This chapter offers a plea for the media to reframe its coverage of campus controversies from free expression to academic freedom. These freedoms are entwined, but distinct. Freedom of expression is extended to all persons with no expectation of quality control, apart from legal prohibitions against defamation, threats, etc. By contrast, academic freedom is a cluster of freedoms afforded to scholarly personnel for a particular purpose – namely, the pursuit of universities’ academic mission to seek truth and advance understanding in (...) the service of society. An academic freedom framing better reflects the distinctive social purpose around which universities are organized, as well as universities’ duty of care to employees and students. While universities have a legal and moral duty of care to all employees and students, the unjust, exclusionary past and present of higher education arguably makes that duty particularly acute in the case of equity-deserving (e.g., racialized, Indigenous, disabled or 2SLGBTQ+) people. Finally, academic freedom framing for campus media stories is less monolithic than free expression framing, allowing for a more nuanced understanding of campus controversies while keeping universities accountable to the public they serve. In this chapter, I survey three very different campus controversies at a single Canadian university, and the media response each received. I show how an academic freedom frame for those stories would have produced better reportage while reducing opportunities for bad actors to manipulate both universities and the media. At the end of the day, the real crisis at universities isn’t the cancellation of ill-judged events that were never a part of the academic mission; it is the ongoing erosion of academic freedom. (shrink)

It is popularly believed that if A owes B a duty of care in negligence, A will not actually have a legal duty to be careful: A will merely be required to pay damages to B if she suffers loss as a result of A's being careless. We can call this the cynical view of duties of care and those who adopt it, cynics. However, it is possible to take a different view of duties of (...) class='Hi'>care in negligence, according to which if A owes B a duty of care of some description, A will actually have a legal duty to be careful. We can call this the idealistic view of duties of care in negligence and those who adopt it, idealists. This article explains the importance of the debate between idealists and cynics over the nature of duties of care in negligence and goes on to argue that the cynical view of duties of care in negligence is, in fact, wrong and that the idealistic view of such duties should be preferred. (shrink)

Background Escalating levels of obesity place enormous and growing demands on Health care provision in the (U.K.) United Kingdom. Resources are limited with increasing and competing demands upon them. Ethical considerations underpin clinical decision making generally, but there is limited evidence regarding the relationship between these variables particularly in terms of treating individuals with obesity. Research aim To investigate the views of National Health Service (NHS) clinicians on navigating the ethical challenges and decision making associated with obesity management in (...) adults with chronic illness. Research design A cross-sectional, multi-site survey distributed electronically. Participants A consensus sample of nurses, doctors, dietitians and final year students in two NHS Trusts and two Universities. Ethical considerations Ethical and governance approvals obtained from a National Ethics Committee (11NIR035), two universities and two teaching hospitals. Results Of the total ( n = 395) participants, the majority were nurses (48%), female (79%) and qualified clinicians (59%). Participants strongly considered the individual to have primary responsibility for a healthy weight and an obligation to attempt to maintain that healthy weight if they wish to access NHS care. Yet two thirds would not withhold treatment for patients with obesity. Discussion While clinicians were clear about patient responsibility and obligations, the majority prioritised their duty of care and would not invoke a utilitarian approach to decision making. This may reflect awareness of obesity as a multi-faceted entity, with responsibility for support and management shared amongst society in general. Conclusions The attitudes of this sample of clinicians complemented the concept of the health service as being built on a principle of community, with each treated according to their need. However limited resources challenge the concept of needs-based decisions consequently societal engagement is necessary to agree a pragmatic way forward. (shrink)

There is a surprising absence of systematic theological reflection on what the church’s response to refugees should be and how its response relates to wider debates on the duty of care to refugees. This article situates theological concerns within wider philosophical debate on what the duty of care to refugees consists of. The first section critically reviews the debate on how liberal democracies should respond to refugees. The second section, following Georgio Agamben’s characterisation of refugees as (...) ‘bare life’, argues that refugees unveil a deep contradiction in contemporary patterns of political sovereignty. It closes by arguing that while a theological account of political authority points to some roads beyond the crisis, the first task of the church is to properly order its own duty of care to refugees. The last section consists of an exegesis of the second clause of the Lord’s Prayer as a way of giving an account of what such care involves. (shrink)

