Self‐care, or self‐management, is presented in healthcare policy as a precursor to patient empowerment and improved patient outcomes. Alternatively, critiques of the self‐care agenda suggest that it represents an over‐reliance on individual autonomy and responsibility, without adequate support, whereby ‘self‐care’ is potentially unachievable and becomes ‘care left undone’. In this sense, self‐care contributes to a blame culture where ill‐health is attributed to personal behaviours or lack thereof. Furthermore, self‐care may represent a covert (...) form of rationing, as the fiscal means to enable effective self‐care and supplement, or replace, self‐care capacities, is not provided. This paper explores these arguments through a contemporary ethical analysis of the self‐care agenda. The terms self‐care and self‐management are used interchangeably throughout whereby self‐management is understood as a point in the wider self‐care continuum. (shrink)

Care left undone, interchangeably referred to as missed care, unfinished nursing care and task incompletion, is pervasive in contemporary healthcare systems. Care left undone can result in adverse outcomes for the patient, nurse and organization. The rhetoric that surrounds care left undone infers it is a contemporary nursing phenomenon; however, a seventeenth‐century Spanish nursing treatise, Instruccion de Enfermeros (Instructions for Nurses), challenges this assumption. Instruccion de Enfermeros was an instructional (...) guide that was written for members of the Congregation of Bernardino de Obregon who worked as nurses at the Madrid General Hospital. The treatise provides a historical commentary on the daily roles, responsibilities and working conditions of the Obregonian nurses. Its content and context suggest the Obregonian nursing resource was consistently time poor due to a confluence of internal and external stressors. Consequently, the Obregonians were under considerable role strain resulting in inferior patient care. This article explores the antecedents of care left undone through a historical lens using exemplars from the 1625 edition of Instruccion de Enfermeros. Factors contributing to care left undone in Obregonian nursing will then be examined to offer insights into the similarities between what a nurse suffered 400 years ago and what exists in contemporary nursing practice. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, (...) while internationally studies highlight instances of covert rationing/missed care/care left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

The concept of missed care refers to an irrefragable truth that required nursing care, which is left undone, occurs in the delivery of health care. As a technical concept, missed care offers nurses the opportunity to articulate a problematic experience. But what are we to make of missed care from an ethical perspective? Can nurses be held morally responsible for missed care? Ethically speaking, it is generally accepted that if a person has (...) a moral obligation to do something, s/he needs to have the capacity to do it. If a person does not have the capacity to fulfil a moral obligation, then s/he cannot be held responsible for failing to do so. This is captured by the “ought implies can” (OIC) principle. This paper brings the OIC principle to the forefront of the discussion on missed care. It is contended that nurses – qua moral agents – may be discharged from a moral obligation to carry out a required caring act because of some inability that is not of their making and therefore may not be morally responsible for missed care. However, the OIC principle may not be applied to all situations of missed care depending on their causes. In addition, following in the thought of Sapontzis (The Southern Journal of Philosophy, 1991, XXIX, 383–393) it is contended that when an original obligation to deliver a required act of care cannot be fulfilled, other obligations may be generated as summed up in the “Principle of Making Amends” and the “Principle of Appropriate Feeling.” It is the view of this paper that these further principles could prevent the OIC principle from being used to simply excuse omissions of care from a normative standard and could support the view that nurses continue to have alternative obligations to make amends and to respond with appropriate feelings to missed care. (shrink)

Ten nurses at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. The main theme in the narratives was being close to and moved by the suffering of patients and relatives. The nurses' responsibility for patients and relatives was expressed as a commitment to act, and they needed to ask themselves (...) whether their responsibility had been fulfilled, that nothing had been left undone, overlooked or neglected, before they could leave the unit. When there was confirmation by the patients, relatives, colleagues and themselves that the needs of patients and relatives had been attended to in a morally and professionally satisfying manner, this increased the nurses' confidence and satisfaction in their work, and their strength to live with the burden of being in ethically difficult situations. (shrink)

Care drain brings the traditional problem of carers' choice between paid work and family at a new level. Taking care drain from Romania as a case study, I analyse the consequences of parents' migration within a normative framework committed to meeting the needs of vulnerable individuals. The temporary migration of parents who cannot take their children with them involves moral harm, particularly the frustration of children's developmental and emotional needs. I use recent feminist work on justice and (...) class='Hi'>care in the economy to address the question whose responsibility it is to fill the void of care created by temporary migration. I argue that the moral issues raised by care drain are also issues of social justice and therefore call for rectification by the states involved. (shrink)

In response to the Covid‐19 pandemic, health care systems worldwide canceled or delayed elective surgeries, outpatient procedures, and clinic appointments. Although such measures may have been necessary to preserve medical resources and to prevent potential exposures early in the pandemic, moving forward, the indirect effects of such an extensive medical shutdown must not outweigh the direct harms of Covid‐19. In this essay, we argue for the reopening of evidence‐based health care with assurance provided to patients about the safety (...) and necessity of high‐value vaccinations, screenings, therapeutics, and procedures. To ensure that virtually all non‐Covid‐related services do not come to a halt again, health care systems and physician practices must preemptively increase their capacity, secure adequate personal protective equipment to safeguard health care personnel, and develop a measured approach to reclosing such routine health care, should it become necessary in the future. (shrink)

Care theory's efforts to valorize care have depended upon the development of a minimally coherent conception of “care.” Despite many disagreements, there is a shared assumption that care is the Other to concepts and activities that are male-dominated and so better paid, more powerful, and included in instead of excluded from politics. However, such an assumption ignores the other, noncaring forms of labor women do, which are likewise underpaid, exploited, and excluded from politics. This becomes a (...) problem when care theorists propose greater inclusion for care workers, for example Joan Tronto's argument to extend citizenship on the basis of care work, because it does not consider the hierarchies it may reproduce between care and its Others, especially feminized commodity production. Using Dorothy Roberts's distinction between spiritual and menial housework, I argue that care theory is susceptible to perpetuating hierarchies among women. Extending Roberts's argument, I argue that the care/noncare division of feminized labor reproduces hierarchies among women in the Global South, and between consumers and producers. Although we do not need to abandon the category of care altogether, we do need to address care's exclusions and its relationship to other forms of feminized labor. (shrink)

‘‘Undone science’’ refers to areas of research that are left unfunded, incomplete, or generally ignored but that social movements or civil society organizations often identify as worthy of more research. This study mobilizes four recent studies to further elaborate the concept of undone science as it relates to the political construction of research agendas. Using these cases, we develop the argument that undone science is part of a broader politics of knowledge, wherein multiple and competing groups (...) struggle over the construction and implementation of alternative research agendas. Overall, the study demonstrates the analytic potential of the concept of undone science to deepen understanding of the systematic nonproduction of knowledge in the institutional matrix of state, industry, and social movements that is characteristic of recent calls for a ‘‘new political sociology of science.’’. (shrink)

We wish to extend the concepts in Ray and Cooper’s (2024) article entitled “The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments” to palliat...

Modern American medicine has wedded scientific advance to a small business model of the individual practitioner, defining professionalism as technical understanding. If the profession is to survive, it must draw on older ideals of the learned professions as acting on behalf of the community, and reinvigorate a civic understanding of professional life.

