In this article we elaborate on the concept of mature care, in which reciprocity is crucial. Emphasizing reciprocity challenges other comprehensions where care is understood as a one-sided activity, with either the carer or the cared for considered the main source of knowledge and sole motivation for caring. We aim to demonstrate the concept of mature care’s advantages with regard to conceptualizing the practice of care, such as in nursing. First, we present and discuss (...) the concept of mature care, then we apply the concept to two real life cases taken from the field of acute psychiatry. In the first example we demonstrate how mature care can grasp tacit reciprocal aspects in caring. In the other, we elucidate a difficulty related to the concept, namely the lack of reciprocity and interaction that affects some relationships. (shrink)

This article addresses some ambiguities and normative problems with the concept of mature care in professional relationships and in health care priorities. Mature care has recently been introduced in the literature on care ethics as an alternative to prevailing altruistic conceptions of care. The essence of mature care is an emphasis on reciprocity, where the mature agent has the ability to balance the concerns of self with those of others and (...) act from a principle of not causing harm. Our basic claim is that the prevailing concept of mature care does not capture the real nature of professional relationships and role obligations in health care. As the focus of attention in professional care is and must be the patient’s particular medical and care needs, such care must principally be altruistic. Furthermore, we argue that mature care cannot adequately address moral conflict in health care without accepting some more principle-based approaches and a richer notion of partiality. (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)

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)

In “Conceptions of Care,” Tove Pettersen discusses and articulates select ways in which care can be comprehended. Several difficulties related to an altruistic understanding of care are examined before the author presents the case for a more favorable concept: mature care. Mature care is intended to take into account the interests of both parties to the caring relationship. This understanding of care facilitates the expression of the relational and reciprocal aspects of caring (...) while emphasizing the equal worth of all involved. Also attended to is the embeddedness of care in wider cultural and political contexts. (shrink)

By comparing alternative evolutionary models, the International Sexuality Description Project marks the transition of evolutionary psychology to the next level of scientific maturation. The lack of final conclusions might partly be a result of the composition of the Sociosexual Orientation Inventory and the sampled populations. Our own data suggest that correcting for both gives further support to the strategic pluralism model.

The likelihood of nurse reflection is examined from the theoretical perspectives of Habermas' Theory of Communicative Action and Moral Action and Sumner's Moral Construct of Caring in Nursing as Communicative Action, through a critical social theory lens. The argument is made that until the nurse reaches the developmental level of post-conventional moral maturity and/or Benner's Stage 5: expert, he or she is not capable of being inwardly directed reflective on self. The three developmental levels of moral maturity and Benner's stages (...) are presented with discussion on whether or not there can be self-reflection because of an innate vulnerability that leads to self-protective behaviours. It is only when the confidence from mastery of practice has been achieved can the nurse be comfortable with reflection that enables him or her to become enlightened, emancipated, and empowered. The influences and constraints of the knowledge power between nurse and patient are acknowledged. The power hierarchy of the institution is recognized as constraining. (shrink)

The doctrine of the mature minor began as an emergency exception to the rule of parental consent. Over time, the doctrine crept into cases that were non-emergent. In this essay, we show how the doctrine also developed in the context of the latter part of the 20th century, at the same time that the sexual revolution, the pill, and sexual liberation came to be seen as important symbols of female liberation—liberation that required that female minors be granted the status (...) of a mature minor. To do so moves sexual morality out of the domain of the family, where it had always been situated, and into the domain of the state. We also show how a phenomenological account of the care of the body in the family conforms to the latest in neuroscientific understandings of adolescent brain development. The family attenuates the dependency of adolescents and provides an important social contextualization for the care of the body, including the inculcation of sexual mores in adolescence. We conclude that the drive to push sexual decision making as a matter of state concern further undermines the foundations of the moral meanings of sex and sexuality. (shrink)

This paper examines corporate social responsibility in Japan today within the context of the paradigm of the moral unity of business. Under this paradigm, business is expected to operate under the same set of moral standards operative in other societal institutions. We suggest that a micro moral unity characterizes Japan—business activity is linked to that society’s moral values but only within carefully circumscribed communities of interest. Because of the strains brought on by the maturing of the Japanese economy, the negative (...) consequences of this micro moral unity are now becoming apparent. A new paradigm will be required to address thesechallenges. A possible foundation for such a paradigm, based on the emerging notion of kyosei (living and working together for the common good), is discussed. (shrink)

In Comprehending Care, Tove Pettersen subjects the ethics of care, as advanced by Carol Gilligan, to a moral-philosophical examination. More precisely, she extracts the philosophical foundation in this ethics, probes its possible implications for moral theory of a more traditional stamp, and explores its normative plausibility. Pettersen exposes several misconceptions of Gilligan's work.

