It is a book all LIS educators and administrators need to read now. The editors and author contributors show us by direct action what critical librarianship is. At the heart of the book is an ethics of care and self-care, an ethics born out of critical stances positioned in examining our rich intersectionalities and inter-being as people of color and allies. Librarians With Spines is a call to action that asks us to reflect on our intentionality as information (...) professionals. It challenges librarians to proudly uphold and carry forward our duty to serve our communities in our daily work. (shrink)

This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we (...) discuss how a case was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA. (shrink)

Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point (...) Likert scales were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience. (shrink)

Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point (...) Likert scales were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience. (shrink)

BackgroundExisting clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care. MethodWe used a participatory development design. We worked together with stakeholders in a Community of Practice (...) throughout the study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.ResultsWe distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.ConclusionsParticipatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments. (shrink)

Special volume of "Thaumàzein - Rivista di Filosofia" dedicated to the theme of Socratic Eudaimonia and care for others. It is a multilingual volume comprising twenty papers divided into six sections with an introduction by Linda Napolitano. Edited by Santiago Chame, Donald Morrison, and Linda Napolitano. -/- Despite the appearances given by certain texts, the moral psychology of Socrates needs not imply selfishness. On the contrary, a close look at passages in Plato and Xenophon (see Plato, Meno 77-78; Protagoras (...) 358; Gorgias 466-468; Euthydemus 278; Lysis 219; Xenophon, Memorabilia III 9, 4-5) suggests that the “egoist”’s welfare depends upon the welfare of others (i.e. family, friends or the whole city). Since the welfare of his family, friends and city is part of his own eudaimonìa, the “egoist” (phìlautos) has a direct and intrinsic motive to promote the welfare of these others. -/- This multilingual issue explores the role that other peoples’ welfare plays in Socratic ethics. Special attention is paid to test-cases in which the principle that moral action is always good only for the agent seems to have no validity. I.e., under which circumstances is the self-sacrifice for the sake of others (such as the soldier’s self-sacrifice on the battlefield) good for the agent (as in Alcibiades I 115a-116d)? Essays deal with contradictions or tensions of this sort, and relate them to more general views on eudaimonìa held within Socratic literature. Comparison between different Socratic authors is used as a means to identify the distinctive features of Socratic eudaimonìa if compared to other Greek theories of happiness, such as the Aristotelian theory of philautìa (NE IX, 1166a-1166b; 1168a-1169b). (shrink)

A partire dalla definizione di cura elaborata insieme a Berenice Fischer, si argomenta come la cura sia un importante strumento concettuale per qualunque genere di teoria politica. Ciň che diviene essenziale č un'analisi delle dimensioni della cura, delle dinamiche di potere insite in ogni relazione di cura, nonché del piů ampio contesto che modella tali preoccupazioni. L'articolo tratteggia, nello specifico, i caratteri essenziali del rapporto fra cura e politica democratica, che postula la ricerca di una (...) riduzione delle asimmetrie nelle relazioni di cura. Affinché i cittadini democratici svolgano bene i compiti di cura e in un modo compatibile con la vita democratica, essi devono immaginarsi allo stesso tempo sia come soggetti che forniscono cura sia come soggetti che la ricevono. Il grande passo da compiere č dunque avvedersi che l'espressione to care significa sempre sia dare sia ricevere cura e solo quando ciň sarÀ stato pienamente compreso si sarÀ in grado di elaborare una teoria democratica davvero inclusiva che riconosca alla cura il suo giusto posto. (shrink)