The passage of the Patient Protection and Affordable Care Act on March 23, 2010, significantly changes the health care landscape. But even with the considerable expansion of insurance, many people will still lack coverage. When fully implemented, the act is designed only to cover about thirty-two million of the forty-six million uninsured Americans. Illegal aliens are specifically excluded. For others, implementation is not immediate; the so-called individual mandate, for example, does not take effect until 2014, and there are (...) exceptions for people for whom available policies are still too expensive, or who have religious objections. Once in effect, the mandate has limited penalties, and some people will choose .. (shrink)

Following the collapse of communism and the decline of Marxism, some commentators have claimed that we have reached the 'end of history' and that the distinction between Left and Right can be forgotten. In this book - which was a tremendous success in Italy - Norberto Bobbio challenges these views, arguing that the fundamental political distinction between Left and Right, which has shaped the two centuries since the French Revolution, has continuing relevance today. Bobbio explores the grounds of (...) this elusive distinction and argues that Left and Right are ultimately divided by different attitudes to equality. He carefully defines the nature of equality and inequality in relative rather than absolute terms. Left and Right is a timely and persuasively argued account of the basic parameters of political action and debate in the modern world - parameters which have remained constant despite the pace of social change. The book will be widely read and, as in Italy, it will have an impact far beyond the academic domain. (shrink)

Capitalist reforms usually drive outmigration of peasants to cities, while elders, children, and women responsible for their care are “left behind” in the countryside. The plight of these “left behind” populations is a major focus of recent agrarian studies in China. However, rural women are not merely passive victims of these transformations. Building on ethnographic research in Guangxi and Henan provinces from 2013 to 2017, and drawing on critical gender studies and feminist political ecology, I show how (...) the food safety crisis in China creates conditions for peasant women to increase control and income from organic food production, often establishing alternative food networks with the support of female scholars and NGO organizers. Thus, I shift focus of scholarship on rural women from “left behind” to leaders in struggles for justice and food sovereignty. (shrink)

The manuscript explores the plausibility of care-based epistemology in a comparative key. Investigating the epistemic virtue of care-giving, the work weaves together insights from care ethics, virtue epistemology and a particular reading of the Mah=abh=arata which, left to themselves, do not appear compatible with one another. Drawing on these traditions, the work goes on to provide a feminist vision of search for truth that is consistent with both ethical relations and interventions for justice.

