learn from their child how to become good, compassionate caregivers and at the same time good parents. (shrink)

The current article deals with the ethics and practice of physician-assisted suicide (PAS) and dying. The debate about PAS must take the important legal and ethical context of medical acts at the end of life into consideration, and cannot be examined independently from physicians’ duties with respect to care for the terminally ill and dying. The discussion in Germany about active euthanasia, limiting medical intervention at the end of life, patient autonomy, advanced directives, and PAS is not fundamentally different (...) in content and arguments from discussions led in other European countries and the United States. This must be emphasized, since it is occasionally claimed that in Germany a thorough discussion could not be held with the same openness as in other countries due to Germany’s recent history. Still, it is worthwhile to portray the debate, which has been held intensively both among experts and the German public, from the German perspective. In general, it can be stated that in Germany debates about questions of medical ethics and bioethics are taking place with relatively large participation of an interested public, as shown, for instance, by the intense recent discussions about the legalisation of advanced directives on June 18 2009, the generation and use of embryonic stem cells in research or the highly difficult challenges for the prioritizing and rationing of scarce resources within the German health care system. Hence, the current article provides some insights into central medical and legal documents and the controversial public debate on the regulation of end-of-life medical care. In conclusion, euthanasia and PAS as practices of direct medical killing or medically assisted killing of vulnerable persons as “due care” is to be strictly rejected. Instead, we propose a more holistically-oriented palliative concept of a compassionate and virtuous doctor-cared dying that is embedded in an ethics of care. (shrink)

In clinical research there is a tension between the role of a doctor, who must serve the best interests of the patient, and the role of the researcher, who must produce knowledge that may not have any immediate benefits for the research participant. This tension is exacerbated in HIV research in low and middle income countries, which frequently uncovers comorbidities other than the condition under study. Some bioethicists argue that as the goals of medicine and those of research are distinct, (...) it is a mistake for researchers to assume therapeutic responsibilities while engaging in research. Others propose that there is a duty of care, but disagree as to how this is limited and specified. In this qualitative study, principal investigators from HIV prevention trials discuss their experience of providing medical benefits to participants within the context of conducting research into HIV biomedical prevention technologies. They describe the limitations imposed at times by funders and at times by infrastructure constraints, and canvass the importance of ancillary care provision and capacity building in trial communities. The views of the principal investigators are compatible with the perspective that there is a duty of care, limited by the nature of the research, the depth of the relationship between research and participant, and the capacity of the research site. The therapeutic orientation in HIV prevention trial appears to be indivisible from competent research practise by making concrete and appropriate benefits available to trial participants and their communities that support rather than compete with local infrastructure. (shrink)

Care ethics as initiated by Gilligan, Held, Tronto and others has from its onset been critical towards ethical concepts established in modernity, like ‘autonomy’, alternatively proposing to think from within relationships and to pay attention to power. In this article the question is raised whether renewal in this same critical vein is necessary and possible as late modern circumstances require rethinking the care ethical inquiry. Two late modern realities that invite to rethink care ethics are complexity (...) and precariousness. Late modern organizations, like the general hospital, codetermined by various systems are characterized by complexity and the need for complexity reduction, both permeating care practices. By means of a heuristic use of the concept of precariousness, taken as the installment of uncertainty, it is shown that relations and power in late modern care organizations have changed, precluding the use of a straightforward domination idea of power. In the final section a proposition is made how to rethink the care ethical inquiry in order to take late modern circumstances into account: inquiry should always be related to the concerns of people and practitioners from within care practices. (shrink)

Definition of the problem Using the example of the emergence of antibiotic resistance, we show in the first part of our article that there are specific sustainability problems in medicine, which can ultimately lead to an impairment of the ability of future patients to satisfy their basic health needs and realize a flourishing life. Methods After clarification of the concept of sustainability in the second part, we explain why the possibility of satisfying basic health needs, for example, is considered a (...) condition for a good life within the framework of a capability approach. The concept of sustainability, as promoted by the United Nations, requires one to adequately consider the demands for a good life of future patients. Conclusion In the last part of the paper, we show that the orientation towards an idea of sustainability can lead to “sustainability dilemma” and we discuss how this can be dealt with. (shrink)