This unique volume explores what ethics has to offer the practicing physician, nurse, and allied health care worker. The authors introduce the basic vocabulary of ethics and present and discuss the most commonly used ethical theories, using case studies to illustrate how ethics work within the context of health care. Newcomers to the field will learn what ethics is all about and how it relates to the pragmatic concerns of the health care professional. Those who already have (...) a working knowledge of the field will find a new approach to ethical theory--personalism--which the authors believe can make the practical use of ethics more effective and reliable. (shrink)

According to the most important theories of justice, personal dignity is closely related to independence, and the care that people with disabilities receive is seen as a way for them to achieve the greatest possible autonomy. However, human beings are naturally subject to periods of dependency, and people without disabilities are only “temporarily abled.” Instead of seeing assistance as a limitation, we consider it to be a resource at the basis of a vision of society that is able (...) to account for inevitable dependency relationships between “unequals” ensuring a fulfilling life both for the carer and the cared for.**. (shrink)

Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. A nationwide cross-sectional survey among older care allowance recipients in private households in Austria was conducted in 2016. In computer-assisted personal interviews, 493 respondents were asked whether or not (...) they approved of the availability of assisted suicide and euthanasia in case of long-term care dependency and whether or not they would consider using assisted suicide or euthanasia for themselves. Multiple logistic regression analysis was used to assess the impact of potential determinants of attitudes towards assisted suicide and euthanasia. About a quarter of the sampled care-dependent older adults approved of the availability of assisted suicide and euthanasia respectively indicated the will to make use of assisted suicide or euthanasia. Attitudes towards assisted suicide were most favourable among care-dependent older adults living in urban areas, those who did not trust physicians, those who reported active suicide ideation, and individuals with a strong fear of dying. With regard to euthanasia, living alone, religiosity and fear of dying were the central determinants of acceptance. Positive attitudes towards and will to use assisted suicide and euthanasia were expressed by a substantial minority of care-dependent older adults in Austria and are driven by current psychological suffering and fear of the process of dying in the future. Community-based psychosocial care should be expanded to address psychological distress and fears about end-of-life issues among care-dependent older adults. (shrink)

Background Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. Methods A nationwide cross-sectional survey among older care allowance recipients in private households in Austria was conducted in 2016. In computer-assisted personal interviews, 493 respondents were asked whether (...) or not they approved of the availability of assisted suicide and euthanasia in case of long-term care dependency and whether or not they would consider using assisted suicide or euthanasia for themselves. Multiple logistic regression analysis was used to assess the impact of potential determinants of attitudes towards assisted suicide and euthanasia. Results About a quarter of the sampled care-dependent older adults approved of the availability of assisted suicide and euthanasia respectively indicated the will to make use of assisted suicide or euthanasia. Attitudes towards assisted suicide were most favourable among care-dependent older adults living in urban areas, those who did not trust physicians, those who reported active suicide ideation, and individuals with a strong fear of dying. With regard to euthanasia, living alone, religiosity and fear of dying were the central determinants of acceptance. Conclusions Positive attitudes towards and will to use assisted suicide and euthanasia were expressed by a substantial minority of care-dependent older adults in Austria and are driven by current psychological suffering and fear of the process of dying in the future. Community-based psychosocial care should be expanded to address psychological distress and fears about end-of-life issues among care-dependent older adults. (shrink)

It is a common view that artificial systems could play an important role in dealing with the shortage of caregivers due to demographic change. One argument to show that this is also in the interest of care-dependent persons is that artificial systems might significantly enhance user autonomy since they might stay longer in their homes. This argument presupposes that the artificial systems in question do not require permanent supervision and control by human caregivers. For this reason, they need the (...) capacity for some degree of moral decision-making and agency to cope with morally relevant situations (artificial morality). Machine ethics provides the theoretical and ethical framework for artificial morality. This article scrutinizes the question how artificial moral agents that enhance user autonomy could look like. It discusses, in particular, the suggestion that they should be designed as moral avatars of their users to enhance user autonomy in a substantial sense. (shrink)

