BackgroundVulnerability is a key concept in traditional and contemporary bioethics. In the philosophical literature, vulnerability is understood not only to be an ontological condition of humanity, but also to be a consequence of contingent factors. Within bioethics debates, vulnerable populations are defined in relation to compromised capacity to consent, increased susceptibility to harm, and/or exploitation. Although vulnerability has historically been associated with older adults, to date, no comprehensive or systematic work exists on the meaning of their vulnerability. To fill this (...) gap, we analysed the literature on aged care for the meaning, foundations, and uses of vulnerability as an ethical concept.MethodsUsing PRISMA guidelines, we conducted a systematic review of argument-based ethics literature in four major databases: PubMed, Embase®, Web of Science™, and Philosopher’s Index. These covered biomedical, philosophy, bioethical, and anthropological literature. Titles, abstracts, and full texts of identified papers were screened for relevance. The snowball technique and citation tracking were used to identify relevant publications. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the QUAGOL methodology.ResultsThirty-eight publications met our criteria and were included. Publication dates ranged from 1984 to 2020, with 17 publications appearing between 2015 and 2020. Publications originated from all five major continents, as indicated by the affiliation of the first author. Our analyses revealed that the concept of vulnerability could be distinguished in terms of basic human and situational vulnerability. Six dimensions of older adults’ vulnerability were identified: physical; psychological; relational/interpersonal; moral; sociocultural, political, and economic; and existential/spiritual. This analysis suggested three ways to relate to older adults’ vulnerability: understanding older adults’ vulnerability, taking care of vulnerable older adults, and intervening through socio-political-economic measures.ConclusionsThe way in which vulnerability was conceptualised in the included publications overlaps with distinctions used within contemporary bioethics literature. Dimensions of aged care vulnerability map onto defining features of humans, giving weight to the claim that vulnerability represents an inherent characteristic of humans. Vulnerability is mostly a value-laden concept, endowed with positive and negative connotations. Most publications focused on and promoted aged care, strengthening the idea that care is a defining practice of being human. (shrink)

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses’ opinions of the content and function of codes and their use in nursing practice. A total of 49 focus (...) groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be ‘paper tigers’ with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice. (shrink)

Philosophy & Social Criticism, Volume 48, Issue 9, Page 1226-1246, November 2022. In this study, we claim that political liberalism, despite harsh criticism, is still the best option available for providing a just and stable society. However, we maintain that political liberalism needs to be revised so as to be justifiable from the perspective of not only the “reasonable” in a Rawlsian sense but also the ones whom Rawls labels as “unreasonable.” To support our claim, going beyond Rawls’s original account, (...) we unpack the concept of unreasonableness and identify three different subsets that we label as the “partially reasonable,” the “non-reasonable,” and the “unreasonable.” We argue that both the “fully” reasonable and the “partially reasonable” would be included into the constituency of public justification; more specifically, we claim that the latter would support liberal institutions out of their reasons: we define these reasons as mutually intelligible reasons and claim that they allow to acknowledge the importance of a convergence approach to public justification. As for the “non-reasonable” and “unreasonable,” we claim that they cannot be included in the constituency of public justification, but they nonetheless could be compliant with liberal institutions if political liberalism offers them some reasons to comply: here, we claim that political liberalism should include them through engagement and propose reasoning from conjecture as an effecting way of offering reasons for compliance. In particular, we claim that through reasoning from conjecture, the “non-reasonable” could find conciliatory reasons to comply with liberal institutions on a stable base. With regard to the “unreasonable” in the strict sense, we claim that through reasoning from conjecture, their unreasonableness could be contained and they could find reasons—even if just self-interested—for complying with liberal institutions rather than defying them. In our discussion, we consider the different subsets not as “frozen” but as dynamic and open to change, and we aim to propose a more complex and multilayered approach to inclusion that would be able to include a wider set of people. To strengthen our argument, we show that the need for a wider public justification and for broader inclusion in liberal societies is grounded in respect for persons both as equal persons and as particular individuals. In particular, we claim that individuals’ values, ends, commitments, and affiliations activate demands of respect and can strengthen the commitment to the liberal–democratic order. Through a reformulation of the role of respect in liberal societies, we also show a kind of social and communitarian dimension that, we claim, is fully compatible with political liberalism and opens it up to “civic friendship” and “social solidarity,” which are constitutive elements for the development of a sense of justice and for the realization of a just and stable society. (shrink)