La cura della salute è un fenomeno originario e insieme una necessità fondamentale, dinamica e non trascurabile della vita, dell’esistenza e dell’esperienza personale e comunitaria di ogni essere umano. La primarietà ontologica della cura, evidenziata anche negli studi filosofici più recenti dedicati alle pratiche dell’aver cura, richiama infatti, attraverso la dimensione co-esistentiva dell’essere insieme nel mondo l’uno con l’altro e l’uno per l’altro, alla stessa primarietà etica e al contempo politica della cura nel naturale e positivo (...) sviluppo della struttura relazionale personale e dell’esistenza condivisa. Si tratta di un processo di rilevazione e conseguente impegno nel favorire oggi concretamente percorsi di cura e umanizzazione della pratica medica e sanitaria, sia quotidiana che straordinaria, nonostante molteplici limiti e complessità rintracciabili nelle stesse pratiche contemporanee dell’aver cura, esemplificativamente ricercati e identificati in alcuni recenti lavori internazionali dal carattere necessariamente interdisciplinare. È significativo, infatti, che in alcuni rilevanti documenti circa gli sviluppi di una delle principali frontiere contemporanee dell’aver cura, come quella costituita dal processo di realizzazione, sviluppo, diffusione e promozione locale, nazionale e internazionale delle reti di cure palliative, vengano ad essere centralmente ricercati, identificati e positivamente ri-evidenziati i principali limiti, gli ostacoli e le barriere attualmente riscontrabili nello sviluppo delle reti di cure palliative; oltre alla messa in evidenza di una sempre positiva e necessaria opportunità di gettare lo sguardo verso il futuro e gli orizzonti di sviluppo della presa in carico globale della persona sofferente nelle varie fasi della malattia e in condizioni di estrema vulnerabilità percepita e vissuta. (shrink)

Sustainability has been gaining recognition as an innovative pathway for general learning from early childhood to higher education. This article advances acura personalis, or care for the entire person, approach for integrating sustainability into the domain of business management education. Such an approach centers on fostering higher-order dispositions including creativity, critical moral awareness, existential authenticity, excellence, relatedness, and overall well-being and thus constitutes a broader, deep ecological alternative to received scientistic and quantitatively controlled programs.

Il lavoro presentato costituisce una ricerca interdisciplinare interessata ad approfondire sia teoreticamente che praticamente il rapporto essenziale, fondativo e dinamico tra cura e persona, le sue profonde implicazioni e la sua rilevanza etico-pratica nel contesto della riflessione bioetica e medico-sanitaria attuale. Attraverso un'analisi multidisciplinarmente fondata sono state rilevate le basi teoretiche per affrontare alcune specifiche situazioni-limite fronteggiate oggi in bioetica clinica, per giungere infine alla messa in evidenza del ruolo e del senso della speranza nella dimensione e rete contemporanea (...) di cure palliative. Particolare attenzione è stata rivolta alla complessità e libertà delle scelte da dover compiere in tali situazioni all'interno della necessità di un'autentica, efficace e originaria relazione di cura, oggi emergente a partire dalla riscoperta in bioetica del rapporto tra cura e persona; ovvero dalla necessità, bellezza e urgenza di tale relazione da approfondire e incoraggiare ad ogni livello. Tale ricerca costituisce in tal senso un’analisi interdisciplinare attenta tanto al piano della teoresi quanto a quello propriamente pratico, al loro costante e positivo dialogo nel tentativo di un’ermeneutica contemporanea del rapporto tra cura e persona in bioetica. (shrink)

The practice of pastoral care (cura animarum) over the ages has been informed and influenced by the need to develop creative ways (interventions) to respond to people’s contextual challenges. These approaches have been well documented. However, the history, developments and emerging pastoral care practices in Africa have not been documented. This article, by way of a survey, considers the pastoral care approaches that emerged in Africa from the period when Christianity was introduced to the continent. It (...) addresses three interlinked questions. Firstly, to what extent has pastoral care approaches and practices in Africa been influenced by the African context and developments? Secondly, to what extent has the context and the emerging pastoral care approaches in Africa been discerned from historical developments and documented? Thirdly, what links can be drawn between pastoral care practices in Africa and its historical as well as cultural context? In answering these questions, the article retrieves pastoral care developments in Africa by discerning pastoral care during the periods of Christianity in Africa. The notion of cura animarum as ‘soul care’, referring to care for the whole person (holistic care, i.e., nephesh care) from a Christian spiritual perspective, will be employed as a framework. The assumption guiding the article is that pastoral care practices and approaches in Africa have arisen as responses to the contextual realities being experienced at the interface of Christianity and the African people. These realities arose and persist to this day as a struggle to relate, apply and live out an authentic African Christian life to cope with life in a meaningful way. It concludes by suggesting ways on how pastoral care in Africa should be practiced in the current period and going forward. (shrink)