continent. 2.2 (2012): 66–75 ~*~ We’re Doomed. Pessimism is the night-side of thought, a melodrama of the futility of the brain, a poetry written in the graveyard of philosophy. Pessimism is a lyrical failure of philosophical thinking, each attempt at clear and coherent thought, sullen and submerged in the hidden joy of its own futility. The closest pessimism comes to philosophical argument is the droll and laconic “We’ll never make it,” or simply: “We’re doomed.” Every effort doomed to failure, every (...) project doomed to incompletion, every life doomed to be unlived, every thought doomed to be unthought. Pessimism is the lowest form of philosophy, frequently disparaged and dismissed, merely the symptom of a bad attitude. No one ever needs pessimism, in the way that one needs optimism to inspire one to great heights and to pick oneself up, in the way one needs constructive criticism, advice and feedback, inspirational books or a pat on the back. No one needs pessimism, though I like to imagine the idea of a pessimist activism. No one needs pessimism, and yet everyone—without exception—has, at some point in their lives, had to confront pessimism, if not as a philosophy then as a grievance—against one’s self or others, against one’s surroundings or one’s life, against the state of things or the world in general. There is little redemption for pessimism, and no consolation prize. Ultimately, pessimism is weary of everything and of itself. Pessimism is the philosophical form of disenchantment—disenchantment as chanting, a chant, a mantra, a solitary, monophonic voice rendered insignificant by the intimate immensity surrounding it. In pessimism, the first axiom is a long, low, funereal sigh. ~*~ We’re Still Doomed. No one has time for pessimism. After all, there are only so many hours in a day. Whatever our temperament, happy or sad, engaged or disengaged, we know pessimism when we hear it. The pessimist is usually understood as the complainer, forever pointing out what is wrong with the world without ever once offering a solution. But more often than not pessimists are the quietest of philosophers, submerging their own sighs within the lethargy of discontent. What little sound it makes is of interest to no one—“I’ve heard it all before,” “tell me something I don’t know,” sound and fury, signifying nothing. In raising problems without solutions, in posing questions without answers, in retreating to the hermetic, cavernous abode of complaint, pessimism is guilty of that most inexcusable of Occidental crimes—the crime of not pretending it’s for real. Pessimism fails to live up to the most basic tenet of philosophy—the “as if.” Think as if it will be helpful, act as if it will make a difference, speak as if there is something to say, live as if you are not, in fact, being lived by some murmuring non-entity both shadowy and muddied. Had it more self-assurance and better social skills, pessimism would turn its disenchantment into a religion, possibly calling itself The Great Refusal. But there is a negation in pessimism that refuses even such a Refusal, an awareness that, from the start, it has already failed, and that the culmination of all that is, is that all is for naught. Pessimism tries very hard to present itself in the low, sustained tones of a Requiem Mass, or the tectonic rumbling of Tibetan chant. But it frequently lets loose dissonant notes at once plaintive and pathetic. Often, its voice cracks, its weighty words abruptly reduced to mere shards of guttural sound. ~*~ Maybe It’s Not So Bad, After All. If we know pessimism when we hear it, this is because we’ve heard it all before—and we didn’t need to hear it in the first place. Life is hard enough. What you need is a change of attitude, a new outlook, a shift in perspective... a cup of coffee. If we have no ears for pessimism, this is because it is always reducible to something as reliably mutable as a voice. If pessimism is so frequently disparaged, it is because it brings everyone down, determined as it is to view each day as a bad day, if only by virtue of the fact that it is not yet a bad day. For pessimism the world is brimming with negative possibility, the collision of a bad mood with an impassive world. In fact, pessimism is the result of a confusion between the world and a statement about the world, a confusion that also prevents it from fully entering the hallowed halls of philosophy. If pessimism is so often dismissed, this is because it is often impossible to separate a “bad mood” from a philosophical proposition (and do not all philosophies stem from a bad mood?) The very term “pessimism” suggests a school of thought, a movement, even a community. But pessimism always has a membership of one—maybe two. Ideally, of course, it would have a membership of none, with only a scribbled, illegible note left behind by someone long forgotten. But this seems unrealistic, though one can always hope. ~*~ Anatomy of Pessimism. Though it may locate itself at the margins of philosophy, pessimism is as much subject to philosophical analysis as any other form of thought. Pessimism’s lyricism of failure gives it the structure of music. What time is to the music of sorrow, reason is to a philosophy of the worst. Pessimism’s two major keys are moral and metaphysical pessimism, its subjective and objective poles, an attitude towards the world and a claim about the world. For moral pessimism, it is better not to have been born at all; for metaphysical pessimism, this is the worst of all possible worlds. For moral pessimism the problem is the solipsism of human beings, the world made in our own image, a world-for-us. For metaphysical pessimism, the problem is the solipsism of the world, objected and projected as a world-in-itself. Both moral and metaphysical pessimism are compromised philosophically; moral pessimism by its failure to locate the human within a larger context, and metaphysical pessimism by its failure to recognize the complicity in the very claim of realism. This is how pessimism makes its music of the worst, a generalized misanthropy without the anthropos . Pessimism crystallizes around this futility—it is its amor fati , rendered as musical form. ~*~ Melancholy of Anatomy. There is a logic of pessimism that is fundamental to its suspicion of philosophical system. Pessimism involves a statement about a condition . In pessimism each statement boils down to an affirmation or a negation, just as any condition boils down to the best or the worst. With Schopenhauer, that arch-pessimist, the thinker for whom the philosopher and the curmudgeon perfectly overlap, we see a no-saying to the worst, a no-saying that secretly covets a yes-saying (through asceticism, mysticism, quietism), even if this hidden yes-saying is a horizon at the limits of comprehension. With Nietzsche comes the pronouncement of a Dionysian pessimism, a pessimism of strength or joy, a yes-saying to the worst, a yes-saying to this world as it is. And with Cioran yet another variation, futile yet lyrical, a no-saying to the worst, and a further no-saying to the possibility of any other world, in here or out there. With Cioran one approaches, but never reaches, an absolute no-saying, a studied abandonment of pessimism itself. The logic of pessimism moves through three refusals: a no-saying to the worst (refusal of the world-for-us, or Schopenhauer’s tears); a yes-saying to the worst (refusal of the world-in-itself, or Nietzsche’s laughter); and a no-saying to the for-us and the in-itself (a double refusal, or Cioran’s sleep). Crying, laughing, sleeping—what other responses are adequate to a life that is so indifferent? ~*~ Cosmic Pessimism. Both moral and metaphysical pessimism point to another kind, a pessimism that is neither subjective nor objective, neither for-us nor in-itself, and instead a pessimism of the world-without-us. We could call this a cosmic pessimism ... but this sounds too majestic, too full of wonder, too much the bitter aftertaste of the Great Beyond. Words falter. And so do ideas. And so we have a cosmic pessimism, a pessimism that is first and last a pessimism about cosmos , about the necessity and possibility of order. The contours of cosmic pessimism are a drastic scaling-up or scaling-down of the human point of view, the unhuman orientation of deep space and deep time, and all of this shadowed by an impasse, a primordial insignificance, the impossibility of ever adequately accounting for one’s relationship to thought—all that remains of pessimism is the desiderata of affects—agonistic, impassive, defiant, reclusive, filled with sorrow and flailing at that architectonic chess match called philosophy, a flailing that pessimism tries to raise to the level of an art form (though what usually results is slapstick). ~*~ Song of Futility. An ethics of futility pervades pessimism. Futility, however, is different from fatality, and different again from simple failure (though failure is never simple). Failure is a breakage within the heart of relations, a fissure between cause and effect, a fissure hastily covered over by trying and trying again. With failure, there is always plenty of blame to go around; it’s not my fault, it’s a technical difficulty, it’s a miscommunication. For the pessimist, failure is a question of “when,” not “if”—failure as a metaphysical principle. Everything withers and passes into an obscurity blacker than night, everything from the melodramatic decline of a person’s life to the banal flickering moments that constitute each day. Everything that is done undone, everything said or known destined for a kind of stellar oblivion. When scaled up in this way, failure becomes fatality. Fatality is the hermeticism of cause and effect. In fatality, everything you do, whatever you do, always leads to a certain end, and ultimately to the end—though that end, or the means to that end, remain shrouded in obscurity. Nothing you do makes a difference because everything you do makes a difference. Hence the effects of your actions are hidden from you, even as you deceive yourself into thinking that, at last, this time you will outwit the order of things. By having a goal, planning ahead, and thinking things through carefully, we attempt, in a daily Prometheanism, to turn fatality to our advantage, to gain a glimpse of an order that seems buried deeper and deeper in the fabric of the universe. But even fatality has its comforts. The chain of cause and effect may be hidden from us, but that’s just because disorder is the order we don’t yet see; it’s just complex, distributed, and requires advanced mathematics. Fatality still clings to the sufficiency of everything that exists... When fatality relinquishes even this idea, it becomes futility. Futility arises out of the grim suspicion that, behind the shroud of causality we drape over the world, there is only the indifference of what exists or doesn’t exist; whatever you do ultimately leads to no end, an irrevocable chasm between thought and world. Futility transforms the act of thinking into a zero-sum game. ~*~ Song of the Worst. At the center of pessimism lies the term pessimus , “the worst,” a term as relative as it is absolute. The worst is about as bad as it gets, “the worst” as “the best” in disguise, shrouded by the passage of time or the twists and turns of fortune. For the pessimist, “the worst” is the propensity for suffering that gradually occludes each living moment, until it eclipses it entirely, overlapping perfectly in death... which, for the pessimist, is no longer “the worst.” Pessimism is marked by an unwillingness to move beyond “the worst,” something only partially attributable to a lack in motivation. In pessimism “the worst” is the ground that gives way beneath every existent—things could be worse, and , things could be better. “The worst” invariably implies a value judgment, one made based on scant evidence and little experience; in this way, pessimism’s greatest nemesis is its moral orientation. Pessimism’s propositions have all the gravitas of a bad joke. Perhaps this is why the true optimists are the most severe pessimists—they are optimists that have run out of options. They are almost ecstatically inundated by the worst. Such an optimism is the only possible outcome of a prolonged period of suffering, physical or metaphysical, intellectual or spiritual. But does this not also describe all the trials and tribulations of each day—in short, of “life?” It seems that sooner or later we are all doomed to become optimists of this sort (the most depressing of thoughts...) ~*~ Song of Doom. Rather than serving as a cause for despair, gloom and doom are the forms of consolation for any pessimist philosophy. Neither quite affects nor quite concepts, gloom and doom transform pessimism into a mortification of philosophy. Doom is not just the sense that all things will turn out badly, but that all things inevitably come to an end, irrespective of whether or not they really do come to an end. What emerges from doom is a sense of the unhuman as an attractor, a horizon towards which the human is fatally drawn. Doom is humanity given over to unhumanity in an act of crystalline self-abnegation. Gloom is not simply the anxiety that precedes doom. Gloom is literally atmospheric, climate as much as impression, and if people are also gloomy, this is simply the by-product of an anodyne atmosphere that only incidentally involves human beings. Gloom is more climatological than psychological, the stuff of dim, hazy, overcast skies, of ruins and overgrown tombs, of a misty, lethargic fog that moves with the same languorousness as our own crouched and sullen listening to a disinterested world. In a sense, gloom is the counterpoint to doom—what futility is to the former, fatality is to the latter. Doom is marked by temporality—all things precariously drawn to their end—whereas gloom is the austerity of stillness, all things sad, static, and suspended, a meandering smoke hovering over cold lichen stones and damp fir trees. If doom is the terror of temporality and death, then gloom is the horror of a hovering stasis that is life. At times I like to imagine that this realization alone is the thread that connects the charnel ground Aghori and