The aim of this article is to continue the discussion about factors of importance for an including ethics of care. A further polarization between partiality and impartiality does not seem a relevant approach. What is important is to direct attention both to the other and to the third person, which requires an acknowledgement of responsibility that extends beyond established relationships. Thus, we need to draw attention not only to the vulnerability existing within every seriously ill or injured person, but to (...) factors of importance for marginalization of groups like refugees, people suffering from serious mental illness, and substance misusers, to mention some in the Western world. Marginalized groups are groups experiencing a discrepancy between need of health care and care given. They are not given proper priority in the distribution of resources, and they may experience ignorance when they first meet the healthcare system as patients.Efforts to understand what circumstances can lead to inadequate inclusion indicate that the elements of differentness and extensive losses of life contexts which may be causing feelings of hopelessness and helplessness in the health professionals, are key factors posing challenges to empathy both within and beyond established relationships, besides geographical distance. Groups of people who have suffered extensive loss in their life contexts may be threatening for us, as they reflect our own fears, and remind us of our own vulnerability.I raise the question: How can we contribute to meeting the need for an ethics of care that extends beyond the familiar to the unfamiliar both in established and non‐established relationships? (shrink)

There is an ongoing discussion concerning personal vs. impersonal considerations in professional care. In this article, three different positions within the ethics of closeness will be discussed. These are: (a) reserving the ethics of closeness for close experienced others, ‘including the experienced Other’, which is Nortvedt's position; (b) trying to bring the distant, non‐experienced others closer, ‘including the Third’; and (c) finally, an examination of whether a perspective of closeness may lead to the exclusion of various groups in need of (...) help, ‘including the Other at the expense of the Third’. These positions are discussed with a view to clarifying some of the challenges that the ethics of closeness faces when it maintains that greater ethical obligation is associated with personal than with impersonal relations, without discussing the terms on which the obligation is based. Key questions that arise for a nurse or other health professional are: If our primary moral responsibility is for those that are close to us, the experienced others, who is to be responsible for those that are outside the established health services, the non‐experienced others? Is it evident that favouring the experienced others is based on legitimate needs? Can a discussion on the legitimate basis of nursing be avoided in questions relating to closeness and priorities? This discussion touches the heart of our discipline. Is a one‐sided perspective of closeness, rejecting moral responsibility for those with whom we have no relationship, a defensible ethical position? (shrink)

With the point of departure in the ongoing discussion of the professional and moral responsibility for those who are not equally included in the established health services, the question of how to include individuals and groups facing marginalisation is one of the major challenges within the ethics of care. This makes marginalisation a core concept in our time, which is challenged by, among other things, differentness with respect to ethnicity and social status as well as breach with norms and laws. (...) The representation of individuals and groups facing marginalisation is not merely an intellectual question, however, but an epistemological one with political, practical and ethical implications. This article discusses a pilot project exploring what we can do within nursing education to sensitise students to professional and moral responsibility for individuals and groups facing marginalisation. A dialogical approach to knowledge, including cooperation with voluntary organisations and low-threshold facilities with a long tradition of trying to prevent people from falling through the net', was chosen to highlight the professional challenges and the ethical dilemmas that arise in the interface between closeness and distance, caring and marginalisation. Evaluation of data indicated that such an approach to knowledge seems to benefit the students' learning. (shrink)