Moral and legal notions engaged in clinical ethics should not only possess analytic clarity but a sound basis in empirical findings. The latter condition brings into question the expansion of the mature minor exception. The mature minor exception in the healthcare law of the United States has served to enable those under the legal age to consent to medical treatment. Although originally developed primarily for minors in emergency or quasi-emergency need for health care, it was expanded especially (...) from the 1970s in order to cover unemancipated minors older than 14 years. This expansion initially appeared plausible, given psychological data that showed the intellectual capacity of minors over 14 to recognize the causal connection between their choices and the consequences of their choices. However, subsequent psychological studies have shown that minors generally fail to have realistic affective and evaluative appreciations of the consequences of their decisions, because they tend to over-emphasize short-term benefits and underestimate long-term risks. Also, unlike most decisionmakers over 21, the decisions of minors are more often marked by the lack of adequate impulse control, all of which is reflected in the far higher involvement of adolescents in acts of violence, intentional injury, and serious automobile accidents. These effects are more evident in circumstances that elicit elevated affective responses. The advent of brain imaging has allowed the actual visualization of qualitative differences between how minors versus persons over the age of 21 generally assess risks and benefits and make decisions. In the case of most under the age of 21, subcortical systems fail adequately to be checked by the prefrontal systems that are involved in adult executive decisions. The neuroanatomical and psychological model developed by Casey, Jones, and Summerville offers an empirical insight into the qualitative differences in the neuroanatomical and neuropsychological bases of adolescent versus adult decision making. These and other data, as well as developing law bearing on the culpability of juvenile criminal offenders, argue for critically re-evaluating the expansion of the mature minor exception with regard to medical decision making, as well as in support of a rebuttable presumption in favor of treating minors as immature decisionmakers. The clinical ethics of adolescent medical decision making will need foundationally to be reconsidered. (shrink)

In this article I argue that the ethics of care provides us with a novel reading of human relations, and therefore makes possible a fresh approach to several empirical challenges. In order to explore this connection, I discuss some specific normative features of the ethics of care—primarily the comprehension of the moral agent and the concept of care—as these two key elements contribute substantially to a new ethical outlook. Subsequently, I argue that the relational and reciprocal mode (...) of thinking with regard to the moral agent must be extended to our understanding of care. I term this comprehension “mature care”. Citing conflicts of interests as examples, I demonstrate how this conceptualization of care may further advance the ethics of care’s ability to take on empirical challenges. Finally, I discuss political implications that may emanate from the ethics of care and the concept of mature care. (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 argument for children's rights in health care has been long in the making. The success of this position is reflected in the 1995 American Academy of Pediatrics recommendations for the role of children in health care decisionmaking, which suggest that children be given greater voice as they mature. But there are good moral and practical reasons for exercising caution in these health care situations, especially when the child and parents disagree. Parents need the moral and (...) legal space within which to make decisions that will facilitate their child's long‐term autonomy, not only her present‐day autonomy. Moreover, third‐party intrusion, by physicians or the state, should be resisted unless negligent and abusive decisions are in the making. (shrink)

Background: By providing healthcare to adolescents, a major opportunity is created to help them cope with the challenges in their lives, develop healthy behaviour and become responsible healthcare consumers. Confidentiality is a major issue in adolescent healthcare, and its perceived absence may be the main barrier to an adolescent seeking medical care. Little is known, however, about confidentiality for adolescents in primary care practices in Spain.Objective: To ascertain the attitudes of Spanish family doctors towards the right of adolescents (...) to confidentiality in different healthcare situations and in the prescription of treatment.Method: A descriptive postal questionnaire was self-administered by family doctors.Results: Parents of patients under 18 years are always informed by 18.5% of family doctors, whereas parents of those under 16 years are informed by 38.8% of doctors. The patients are warned of this likelihood by 79.3% of doctors. The proportion of doctors supporting confidentiality for adolescents increases with the age and maturity of the patients, whereas workload and previous training has a negative effect.Conclusions: Spanish laws on adolescent healthcare are not reflected by the paternalistic attitude that Spanish primary care doctors have towards their adolescent patients. Doctors need to be provided with up-to-date and clinically relevant explanations on contemporary legal positions. In primary care, more attention should be paid to adolescents’ rights to information, privacy and confidentiality. Doctors should be more aware of the need to encourage communication between teenagers and their parents, while also safeguarding their patients’ rights to confidential care. (shrink)

Clinical ethics, like bioethics more generally, until recently has tended to focus on the present and future, with little attention to the history of moral thought about health care that preceded bioethics. As a consequence, clinical ethics and bioethics lack maturity as fields of the humanities. The papers in this year's clinical ethics issue of the Journal put contemporary clinical ethics in critical dialogue with the past, making the former accountable to the latter. The six papers in this issue (...) of the Journal are briefly described, with an emphasis on how they contribute to the maturation of clinical ethics as a field of the humanities. (shrink)

According to Oppenheim, "The present study aims to bring the American philosopher Josiah Royce out of the shadows that often cover his final decade". More precisely, he contends, it aims to discern and to relate accurately Royce's doctrine and method in his mature philosophy of religion. Even more specifically, says Oppenheim, the study "aims carefully to search out from Royce's The Problem of Christianity his principal and subordinate methods and accurately to identify his human and 'Christian' doctrines as rooted (...) in experience". Oppenheim insists "that the mature Royce identified and carried out, in a generally successful way, both a new and fully human method of philosophizing and a Christian metaphysics of community". Royce's greatest achievement may be his employment of a new method in philosophy of religion. (shrink)