the graveyard poets. ~*~ Song of Spite. There is an intolerance in pessimism that knows no bounds. In pessimism spite begins by fixing on a particular object of spite—someone one hardly knows, or someone one knows too well; a spite for this person or a spite for all of humanity; a spectacular or a banal spite; a spite for a noisy neighbor, a yapping dog, a battalion of strollers, the meandering idiot walking in front of you on their smart phone, large loud celebrations, traumatic injustices anywhere in the world regurgitated as media blitz, spite for the self-absorbed and overly performative people talking way too loud at the table next to you, technical difficulties and troubleshooting, the reduction of everything to branding, spite of the refusal to admit one’s own errors, of self-help books, of people who know absolutely everything and make sure to tell you, of all people, all living beings, all things, the world, the spiteful planet, the inanity of existence... Spite is the motor of pessimism because it is so egalitarian, so expansive, it runs amok, stumbling across intuitions that can only half-heartedly be called philosophical. Spite lacks the confidence and the clarity of hatred, but it also lacks the almost cordial judgment of dislike. For the pessimist, the smallest detail can be an indication of a metaphysical futility so vast and funereal that it eclipses pessimism itself—a spite that pessimism carefully places beyond the horizon of intelligibility, like the experience of dusk, or like the phrase, “it is raining jewels and daggers.” ~*~ Song of Sleep. A paraphrase of Schopenhauer: what death is for the organism, sleep is for the individual. Pessimists sleep not because they are depressed, but because for them sleep is a form of ascetic practice. Sleep is the askesis of pessimism. If, while sleeping, we have a bad dream, we abruptly wake up, and suddenly the horrors of the night vanish. There is no reason to think that the same does not happen with the bad dream we call “life.” ~*~ Song of Sorrow. Nietzsche, commenting on pessimism, once castigated Schopenhauer for taking things too lightly. He writes: ...Schopenhauer, though a pessimist, really —played the flute. Every day, after dinner: one should read his biography on that. And incidentally: a pessimist, one who denies God and the world but comes to a stop before morality—who affirms morality and plays the flute... what? Is that really—a pessimist? We know that Schopenhauer did possess a collection of instruments, and we also know that Nietzsche himself composed music. There is no reason to think that either of them would ever banish music from the Republic of philosophy. But Nietzsche’s jibes at Schopenhauer are as much about music as they are about pessimism. For the pessimist who says no to everything and yet finds comfort in music, the no-saying of pessimism can only be a weak way of saying yes—the weightiest statement undercut by the flightiest of replies. The least that Schopenhauer could’ve done is to play the bass. I’m not a big fan of the flute, or, for that matter, wind instruments generally. But what Nietzsche forgets is the role that the flute has historically played in Greek tragedy. In tragedy, the flute ( aulos ) is not an instrument of levity and joy, but of solitude and sorrow. The Greek aulos not only expresses the grief of tragic loss, but it does so in a way that renders weeping and singing inseparable from each other. The classicist Nicole Loraux calls this the mourning voice . Set apart from the more official civic rituals of funerary mourning, the mourning voice of Greek tragedy constantly threatens to dissolve song into wailing, music into moaning, and the voice into a primordial, disarticulate anti-music. The mourning voice delineates all the forms of suffering—tears, weeping, sobbing, wailing, moaning, and the convulsions of thought reduced to an elemental unintelligibility. In the collapsed space between the voice that speaks and the voice that sings, pessimism discovers its mourning voice. Pessimism: the failure of sound and sense, the disarticulation of phone and logos . Have we rescued Schopenhauer from Nietzsche? Probably not. Perhaps Schopenhauer played the flute to remind himself of the real function of the mourning voice—sorrow, sighs, and moaning rendered indistinguishable from music, the crumbling of the human into the unhuman. Failure par excellence of pessimism. ~*~ Song of Nothing. In Buddhist thought, the First Noble Truth of existence is encapsulated in the Pali term dukkha , conventionally translated as “suffering,” “sorrow,” or “misery.” The Buddhist teachings are clear, however, that this is an objective claim, and not simply one point of view among others. Existence is suffering and sorrow—and yet this is not, the teachings tell us, a pessimistic attitude. It is likely that Schopenhauer, reading the Buddhist texts available to him, recognized some filiation with the concept of dukkha . But dukkha is a multi-faceted term. There is, certainly, dukkha in the usual sense of the suffering, strife, and loss associated with living a life. But this is, in turn, dependent on the finitude and temporality of dukkha , existence as determined by impermanence and imperfection. And this ultimately points to the way in which both suffering and finitude are grounded by the paradoxical groundlessness of dukkha as a metaphysical principle—the insubstantiality and the emptiness of all that is. Beyond what is worse to me, beyond a world ordered for the worst, there is the emptiness of dukkha as an impersonal suffering... the tears of the cosmos. In this context, it is easy to see how Schopenhauer’s pessimism attempts to compress all the aspects of dukkha into a nothingness at the core of existence, a Willlessness coursing through the Will. Though one thing for certain is that with Schopenhauer we do not find the “ever-smiling” countenance of Buddhism—or do we? The texts of the Pali Canon also contain lists of the different types of happiness—including the happiness of renunciation and the strange happiness of detachment. But Buddhism considers even the different types of happiness as part of dukkha , in this final sense of nothingness or emptiness. Perhaps Schopenhauer understood Buddhism better than he is usually given credit for. Thus the experiment of Schopenhauer’s philosophy—the point at which a Western pessimus and an Eastern dukkha overlap or exchange glances. Empty sorrow, a lyricism of indifference. The result is a strange, and ultimately untenable, nocturnal form of Buddhism. ~*~ Cioran once called music a “physics of tears.” If this is true, then perhaps metaphysics is its commentary. Or its apology. ~*~ Pessimism would be more mystical were it not for its defeatism. Mysticism is much too proactive for the pessimist, and pessimism too impassive even for the mystic. At the same time, there is something enviable about mysticism—despite its sufferings. There is a sense in which pessimists are really failed mystics. ~*~ You, the Night, and the Music. In a suggestive passage, Schopenhauer once noted that, “music is the melody to which the world is the text." Given Schopenhauer’s view on life—that life is suffering, that human life is absurd, that the nothingness before my birth is equal to the nothingness after my death—given all this, one wonders what kind of music Schopenhauer had in mind when he described music as the melody to which the world is text—was it opera, a Requiem Mass, a madrigal, or perhaps a drinking song? Or something like Eine kleine Nachtmusik , a little night music for the twilight of thought, a sullen nocturne for the night-side of logic, an era of sad wings sung by a solitary banshee. Perhaps the music Schopenhauer had in mind is music eliminated to non-music. A whisper would suffice. Perhaps a sigh of fatigue or resignation, perhaps a moan of despair or sorrow. Perhaps a sound just articulate enough that it could be heard to dissipate. ~*~ Teach me to laugh through tears. ~*~ Pessimism always falls short of being philosophical. My back aches, my knees hurt, I couldn’t sleep last night, I’m stressed-out, and I think I’m finally coming down with something. Pessimism abjures all pretenses towards system—towards the purity of analysis and the dignity of critique. We didn’t really think we could figure it out, did we? It was just passing time, taking a piss, something to do, a bold gesture put forth in all its fragility, according to rules that we have agreed to forget that we made up in the first place. Every thought marked by a shadowy incomprehension that precedes it, and a futility that undermines it. That pessimism speaks, in whatever voice, is the singing testimony to this futility and this incomprehension—take a chance and step outside, lose some sleep and say you tried... ~*~ Is there a music of pessimism? And would such a music be audible? ~*~ The impact of music on a person compels them to put their experience into words. When this fails, the result is a faltering of thought and language that is itself a kind of music. Cioran writes: “Music is everything. God himself is nothing more than an acoustic hallucination.” ~*~ If a thinker like Schopenhauer has any redeeming qualities, it is that he identified the great lie of Western culture—the preference for existence over non-existence. As he notes: “If we knocked on the graves and asked the dead whether they would like to rise again, they would shake their heads.” In Western cultures it is commonly accepted that one celebrates birth and mourns death. But there must be a mistake here. Wouldn’t it make more sense to mourn birth and celebrate death? Strange though, because the mourning of birth would, presumably, last the entirety of that person’s life, so that mourning and living would the be same thing. ~*~ To the musical idea of the harmony of the universe corresponds the philosophical principle of sufficient reason. Like the music of mourning, pessimism gives voice to the inevitable breakdown of word and song. In this way, music is the overtone of thought. ~*~ The Patron Saints of Pessimism. The patron saints of pessimism watch over suffering. Laconic and sullen, the patron saints of pessimism never seem to do a good job at protecting, interceding, or advocating for those who suffer. Perhaps they need us more than we need them. Lest we forget, there do exist patron saints of philosophy, but their stories are not happy ones. There is, for instance, the fourth century Saint Catherine of Alexandria, or Catherine of the Wheel, named after the torture device used on her. A precocious fourteen year old scholar, Catherine was subject to continual persecution. After all forms of torture failed—including the “breaking wheel”—the emperor finally settled for her decapitation, a violent yet appropriate reminder of the protector of philosophers. There are also patron saints of music and musicians, but theirs too are sad stories. In the second century, Saint Cecilia was also subject to persecution and torture. As she knelt to receive the blade that would separate her head from her body, she ardently sang a song to God. It took three attempts before she was fully decapitated, all the while she continued, perhaps miraculously, to sing. Does pessimism not deserve its own patron saints, even if they are unworthy of martyrdom? But in our search, even the most ardent nay-sayers frequently lapse into brief moments of enthusiasm—Pascal’s love of solitude, Leopardi’s love of poetry, Schopenhauer’s love of music, Nietzsche’s love of Schopenhauer, and so on. Should one then focus on individual works of pessimism? We could include Kierkegaard’s trilogy of horror— Sickness Unto Death , The Concept of Dread , and Fear and Trembling —but all these are undermined by their fabricated and unreliable authors. Besides, how can one separate the pessimist from the optimist in works like Unamuno’s The Tragic Sense of Life , Shestov’s Postetas Clavium , or Edgar Saltus’ under-read The Philosophy of Disenchantment ? Even in cases where the entire corpus of an author is pessimistic, the project always seems incomplete—witness Cioran’s trajectory, from his first book, On the Heights of Despair , to the last unpublished notebooks of acrid and taut aphorisms. And this is to say nothing of literary pessimism, from Goethe’s sorrowful Werther, to Dostoevsky’s underground man, to Pessoa’s disquiet scribbler; Baudelaire’s spleen and ennui, the mystical Satanism of Huysmans and Strindberg, the hauntologies of Mário de Sá-Carniero, Izumi Kyoka, H.P. Lovecraft, grumpy old Beckett... even the great pessimist comedians. All that remains are singular, perhaps anomalous statements of pessimism, a litany of quotes and citations crammed into fortune cookies. Patron saints are traditionally named after a locale, either a place of birth or of a mystical experience. Perhaps the better approach is to focus on the places where pessimists were forced to live out their pessimism—Schopenhauer facing an empty Berlin lecture hall, Nietzsche mute and convalescent at the home of his sister, Wittgenstein the relinquished professor and solitary gardener, Cioran grappling with Alzheimer’s in his tiny writing alcove in the Latin Quarter. ~*~ There’s a ghost that grows inside of me, damaged in the making, and there’s a hunt sprung from necessity, elliptical and drowned. Where the moving quiet of our insomnia offers up each thought, there’s a luminous field of grey inertia, and obsidian dreams burnt all the way down. ~*~ If pessimism has any pedagogical value, it is that the failure of pessimism as a philosophy is inextricably tied to the failure of pessimism as voice. I read the following, from Shestov’s The Apotheosis of Groundlessness : When a person is young he writes because it seems to him he has discovered a new almighty truth which he must make haste to impart to forlorn humankind. Later, becoming more modest, he begins to doubt his truths: and then he tries to convince himself. A few more years go by, and he knows he was mistaken all round, so there is no need to convince himself. Nevertheless he continues to write, because he is not fit for any other work, and to be accounted a superfluous person is so horrible. (shrink)