Philosophy & Social Criticism, Volume 48, Issue 9, Page 1226-1246, November 2022. In this study, we claim that political liberalism, despite harsh criticism, is still the best option available for providing a just and stable society. However, we maintain that political liberalism needs to be revised so as to be justifiable from the perspective of not only the “reasonable” in a Rawlsian sense but also the ones whom Rawls labels as “unreasonable.” To support our claim, going beyond Rawls’s original account, (...) we unpack the concept of unreasonableness and identify three different subsets that we label as the “partially reasonable,” the “non-reasonable,” and the “unreasonable.” We argue that both the “fully” reasonable and the “partially reasonable” would be included into the constituency of public justification; more specifically, we claim that the latter would support liberal institutions out of their reasons: we define these reasons as mutually intelligible reasons and claim that they allow to acknowledge the importance of a convergence approach to public justification. As for the “non-reasonable” and “unreasonable,” we claim that they cannot be included in the constituency of public justification, but they nonetheless could be compliant with liberal institutions if political liberalism offers them some reasons to comply: here, we claim that political liberalism should include them through engagement and propose reasoning from conjecture as an effecting way of offering reasons for compliance. In particular, we claim that through reasoning from conjecture, the “non-reasonable” could find conciliatory reasons to comply with liberal institutions on a stable base. With regard to the “unreasonable” in the strict sense, we claim that through reasoning from conjecture, their unreasonableness could be contained and they could find reasons—even if just self-interested—for complying with liberal institutions rather than defying them. In our discussion, we consider the different subsets not as “frozen” but as dynamic and open to change, and we aim to propose a more complex and multilayered approach to inclusion that would be able to include a wider set of people. To strengthen our argument, we show that the need for a wider public justification and for broader inclusion in liberal societies is grounded in respect for persons both as equal persons and as particular individuals. In particular, we claim that individuals’ values, ends, commitments, and affiliations activate demands of respect and can strengthen the commitment to the liberal–democratic order. Through a reformulation of the role of respect in liberal societies, we also show a kind of social and communitarian dimension that, we claim, is fully compatible with political liberalism and opens it up to “civic friendship” and “social solidarity,” which are constitutive elements for the development of a sense of justice and for the realization of a just and stable society. (shrink)

Ethical challenges are traditionally described in a negative light, even though moral conflict can express the individual ability to perceive when something is not working and promote change. The true question, therefore, is not to how to silence moral conflict but how to educate it. Although the need for ethical support of health- and social-care professionals in elderly care is clearly perceived, there is no universal method for providing effective interventions. The authors hypothesize that adequate training sessions can help care (...) professionals enhance this skill, once clear goals and specific educational techniques are set. This research tests the hypothesis on twenty care professionals working in acute and residential care settings for the elderly, building on the ethics round method. Mixed methods drawn from literature and the experience of educators were adapted to meet different educational goals. Moral issues can hardly be removed from a context characterized by increasing demand and decreasing resources, but they can be recognized and addressed with common efforts, a critical attitude, and a growth mindset. Enhancing these skills in qualified workers can help them accept the reality of work, release pressure, and identify common team goals. Introducing these skills before graduation can help future workers avoid unreal expectations and reduce frustration and early job quit rates. (shrink)

In this article I look for an alternative way in which ‘unreasonable’ people may be included in a liberal society. Differing from Rawls, whose reasonable hope is for unreasonable people gradually to adhere to liberal institutions so that, over time, an overlapping consensus is reached, I propose the alternative way of them supporting these institutions as a special modus vivendi, which does not require them to renounce their non-reasonableness. First I detail the Rawlsian notion of reasonableness and unreasonableness; second, I (...) discuss how the treatment of the unreasonable is addressed by Rawls; third, taking inspiration from two accounts of how to consider the ‘unreasonable’ within a liberal society, I maintain that a subset of ‘unreasonable’ (I call them ‘non-reasonable’) may be included in public debate; fourth, I propose that their way of inclusion is a stable modus vivendi. (shrink)