Paternalism in the medical care of children is appropriate and ethically justifiable. However, dilemmatic disagreement by paternalistic agents as to which clinical choice is in the child's best interest may occur because of the underlying conflict between two rival standards for the moral value of life: longevity versus quality. Neither standard is unreasonable. Either could be the basis for choice of medical care by the parents or by the pediatrician. Having the child choose between options disputed by his (...) parents and the pediatrician is unlikely to resolve their conflict. Exercise of informed consent by the adolescent requires agreement by his parents to relinquish their paternalistic veto. The probable best-interest choice by the child when he has matured could be reasonably made from either standard. Therefore, the longevity/quality of life question ought not ordinarily to be foreclosed by paternalistic authority which opts for one standard to the exclusion of the other. Medical interventions, paternalistically determined, are justified in the face of deteriorating quality, but only as long as the interventions themselves do not cause deterioration. Application of this limitation of paternalism to the zone of agreement between the rival life standards is made to clinical case examples. Multiple extrinsic criteria may measure the quality of life. Three quality factors, sensation of pain, capacity to communicate and physical functioning are considered. The extent of the zone of agreement between the two life standards varies because quality of life is a relative good, contingent both upon which extrinsic criteria are selected to assess it and upon the priorities which are set among these criteria. (shrink)

Throughout the years, care ethicists have raised concerns that prevalent definitions of empathy fail to adequately address the problem of otherness. They have proposed alternative conceptualizations of empathy that aim to acknowledge individual differences, help to extend care beyond one’s inner circle, and develop a critical awareness of biases and prejudices. We explore three such alternatives: Noddings’ concept of engrossment, Meyers’ account of broad empathy, and Baart’s concept of perspective-shifting. Based on these accounts, we explain that care (...) ethics promotes a conceptualization of empathy that is radical in its commitment to engage otherness and that is characterized by being: (1) receptive and open, (2) broad and deep in scope, (3) relational and interactive, (4) mature and multifaceted, (5) critical and reflective, (6) disruptive and transformative. This type of empathy is both demanding and rewarding, as it may inspire health professionals to rethink empathy, its challenges, and its contribution to good care and as it may enrich empathy education and professional empathy practices in health care. (shrink)

This article examines some of the phenomenological features in Lev Vygotsky’s mature psychological theory, especially in Thinking and Speech and The Current Crisis in Psychology. It traces the complex literary and philosophical influences in 1920s Moscow on Vygotsky’s thought, through Gustav Shpet’s seminars on Husserl and the inner form of the word, Chelpanov’s seminars on phenomenology, Bakhtin’s theory of the production of inner speech, and the theoretical insights of the early Gestalt psychologists. It begins with an exposition of two (...) central Husserlian schemas: part-whole theory and the thesis of the naïve standpoint, both of which Vygotsky was clearly familiar with. This is followed by an account of the reception of phenomenology in early Soviet Russia. The article’s central sections are concerned with a careful unpacking and critique of Vygotsky’s employment of Husserlian method and analysis in his later doctrine of the ‘inner plane of speech’, his use of part-whole theory, and his identification of Husserl’s position with an untenable version of idealism. The article closes with the contention that Vygotsky misrepresents the phenomenological analysis of meaning formation and appropriates basic Husserlian conceptual terms in his elaboration of the ‘inner form of the word’; but Vygotsky does so in such a way that he enriches our descriptive access to the individual development of humans’ dynamic use of language. (shrink)

Aging brings about the ordeal of coping. Younger people also cope, but for those in old age, the ordeal is so often elegiac, forced upon the self by changing functions within the body and by the outside social world, with its many impediments to the continuity of former roles, pursuits, and self‐identities. Coping with change can be affirming, but when what is being forgone seems more valuable than what lies ahead, it is travail. For most, the coping is managed more (...) moderately by a sense of resignation. This is especially true for those who survive into profound old age, when one is viewed as if being old is one’s essential identity and nature. We must recognize and affirm difference and change without stigmatizing or losing sight of the specific capabilities and circumstances of the individual. This is what I think the often‐used, but less often clearly defined, notion of a “person‐centered” orientation should signify.Individuals age, but so do societies, not simply because they have a large population over age sixty‐five, but in the sense that societies as a whole are also buffeted by significant disruption in orders of meaning. Aging has a public as well as a private manifestation, a social as well as a personal embodiment, and how it is paid attention to in culture, politics, and policy makes a great difference to how aging is concretely experienced in human lives. In this essay, I explore how the moral imagination nurtured by the practices of solidarity and care—and nurturing them in turn—can come of age—and how these practices can take their rightful place in an ethically mature political culture. (shrink)

This article examines a model of formation within higher education that is committed to educationally based spiritual formation, desiring to see students formed as people who love God and neighbor, devoting their lives to redemptive labor in the world. Deeply influenced by the evolving relationship between the department, the institution, and the broader evangelical culture, the Christian Formation and Ministry department of Wheaton College seeks to equip students with the theological and theoretical foundation, the personal maturity of character and faith, (...) and the practical ministry skills necessary to lead and participate in the formational and caring mission of the church in the world. Wheaton College’s unique approach to teaching spiritual formation and soul care in both their undergraduate and graduate programs is examined through a historical context of the department, a liberal arts and learning-centered approach to education that includes biblical foundations, philosophical framework, pedagogy, and teaching curriculum and assessment. (shrink)