Caring for Liberalism brings together chapters that explore how liberal political theory, in its many guises, might be modified or transformed to take the fact of dependency on board. In addressing the place of care in liberalism, this collection advances the idea that care ethics can help respond to legitimate criticisms from feminists who argue that liberalism ignores issues of race, class, and ethnicity. The chapters do not simply add care to existing liberal political frameworks; rather, (...) they explore how integrating dependency might leave core components of the traditional liberal philosophical apparatus intact, while transforming other aspects of it. Additionally, the contributors address the design of social and political institutions through which care is given and received, with special attention paid to non-Western care practices. This book will appeal to scholars working on liberalism in philosophy, political science, law, and public policy, and it is a must-read for feminist political philosophers. (shrink)

Respecting the autonomy of disabled people is an important ethical issue for providers of long-term care. In this influential book, George Agich abandons comfortable abstractions to reveal the concrete threats to personal autonomy in this setting, where ethical conflict, dilemma and tragedy are inescapable. He argues that liberal accounts of autonomy and individual rights are insufficient, and offers an account of autonomy that matches the realities of long-term care. The book therefore offers a framework for carers to develop (...) an ethic of long-term care within the complex environment in which many dependent and aged people find themselves. Previously published as Autonomy and Long-term Care, this revised edition, in paperback for the first time, takes account of recent work and develops the author's views of what autonomy means in the real world. It will have wide appeal among bioethicists and health care professionals. (shrink)

Dependency care is an asymmetric good; everyone needs to receive it, but it is not the case that we all have to provide it. Despite ethicists’ of care’s theorizing about the importance of dependency care, it has yet to be theorized within a form of liberalism. This paper theorizes two components of a liberal theory of dependency care. First, it advances a liberal justification to include the receipt of dependency care among (...) the benefits of social cooperation. Then, it advances an autonomy-based principle to guide how care should be provided (“strong proceduralism”). Strong proceduralism is based on an account of autonomy that incorporates the significance of a person’s skills when he parses options. Strong proceduralism consequently requires educational efforts to teach care-giving skills to groups who have not previously possessed them. I hypothesize that strong proceduralism will secure adequate care provision as the outcome of autonomous choice, but if an inadequate number of people choose to provide care, then a secondary stage of deliberations will be necessary. If the outcome of those secondary deliberations is that people want to have their care needs met, then a fair process for distributing infringements on autonomy must be devised. (shrink)

ABSTRACT People who are paid to provide basic care for others are frequently undervalued, exploited and expected to reach often unrealistic standards of care. I argue that appropriate social recognition, support and fair pay for people who provide care for those who are disabled, frail and aged, or suffering ill health that impedes their capacity to negotiate daily activities without support, depends on a reconsideration of the paradigm of the citizen or and moral agent. I argue that (...) by drawing on the ideas of human vulnerability and dependency as central to our personhood, a more realistic conception of selves, citizens and persons can be developed that better recognises the inevitability of human dependency and the social value of care work. I also indicate the significance of this vulnerability‐focussed view for ethical evaluation of the emotional aspects of care relationships. (shrink)

This book presents the first systematic account of dependency care in a liberal theory of justice. Despite the fact that receiving dependency care is necessary for human survival, the practices with which we meet society’s care needs are seldom recognized for their functional role. Instead, norms about gender and race obscure and shape expectations about whose needs for care are legitimate as well as about whose caregiving labor more advantaged members of society will receive. (...) These opaque arrangements must be made visible if we are to remedy skewed intuitions and judgements about care. Freedom to Care develops a modified form of social contract theory with which to evaluate society’s caregiving arrangements. Building on work by feminist liberals and care ethicists, it reframes debates about care to move beyond gender with an inequality-tracking framework that can be employed in any culture. Because care provision has been enmeshed in the subordination of women and people of color, eliminating the invisibility of these forms of labor yields a critical liberal theory of justice with feminist and anti-racist aims. (shrink)