This article is a first assessment of the Italian Code of deontology for nurses (revised in 1999) on the basis of data collected from focus groups with nurses taking part in the Ethical Codes in Nursing (ECN) project. We illustrate the professional context in which the Code was introduced and explain why the 1999 revision was necessary in the light of changes affecting the Italian nursing profession. The most remarkable findings concern professional autonomy and responsibility, and how the Code is (...) thought of as a set of guidelines for nursing practice. We discuss these issues, underlining that the 1999 Code represents a valuable instrument for ethical reflection and examination, a stimulus for putting the moral sense of the nursing profession into action, and that it represents a new era for professional nursing practice in Italy. The results of the analysis also deserve further qualitative study and future consideration. (shrink)

In this paper we investigate ways to comply with justice in a liberal democracy. In order to do that, we sketch Rawls’s account of moral-consensus stability and discuss the alternative idea of stability reached through a modus vivendi. We defend modus vivendi as a way to achieve stability backed by a variety of reasons and even by ‘non-reasons’. By ‘non-reasons’ we mean alternative sources of motivation for compliance as a precondition of a stable coexistence. We focus on such sources, which (...) differ from reasons and beliefs, that are practices, shared values, and value experiences, in light of both a theoretical-political and a qualitative social-ontological perspective. We argue that individuals who experience the same values become collectives and even stable ones: the sharing of values creates social unity and makes collectives solid and resistant to individualistically centrifugal tendencies. (shrink)

In this paper the authors deal with the story of Saman Abbas, an 18-year-old girl of Pakistani origin, who disappeared in Italy and was killed by her family after she refused an arranged marriage. The case raised a public debate between right-wing parties, who accused the left-wing parties of being culpably blind to the danger of Islam and too tolerant towards illiberal cultures, and left-wing politicians who responded equating Saman’s murder with the domestic killing of Italian women. We argue that (...) neither position does justice to Saman’s story. We hold that Saman’s case is an example of intersectional oppression where gender oppression is intertwined with the immigrant’s oppression in a Western democracy. Thus, we counter the dilemma posed by Susan Okin, namely that there is an inherent conflict between the rights of minority cultures and the rights of women. In order to rebut Okin’s position, we rehearse multicultural positions concerning the protection of minority cultures, on the one side, and feminist positions regarding the promotion of autonomous choice, on the other. Our conclusion is that (a) multiculturalism cannot be identified with cultural rights, and (b) that what are autonomous choices and what are, instead, adaptive is difficult to ascertain and, especially, difficult to apply in politics. Structural oppression is instead the key normative notion for addressing equality among genders and among citizens at large. The intersectional oppression suffered by women like Saman cannot be addressed by a restriction of toleration for immigrant cultures or simply by security measures. To prevent more cases like Saman’s in the future, the immigrant oppression should be taken seriously as well. In the context of fairer terms of inclusion, conditions of reciprocal trust between minority and majority may develop and the deconstruction of the patriarchal view of family can start. (shrink)

Among the main assumptions of the well-known principle-based method in bioethics, the ideal of consensus assumes central importance. Indeed, by proposing this method, Beauchamp and Childress offer a base for a practical agreement that can be reached starting from different moral perspectives: they defend the universality of the principles shared by the common-morality theories. The ideal of consensus based on the universal acceptability of the principles is criticized by a large number of authors, communitarians and feminists. They attack the notion (...) of universality in different ways: universal principles cannot yield any practical solution to ethical problems. The feminists in particular emphasize the relational, emotional involvement, and also the particular context ofeach situation, as central elements of any practical decision, rather than the cold detachment of the conformity to principles and norms. The case of abortion provides a good example of this position. (shrink)

In this article we focus on female genital mutilation. We analyse this problem as one of the most important issues of multiculturalism, which is also coming to the attention of the public in Italy as a consequence of the growing number of immigrants from African countries. The fundamental problem is about the acceptability of this practice: can female genital mutilation be permitted and, if so, on what basis? We will try to cope with this as a genuine conflict between culture-relative (...) values and universal values, such as human rights. Some attention will be drawn to Italian law. Finally, the impact on nurses of requests for genital mutilation will be described. (shrink)

We reflect upon the meaning of freedom and autonomy in nursing behaviour, attempting to outline the contemporary situation of nursing in Italy, where the profession is achieving important results after a long period of submission and subordination. The way to real emancipation is not easy, but a statement of law on the one hand - abolishing constraints such as the Mansionario - and professional self-regulation on the other - the recent new Deontological Code - represent a real conquest in that (...) direction. However, no statement of law or deontology can be sufficient without deeper reflection by the profession on itself and its tasks, potentiality, social importance and self-esteem. (shrink)