This is a splendid, important book. It is original, masterfully researched, clearly written, and compellingly argued. Both beginners and more advanced readers will find it a valuable guide to the development, meaning, and importance of Royce’s philosophy of religion as set forth in The Problem of Christianity. As such, it is without question one of the very best books on one of the very best philosophers. More significantly, like Royce’s philosophy itself, Oppenheim’s book offers careful reasoning, rich suggestions and fundamental (...) challenges to all reflective persons grappling with, not merely idly considering, issues of individuality, community, love, loyalty, commitment, and salvation. (shrink)

Research concerning work on caring for older people shows that care providers experience a variety of consuming emotions and stress. They can be said to be in a vulnerable position. It is not known, however, how the care providers themselves understand vulnerability. The aim of this study was to illuminate the meaning of vulnerability to care providers caring for older people. A qualitative interpretive approach was adopted. Data were collected through tape-recorded interviews with 16 female registered and (...) practical nurses who were experienced in caring for older people. Qualitative analysis resulted in one core theme and six themes with subthemes. The core theme showed that, for the participating nurses, vulnerability essentially meant being human. The meanings of being human were illustrated by the six themes: having feelings; experiencing moral indignation; being harmed; having courage; protecting oneself; and maturing and developing. Analysis showed that vulnerability was a resource as well as a burden. (shrink)

Digital technologies induce organised immaturity by generating toxic sociotechnical conditions that lead us to delegate autonomous, individual, and responsible thoughts and actions to external technological systems. Aiming to move beyond a diagnostic critical reading of the toxicity of digitalisation, we bring Bernard Stiegler’s pharmacological analysis of technology into dialogue with the ethics of care to speculatively explore how the socially engaged arts—a type of artistic practice emphasising audience co-production and processual collective responses to social challenges—play a care-giving role (...) that helps counter technology-induced organised immaturity. We outline and illustrate two modes by which the socially engaged arts play this role: 1) disorganising immaturity through artivism, most notably anti-surveillance art, that imparts savoir vivre, that is, shared knowledge and meaning to counter the toxic side of technologies while enabling the imagination of alternative worlds in which humans coexist harmoniously with digital technologies, and 2) organising maturity through arts-based hacking that imparts savoir faire, that is, hands-on knowledge for experimental creation and practical enactment of better technological worlds. (shrink)

Many experts have emphasised that chatbots are not sufficiently mature to be able to technically diagnose patient conditions or replace the judgements of health professionals. The COVID-19 pandemic, however, has significantly increased the utilisation of health-oriented chatbots, for instance, as a conversational interface to answer questions, recommend care options, check symptoms and complete tasks such as booking appointments. In this paper, we take a proactive approach and consider how the emergence of task-oriented chatbots as partially automated consulting systems (...) can influence clinical practices and expert–client relationships. We suggest the need for new approaches in professional ethics as the large-scale deployment of artificial intelligence may revolutionise professional decision-making and client–expert interaction in healthcare organisations. We argue that the implementation of chatbots amplifies the project of rationality and automation in clinical practice and alters traditional decision-making practices based on epistemic probability and prudence. This article contributes to the discussion on the ethical challenges posed by chatbots from the perspective of healthcare professional ethics. (shrink)

Using data from China, where the identity of engagement auditors is disclosed, we find significant relationships between engagement auditors’ negative experiences and the costs of corporate bonds. Further tests differentiate field and review auditors’ experiences, and we find that both field and review auditors’ negative experiences are significantly related to higher costs of corporate bonds. In addition, we find that the above results are significant only when the engagement auditors are affiliated with non-Big10 audit firms. Using path analysis, we find (...) that credit rating is a possible channel through which information on engagement auditors’ negative experiences can transfer to bond investors. Regarding non-price terms, we conclude that engagement auditors with negative experiences are associated with smaller bond sizes, shorter bond maturities, a higher likelihood of requiring collateral, and more restrictive covenants. Further analyses also show that the effects of engagement auditors’ negative experiences on the costs of corporate bonds are less pronounced for well-governed firms. To show that our results obtained from China’s corporate bond market are relevant to loan markets, we replicate the above tests using a Chinese sample, and the results from the loan market are consistent with those from the corporate bond market. Overall, our empirical results suggest that investors are indeed concerned with engagement auditors’ negative experiences. (shrink)