This essay responds to Jan Narveson’s libertarian commentary on my earlier work “Liberal Dependency Care.” There, I argued that the underlying logic of the circumstances of justice warrants adding care to a liberal theory of justice. In this essay, I rebut Narveson’s skeptical claims about the liberal credentials of my justificatory argument by identifying the extent to which my view shares the same reasonable constraints on liberty as those defended by John Stuart Mill. I also suggest that (...) a libertarian refusal to add care to the core functions of the state is plausible only if women’s labor remains invisible. Finally, I refute Narveson’s contention that my strong procedural principle of care provision is incipiently totalitarian. The case for public support to teach basic levels of attentiveness and responsiveness is analogous to the case for teaching the foundational skills of arithmetic, which are legitimately taught in primary and secondary schools. (shrink)

In this essay, Ben-Porath begins from the assumption that just war theory should be extended to include a jus post bellum component. Postwar conduct should be significantly informed by a care ethics perspective, particularly its political aspects as developed by Joan Tronto and others. Care ethics should be extended to the international postwar arena with one significant amendment, namely, weakening the aim of ending dependence.

How do we theorize the experiences of caregivers abused by their children with autism without intensifying stigma toward disability? Eva Kittay emphasizes examples of extreme vulnerability to overturn myths of independence, but she ignores the possibility that dependents with disabilities may be vulnerable and aggressive. Instead, her work over-emphasizes caregivers' capabilities and the constancy of disabled dependents' vulnerability. I turn to Judith Butler's ethics and her conception of the self as opaque to rethink care amid conflict. Person-centered planning approaches, (...) pioneered by disability rights activists, merge Butler's analysis of opacity with Kittay's work on embodied care, while also inviting a broader network of people to both interpret needs and change communities. By expanding our conceptions of dependency, feminist disability studies can continue the aim of both Kittay and Butler: to humanize unintelligible lives. (shrink)

In this essay, Ben-Porath begins from the assumption that just war theory should be extended to include a jus post bellum component. Postwar conduct should be significantly informed by a care ethics perspective, particularly its political aspects as developed by Joan Tronto and others. Care ethics should be extended to the international postwar arena with one significant amendment, namely, weakening the aim of ending dependence.

In this essay, Ben-Porath begins from the assumption that just war theory should be extended to include a jus post bellum component. Postwar conduct should be significantly informed by a care ethics perspective, particularly its political aspects as developed by Joan Tronto and others. Care ethics should be extended to the international postwar arena with one significant amendment, namely, weakening the aim of ending dependence.

Eoin Carney | : Continuing on from recent discussions on the overlap between Paul Ricoeur’s philosophy and care ethics, this article will aim to clarify the status of practice in Ricoeur’s work. I will argue that even though Ricoeur’s philosophy is indeed marked by its “desire for a foundation,” as care ethicist Joan Tronto has pointed out, this aim is more of a fragile wager than a principle, and is always at risk of being overturned by practices and (...) other worldviews. I will demonstrate this point by arguing that Ricoeur’s hermeneutic approach to practice leads to the view that objective methods of knowledge and explanation are always grounded by the broader hermeneutic task of practical understanding and care for the self; in moral reasoning, Ricoeur’s analysis of the conflict between respect for the rule and respect for persons results in his prioritizing of respect for the singular other rather than the universal rule, meaning that the other can always disrupt and reorient universal or foundational modes of reasoning; and finally within healthcare relations Ricoeur aims to develop an alternative understanding of respect that places it in a dialectical relation with care. These practice-oriented readings of hermeneutics, morality, and respect aim to open up a dialogue between care ethics and philosophical approaches that have often been placed outside of care ethics. | : Poursuivant les récentes discussions concernant les recoupements entre la philosophie de Paul Ricoeur et les éthiques du care, cet article a pour objectif de clarifier le statut de la pratique dans l’oeuvre de Ricoeur. Je soutiendrai que même si la philosophie ricoeurienne est bien marquée par un « désir d’un fondement », ainsi que l’éthicienne du care Joan C. Tronto le souligne, cet objectif repose plus sur un pari que sur un véritable principe, et risque toujours d’être renversé par les pratiques ou d’autres visions du monde. Je démontrerai cela en soutenant trois arguments. 1) L’approche herméneutique de Ricoeur concernant la pratique mène à penser que les méthodes objectives de connaissance et d’explication sont toujours soutenues par une tâche herméneutique plus large de la compréhension pratique et du souci de soi. 2) En ce qui a trait au raisonnement moral, l’analyse de Ricoeur sur le conflit entre le respect de la règle et le respect de la personne accorde la priorité au respect de l’autre singulier plutôt que de la règle universelle. Ainsi, l’autre peut toujours perturber et réorienter l’universel ou les modes fondateurs du raisonnement. 3) Réfléchissant aux relations thérapeutiques, Ricoeur tend à suggérer une nouvelle compréhension du respect qui se place dans une relation dialectique avec le souci. Ces lectures – de l’herméneutique, de la moralité et du respect – orientées vers la pratique ouvrent la voie à un dialogue entre les éthiques du care et des approches philosophiques que l’on considère souvent éloignées de celles-ci. (shrink)