The general relationship between a bank and customer is contractualin nature. For conventional banks, the banker-customer relationship is basedon the debtor-creditor relationship with the bank earning a profit from a spreadmade between interest charged on the borrower of funds and interest paid tothe depositors. In Islamic banking, due to the different contractual transactionsof Islamic banking operation, it is based on a multi-contractual relationships.However, bank consumers perceive that banks enhance their profits by treatingconsumers unfairly and failing to take responsibility when things (...) go wrong.This study examines the duty of care of conventional and Islamic banks towardsbank consumers. It also focuses on the Islamic banks’ duty of care from theperspective of maqāṣid al-Sharī‛ah, to those who use their services. Adoptingthe doctrinal analysis method, this study analyses and compares the duty ofcare of both conventional and Islamic banks. Findings of this study includethat misconduct by banking industries remains rife and that unfair treatment ofcustomers are frequent. As for Islamic banks, the maqāṣid al-Sharī‛ah basedduty of care is found missing in their Islamic banking operation. This studysuggests that the duty of care for both banks should be reformed to improvebank consumers’ experience. For Islamic banks, an improved standard is usefulin performing their duties based on Islamic values. (shrink)

Vaccine hesitancy or refusal has been one of the major obstacles to herd immunity against Covid-19 in high-income countries and one of the causes for the emergence of variants. The refusal of people who are eligible for vaccination to receive vaccination creates an ethical dilemma between the duty of healthcare professionals (HCPs) to care for patients and their right to be taken care of. This paper argues for an extended social contract between patients and society wherein vaccination (...) against Covid-19 is conceived as essential for the protection of the right of healthcare providers to be taken care of. Thus, a duty of care is only valid when those who can receive vaccination actually receive it. Whenever that is not the case, the continuing functioning of HCPs can only be perceived as supererogatory and not obligatory. (shrink)

In the course of attacking the idea that the concept of the duty of care can be dispensed with and replaced by a view of negligence that deals only with fault and causation, critics have revived the notion that there are many duties of care. This article argues that the idea of many duties of care is unworkable, but that there is no need to revive such an idea to avoid falling into the view that the (...) whole concept of the duty of care can be discarded. It argues instead for a unified view of the duty of care as a single duty. It also argues for a new analysis of negligence, facilitated by the one-duty view, which does see fault as central to negligence but which, instead of discarding duty, sees arguments about duty as about whether the defendant should be permitted to act unreasonably. The article defends the one-duty view and the new analysis of negligence against the relational view of negligence and against charges that it is motivated by a desire for unity between English and French law, that it would be incompatible with the conventional economic analysis of tort law (in the course of which it suggests an economic analysis of the duty of care), and that, unlike the no-duty view or the many-duties view, it fails to articulate a coherent view of the relationship between freedom and community. (shrink)

Anti-abortion proponents argue that a fetus holds the status of a person akin to healthy adult human beings. The fetus possesses inherent dignity and a fundamental right to life, which must be resp...

This case describes a psychiatric patient who stalked and harassed her former psychiatrist. Balancing the safety risk to her physician against the duty to continue to treat this vulnerable patient, what should the current psychiatrist and the treating institution do?

In NX v. Cabrini Medical Center, New York's highest court overruled a divided Appellate Division and held that, as a matter of law, a jury could find a hospital negligent for its failure to protect a patient from sexual assault. The court refused, however, to adopt a higher standard of tort liability for health-care providers who treat incapacitated patients.

Among the options of government for reducing negative environmental externalities from agriculture is the institution of a polluter statutory liability. An environmental duty of care imposes a statutory liability on agents who interact with the environment to avoid causing environmental harm. This paper documents environmental duty of care provisions governing landholders in Queensland, Australia, with specific reference to the 2007 Queensland State Rural Leasehold Land Strategy. The paper reports on a positive response by a group of (...) leaseholders within the Northern Gulf Region in Queensland who developed a prototype environmental code of practice for grazing—a land use not previously covered by such an institution in Australia. The paper concludes that (1) a statutory environmental duty of care and specific forms of leasehold tenure are elements of an effective strategy for implementing an agricultural environmental ethics in north Australia’s rangelands and (2) a grazing industry code of practice is a practical and important tool for the grazing industry to safeguard its social licence to operate. (shrink)