This article examined an ecclesiology that has led to the administrative and spiritual subjugation of members of local assemblies as God's will and modus operandi under the New Covenant. The article will help adherents to re-examine the conclusions of the ecclesiology through a careful exegesis of the texts used in support. This article aimed at highlighting to Christians the potential dangers of this ecclesiology. It provided an analysis that can be consulted by any Christian who has been affected by this (...) ecclesiology. This article examined a specific articulation of the teachings supporting a new ecclesiology and its bases in a local assembly in Lusaka, Zambia, during a 're-envisioning' process. The author participated in this process, purchased the videos, transcribed the teachings and used them as his primary research data. The research was based on transcriptions of a series of teachings that were recorded in video format. The author explored key themes in the teachings, identified the texts used in support, examined those texts by critically using the historical-critical method and drew conclusions. A careful examination of the ecclesiology and the texts used as its proof-texts showed that it was based on flawed exegesis of the texts. The ecclesiology extracted from the transcripts was based on grounds other than careful interpretation of the texts used. The outcomes of this study were that proponents of this ecclesiology must find biblical texts that support it, or consider it to be wrongly derived doctrine.CONTRIBUTION: The primary contribution of this article is re-examination of a specific teaching that is purportedly derived from the Bible, through a critical analysis of the texts used in its support. The article fits with the scope of the journal to be a critical forum for theological reflection and praxis. (shrink)

Twenty-three years ago Robert Ayers noticed several brief and intriguing comments on miracles in the Collected Papers of Charles Sanders Peirce. Working with just those scraps of information from the CP, he stitched together a rough but helpful starting point for understanding this aspect of Peirce's religious and scientific thought. In the last few years several more articles on this subject have been written, each filling in a gap left by the others: Ayers' is a theological view, based solely on (...) the CP; later articles fill out Peirce's mathematics and his logic. This paper attempts to fill in a genealogical gap by showing how his thought on miracles is directly related to his dialogues with Plato, Hume, and Lutoslawski. My resources are largely unpublished manuscripts, many of which are fragmentary. I show the relationship between these manuscripts and two key published essays, "Philosophy and the Conduct of Life", and "On the Logic of Drawing History from Ancient Documents, Especially from Testimonies", and then show how Peirce, in dialogue with Plato, exposes and overcomes the nominalistic and anti- miracle prejudices of historiography in his day. The resulting view of history is fallibilistic, realistic and evolutionary, in which miracles are not violations of laws of nature but are to be expected as evolutionary variations that form part of the ongoing self-revelation of the cosmos. Miracles, like all events in history, must not be viewed prejudicially by adherents or detractors, but must be taken into careful account in the grand induction of history and science. (shrink)

The purpose of this study was to explore situations experienced by 12 health-care providers working in two nursing homes. Individual interviews, using a narrative approach, were conducted. A phenomenological–hermeneutical method, developed for researching life experiences, was applied in the analysis. The findings showed that good care situations are experienced when the time culture is flexible, the carers act in a sovereign time rhythm, not mentioning clock time or time as a stress factor. The results are discussed in terms (...) of anthropological and sociological theory: time as event and action and flexible time cultures. Care settings for persons with dementia represent many challenges, such as a heavy workload and time strain. Time ethics is a construction, understanding time used in caring for persons suffering from dementia, which involves a mature, responsible and flexible nursing approach to these patients. (shrink)

abstract: Despite the maturing and formalizing of Buddhist-Christian studies as an academic discipline, its practical and pastoral implications are insufficiently addressed. Most of the practical literature to date addresses spiritual care, broadly conceived, within a narrow range of sources and theories. This scoping study identifies three primary resources offered to providers of spiritual care by scholars of Buddhist-Christian studies: an expanded theoretical base for assessment and interpretation, practices for caregiver formation and cultivation, and guidance for care with (...) spiritually fluid people. Scholars of Buddhist-Christian studies could make at least four additional contributions to chaplaincy and spiritual care: a revised telos of care, attention to care as a site of spiritual practice, criteria for salutogenic spiritualities, and refined practices for interreligious and postcolonializing care. These potential contributions require the discipline to carefully consider methodological issues and broaden its range of sources. (shrink)

Background: This article describes the overall attitudes of children, their parents, and attending physicians toward including or excluding pediatric patients in medical communication and health care decision-making processes. Methods: Fifty-two interviews were carried out with pediatric patients (n = 17), their parents (n = 19), and attending oncologists (n = 16) in eight Swiss pediatric oncology centers. The interviews were analyzed using thematic coding. Results: Parenting styles, the child's personality, and maturity are factors that have a great impact upon (...) the inclusion of children in their health care processes. Children reported the desire to be heard and involved, but they did not want to dominate the decision-making process. Ensuring trust in the parent–child and physician–patient relationships and respecting the child as the affected person were important values determining children's involvement. These two considerations were closely connected with the concern that fantasies are often worse than reality. Seeking children's compliance with treatment was a practical but critical reason for informing them about their health care. The urge to protect them from upsetting news sometimes resulted in their (partial) exclusion. Conclusions: The ethical imperative for inclusion of children in their health care choices was not so much determined by the right for self-determination, but by the need to include them. If children are excluded, they imagine things, become more isolated, and are left alone with their fears. Nevertheless, the urge to protect children is innate, as adults often underestimate children's coping capacities. (shrink)

Learning to work as a relational caring professional in healthcare and social welfare, is foremost a process of transformative learning, of Building, of professional subjectification. In this article we contribute to the design of such a process of formation by presenting a structured map of five domains of formational goals. It is mainly informed by many years of care-ethical research and training of professionals in healthcare and social work. The five formational domains are:Relational Caring Approach,Perception,Knowledge,Interpretation, andPractical Wisdom. The formation (...) process, described as the recurring detour of a continuing practice, requires ‘exposure’, in-depth learning and learning communities. Relational caring—care consequently resulting from and structured by relational thinking, exploring, and steering—requires ‘inquiry’ as a continuous learning process in practice. The process is ultimately aimed at fostering mature, competent, and practically wise professional caregivers who are able to relationally connect with and attune to care receivers, and adequately navigate existential, moral, and political-institutional tensions in relational caring in complex organizations in Late-Modern society. (shrink)