RésuméLes soins sont cruciaux pour toute société ; cependant, les théories de la justice les ignorent souvent dans leur analyse. La théorie d'Asha Bhandary sur la prise en charge libérale de la dépendance cherche autant à rectifier l'invisibilité des soins qu’à défendre les principes de justice concernant les modalités de soins en revendiquant plusieurs modifications importantes à la théorie de la justice de John Rawls. Dans cet article, j'analyse les modifications de Bhandary à la théorie de Rawls pour examiner comment (...) la prise en charge libérale de la dépendance s'intègre dans un cadre politique libéral plus large, tout en protégeant contre l'oppression. J’évalue également la licéité et les limites de l'enseignement de l'autonomie et des habiletés de soins aux enfants dans une société politiquement libérale. (shrink)

The fight for emancipation takes place on different levels, and one of them is the level of contemporary financial capitalism as debt-economy. Debt can be a major tool of control and exploitation in that it produces subordinate subjects situated in exchange relations of debt and credit. Recent work on financial debt and the debt-economy has, however, not taken gender adequately into account in philosophical definitions of indebted subjects. Gender analysis discloses how the debtor–creditor relationship is based on a contractarian idea (...) of the indebted subject as an autonomous moral agent, and on a masculine, that is, a-relational understanding of what counts as debt and what does not in the contemporary debt-economy. In contrast to atomistic notions of the subject in liberal, contractarian theories, relational notions of the subject as advanced in care ethics are a better point of departure for capturing the interdependence of subjects within a debt-economy as a core feature of a nonsustainable monetary system. On the basis of such analysis, care ethics also offers means for imagining ways of emancipation from private and public problem credit in order to make financial systems more sustainable and more just. (shrink)

RésuméJohn Rawls et Asha Bhandary utilisent les conditions de justice définies par David Hume pour encadrer le choix de la position originale à partir de laquelle les principes de justice sont sélectionnés. Utiliser les conditions de Hume de cette manière exclut de la représentation ceux qui ne sont pas des coopérateurs à part entière, y compris les personnes qui ont besoin de soins de dépendance pendant toute la vie. Cela implique que la demande de soins de ces personnes n'est pas (...) une revendication fondamentale de justice, mais qu'elle doit avoir une priorité nettement inférieure. Cet article soutient qu'une théorie libérale appropriée de la prise en charge de la dépendance abandonnera ce cadrage humien et traitera la demande de prise en charge de la dépendance comme une exigence fondamentale de justice. (shrink)

Perhaps the change of title says it all. This is the revised edition of Agich’s Autonomy and Long Term Care, which was itself a seminal work. The new title gives us the main drift: if autonomy is important in old age, so too is dependence. Indeed, in the actual world in which Agich is keen to locate his study, autonomy and dependence intermingle as inescapable features of old age for real people. As he says: “Maintaining a sense of autonomous (...) wellbeing is consistent with dependencies on medication or professional care if those dependencies help to maintain a more basic sense of functional integrity in those areas of life that individuals value” .The present book retains and renews its standing as a first rate work in the field of philosophical medical ethics. It aims “to sketch a framework for respecting autonomy in long term care”, rather than to work out practical guidelines . Nevertheless, its strength lies in Agich’s ability to move from the real world of often dependent older people to the philosophical underpinnings of our thinking about how we care for them. In so doing, Agich mounts a powerful attack on what he sees as a prevailing tendency in bioethics. It is the tendency to define autonomy “primarily in terms of a concept of human persons as rational, independent agents and decision makers, who are assumed to be competent and who can be understood without serious reference to society or history” . As he says: “Influenced by liberal theory, autonomy is often treated in bioethics as a concept that primarily applies to the public realm …. (shrink)