Franklin G. Miller and colleagues have stimulated renewed interest in research ethics through their work criticizing clinical equipoise. Over three years and some twenty articles, they have also worked to articulate a positive alternative view on norms governing the conduct of clinical research. Shared presuppositions underlie the positive and critical dimensions of Miller and colleagues' work. However, recognizing that constructive contributions to the field ought to enjoy priority, we presently scrutinize the constructive dimension of their work. We argue that it (...) is wanting in several respects. (shrink)

Scholarly inquiry into medical ethics should inform and guide those involved in making challenging ethical decisions.1 It should strive to be integral to the work of health care professionals and health care institutions2 and clinical relevance seems essential for this to happen. To acknowledge the importance of clinical relevance for medical ethics, the Journal of Medical Ethics has introduced a regular Clinical Ethics section at the beginning of each issue. Papers that we think are likely to be of (...) particular interest and relevance to clinicians will be placed in this section of the journal. One way in which a paper can be framed for a more clinical audience is by organising it around a scenario that healthcare professions might face. The paper published in this issue’s Clinical Ethics section considers a dilemma about whether an egg donor should be contacted to help diagnose a condition that the resulting child might have.3 While egg donation has become more common, the complexities presented by this scenario might appear removed from those which most health professionals face. However, the way in which genomics is becoming incorporated into healthcare means that the issues this scenario raises are relevant to all healthcare professionals. The spread of genomics into practice means that the …. (shrink)

To celebrate forty years of publication, we asked people new to bioethics to tell us what should be next on the docket. We received 195 essays. Here are four we especially like. Bioethics has, until now, focused mainly on those who directly influence human health. It worked to establish guidelines for doctors to follow when treating their patients, and it provided a backbone for ethical human research. Bioethics has done a lot of good, but it is time for the field (...) to branch out to things that affect human health in less obvious ways. Of the things that bioethics must turn its focus to, one of the most pressing issues is establishing a duty of care between pharmaceutical companies and the people they .. (shrink)

Doctors have an ethical and legal duty to respect patient confidentiality. We consider the basis for this duty, looking particularly at the meaning and value of autonomy in health care. Enabling patients to decide how information about them is disclosed is an important element in autonomy and helps patients engage as active partners in their care.Good quality data is, however, essential for research, education, public health monitoring, and for many other activities essential to provision of health (...) care. We discuss whether it is necessary to choose between individual rights and the wider public interest and conclude that this should only rarely be necessary. The paper makes some recommendations on practical steps which could help ensure that good quality information is available for work which benefits society and the public health, while still enabling patients’ autonomy to be respected. (shrink)

This article examines the criteria for determining when a local authority owes a duty of care at Common Law, concurrent with statutory obligations, in light of the decisions of the House of Lords in X (Minors) v Bedfordshire County Council and M (A Minor) v Newham Borough Council. The various policy arguments employed by their Lordships are analysed and located within current debate regarding the purpose and scope of the tort of negligence. It is argued that, in relevant (...) circumstances, English courts should have regard to the European Convention on Human Rights in order to conclude whether it is ‘just and reasonable’ to impose a duty of care. The cases under discussion raised issues under several Articles of the Convention (Article 6 and Article 8, in particular), and their impact upon the decision of the House of Lords, as well as the facts themselves, is assessed. (shrink)

Despite growing evidence to the contrary, researchers continue to posit causal links between cannabis, crime, psychosis, and violence. These spurious connections are rooted in history and fueled decades of structural limitations that shaped how researchers studied cannabis. Until recently, research in this area was explicitly funded to link cannabis use and harm and ignore any potential benefits. Post-prohibition cannabis research has failed to replicate the dire findings of the past. This article outlines how the history of controlling cannabis research has (...) led to various harms, injustices, and ethical complications. We compare commonly cited research from both the prohibition and post-prohibition eras and argue that many popular claims about the dangers of cannabis are the result of ethical lapses by researchers, journals, and funders. We propose researchers in this area adopt a duty of care in cannabis research going forward. This would oblige individual researchers to establish robust research designs, employ careful analytic strategies, and acknowledge limitations in more detail. This duty involves the institutional recognition by funders, journals, and others that cannabis research has been deliberately misconstrued to criminalize, stigmatize, and pathologize. (shrink)