The aim of this article is to explore some of the challenges of measuring Christian spiritual development across distinct traditions of Christian spirituality. This presses into questions of what might be universal and what might be particular when it comes to Christian spirituality in how it is understood and practiced. We address the feasibility of a general, ecumenical measure by hearing from representative voices of five traditions of Christian spirituality: African American spirituality, Anglican spirituality, Benedictine spirituality, Pentecostal spirituality, and Reformed (...) spirituality. After noting some of the distinctives of these traditions, we conclude with four strategies for navigating the unity and diversity of Christian spirituality in conceptualizing and measuring Christian formation. (shrink)

This study examines local communities’ lived experiences and organizations’ care-giving processes regarding four oil and gas projects deployed in three countries. Analyzing the empirical data through the lens of ethics of care reveals that, together with mature justice, the inclination to care conceived at the focal organization creates an ethical culture encouraging caring activities by individuals at the local level. Through close communications with communities, project decision makers at the local level recognize the demanded care (...) of local communities and develop organizations’ caring capacity. The empirical analysis revealed that the care-giving process can also be influenced by the power dynamics of the network of stakeholders. This research emphasizes on the success of a bottom-up approach in caring for local communities, and sheds light on the capability of large organizations in giving care to their distal stakeholders by adopting this approach. Furthermore, it indicates that justice and care both have some useful characteristics and are complementary but, most importantly, are socially constructed and not mutually exclusive. (shrink)

Artificial Intelligence (AI), especially of the machine learning (ML) variety, is used by health care organizations to assist with a number of tasks, including diagnosing patients and optimizing operational workflows. AI products already proliferate the health care market, with usage increasing as the technology matures. Although AI may potentially revolutionize health care, the use of AI in health settings also leads to risks ranging from violating patient privacy to implementing a biased algorithm. This chapter begins with a (...) broad overview of health care AI and how it is currently used. We then adopt a “lifecycle” approach to discussing issues with health care AI. We start by discussing the legal and ethical issues pertaining to how data to build AI are gathered in health care settings, focusing on privacy. Next, we turn to issues in algorithm development, especially algorithmic bias. We then discuss AI deployment to treat patients, focusing on informed consent. Finally, we will discuss existing oversight mechanisms for health AI in the United States: liability and regulation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Teaching Ethics in the Health Care Setting Part I:Survey of the LiteratureMary Carrington Coutts (bio)The last twenty years have brought important changes to health care and health care education. Educators and students alike face an enormous number of new fields of study and new medical technologies. Health care professionals and institutions are also facing new challenges in the form of shrinking economic resources, and the (...) AIDS epidemic. They must also respond to increased patient participation in health care decisions, and public concern about abortion and euthanasia. These challenges to the health care professional have compelled educators to accommodate ethics within their already overcrowded curriculum. Those same dilemmas have influenced health care institutions to become active in health care ethics education.Medical ethics education gained a foothold in the United States during the late 1960s, when the medical schools of Pennsylvania State University, the University of Florida, and the State University of New York at Stonybrook established programs in the humanities (Pellegrino 1982). In 1978 Robert Veatch noted that formal teaching in medical ethics was rare; most institutions that taught medical ethics used "informal instruction in the apprenticeship mode" (Veatch 1978). However, by 1982 a survey by the American Medical Association (AMA) revealed that all but one of the 127 medical schools had courses that included medical ethics. Thirty eight of these had medical ethics as a required course (Pellegrino 1985). And by 1989, 43 of the 127 medical schools had separate courses in medical ethics, while 100 covered medical ethics within required courses. Medical ethics is now an accepted part of medical curriculum, though it is not fully mature, and its future remains somewhat unclear (Miles 1989).The evolution of ethics in the nursing curriculum has essentially mirrored that of the medical curriculum. A 1977 survey of baccalaureate nursing programs revealed that only 7 percent of nursing programs required courses in ethics [End Page 171] (Aroskar 1977). A decade later a second survey of undergraduate programs identified 85 percent of responding nursing schools as teaching nursing ethics either in separate ethics courses or within other required courses (Cassells and Redman 1989).Though the precise future of health care ethics may be unpredictable, there is little thought that the role of ethics will diminish in importance as the 21st century approaches. Ethics is seen as part of a larger plan to develop and enhance the health professional's human values, social conscience, and interpersonal skills. "This broader effort derives from concerns about the personal attributes and humanistic sensitivity of physicians, the recent overly 'scientized' trend in premedical education, the selection of medical students, and the socialization and cynicism engendered by medical education" (Miles 1989, p. 705).While nearly every medical and nursing school in the United States now teaches ethics in one form or another, the degree to which ethics is integrated into the curriculum varies from school to school. Some ethics courses are required elements of the students' education; some institutions require attendance at seminars and ethics grand rounds. Other schools offer an array of elective courses in topics that relate to ethics in medicine and nursing (including medical humanities, medicine and the law, literature and medicine, history of medicine, patient advocacy, and human values in nursing.) "Brown bag" seminars and journal clubs are also common.There is much debate over how health care ethics should be taught. Some argue that medical professionals should be conversant with theories of ethics and principles of biomedical ethics. Others think that a theoretical approach will alienate already over-worked medical or nursing students, and that instruction in ethical theory should be kept to a minimum. Case studies are frequently cited as a way to involve students in medical decision making, forcing them to analyze problems that they can relate to their own experiences.Additional concerns center around who should teach health care ethics. Frequently, physicians and nurses interested in ethics teach courses. Some commentators see this as the most desirable arrangement, asserting that practicing health care professionals best understand the conflicts faced by physicians and nurses-in-training. However, there is a growing pool of professionals who are undergoing training as medical ethicists. These individuals study ethical theory and bioethical... (shrink)