This author’s reply addresses critiques by Daniel Engster, Kelly Gawel, and Andrea Westlund about my 2020 book, Freedom to Care: Liberalism, Dependency Care, and Culture. I begin with a statement of my commitment to liberalism. In section two, I defend the value of a distinction between conceptions of persons in the real world and in contract theory to track inequalities in care when indexed to legitimate needs. I argue, as well, that my variety of contract theory (...) supplies the normative content needed to reject the subordination of women of color. Acknowledging the enduring danger of expressive subordination, I emphasize my theory’s compatibility with the full social inclusion of people with disabilities. Section three then defends liberal dependency care’s compatibility with radical critique and transformative change by emphasizing the abstract nature of its core theoretical module. Finally, in section four, I reaffirm conceptual distinctions between autonomy skills, care skills, and a sense of justice by explicating their theoretical roles. In that section, I also embrace Westlund’s insight that theorists of justice need to have skills enabling responsiveness to other perspectives. To this new requirement for actual theorists of justice, I further add that we must attain capacities to engage critically with our society’s norms. Thus, the final section of this article supplements the justificatory module of liberal dependency care, building from the necessary conditions specified as two-level contract theory toward an account of necessary and sufficient conditions for this liberalism’s justificatory module. (shrink)

the arguments in their favour are weak. Arguments based on reciprocity fail to explain why only means-tested public benefits should be subject to work requirements, and why unpaid dependant care work should not count as satisfying citizens’ obligations to reciprocate. Argu- ments based on promoting the work ethic misattribute recipients’ nonwork to deviant values, when their core problem is finding steady employment consistent with supporting a family and meeting dependant care responsibilities. Rigid work requirements impose unreasonable costs on (...) some of the poor. A welfare system based on a rebuttable presumption that recipients will work for pay, conjoined with more generous work supports, would promote justice better than either unconditional welfare or strict requirements [1]. (shrink)

Aging populations have become a major concern in the developed world and are expected to require novel care strategies. Public policies, health-care regimes and technology developers alike stress the need for a more individualized care to meet the increased demand for care services in response to demographic change. Increasingly, care services are offered to individuals with diseases and or disabilities in their homes by means of Personalized Health-Monitoring (PHM) technologies. PHM-based home care is typically (...) portrayed as the key to a cost-effective future care that better can accommodate the needs of an aging population and promote care recipients’ independence. In light of the emerging technology-based home care, this article sets forth to investigate the significance and implications of a strong emphasis on independence in relation to this novel care form. Notions of independence as used by care planners, care providers and technology developers are examined in relation to ICT-based home care and the reasonableness of independence as an aim for future health-care is critically discussed. In conclusion, the need for a shift from a strong emphasis on independence to a right to healthy dependence is advocated. (shrink)

Answering the question of whether and how liberalism could acknowledge dependency and foster just care arrangements—with a sensitivity to issues of race, class.

In this article I review the contested terrain of relationality, dependency and care within contemporary disability studies and feminist care theory. I begin and end with short personal nar...

Despite recent efforts to improve on counterfactual theories of causation, failures to explain how effects depend on their causes are still manifest in a variety of cases. In particular, theories that do a decent job explaining cases of causal preemption have problems accounting for cases of causal intransitivity. Moreover, the increasing complexity of the counterfactual accounts makes it difficult to see why the concept of causation would be such a central part of our cognition. In this paper, I propose an (...) account of our causal thinking that not only explains the hitherto puzzling variety of causal judgments, but also makes it intelligible why we would employ such an elusive concept. (shrink)