The article suggests an ethical-anthropological reading of Thoughts, magna opera of the French mathematician and philosopher Blaise Pascal, which was published after his death by his relatives and friends. Such a reading is presented in three moments: Firstly, an anthropological description aimed at answering the question ‘who is man?’; secondly, an analysis of Pascal’s erotic condition; and, finally, an ethical proposal as cura amoris. The main argument of the article is that every human being has a motivation in acting, (...) that of love and being loved. Thus, having a happy or unhappy life depends on the care for this erotic condition, and the latter is achieved through thought. (shrink)

Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences. Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences. Design: Single group pre-/post-test design with two questionnaires. Methods: Questionnaires used were (...) the Rushton Moral Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist. Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents. Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales. Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice. (shrink)

This article examines Niccolò Machiavelli’s central political writings by means of asking whether his thinking is structured by an underlying concept of the political. In exploring the ways in which Machiavelli (a) addresses some of the basic conditions that determine the political realm and (b) reflects upon the conditions for practical success in this domain, the contours of an implicit, yet consistent concept of the political become apparent. It will be argued that, with regard to its content, this concept is (...) irreducible to the aspect of power. Instead, it is an element of care – or more specifically: ‘care of many’ – that is characteristic of Machiavelli’s understanding of the political and that decisively informs his considerations on both principalities and republics. (shrink)

Possiamo intenderci, quando parliamo di etica della cura?

Con-essere, questa forma verbale infinita dalla profonda risonanza filosofica apre ancora oggi la ricerca al cuore e all’agire relazionale dell’essere umano curante. Non solo, essa richiama la riflessione alle stesse radici della questione sociale della cura. La cura è infatti, nella sua radicalità ontologica ed esistenziale, essenzialmente sociale, cioè manifestazione storico-temporale strutturata del con-essere insieme con gli altri e per gli altri proprio dell’esserci. Sociale è la cura nella sua struttura, aperta come è costantemente alla relazione con (...) l’altro esserci, e sociale nella sua dimensione, caratterizzata da un silenzioso rimando all’essere che abita l’esistente nelle forme fattive del suo incontro, soprattutto in ambito medico e sanitario, laddove la frequentazione del limite diviene esperienza concreta e quotidiana. Carattere effettivo, fondamentale e dicibile della cura, nonché espressione della sua struttura dimensionale profondamente sociale, è così quello della responsabilità con, per e verso l’altro. Alle radici della questione sociale della cura sta infatti la percezione vivente di un con-essere originario e fondamentale che si concretizza come agire curante caratterizzato dalla presenza della responsabilità personale e comunitaria con l’altro, per l’altro e verso l’altro, una responsabilità co-originaria allo stesso sorgere della dimensione della cura. (shrink)

The phenomenological attitude allows us to grasp something that happens before the distinction between subject and object. The application to groups of human beings in a clinical and therapeutic context of the phenomenological setting allows us, in spite of its descriptive-contemplative aura, the extreme richness of potentialities, applicative and transformative, of one of the greatest intuitions of modern thought: the disappearance of the fracture between the subject, the others and the world-of-life, in the evidence of meaning that the mutual experience (...) of one's own presence or being-there opens up. The Mitsein doesn’t represent the only existential structure that makes the Dasein able to exist with others, but the relationship between the ‘originary temporality’ of the Dasein and the other as ‘you’. Dasein is that entity that is structurally “with” others. And it is in this relationship dynamic that unfolds the theme of the care. Care becomes for Heidegger the existential of the existentials, fundamental ontological structure, indicating the original opening of being. Being-with-in-loving could consist in the atmosphere, a kind of well-being which these flow-experiences, relatively rare in everyday life, are immersed in. (shrink)