The interaction between evidence-based medicineand doctors' duty of care to patients iscomplex. One the one hand, there is surely anobligation to take account of the bestavailable evidence when offering health care topatients. On the other hand, it is equallyimportant to be aware of important shortcomingsin the processes and practices ofevidence-based medicine. There are tensionsbetween the population focus of evidence-basedmedicine and the duties that doctors have toindividual patients. Implementingevidence-based medicine may have unpredictableconsequences upon the overall quality of healthcare. (...) Patients may have a range of reasons forpreferring one form of treatment over another,not all of which are captured by currentformulations of evidence. This paper examinesthese issues, using relevant examples fromevidence-based medicine. (shrink)

This paper develops and explores the idea of moral entanglements: the ways in which, through innocent transactions with others, we can unintendedly accrue special obligations to them. More particularly, the paper explains intimacy-based moral entanglements, to which we become liable by accepting another's waiver of privacy rights. Sometimes, having entered into others' private affairs for innocent or even helpful reasons, one discovers needs of theirs that then become the focus of special duties of care. The general duty to (...) warn them of their need cannot directly account for the full extent of these duties, but does indicate why a silent retreat is impermissible. The special duties of care importantly rest on a transfer of responsibilities that accompanies the privacy waivers. The result is a special obligation of beneficence that, while grounded in a voluntary transaction, was never voluntarily undertaken. Impartialist views of beneficence cannot capture the relevant phenomena well. (shrink)

Even though it offers a compelling account of the responsibility-component in the negligence standard—arguably the Holy Grail of negligence theory—Professor John Gardner is mistaken in conceptualizing the duty of care in negligence as a duty to try to avert harm. My goal here is to explain why and to point to an alternative account of the responsibility component in negligence. The flaws in conceiving of the duty of care as a duty to try are: (...) failing to comport with the legal doctrine of negligence and failing as a revisionary account for the law; overly burdening autonomy and restricting the liberty of thought; adversely affecting the prevention of negligent harm—the essence of the negligence standard—; and, raising severe probative difficulties. Moreover, the duty of care also does not give rise to what I call a de facto duty to try. The duty of care is better construed to require only certain conduct and not trying. Returning to the primary appeal and motivation for exploring the validity of equating the duty of care with a duty to try—searching for the responsibility-component in the negligence standard—I argue that the responsibility-component in negligence does not take the form of an obligation to try but rather has a conditional form, manifested in the conditions of applicability of the negligence standard. In other words, the negligence standard comprises a conduct-based as opposed to a combined action-/intent-based duty (such as a duty to try) as its duty of care, a duty that only applies to actors who possess the capacity to intentionally or knowingly comply with it, or, put differently, possess the capacity to try. (shrink)

Using an interpretative research approach to ethical and legal literature, it is argued that nursing in the battlefield is distinctly different to civilian nursing, even in an emergency, and that the environment is so different that a duty of care owed by military nurses to wounded soldiers should not apply. Such distinct differences in wartime can override normal peacetime professional ethics to the extent that the duty of care owed by military nurses to their patients on (...) the battlefield should not exist. It is also argued that as military nurses have legal and professional obligations to care for wounded soldiers on the battlefield, this obligation conflicts with following military orders, causing a dual loyalty conflict. This is because soldiers are part of the ‘fighting force’ and must be fit to fight and win the battle. This makes them more of a commodity rather than individual persons with distinct health care needs. (shrink)

It has become fashionable to question attempts to derive internationally agreed duties of clinical care from more general theories of human rights. For example, some argue that such attempts risk moral abstraction through their neglect for the importance of culture and community in shaping moral consciousness and are thus often unhelpful in the resolution of concrete moral dilemmas within medicine. Others denounce the importance of general moral principles altogether in bioethics and attempt to articulate what are claimed to be (...) more practical approaches to resolving moral conflict. This paper challenges such arguments. It does so through arguing that: i) all humans everywhere have the same basic human needs; ii) the satisfaction of these needs varies with culture; iii) the imputation of moral duties on others entails respect for their right to basic need satisfaction, including the right to choose between cultures; iv) internationally accepted clinical duties of care embrace presumptions about the duties and rights of patients which follow from these more general principles and v) problems of moral indeterminacy that arise from putting these principles into practice can be resolved through associated procedural policies of rational negotiation and compromise. The moral importance and practicality of respect for individual human rights within the practice of medicine is thus defended. Indeed, the paper concludes by arguing that without belief in human rights linked to a theory of basic human needs, communitarian theories of morality are incoherent. (shrink)