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as (...) a destination therapy raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers. Short-term mechanical circulatory devices (e.g. percutaneous cardiopulmonary bypass, percutaneous ventricular assist devices, etc.) can be initiated in emergency situations as a bridge to permanent implantation of ventricular assist devices in chronic end-stage heart failure. In the absence of first-person (patient) consent, presumed consent or surrogate consent should be used cautiously for the initiation of short-term mechanical circulatory devices in emergency situations as a bridge to permanent implantation of left ventricular assist devices. Future clinical studies of destination therapy with left ventricular assist devices should include measures of recipients' quality of end-of-life care and caregivers' burden. (shrink)

In the context of military medical care, Eisenstein and colleagues have introduced the notion ‘left of bang intervention in trauma’, which refers to interventions administered before trauma to reduce morbidity and mortality after injury. This paper responds to Eisenstein and colleagues’ ethical analysis of such interventions, highlighting the difficulty in distinguishing between purely prophylactic and enhancing interventions. This response also addresses legal issues that arise from left of bang interventions under human rights law and the law of (...) armed conflict, in particular the questions as to whether the consent of service members would need to be obtained and whether the adversary would as a consequence be authorised to resort to more injurious weapons. (shrink)

Although the author concedes that much criticism from the left alleging ulterior imperialist motives of missions for “humanitarian intervention” is valid; nevertheless, the author argues that it would be wrong to rule out the concept of humanitarian intervention, even when conducted by imperialist powers for imperialist motives. The concept of “rescue” remains a valid humanitarian concept, and a logical foundation for solidarity with populations who find themselves under assault and defenseless. The author considers various regulative principles that may guide (...) more careful thinking about humanitarian intervention. (shrink)

Migrant women are often stereotyped. Some scholars associate the feminization of migration with domestic work and criticize the “care drain” as a new form of imperialism that the First World imposes on the Third World. However, migrant women employed as domestic workers in Northern America and Europe represent only 2% of migrant women worldwide and cannot be seen as characterizing the “feminization of migration”. Why are migrant domestic workers overestimated? This paper explores two possible sources of bias. The first (...) is sampling: conclusions about “care drain” are often generalized from small samples of domestic workers. The second stems from the affect heuristic: imagining children left behind by migrant mothers provokes strong feelings of injustice which trump other considerations. The paper argues that neither source of bias is unavoidable and finds evidence of gender stereotypes in the “care drain” construal. (shrink)

:A common goal of ethics education is to equip students who later become health practitioners to not only know about the ethical principles guiding their practice, but to also autonomously recognize when and how these principles might apply and assist these future practitioners in providing care for patients and families. This article aims to contribute to discussions about ethics education pedagogy and teaching, by presenting and evaluating the use of the visual arts as an educational approach designed to facilitate (...) students’ moral imagination and independent critical thinking about ethics in clinical practice. We describe a sequence of ethics education strategies over a 3 year Doctor of Physiotherapy program, focusing on the final year professional ethics assessment task, which involved the use of visual arts to stimulate the exploration of ethics in healthcare. The data were analyzed using both thematic and content analysis. Two key themes centered on emotional responses and lateral thinking. The use of artwork appeared to facilitate imaginative, emotional, and conceptual thinking about ethics and clinical experience. This study provides some evidence to support the effectiveness of the use of the visual arts in promoting students’ recognition of ethical dimensions within their clinical experience and reflection on their emerging professional identity. As one student noted, she left the museum “somewhat changed.”. (shrink)

In recent years philosophers and bioethicists have given considerable attention to the concept of care. Thus we have seen important work on questions such as: whether there is a uniquely female approach to ethics, whether ethics should be partial or impartial, and whether care must be supplemented by justice. Despite this valuable and extensive work, however, some important distinctions have gone largely undiscussed. This paper tries to fill a gap left in our understanding of the concept of (...) care itself by distinguishing between compassion and two kinds of pity. While all three are kinds of caring, we should not give them similar moral evaluations. Consequently, the distinction between compassion and different kinds of pity gives us an important insight into the question of whether we can consider care a virtue for health care professionals. (shrink)