Il processo di riconoscimento delle cure palliative quale diritto umano individuale di base ha recentemente riscontrato una proficua quanto attesa accelerazione. Parimenti allo sviluppo tecnico dei nostri giorni non si esauriscono infatti le forme dell’umano sentire e sperare, l’esigenza e l’impeto dell’aver-cura autentico dell’altro, la risposta multidisciplinare, comunitaria e sociale che ne consegue doverosa. È quanto attesta e promuove la recente Dichiarazione di Astana sull’assistenza sanitaria primaria, nel riconoscere le cure palliative tra le forme di cura primarie oggi (...) possibili e dovute ad ogni individuo, espressione di un diritto alla salute non riconducibile a mere forme di assistenzialismo tecnico-burocratico, lontane dall’uomo e dalla vita, ma segno e presenza concreta e tangibile dell’umanità inalienabile da cui esso proviene. Ciò che accomuna in questo percorso di riscoperta e ridestazione è l’essenza della nostra umanità, il desiderio di non cadere intrappolati in una in-umanizzazione collettivizzata, assurda quanto brutale, l’umanità di un diritto alla vita, alla salute e alla sua tutela che nasce rinnovato nel cuore di ogni generazione, la consapevolezza originaria di una determinazione ontologico-esistenziale comune e condivisibile. Il problema della reciprocità del riconoscimento personale fra gli esseri umani nelle pratiche dell’aver-cura e la necessità di un’instancabile promozione di forme di presa in carico realmente globali ed affidabili permea profondamente lo stesso processo di un autentico, efficace e quanto più conforme possibile sviluppo sociale, in una comunità di uomini e di popoli che stenta a riconoscersi come tale e dove occorre innanzitutto curare la speranza affinché ne venga abitata la cura di ogni persona. (shrink)

After a period during which the theological categories of sin and forgiveness were ignored or trivialized, presently these notions are being rediscovered. What could their impact be on bioethics, either in the narrow sense of medical ethics, or in the more encompassing sense of the ethics of the life sciences? This essay begins with describing the processes of transcending and ethitization, which gave rise to the biblical notion of sin. It portrays the theological foundation of sin in terms of a (...) twofold refusal of proper relations to God and other humans. Through the practise of confession in the face of God (coram deo), sin is placed into a horizon of hope for forgiveness and reconciliation. The heuristic and hermeneutical significance of these categories results from their introducing a “surplus value,” which transcends biological and ethical considerations. This additional dimension is illustrated in view of care (cura) for the injured, and in view of individual as well as collective willingness to forgive. (shrink)

La fenomenologia possiede un implicito potenziale pedagogico estremamente promettente e tuttavia ancora largamente inesplorato. Il presente articolo suggerisce che l’orientamento fenomenologico-esistenziale nella didattica e nell’educazione rappresenti una possibile soluzione per: 1) riportare tutti i differenti aspetti metodologici del processo formativo ad una unità tematica; 2) sviluppare negli studenti che si preparano ad esercitare una professione di cura l’attitudine a svolgere il loro servizio in modo autentico, sostenendo la motivazione, rendendo possibile il coinvolgimento emotivo senza il quale il gesto di (...) cura non potrebbe nascere, favorendo la realizzazione di significati e di valori e prevenendo il rischio sempre presente di burnout. Viene qui esplorato il significato dei termini fenomenologia ed esistenzialismo, intendendo con il primo una particolare postura metodologica dinanzi alla realtà, e con l’altro un ambito di ricerca concernente il senso dell’esistenza umana. In tal modo, la formazione del professionista, ancorché scientificamente fondata, non perde di vista i due riferimenti ineludibili che sostengono le professioni d’aiuto: il contatto con la soggettività e la coltivazione dell’umanità quale imprescindibile risorsa professionale . Poiché l’approccio fenomenologico-esistenziale abitua ad un sapere contestualizzato,individualizzato e “sapienziale”, i professionisti del lavoro cura che sono stati formati secondo una sensibilità fenomenologico-esistenziale saranno meglio equipaggiati per fronteggiare e gestire le sfide che quotidianamente coloro che svolgono un lavoro di cura devono affrontare, nonché più preparati a cogliere in modo profondo i bisogni della popolazione e a rispondervi in modo creativo ed efficace. È una questione di sguardo: l’atteggiamento fenomenologico forma nei professionisti la capacità di “vedere” ciò che altrimenti resterebbe implicito, latente, imbrigliato nelle maglie dell’ovvietà e della routine. In questo senso si parla qui di una sorta di “oftalmologia” pedagogica: perché lo scopo della formazione non consiste tanto nel trasmettere una nozione della realtà , quanto nell’affinare la capacità di coglierne l’essenza e il significato più profondo. L’articolo offre alcune suggestioni rispetto al modo in cui i formatori possono trasferire queste nozioni nella costruzione di un ambiente di apprendimento aperto all’esperienza viva e aderente al mondo della vita.This paper poses the suggestion that existential phenomenology provides an ideal solution for 1) integrating all of the different methodological aspects of the educational process into a thematic unity for the student and 2) empowering students entering the caring professions to best serve their intended populations authentically, while avoiding the ever-present peril of burnout. The meanings of both phenomenology and existentialism are clarified, with phenomenology indicating a particular methodological stance toward phenomena, and existentialism indicating research content concerned with domains of human meaning. It is anticipated that students preparing to enter the caring professions who have training in existential phenomenology will be better equipped to manage challenges commonly faced by those in the caring vocations, as well as to prepare them to assist the populations they serve with meaning-oriented crises and needs. A few suggestions on how educators might bring these notions into the classroom environmentensue. (shrink)