This essay considers the dependency of trans youth by bridging transgender studies with feminist care ethics to emphasize a trans wisdom about solidarity through dependency. The first major section of the essay argues for reworking Sara Ruddick's philosophy of mothering in the context of trans and gender‐creative youth. This requires, first, stressing a more robust interaction among her divisions of preservative love, nurturance for growth, and training for acceptability, and second, creating a more nuanced account of “nature” (...) in relation to nurturance for growth to avoid casting transition as contrary to a trans youth's healthy development. In the second major section of the essay, I depart from Ruddick's framework to emphasize the difference of care for trans youth by trans and/or queer communities and through mutual caregiving, stressing a trans wisdom about dependency and solidarity found in the work of Sylvia Rivera and Marsha P. Johnson. Turning to Eva Feder Kittay's links between dependency work and equality, I argue that Rivera and Johnson's work contains a distinct knowledge derived from practice necessitating the connection between solidarity and dependency in particular communities. I then call for more work on trans care ethics, trans ethics, and trans wisdom more broadly. (shrink)

This author’s reply addresses critiques by Daniel Engster, Kelly Gawel, and Andrea Westlund about my 2020 book, Freedom to Care: Liberalism, Dependency Care, and Culture. I begin with a statement of my commitment to liberalism. In section two, I defend the value of a distinction between conceptions of persons in the real world and in contract theory to track inequalities in care when indexed to legitimate needs. I argue, as well, that my variety of contract theory (...) supplies the normative content needed to reject the subordination of women of color. Acknowledging the enduring danger of expressive subordination, I emphasize my theory’s compatibility with the full social inclusion of people with disabilities. Section three then defends liberal dependency care’s compatibility with radical critique and transformative change by emphasizing the abstract nature of its core theoretical module. Finally, in section four, I reaffirm conceptual distinctions between autonomy skills, care skills, and a sense of justice by explicating their theoretical roles. In that section, I also embrace Westlund’s insight that theorists of justice need to have skills enabling responsiveness to other perspectives. To this new requirement for actual theorists of justice, I further add that we must attain capacities to engage critically with our society’s norms. Thus, the final section of this article supplements the justificatory module of liberal dependency care, building from the necessary conditions specified as two-level contract theory toward an account of necessary and sufficient conditions for this liberalism’s justificatory module. (shrink)

Dependency functions as a keyword in care theory. However, care theorists have spelled out the ontological and moral ramifications of dependency in different and often conflicting ways. In this article, I argue that conceptual disputes about dependency betray a fundamental discordance among authors, rooted in the empirical premises of their arguments. Hence, although authors appear to share a vocabulary of dependency, they are not writing about quite the same phenomenon. I seek to elucidate these (...) differences by teasing out and comparing different conceptions of dependency found in the literature. Borrowing a phrase from Eva Kittay, I trace four “paradigm cases” of dependency: the infant, the physically disabled person, the profoundly intellectually disabled person, and the refugee. These paradigm cases serve as the empirical touchstone from which theorists extract their conceptions of dependency. Each paradigm case, moreover, permits a particular ethical sensibility toward care. How we understand and value dependency thus seems to determine how we understand and value care, and vice versa. In this way, I contend, our normative orientation toward care might influence what sorts of dependency we see—and, by extension, which forms of dependency we fail to notice. (shrink)

The essays of this volume consider how acknowledgement of the fact of dependency changes our conceptions of law, political theory, and morality, as well as our very conceptions of self.

Asha Bhandary’s Freedom to Care represents an important challenge to the idea that care ethics and liberalism necessarily stand in tension, arguing instead that most of the commitments of care ethics can be integrated within a recognizably mainstream liberal contract theory. Although I am sympathetic to Bhandary’s project, I identify three ways in which it falls short: Bhandary’s thin moral premises fail to support decent care for all; her survival baseline principle of care does not (...) support some important forms of care; and her proceduralist approach offers little alternative other than coercion for assuring sufficient care for all. I argue a thicker set of moral assumptions based on the importance of decent care for all are necessary for reconciling liberalism and care ethics on more equal terms. (shrink)

Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis. It (...) is hard to reliably identify these patients on admission and more research is needed to better understand the unique medical needs of this population. But the inability to safely discharge these patients to their home or to a skilled nursing facility without rapid readmissions also creates ethical implications for the physicians who care for them. The aim of this paper is to clarify some of the ethical considerations involved in caring for hospital-dependent patients. Among physicians, the care of hospital-dependent patients is likely to disproportionately affect hospitalists and intensivists, whose care is often evaluated in terms of reducing patient length of stay and readmissions. Because hospital-dependent patients’ medical needs thwart the traditional goal of safe discharge, both clinical ethics and physicians’ professional obligations are implicated by their care. The inability to reliably identify these patients early can complicate discussions about treatment goals and informed consent. Similarly, the tremendous dedication of limited resources to these patients without safe discharge back to the community may raise concerns about the just allocation of healthcare resources. Our current acute care hospitals are not designed to provide long-term care for hospital-dependent patients. Unfortunately, safe discharge options remain elusive for these patients. Further research and support of this population is needed to more reliably identify hospital-dependent patients on admission, better inform the discussions of short- and long-term treatment goals, and more wisely allocate resources both within our acute care hospitals and larger healthcare system. (shrink)

This contribution discusses Asha Bhandary’s book Freedom to Care: Liberalism, Dependency Care and Justice and engages with some key concepts used by three commentators Daniel Engster, Kelly Gawel, and Andrea Westlund in this book symposium. The symposium makes it clear that care can be a central notion not only in the ethics of care, but also in debates about liberalism, justice and autonomy.

This study attempts to identify differences in the perceptions of top management (defined as CEOs, directors, and presidents) and employees (defined as middle and supervisory management) regarding (a) the effects of dependent care responsibilities on job performance, and (b) the extent of a firm's responsibility in providing support for those faced with caring needs concerning eldercare, childcare, substance abuse, and mental/physical handicaps.The results indicate that these two groups have significantly different perceptions of the effect of dependent care responsibilities (...) on job performance, and on the firm's responsibility in providing support for three types of dependent care. (shrink)

Background Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis. (...) It is hard to reliably identify these patients on admission and more research is needed to better understand the unique medical needs of this population. But the inability to safely discharge these patients to their home or to a skilled nursing facility without rapid readmissions also creates ethical implications for the physicians who care for them. The aim of this paper is to clarify some of the ethical considerations involved in caring for hospital-dependent patients. Main body Among physicians, the care of hospital-dependent patients is likely to disproportionately affect hospitalists and intensivists, whose care is often evaluated in terms of reducing patient length of stay and readmissions. Because hospital-dependent patients’ medical needs thwart the traditional goal of safe discharge, both clinical ethics and physicians’ professional obligations are implicated by their care. The inability to reliably identify these patients early can complicate discussions about treatment goals and informed consent. Similarly, the tremendous dedication of limited resources to these patients without safe discharge back to the community may raise concerns about the just allocation of healthcare resources. Conclusion Our current acute care hospitals are not designed to provide long-term care for hospital-dependent patients. Unfortunately, safe discharge options remain elusive for these patients. Further research and support of this population is needed to more reliably identify hospital-dependent patients on admission, better inform the discussions of short- and long-term treatment goals, and more wisely allocate resources both within our acute care hospitals and larger healthcare system. (shrink)

Two studies document that people are more willing to express emotions that reveal vulnerabilities to partners when they perceive those partners to be more communally responsive to them. In Study 1, participants rated the communal strength they thought various partners felt toward them and their own willingness to express happiness, sadness and anxiety to each partner. Individuals who generally perceive high communal strength from their partners were also generally most willing to express emotion to partners. Independently, participants were more willing (...) to express emotion to particular partners whom they perceived felt more communal strength toward them. In Study 2, members of romantic couples independently reported their own felt communal strength toward one another, perceptions of their partners’ felt communal strength toward them, and willingness to express emotions to each other. The communal strength partners reported feeling toward the participants predicted the participants’ willingness to express emotion to those partners. This link was mediated by participants’ perceptions of the partner’s communal strength toward them which, itself, was a joint function of accurate perceptions of the communal strength partners had reported feeling toward them and projections of their own felt communal strength for their partners onto those partners. (shrink)