This research investigates sociological ambivalence in negotiating care work in Japanese families. Women and their aging parents experience ambivalence based on conflicting norms of filial obligation, gender ideology, and cultural beliefs about the parent—child bond. Analysis of in-depth interview data showed ambivalence was based on conflict between norms and cultural beliefs and intergenerational differences in norms of caregiving. Not only are norms of care work in Japan gendered, but they also create conflicting demands for women who are torn (...) among providing care for their parents, providing care for their in-laws, and changing expectations for women in contemporary Japan. In the families studied, norms of filial obligation were challenged, but gendered definitions of care work were left largely intact. These findings challenge theories of elder care that identify a hierarchy of preferred caregivers based on filial obligation and gender. (shrink)

The metaphor of “care drain” has been created as a womanly parallel to the “brain drain” idea. Just as “brain drain” suggests that the skilled migrants are an economic loss for the sending country, “care drain” describes the migrant women hired as care workers as a loss of care for their children left behind. This paper criticizes the construction of migrant women as “care drain” for three reasons: 1) it is built on sexist stereotypes, (...) 2) it misrepresents and devalues care work, and 3) it misses the opportunity for a theoretical change about how skills in migration contexts can be understood. (shrink)

A work of popular philosophy that articulates a new way of understanding th moral foundations of liberalism in terms of an ethic of care and responsibility rather than social contract theory. Reviving the Left defends "rootstock liberalism", a cultural liberalism that develops the moral basis of society from the ground up, propagating relationships of social trust that provide the moral foundation of society. All intact human relationships depend on an ethical commitment that commands us to be responsible. Rootstock (...) liberalism names a politics that seeks to build institutions and practices that strengthen that ethical commitment. (shrink)

Whether we should respect international law is in dispute. In the United States, international law is dismissed by the left as merely promoting the interests of powerful states. It is attacked by the right as irrelevant and an interference with the interests and mission of the United States. And it follows from the arguments of many liberals that in the absence of world government the world is in a Hobbesian state of nature and international law inapplicable. This article reviews (...) the thinking of Kant, Locke, and Rawls, among others and shows how arguments against respect for international law can be answered. It questions arguments based on the analogy between states and individuals, and between international law as it has developed and law based on an ideal social contract between individuals. It then turns to the ethics of care, a recent addition to moral theory, and examines its major characteristics and recommendations. It considers how the ethics of care would view international law and the guidance this moral approach could provide for international relations. The article shows how the ethics of care is compatible with various current trends, and how thinking about globalization and greater international interdependence would benefit from greater attention to it. The article argues that the ethics of care would clearly support respect for international law as it has developed, but that it would even more strongly support addressing current problems in ways that would, in the longer term, make appeals to law and its enforcements ever less necessary. Keywords: international law; the ethics of care; moral theory; political theory; social contract; states; groups; Hobbes; Kant; Locke (Published: 16 September 2011) Citation: Ethics & Global Politics, Vol. 4 , No. 3, 2011, pp. 173-194. DOI: 10.3402/egp.v4i3.8405. (shrink)

The discourse on the future of work should learn from a turn in philosophy that occurred in the 1980s, one that recognizes the good life towards which ethics strives can only be reached on a foundation of caring relationships (Gillian, 1982; Noddings, 1984). Care ethics recognizes that human well-being is a group project, one that involves strong relationships, and concern for bodies and emotions. Too often, these features are left out of research exploring robotics in the workplace. This (...) paper outlines the main tenets of care ethics, then applies the moral framework to the context of industrial and retail settings using robots. This approach sees these contexts through a relational lens, helping to identify, evaluate, and improve relationships critical to ensuring workers’ well-being. Second, care ethics considers taking care of people’s bodies beyond mere safety, examining how working with robots can exacerbate societal or economic pressures. Lastly, care ethics takes emotions as an important source of knowledge in building and supporting care. Additionally, this paper contributes to the care ethics literature by applying the framework to the context of robotized industrial workplaces, which has yet to be done. (shrink)

Background When a patient commits suicide while hospitalized in the psychiatric ward, the mental healthcare professionals (MHCPs) who have had the patient in their care encounter the family members immediately following the suicide. Professionals who encounter the bereaved in this first critical phase may have a significant impact on the grieving process. By providing ethically responsible and professionally competent care, they have the opportunity to influence what can alleviate and reduce suffering and promote health in a longer perspective. (...) Aim The aim of this study is to investigate MHCPs’ experiences in the encounter with family members who has been bereaved by suicide. Methods Data material consists of text from in-depth interviews with six MHCPs belonging to a total of five different psychiatric units in two hospitals. The findings have emerged through analysis using a hermeneutical approach based on Gadamer’s philosophical hermeneutics. Ethical considerations The study was approved by the Ombudsman for Privacy of the Norwegian Social Science Data Services and is based on informed consent and confidentiality. Findings Three themes emerged: Confirming the suffering. Creating encounter through dialogue. Providing consolation and reconciliation. Findings illuminate how MHCPs understand their responsibilities and how they act in the encounter with the bereaved following suicide. Conclusion The participants appear to be led by the responsibility that grows through witnessing the suffering of the bereaved. Encountering the family member’s aggression and threats against staff members is an ethical challenge to the professional’s ability to confirm the bereaved, create dialogue and provide consolation and reconciliation at the start of their grieving process. MHCPs need to be aware of the different reactions and needs of family members following suicide. More research is needed about how to provide sensitive and flexible care in ways that can be perceived as helpful for those left behind. (shrink)