This book on the history of palliative care, 1500-1970 traces the historical roots of modern palliative care in Europe to the rise of the hospice movement in the 1960s. The author discusses largely forgotten premodern concepts like cura palliativa and euthanasia medica and describes, how patients and physicians experienced and dealt with terminal illness. He traces the origins of hospitals for incurable and dying patients and follows the long history of ethical debates on issues like truth-telling and (...) the intentional shortening of the dying patients’ lives and the controversies they sparked between physicians and patients. An eye opener for anyone interested in the history of ethical decision making regarding terminal care of critically ill patients. (shrink)

Lo scopo del presente lavoro è quello di esplorare nella letteratura sanitaria internazionale il ruolo delle humanities nella formazione al lavoro di cura, offrendo una prospettiva “interna” rispetto ai temi in questione. A partire da una ricerca bibliografica nella banca dati PubMed, con le parole chiave “medical humanities” e “caring”, si analizzerà il significato di questi termini in alcuni ambiti sanitari, esaminando se e perché le medical humanities vengono considerate un valido metodo per formare professionisti con competenze di caring. (...) Nelle conclusioni si discuteranno il potenziale e i limiti di una formazione alla competenza di caring basata sulle medical humanities, mettendo in luce come tale competenza possa essere sviluppata anche e soprattutto a partire dalla riflessione sulla pratica clinica e, soprattutto, dalle relazioni con i docenti. Infine, verrà proposta come altrettanto cruciale la cura con cui i formatori allestiscono il dispositivo educativo dei professionisti sanitari.The aim of this paper is to explore the role of the humanities in training caringcompetencies in the international medical literature, giving an “internal” perspective about these topics. Starting from a bibliographic research in PubMed data source, with the key words “medical humanities” and “caring”, it will be analyzed the meaning of these expressions in some healthcare professional fields, exploring if and why medical humanities are considered a suitable method to train operators to the caring work. Conclusively, the strengths and limitations of training caring competencies through medical humanities will be discussed, clarifying that these competencies can also be improved by reflecting on clinical practice, and, moreover, by the relationship that teachers establish with their students. Finally, a caring attitude in setting up the educational environment of the healthcare professionals will be introduced as a paramount competence, too. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deep Listening and Virtuous Friendship:Spiritual Care in the Context of Religious MultiplicityDuane R. BidwellA monk asked Zen master Yunmen: “What is the teaching of the Buddha’s entire lifetime?” Yunmen answered:“An appropriate response.”1In a pivotal scene from the 1988 film A Fish Called Wanda, con artist Wanda Gershwitz is fed up—finally—with her partner, Otto West. When his jealousy and ersatz intellectualism repeatedly jeopardize their attempts to steal $20 million (...) in diamonds, Wanda yells: “Now let me correct you on a few things, okay? Aristotle was not Belgian. The central message of Buddhism is not ‘Every Man for Himself.’ And the London Underground is not a political movement. Those are all mistakes, Otto, I looked them up.”2 It’s a funny moment, of course. But Otto’s (mis)understanding of Gautama’s teaching demonstrates a challenge in translating a spiritual-religious tradition from one cultural setting to another. Too often, and usually without intention, we are like Otto; we colonize and domesticate unfamiliar ideas, assimilating them into our existing worldview instead of experiencing and accommodating their challenging differences. Otto’s facile appropriation of Buddhism confirms rather than confronts his pre-critical, individualistic, and perhaps Darwinist worldview. A Buddhist caregiver might say that Otto was not “listening deeply” to the myriad voices that shaped his perspective.Similar hazards face someone writing about deep listening in relation to religious multiplicity.3 Deep listening, as a caring practice, “belongs” to the emerging field of Buddhist contemplative care,4 in which it has a technical (although perhaps undertheorized) usage richly informed by Buddhist thought and practice. But when I reflect as a pastoral theologian and spiritual caregiver trained in the Christian traditions of cura animarum, the cure or care of souls, deep listening can become unmoored from its origins. Someone marinated in the discourses and practices of Christian care can easily and perhaps unintentionally conflate deep listening with classic Christian [End Page 3] concepts of care such as the ministry of presence, the practice of unconditional positive regard,5 and the giving of oneself to God for the sake of the care seeker. Although I identify as a Buddhist Christian, habitual Christian views shape my thinking the way a canyon or streambed shapes the flow of water; unless I am attentive to the ways that Buddhist thought and practice seek fissures and carve new channels through the sediment of Christian spiritual care, I risk appropriating or erasing the practices that Buddhist caregivers call deep listening.Mindful of these waters, I want to immerse myself and readers in a particular question: In the context of spiritual care, what happens at the confluence of deep listening and a practitioner’s multiple religious voices? In responding to this question I have three aims: to describe deep listening, to provide a theoretical and experiential account of deep listening in the context of religious multiplicity, and to suggest an image from the Pāli canon that can help practitioners engage religious multiplicity in ways that minimize harm, increase compassion, and realize wisdom. A particular moment in spiritually integrative psychotherapy serves as a touchstone for my reflection; thus, I begin where the canyon creates a slender and fast-moving channel for deep listening: psychotherapy with Julie.6violence, karma, and compassionAt twenty-seven years of age, Julie was a soft-spoken, biracial graduate student who radiated mindful presence. She identifies as Asian American, and with her shaved head and tendency to wear dark colors and dramatic scarves, she might seem a typical LA hipster to other passengers on the commuter train she rode to and from our appointments. One year before our psychotherapeutic work, Julie had been beaten and raped by a boyfriend; subsequent thoughts of suicide led to a brief hospitalization. At that time she was assigned diagnoses of bipolar II and post-traumatic stress disorders. Daily, she swallowed a powerful mood stabilizer; monthly, she visited a psychiatrist. The symptoms of bipolar disorder, substance abuse, addiction, schizophrenia, depression, and suicide were present in her extended family. Julie sought counseling because of tension between what she called her “Buddhist identity” and the mental health diagnoses assigned to her. She said she... (shrink)