Background:Nurses must balance their perceived duty to care against their perceived risk of harm to determine their willingness to report during disaster events, potentially creating an ethical dilemma and impacting patient care.Research aim:The purpose of this study was to investigate nurses’ perceived duty to care and whether there were differences in willingness to respond during disaster events based on perceived levels of duty to care.Research design:A cross-sectional survey research design was used in this (...) study.Participants and research context:Using a convenience sample with a snowball technique, data were collected from 289 nurses throughout the United States in 2017. Participants were recruited through host university websites, Facebook, and an American Nurses Association discussion board.Ethical considerations:Institutional review board approval was obtained from the University of Texas at Tyler and the University of Arkansas.Findings:Analysis of willingness to report to work based on levels of perceived duty to care resulted in the emergence of two groups: “lower level of perceived duty to care group” and “higher level of perceived duty to care group.” The most discriminating characteristics differentiating the groups included fear of abandonment by co-workers, reporting because it is morally the right thing to, and because of imperatives within the Nursing Code of Ethics.Discussion:The number of nurses in the lower level of perceived duty to care group causes concern. It is important for nursing management to develop strategies to advance nurses’ safety, minimize nurses’ risk, and promote nurses’ knowledge to confidently work during disaster situations.Conclusion:Level of perceived duty to care affects nurses’ willingness to report to work during disasters. Primary indicators of low perceived duty to care are amenable to actionable strategies, potentially increasing nurses’ perceived duty to provide care and willingness to report to work during disasters. (shrink)

A central feature of Confucianism is the doctrine that an adult child has, for want of a better word, the ‘duty’ to care for his elderly parents1. Whether this doctrine should be framed in terms of an ethic of duties as opposed to an ethic of virtues is a vexed question. It might be argued that the doctrine is best framed in terms of the behaviour and dispositions appropriate to an agent who is, within the Confucian moral vision, (...) good. Nonetheless, in both popular discourse and in much the secondary literature, the doctrine is characterized in terms of a moral ‘ought’. We will adopt this perspective, and talk of the ‘filial duty of care’. We investigate the empirical question of whether Chinese communities still have a strong sense of this duty. We conclude that although there is a widespread perception among Chinese communities that their sense of filial duty of care has been eroded, in fact the adherence to it remains robust. (shrink)

Guidelines advise that x-rays do not contribute to the clinical management of simple nasal fractures. However, in cases of simple nasal fracture secondary to assault, a facial x-ray may provide additional legal evidence should the victim wish to press charges, though there is no published guidance. We examine the ethical and medico-legal issues surrounding this controversial area.

Malm and colleagues (2008) consider (and reject) five arguments putatively justifying the idea that healthcare workers (HCWs) have a duty to treat (DTT) during a pandemic. We do not have sufficient...

Genetic testing reveals information about a patient's health status and predictions about the patient's future wellness, while also potentially disclosing health information relevant to other family members. With the increasing availability and affordability of genetic testing and the integration of genetics into mainstream medicine, the importance of clarifying the scope of confidentiality and the rules regarding disclosure of genetic findings to genetic relatives is prime. The United Nations International Declaration on Human Genetic Data urges an appreciation for principles of equality, (...) justice, solidarity and responsibility in the context of genetic testing, including a commitment to honoring the privacy and security of the person tested. Considering this global mandate and recent professional statements in the context of a legal amendment to patient privacy policies in Australia, a fresh scrutiny of the legal history of a physician's duty to warn is warranted. This article inquiries whether there may be anything ethically or socially amiss with a potential future recommendation for health professionals or patients to universally disclose particular cancer predisposition genetic diagnosis to genetic family members. While much of the discussion remains applicable to all genetic diagnosis, the article focuses on the practice of disclosure within the context of BRCA1/2 diagnosis. An ‘ethic of care’ interpretation of legal tradition and current practice will serve to reconcile law and medical policy on the issue of physician disclosure of genetic results to family members without patient consent. (shrink)