Microethics is about the ethics of everyday clinical practice. The subtle nuances in communication between doctor and patient (the doctor’s choice of words, tone, body language, gestures, etc.) can influence the exercise of the patient’s autonomy. The four models of the doctor- patient/physician-patient relationship (paternalistic, informative, interpretive, deliberative) weigh respect for autonomy and beneficence in varying proportions. Each model may be appropriate in certain circumstances. This article considers these models from the perspective of microethics and the unique dimensions created by (...) the doctor-child-parent relationship. In particular, the article considers the nuances to the autonomy principle created by the child’s developing maturity and the parent’s role as a co-fiduciary of the child’s interests. Ultimately, the deliberative model seems most appropriate to the paediatric setting, since it accommodates the child’s developing maturity in making healthcare-related decisions. This model infuses care into the doctor’s communication with the child and parent. (shrink)

This paper examines the structural features of the U.S. Health Care System that make it particularly vulnerable to fraud, and which help to account for the types of fraud that arise and the difficulties authorities confront in controlling them. These structural features include the predominance of fee-for-service structures, private sector involvement in health care delivery and health insurance, highly automated cl aims processing systems, and a processing culture and audit mentality that emphasize process accuracy over verification. The paper (...) also discusses the underlying pathology of fraud as a white-collar crime problem, and explains how the more general challenges of controlling fraud are exacerbated by particular features of the health system. The central and unsolved problem of False Claims is examined in some detail. A series of recent governmental responses to medically impossible claims of various types is shown to align more closely with a claims-process-improvement mindset than with a crime-control approach. A more mature crime-control orientation is a pre-requisite for any serious progress in reducing the levels of fraud in the U.S. health system. (shrink)

Research teams have used extra-uterine systems to support premature fetal lambs and to bring them to maturation in a way not previously possible. The researchers have called attention to possible implications of these systems for sustaining premature human fetuses in a similar way. Some commentators have pointed out that perfecting these systems for human fetuses might alter a standard expectation in abortion practices: that the termination of a pregnancy also entails the death of the fetus. With Biobags, it might be (...) possible, some argue, that no woman has the right to expect that outcome if the technology is able to sustain fetal lifeafteran abortion. In order to protect the expectation that the termination of a pregnancy always entails the death of the fetus, Elizabeth Romanis has argued that fetuses sustained in Biobags have a status different than otherwise ‘born’ children. In support of that view, she argues that these ‘gestatelings’ are incapable of independent life. This argument involves a misunderstanding of the gestational support involved, as well as a misapprehension of neonatology practice. Here, we argue that any human fetus sustained in a Biobag would be as ‘independent’ as any other premature infant, and just as ‘born’. Neonatologists would seem to have certain presumptive moral responsibilities toward any human fetus gestating in a Biobag. It remains a separate question whether the perfection and widespread application of Biobags for premature human beings would or should alter the expectation that ending a pregnancy also entails fetal death. (shrink)

Research teams have used extra-uterine systems to support premature fetal lambs and to bring them to maturation in a way not previously possible. The researchers have called attention to possible implications of these systems for sustaining premature human fetuses in a similar way. Some commentators have pointed out that perfecting these systems for human fetuses might alter a standard expectation in abortion practices: that the termination of a pregnancy also entails the death of the fetus. With Biobags, it might be (...) possible, some argue, that no woman has the right to expect that outcome if the technology is able to sustain fetal life _after_ an abortion. In order to protect the expectation that the termination of a pregnancy always entails the death of the fetus, Elizabeth Romanis has argued that fetuses sustained in Biobags have a status different than otherwise ‘born’ children. In support of that view, she argues that these ‘gestatelings’ are incapable of independent life. This argument involves a misunderstanding of the gestational support involved, as well as a misapprehension of neonatology practice. Here, we argue that any human fetus sustained in a Biobag would be as ‘independent’ as any other premature infant, and just as ‘born’. Neonatologists would seem to have certain presumptive moral responsibilities toward any human fetus gestating in a Biobag. It remains a separate question whether the perfection and widespread application of Biobags for premature human beings would or should alter the expectation that ending a pregnancy also entails fetal death. (shrink)