BackgroundFindings suggest pandemic control measures have modified maternal health practices, compromising the quality of care provided to new and expectant mothers and interfering with their birthing experiences. For this reason, this study explored the lived experiences of post-partum Victorian mothers during the pandemic as well as the potential influence of control measures over their perceptions regarding the health system.MethodsThis study used a qualitative approach. Recruitment was conducted between May and June 2021, using both the Australian Breastfeeding Association’s social media (...) pages and snowball recruitment. Interviews were semi-structured using open-ended questions relating to key themes. Seven Victorian post-partum mothers were identified and their transcripts analysed using Interpretative Phenomenological Analysis.ResultsMothers described how unexpected changes to maternal care exacerbated feelings of uncertainty regarding pregnancy and birth. Mothers also differentiated between impacts by the health system and the role healthcare professionals played in moderating these effects. Whilst visitor restrictions provided some benefit, restrictions to familial and social support left many of the mothers feeling alone during their pregnancy and interfered with their immediate post-partum experience.ConclusionThis study illustrates the importance of evidence-based practice in maternal care and provides insights for both health professionals and policy analysts in developing new or modifying existing guidelines that better balance the needs of expectant and post-partum mothers with pandemic control measures. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Providing Care to a Potential Aggressor: An Ethical DilemmaHandreen Mohammed SaeedFollowing the abrupt fall of almost a third of its territory in 2014 to armed militias, Iraq fell into civil war turmoil. As a direct result of the armed conflicts, hundreds of thousands of Iraqis were displaced or subjected to atrocious human rights violations with physical, sexual, and psychosocial abuse. While the scenes on the TV provided only (...) a glimpse of what was happening on the ground, the true stories circulating about people’s suffering left me personally in absolute shock. Among those who suffered the most from the offences were marginalized religious and ethnic minority groups, who were viewed and treated as infidels by the aggressor militants. Those marginalized communities not only endured displacement due to the armed conflicts but they were also mass-exterminated, sexually abused, and underwent massive destruction of their towns and villages.In 2016, I was working for Ministry of Health as a primary care physician in a small town in Iraqi Kurdistan, which hosted tens of thousands of internally displaced people (IDPs) from one of those marginalized minority communities. I had the opportunity to hear their tragic stories firsthand as they fled for their lives in 2014. Working in those communities as a primary care physician allowed me to truly understand their feelings and emotions and reflect on their experiences while providing healthcare services. This experience sparked an interest in humanitarian work, in which I could be close to areas of need and involved in providing physical health first-aid and also psychological and social first-aid; all crucial in addressing the future health consequences experienced by people going through humanitarian crises. In the same year, 2016, I joined an international medical organization and started working in remote and low-resource settings in northern Iraq as a humanitarian physician. Our projects included a variety of primary care, psychosocial, and urgent care services targeting refugees, IDPs, and vulnerable host communities in areas near conflict zones. The projects were designed and implemented with the hope that the most vulnerable populations have access to our services.In October 2016, the Iraqi authorities launched a massive military operation known as the “Battle of Mosul” to regain control of Mosul, the second-largest city in Iraq. As an emergency medical humanitarian organization, we had to be near the battlefield and respond to the unfolding humanitarian crisis on a daily basis. As the official security forces backed by the international alliance started to advance, tens of thousands of people, including some militants and their families, fled Mosul and headed towards areas controlled by the Kurdistan Regional Government’s forces in the north, where our organization was operational. Some of them sought refuge in one of our medical facilities in northern Iraq, which was operated by local staff, [End Page 172] including members from some of the minority communities that had suffered the most from the militants’ aggression in 2014. The patients entering our facilities were mainly older adults, women, and children, but we were also visited by a small group of potential militants who were either injured, malnourished, or just seeking help and refuge. As a neutral, impartial, independent, humanitarian organization compliant with medical ethics, we were committed to providing healthcare services to anybody in need without discrimination or judgment.As we responded to the humanitarian crisis unfolding before our eyes, some of our staff members came forward and raised valid questions about the ethics of treating patients potentially involved in serious human rights violations. With tears in her eyes, one nurse approached me and stated, “Seeing these people reminds me of all the girls and women who went missing from my village and are now being sold as sex slaves in Syria”. The staff expressed serious concerns about their ability to provide care to patients who may have been involved in mass killing, torture, and the destruction of their own towns, as well as sexual abuse against their family members, friends, and people in their communities. Due to the psychological and physical trauma caused by the militants’ conquest, the staff was reluctant to provide medical care to these patients, as seeing and hearing them brought back... (shrink)

Two years ago, a professor at the University of California, Herbert Marcuse, an American social philosopher with traditional German training, came to be regarded as the recognized theoretician of the "New Left" movement. Marcuse's popularity compelled many writers, including ourselves , to make a careful examination specifically of the theoretical content of that teaching, which laid claim to performing the role of a critical and revolutionary theory of society. The development of a critique of the philosophical and theoretical foundations (...) and the internal contradictions of Marcuse's teachings was thus dictated by a real situation, by the actual struggle of ideas, and has perhaps still not lost its significance. Another problem, which aroused the interest of researchers even then but which had not found an answer in our article because of its specific purpose, had to do with the relationship between Marcuse's philosophical concept and the spontaneous consciousness of the "mass" participants in the real protest movement that came to be known as the "New Left" movement. (shrink)

While caregiving in northern, rural and remote communities takes place in the context of conditions unique to smaller communities, caregivers live with social policies that are shaped by urban norms rather than rural realities. In times of economic decline and government cuts rural issues of limited services and infrastructure as well as dependency on a single industry can lead to unemployment, community and family instability, and a decline in health and well-being. During these times caregivers face increased pressure to voluntarily (...) fill the gaps left by service cuts. Research with women caregivers in four communities in northern British Columbia (BC), Canada explores the experiences of caring and the social, geographic, economic and political contexts within which the caregiving occurs. The discourse of economic efficiencies that speaks solely to the monetary value of care is contrasted with the human condition of connectedness and relationships. These two contradictory perspectives are uncovered during interviews with women caregivers and analyzed in the framework of Olena Hankivsky's discussion of an ethic of care. (shrink)

In the post-Gilligan debate about the differences, if any, between the ways in which people of different genders see the moral world in which they live, I detect two assumptions. These can be found in Gilligan's early work, and have infected the thought of others. The first, perhaps surprisingly, is Kohlberg's Kantian account of one moral perspective, the one more easily or more naturally operated by men and which has come to be called the justice perspective. This is the perspective (...) whose claims Gilligan initially found suspect, not because she thought it a distorted account of the way in which male subjects operated, but because she disputed its claims to be the only account or the best or dominant one. Throughout the ensuing debate Kohlberg's account has been left in place, and challenged not for correctness but only for uniqueness. (shrink)

Growing data on the socioeconomic determinants of health pose a challenge to analysis and application of fairness in health. In Just health: meeting health needs fairly, Norman Daniels argues for a change in the population end of our thinking about just health. What about clinical care? Given our knowledge of the importance of wealth, education or social status to health, is fairness in medicine served better by continuing to avoid considering our patients’ social status in setting clinical priorities, or (...) by attempting to equalise existing health inequalities by giving priority to the socioeconomically disadvantaged at the point of care? In this article, I argue that doctors should not attempt the latter. Granted, giving priority to low status would go some way towards compensating unjust health inequalities and the impression of being left aside in other social spaces. It would represent reverse discrimination, but could still be justified inasmuch as disadvantaged groups could be identifiable, and as long as the intent was compensation rather than retribution. However, under current circumstances such priority would risk being attributed arbitrarily, would represent a form of medical proselytising, risk leaving the worst-off with less by alienating the powerful, and require teaching doctors to act in strongly counter-cultural ways—possibly at great cost. Crucially, however, we protect both equal health and equal regard by treating all alike: priority to low status would promote the first somewhat, but at the expense of sacrificing the second. (shrink)

Can a competent individual refuse care in order to make their natural death reasonably foreseeable in order to qualify for medical assistance in dying (MAiD)? Consider a competent patient with left-side paralysis following a right brain stroke who is not expected to die for many years; normally his cause of death would not be predictable. However, he refuses regular turning, so his physician can predict that pressure ulcers will develop, leading to infection for which he will refuse treatment (...) and consequently die. Is he now eligible for MAiD? Consider a competent patient with spinal stenosis (a non-fatal condition) who refuses food (but not liquids in order not to lose capacity from dehydration). Consequently, her physician can predict death from starvation. Is she now eligible for MAiD? Answering these questions requires that we answer three sub-questions: 1) do competent patients have the right to refuse care?; 2) do healthcare providers have a duty to respect such refusals?; and 3) are deaths resulting from refusals of care natural for the purposes of determining whether a patient is eligible for MAiD? If a competent patient has the right to refuse some particular care, and healthcare providers have a duty to respect that refusal, and if the death that would result from the refusal of that care is natural, then that refusal of care is a legal pathway to MAiD. However, if the competent patient does not have the right to refuse some particular care, or if healthcare providers do not have a duty to respect that refusal, or if the death that would result from the refusal of that care is not natural, then that refusal of care is not a legal pathway to MAiD. In this paper, we explore this complex legal terrain with the most profound of ethical implications – access to MAiD. (shrink)