In 1991, the CDC recommended that health care workers (HCWs) infectedwith HIV or HBV (HbeAg positive) should be reviewed by an expert paneland should inform patients of their serologic status before engaging inexposure-prone procedures. The CDC, in light of the existing scientificuncertainty about the risk of transmission, issued cautiousrecommendations. However, considerable evidence has emerged since 1991suggesting that we should reform national policy. The data demonstratesthat risks of transmission of infection in the health care setting areexceedingly low. Current policy, (...) moreover, does not improve patientsafety. At the same time, implementation of current national policy atthe local level poses significant human rights burdens on HCWs.Consequently, national policy should be changed to ensure patient safetywhile protecting the human rights of HCWs. This article proposes a newnational policy, including: (1) a program to prevent bloodborne pathogentransmission; (2) a responsibility placed on infected HCWs to promotetheir own health and well-being and to assure patient safety; (3) adiscontinuation of expert review panels and special restrictions forexposure-prone procedures; (4) a discontinuation of mandatorydisclosure of a HCW's inflection status; and (5) the imposition ofpractice restrictions if a HCW is unable to practice safely because of aphysical or mental impairment or failure to follow careful infectioncontrol techniques. A new national policy, focused on management of theworkplace environment and injury prevention, would achieve high levelsof patient safety without discrimination and invasion of privacy. (shrink)

The seriousness of the risk that healthcare workers faced during SARS, and their response of service in the face of this risk, brings to light unrealistic assumptions about duty and risk that informed the debate on duty to care in the early years of HIV/AIDS. Duty to care is not based upon particular virtues of the health professions, but arises from social reflection on what response to an epidemic would be consistent with our values and (...) our needs, recognizing our shared vulnerability to disease and death. Such reflection underwrites a strong duty of care, but one not to be borne solely by the altruism and heroism of individual healthcare workers. (shrink)

Background: The coronavirus disease 2019 pandemic is impacting the delivery of healthcare worldwide, creating dilemmas related to the duty to care. Although understanding the ethical dilemmas about the duty to care among nurses is necessary to allow effective preparation, few studies have explored these concerns. Aim: This study aimed to identify the ethical dilemmas among clinical nurses in Spain and Chile. It primarily aimed to identify nurses’ agreement with the duty to care despite high (...) risks for themselves and/or their families, describe nurses’ well-being and describe the associations between well-being and the duty to care. Research design: Cross-sectional self-reported anonymous data were collected between May and June 2020 via electronic survey distribution. Ethical considerations: The Institutional Ethical Review Committees in both countries approved the study. Findings: In total, 345 clinical nurses answered the primary question about the duty to care for the sick. Although in the total sample 77.4% agreed they have a duty to care for the sick, significant differences were found between the Spanish and Chilean samples. Overall, 53.6% of the nurses reported low levels of well-being; however, among those reporting low well-being, statistically significant differences were found between Spanish and Chilean nurses as 19.4% and 37.8%, respectively, disagreed with the statement regarding the duty to care. Discussion: Participants in both countries reported several ethical dilemmas, safety fears, consequent stress and low well-being. These results suggest that prompt actions are required to address nurses’ ethical concerns, as they might affect their willingness to work and psychological well-being. Conclusion: Our findings shed light on the ethical dilemmas nurses are facing related to the duty to care. Not only has the coronavirus disease 2019 pandemic given rise to ethical challenges, but it has also affected nurses’ well-being and willingness to work during a pandemic. (shrink)

The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. (...) I examine two types of institutional contexts: (1) public research agencies – agencies or departments of states that fund or conduct clinical research in the public interest; and (2) private-for-profit corporations. I argue that investigators who are employed or have their research sponsored by the former have a distinctive institutional obligation to conduct their research in a way that is consistent with the state's duty of distributive justice to provide its citizens with access to basic health care, and its duty to aid citizens of lower income countries. By contrast, I argue that investigators who are employed or have their research sponsored by private-for-profit corporations do not possess this obligation nor any other institutional obligation that is directly relevant to the ethics of RCTs. My account of the institutional obligations of investigators aims to contribute to the development of a reasonable, distributive justice-based account of standard of care. (shrink)