How should we shape the practice of pastoral care, especially in the context of bioethical counseling? Martin Luther grounded it in a mutual dialogue of brethren. Friedrich Schleiermacher transformed this Protestant understanding according to the modern ideals of freedom and responsibility for oneself. In response to the other basic question of pastoral care: What is the human soul?, Sigmund Freud overcame the Platonic model undergirding Schleiermacher's account. Whoever seeks to care for his own soul and the soul (...) of the other should learn from Freud. One of the most fruitful consequences of such study lies in the formation of a mature religiosity. Another such consequence concerns the pastor's aspiring to an attitude of self-control in counseling. Building one's own competence on the experience and the knowledge of Freud can help one counteract the temptation to transfer one's own (unconscious) wishes onto the conversation partner and conversely to ward off transference from the other onto oneself. On the level of ideals and ultimate principles, however, Christian pastors, unlike Freud, will not see fate and the anonymous forces of Eros and Thanatos, as the ultimate last horizons of human self-understanding. Instead, the good news of sinful man's justification by God transcends even the limits of human existence imposed by fate. (shrink)

An outstanding feature of the study of nursing ethics is that it raises questions concerning moral virtue, conscience, consistency and character. A considerable section of the literature is devoted to ideas of how best to teach ethics to health professionals. It has been shown that when faced with ethical dilemmas nurses tended to rely on intuition and instinct to resolve them, with little systematic analysis to help the process. Nurses who have been in practice for a number of years may (...) experience particular difficulties in resolving ethical dilemmas, for although they may be able easily to identify ethical problems they may feel powerless to behave appropriately through lack of theoretical background and/or confidence in participating in informed debate. An educational programme was designed to meet the needs of mature registered nurses who were undertaking a post-qualification part-time honours degree in nursing studies. A variety of teaching methods were employed in teaching the nurses. These included discussion, student-led seminars, structured debate and role play. A session which dealt with sudden death and organ donation is described in some detail. Because the topic involved communication between professionals and patients and/or relatives and was linked with ethics, role play was used to explore the dynamics in these areas. The participants were invited to act out the situation as they felt it might occur. Role play highlighted the stress and shock attached to such an experience. Before working through the dynamics of a situation the nurses were conscious of being part of decision-making 'in the cold' and 'in isolation'. As a result of the experiential learning they felt more able to reflect analytically and to participate in discussions in an informed and articulate way. (shrink)

Abstrak: Paper ini berbicara mengenai parrhesia, salah satu dari sekian banyak istilah teknis utama dari Michel Foucault. Parrhesia merupakan seminar terakhir yang didiskusikan Foucault di Universitas Calofornia di Berkeley, USA, di bawah judul: ‘Discourse on Truth: The Problemati- zation of Parrhesia.’ Seri seminar ini dan seksualitas sebagaimana didiskusikan dalam History of Sexuality vol. 2 dan 3, berikut semua bahan kuliah dan interviu selama dua tahun terakhir sebelum kematiannya, dilihat sebagai puncak dari tiga jurus berpikir Foucault, terutama dalam hal ini jurus (...) subyektivitas dan etika. Di sini terlihat, bagaimana manusia menyadari diri sebagai subjek bagi dirinya sendiri atau menjadi subjek etika. Ini berarti bahwa individu, berdasarkan kebebasan dan kema- tangannya, secara praktis mampu berhubungan dengan dirinya sendiri (rapport a soi). Dengan itu, ia dapat disebut sebagai parrhesiast, yang tidak hanya menyampaikan kebenaran kepada orang lain, tetapi juga mampu menyampaikan kebenaran kepada dirinya sendiri. Dengan kata lain, supaya bisa disebut sebagai parrhesiast, seorang individu harus memper- lihatkan dalam dirinya suatu hubungan erat antara apa yang ia katakan dengan apa yang ia perbuat. Teori dan praktek selalu harus berjalan beriringan. Seseorang boleh berbicara secara meyakinkan, namun ia juga harus bertindak dan berlaku benar dan baik. Kata-kata kunci: Foucault, parrhesia, intelektual, subyek, etika. Abstract: The paper presents one of Foucault’s many pregnant technical terms called πάρήσίά (parrhesia). Parrhesia is the main topic of his last seminar delivered at the University of California in Berkeley, USA, entitled “Discourse on Truth: The Problematization of Parrhesia.” These series of seminar and the issue of sexuality as discussed in his History of Sexuality vol. 2 and 3, added with all his lectures and interviews during the last two years before his death, are seen as the peak of his three axes of thought, namely the axis of subjectivity and ethics. There, we see how humanbeing is aware of him/her self as subject of him/her own self or of being the subject of ethics. This means that the invididual, based on his freedom and maturity, is practically able to relate with him/her self (rapport a soi). He is then to be called the parrhesiast, who not only tells the truth to other people, but also be able to tell the truth to him/her self. In other words, in order to be a parrhesiast, an individual should show in his/her life a correspondence between what he/she speaks and what he/she does. Theory and practice should go hand in hand. One can speak convincingly, yet is also to behave well. Keywords: Foucault, parrhesia, intellectual, subject, ethics. (shrink)