O objetivo deste artigo é analisar a ética do cuidado de enfermagem no tratamento de pacientes oncológicos. Optou-se pela pesquisa bibliográfica de abordagem qualitativa cuja metodologia foi dividida em etapas. Na primeira etapa, foi realizado um levantamento de artigos publicados, no período de 2000 a 2009, em periódicos do Scielo, utilizando os descritores: saúde/doença, enfermagem, ética do cuidado e oncologia. Esse levantamento culminou com a seleção de 28 artigos, 21 dos quais foram eleitos posteriormente para leitura aprofundada, assim como para (...) utilização no estudo. Na segunda etapa, foram explorados dados do campo, com a transcrição e análise de depoimentos de profissionais da enfermagem sobre a concepção de cuidado bem como de dados sobre pacientes oncológicos, acompanhados no período de 2007 e 2008. A pesquisa e suas exigências protocolares, sob o número CAAE - 0147.0.213.000-10, foi aprovada pelo Comitê de Ética da PUC Minas em 31 de agosto de 2010. O referencial teórico foi composto por autores que discutem o cuidado na perspectiva filosófica e teológica - Boff (2001, 2005 e 2006), Efken (2005) - e autores da área da saúde oncológica, entre eles, Carvalho et al. (2002), Popim & Boemer (2005), Visentin, Labronici & Lenardt (2007) e Araújo et al. (2009). Os resultados evidenciaram o cuidado na enfermagem como princípio ético essencial, assim como a necessidade de investimentos em políticas públicas de saúde no Brasil, que efetivem o trabalho de prevenção, educação e cura do câncer. Palavras-Chave: Saúde/Doença; Enfermagem; Ética do cuidado; Oncologia.The objective of this article is to analyze the nursing care in the treatment of oncology patients. We have opted for bibliographical research of qualitative nature, a methodology divided into stages. In the first stage we gathered articles in a publication called Scielo from 2000 to 2009, which described: health/illness, nursing, ethics of care, and oncology. Through this process the selection of twenty-eight articles was accomplished, however only twenty-one articles were utilized in the production of this study. In the second stage field data were explored, we transcribed and analyzed the statements of nursing professionals on the conception of care and on oncology patients overseen by them in the period of 2007 to 2008. The research protocol and its requirements under the number CAAE - 0147.0.213.000-10, was approved by the Ethics Committee of PUC Minas on August 31, 2010. The theoretical support was provided by authors who discuss care in a philosophical and theological perspective: Boff (2001, 2005, and 2006), Efken (2005); and authors in the field of healthcare, among them Popim & Boemer (2005), Silva et. al , (2005), Souza et al. (2005), Visentin, et al. (2007), and Araújo, et. al. (2008). The results demonstrated the care in nursing as an essential ethical principal, as much as the necessity of investment in public health policies in Brazil, for the effective promotion of cancer prevention, education and cure. Key words : Health/Illness; Nursing; Ethics of Care; Oncology. (shrink)

In Homo Sacer, Giorgio Agamben criticizes Michel Foucault's distinction between 'productive' bio-power and 'deductive' sovereign power, emphasizing that it is not possible to distinguish between these two. In his view, the production of what he calls 'bare life' is the original, although concealed, activity of sovereign power. In this article, Agamben's conclusions are called into question. (1) The notion of 'bare life', distinguished from the 'form of life', belongs exclusively to the order of sovereignty, being incompatible with the modern bio-political (...) notion of life, that is univocal and immanent to itself. In the era of bio-politics, life is already a bios that is only its own zoe ('form-of-life'). (2) Violence is not hidden in the foundation of bio-politics; the 'hidden' foundation of bio-politics is love (agape) and care (cura), 'care for individual life'. (3) Bio-politics is not absolutised in the Third Reich; the only thing that the Third Reich absolutises is the sovereignty of power (Aryan race) and the nakedness of life (the Jews). (4) St Paul's 'messianic revolution' does not endow us with the means of breaking away from the closure of bio-political rationality; on the contrary, Paul's 'messianic revolution' is a historical precondition for the deployment of modern bio-politics. (5) Instead of homo sacer, who is permitted to kill without committing homicide, the paradigmatic figure of the bio-political society can be seen, for example, in the middle-class Swedish social-democrat. (shrink)

This article discusses an approach to translational bioethics (TB) that is concerned with the adaptation—or ‘translation’—of concepts, theories and methods from bioethics to practical contexts, in order to support ‘non-bioethicists’, such as researchers and healthcare practitioners, in dealing with their ethical issues themselves. Specifically, it goes into the participatory development of clinical ethics support (CES) instruments that respond to the needs and wishes of healthcare practitioners and that are tailored to the specific care contexts in which they are to (...) be used. The theoretical underpinnings of this participatory approach to TB are found in hermeneutic ethics and pragmatism. As an example, the development of CURA, a low-threshold CES instrument for healthcare professionals in palliative care, is discussed. From this example, it becomes clear that TB is a two-way street. Practice may be improved by means of CES that is effectively tailored to specific end users and care contexts. The other way around, ethical theory may be enriched by means of the insights gained from engaging with practice in developing CES in a process of co-creation. TB is also a two-way street in the sense that it requires collaboration and commitment of both bioethicists and practitioners, who engage in a process of mutual learning. However, substantial challenges remain. For instance, is there a limit to the extent to which a method of moral reasoning can be adapted in order to meet the constraints of a given healthcare setting? Who is to decide, the bioethicist or the practitioners? (shrink)