This paper gives a review of the academic literature on the duty to care during epidemics and the question of how much risk has to be accepted by medical personnel during their work. It will then address ask to what extent military personnel have this duty in the same way as their civilian counterparts or whether military health care personnel might act under a different moral obligation – with more or less encompassing or at least different (...) duties. (shrink)

Patient’s duties are a topical but little researched area in nursing ethics. However, patient’s duties are closely connected to nursing practice in terms of autonomy, the best purpose of care and rethinking from the patient’s perspective. This article is a metasynthesis (N = 11 original articles) of patient’s duties, aimed to create a tentative model. In this article, a tentative model called ‘right-based duties of a patient’ was constructed. With its aid, a coherent structure of patient’s duties within different (...) roles and objects of a patient can be defined. In addition, the ethical basis, prerequisites, outcomes and risks of patient’s duties can be named. In conclusion, so-called right-based duties of a patient constitute the basic argument. Patient’s duties are not unambiguous for all patients, and the global perspective to duties has been challenged. However, due to both conceptual and practical reasons, rethinking of patient’s duties is needed. (shrink)

Contemporary ethical and political discourses frequently refer to the moral force of needs as justifying access to resources and rights to goods. Can needs make normative claims on anyone, and if so, how? What obligations do moral agents have to respond to the needs of other people? As finite creatures, humans inevitably experience need. Certain kinds of needs, namely fundamental needs, must be met if individuals are to avoid the harm of compromised agency. Fundamental needs involve agency-threatening events or circumstances (...) to which another must respond in order to cultivate, sustain or restore the agency of the one in need. I establish that fundamental needs have moral significance through an argument demonstrating the good of agency. I develop a robust account of agency, one that moves beyond the traditional identification of agency with rational capacities, to incorporate both emotional and relational abilities. Following the Kantian duty of beneficence, I then argue that our mutual and inevitable interdependence gives rise to a duty to care for the fundamental needs of others. Next, drawing upon care ethics, I suggest that moral agents are obligated not only to meet fundamental needs present in others, but also to do so in a manner indebted to forms of dignifying care. It is not enough that we meet the needs of others. How we do so carries with it the conferral or denial of dignity and inclusion in a moral community. Finally, I demonstrate the applied ethical import of the foregoing theoretical account by discussing practices of caring for the fundamental needs of elderly individuals, who are often relegated to the margins of agency. Specifically, I consider two cases: recommended rationing of healthcare resources for the elderly and filial obligation. (shrink)

The COVID-19 pandemic exposed social shortcomings and ethical failures, but it also revealed strengths and successes. In this perspective article, we examine and discuss one strength: the duty to care. We understand this duty in a broad sense, as more than a duty to treat individual patients who could infect health care workers. We understand it as a prima facie duty to work to provide care and promote health in the face of risks, (...) obstacles, and inconveniences. Although at least one survey suggested that health care workers would not respond to a SARS-like outbreak according to a duty to care, we give reasons to show that the response was better than expected. The reasons we discuss lead us to consider normative accounts of the duty to care based on the adoption of social roles. Then, we consider one view of the relationship between empirical claims and normative claims about the duty to care in the COVID-19 pandemic. Here, we draw insight from Mengzi, with an emendation from Dewey. Our perspective leaves many question to research, but one point seems clear: there will be future pandemics and the need for health care workers who respond. (shrink)

Displaying her intellectual and literary abilities from a young age, 'Mrs Taylor of Ongar' enjoyed writing all her life. She had eleven children, of whom six survived to adulthood. Her published works began with advice books for her own daughters, produced when increasing deafness made ordinary conversation difficult for her. This book, published in 1818, follows her earlier works for young women with a guide to conduct and 'reciprocal duties' within the family. Stern warnings and cautionary tales are given to (...) show the importance of duty to and respect for parents by children, but the parental duties of care in rearing and especially in education are emphasised. Early discipline, lovingly applied, is seen as the key to successful parenting, and its absence is deemed disastrous. Like Ann Taylor's Practical Hints to Young Females, the book offers fascinating insights into the middle-class ideal of domestic happiness. (shrink)

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see (...) more patients per unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so. (shrink)