The article which is presented here includes an analysis of concept of “care” which mostly has found itself a place in history of philosophy in different forms. Even though thinkers who gave a place to this concept in their works, the main interest is about what Herder and Heidegger said. It has been tried to show how concept of “care” is understood throughout the history of philosophy. Lastly, it has been tried if there is a possible and genuine (...) interpretation. (shrink)

Moral distress forms a major threat to the well-being of healthcare professionals, and is argued to negatively impact patient care. It is associated with emotions such as anger, frustration, guilt, and anxiety. In order to effectively deal with moral distress, the concept of moral resilience is introduced as the positive capacity of an individual to sustain or restore their integrity in response to moral adversity. Interventions are needed that foster moral resilience among healthcare professionals. Ethics consultation has been proposed (...) as such an intervention. In this paper, we add to this proposition by discussing Moral Case Deliberation (MCD) as a specific form of clinical ethics support that promotes moral resilience. We argue that MCD in general may contribute to the moral resilience of healthcare professionals as it promotes moral agency. In addition, we focus on three specific MCD reflection methods: the Dilemma Method, the Aristotelian moral inquiry into emotions, and CURA, a method consisting of four main steps: Concentrate, Unrush, Reflect, and Act. In practice, all three methods are used by nurse ethicists or by nurses who received training to facilitate reflection sessions with these methods. We maintain that these methods also have specific elements that promote moral resilience. However, the Dilemma Method fosters dealing well with tragedy, the latter two promote moral resilience by including attention to emotions as part of the reflection process. We will end with discussing the importance of future empirical research on the impact of MCD on moral resilience, and of comparing MCD with other interventions that seek to mitigate moral distress and promote moral resilience. (shrink)

Botticelli and Tizian depict the Annunciation in two very different ways. Botticelli portrays a kneeling angel in an act of guiding from below, while Tizian represents an angel imposing himself from above with an authoritarian forefinger. Botticelli's painting suggests an intention of orientation that is not authoritarian yet able to bring about a transformation (Umbildung). It also suggests that an individual's transformation cannot be achieved in a closed solipsistic dimension, but requires a disclosure from otherness. My theory is that at (...) the origin of ethics there is a non-authoritarian way of orientation that comes from otherness and arises from the emotional sphere thanks to a "care of desire". The expression cura sui has often been interpreted as a care confined to a private and solipsistic dimension with the aim of strengthening the self-referential subject. By "care of desire" I mean a care not turned upon itself but made possible by a disclosure coming from otherness and addressed to the transformation of the individual and of society. In the human existence, emotions reveal an extraordinary plasticity. They are not already regulated by instinct but develop and get to maturity even many years after biological birth. Moreover, this maturation process does not follow a universal process identical for everyone, being different for every individual. In fact it finds its realization in the unique order of feelings (ordo amoris) that characterizes every individual. Emotions guide actions and the way we interact with the others and with the world. In the human existence they become plastic and don't have only a homeostatic function of self-regulation. They give flexibility to our way of perceiving, of existing and of taking our position in the world. The care of desire is dedicated to the plasticity of emotions and makes ethics, i.e. a person's formation process (Bildung) and flourishing, possible. It also allows the transition from the “environmental closedness” (Umweltgeschlossenheit) to the world-openness (Weltoffenheit). To sum up, the care of desire implies the transition from a solipsistic self-care to a “care for world-openness”. From this point of view, emotion is no more the secondary result of a cognitive process, but at the origin of every formative, perceptive and cognitive process: In the beginning was the emotion. Yet in this process of creative transformation not every emotion has the same significance: at the core of emotions’ plasticity there are love and wonder (thaumàzein), whose peculiar feature is “lack of envy” (aphthonoi). (shrink)