This article revisits the left-wing response to sociobiology in the 1970s and 1980s by examining the sociobiology debate in Finland in a larger European context. It argues that the Finnish academic left’s response to sociobiology represents a “third way” alongside the purely negative, often Marxist denial of biology’s relevance, which characterized the left’s response to sociobiology in many European countries such as Hungary and Sweden, and alongside the disregard that sociobiology confronted in most parts of Eastern Europe, (...) as well as in Germany. In the context of the last great political conflict of the Cold War in Europe, the controversy over the American “Euromissiles” in 1979–1983, the Finnish academic left challenged the allegedly fatalistic sociobiological aggression and war theories with an alternative biological language, turning the increasing enthusiasm over evolutionary ideas into a pacifist cause. Using leftist and pacifist forums to inform citizens and politicians of such biologically evolved human characteristics as mutual care and sociability, the Finnish critics of sociobiology wished to boost the public spirit, and to rationalize the pacifist ideal of the European-wide popular movement against nuclear weapons and militarism. As a result, the academic leftists in Finland revived the early twentieth-century tradition of “peace biology.” A proper understanding of this development calls for an analysis that acknowledges Finland’s special geopolitical and cultural position in the Cold War world between East and West. (shrink)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as autonomy (...) and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

ABSTRACT In this article, we first document the virtually complete absence of infectious disease examples and concerns at the time bioethics emerged as a field. We then argue that this oversight was not benign by considering two central issues in the field, informed consent and distributive justice, and showing how they might have been framed differently had infectiousness been at the forefront of concern. The solution to this omission might be to apply standard approaches in liberal bioethics, such as autonomy (...) and the harm principle, to infectious examples. We argue that this is insufficient, however. Taking infectious disease into account requires understanding the patient as victim and as vector. Infectiousness reminds us that as autonomous agents we are both embodied and vulnerable in our relationships with others. We conclude by applying this reunderstanding of agency to the examples of informed consent and distributive justice in health care. (shrink)

This article explores an aspect of women’s transnational labor migration that has been understudied in many labor-sending countries: how men experience shifts in the household labor division triggered by women’s migration. In so doing, we shed light on the diverse ways notions of masculinity and gender identities are being reworked and renegotiated in the transnational family. Drawing on qualitative data collected from in-depth interviews with carers of left-behind children in Northern Vietnam, we show how men are confronted with the (...) need to take on child care duties, which have traditionally been ascribed to women, while at the same time being under considerable pressure to live up to locally accepted masculinity ideals. We provide interesting insights into the changing family structures and dynamics in Vietnamese society where patriarchal norms continue to exert significant influence on different facets of life. (shrink)

In Algerian Kabyle families, the intersection of tradition and modernity creates a dilemma for family-based eldercare. As daughters-in-law choose to live independently from their in-laws’ home, some unmarried daughters may be left to fill the care gap. Given the shift from traditional to modern caregiving arrangements, how can elders and the members of their family survive and thrive? Choosing an empirical case study that is analyzed using key concepts from care ethics and gender justice, we develop a (...) notion of “caring with the heart” for aging family members in need of long-term care. We offer seven possible solutions and policy options for the modern Kabyle context. (shrink)

When should we use care robots? In this paper we endorse the shift from a simple normative approach to care robots ethics to a complex one: we think that one main task of a care robot ethics is that of analysing the different ways in which different care robots may affect the different values at stake in different care practices. We start filling a gap in the literature by showing how the philosophical analysis of the (...) nature of healthcare activities can contribute to robot ethics. We rely on the nature-of-activities approach recently proposed in the debate on human enhancement, and we apply it to the ethics of care robots. The nature-of-activities approach will help us to understand why certain practice-oriented activities in healthcare should arguably be left to humans, but certain goal-directed activities in healthcare can be fulfilled with the assistance of a robot. In relation to the latter, we aim to show that even though all healthcare activities can be considered as practice-oriented, when we understand the activity in terms of different legitimate ‘fine-grained’ descriptions, the same activities or at least certain components of them can be seen as clearly goal-directed. Insofar as it allows us to ethically assess specific functionalities of specific robots to be deployed in well-defined circumstances, we hold the nature-of-activities approach to be particularly helpful also from a design perspective, i.e. to realize the Value Sensitive Design approach. (shrink)

Conscientious objection in health care is a form of compromise whereby health care practitioners can refuse to take part in safe, legal, and beneficial medical procedures to which they have a moral opposition (for instance abortion). Arguments in defense of conscientious objection in medicine are usually based on the value of respect for the moral integrity of practitioners. I will show that philosophical arguments in defense of conscientious objection based on respect for such moral integrity are extremely weak (...) and, if taken seriously, lead to consequences that we would not (and should not) accept. I then propose that the best philosophical argument that defenders of conscientious objection in medicine can consistently deploy is one that appeals to (some form of) either moral relativism or subjectivism. I suggest that, unless either moral relativism or subjectivism is a valid theory—which is exactly what many defenders of conscientious objection (as well as many others) do not think—the role of moral integrity and conscientious objection in health care should be significantly downplayed and left out of the range of ethically relevant considerations. (shrink)

The Royal Dutch Medical Association recently completed a researchproject aimed at investigating how guidelines for `appropriatemedical care' should be construed. The project took as a startingpoint that explicit attention should be given to ethical andpolitical considerations in addition to data about costs andeffectiveness. In the project, two research groups set out todesign guidelines and cost-effectiveness analyses (CEAs) for twocircumscribed medical areas (angina pectoris and majordepression). Our third group was responsible for the normativeanalysis. We undertook an explorative, qualitative pilot study (...) ofthe normative considerations that played a role in constructingthe guidelines and CEAs, and simultaneously interviewedspecialists about the normative considerations that guided theirdiagnostic and treatment decisions. Explicating normativeconsiderations, we argue, is important democratically: the issuesat stake should not be left to decision analysts and guidelinedevelopers to decide. Moreover, it is a necessary condition for asuccessful implementation of such tools: those who draw uponthese tools will only accept them when they can recognizethemselves in the considerations implied. Empirical normativeanalysis, we argue, is a crucial tool in developing guidelinesfor appropriate medical care. (shrink)

Non-communicable diseases are no longer largely limited to high-income countries and the elderly. The burden of non-communicable diseases is rising across all country income categories, in part because these diseases have been relatively overlooked on the global health agenda. Historically, communicable diseases have been prioritized in many countries as they were perceived to constitute the greatest disease burden, especially among vulnerable and poor populations, and strategies for prevention and treatment, which had been successful in high-income settings, were considered feasible and (...) often affordable in low-income settings. This prioritization has reduced the communicable diseases burden globally but has left non-communicable diseases largely neglected. A new approach is urgently needed to tackle non-communicable diseases. Based on an analysis of potential features which may have underlain the different approaches to non-communicable diseases and communicable diseases until now, including acuity of disease, potential for control or cure, cost, infectiousness, blaming of individuals and logistical barriers, little ethical or rational justification can be found to support continued neglect of non-communicable diseases. Justice demands access to quality and affordable care for all. An equitable approach to non-communicable diseases is therefore strongly mandated on medical, ethical, economic, and public health grounds. Funding must not however be diverted away from communicable diseases, which continue to require attention—but concomitantly, funding for non-communicable diseases must be increased. International and multi-sectoral action is required to accelerate progress towards true universal health coverage and towards achievement of all of the sustainable development goals, such that prevention and access to care for non-communicable disease can become a global reality. (shrink)

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

In December of 1899, Sir John Scott Burdon-Sanderson delivered an address to the Middlesex Hospital Medical Society in London on the relation between science and medicine. Commenting specifically on the future of medicine in the upcoming century, he criticized the gap between scientific research in academic settings and the practice of medicine in the clinical setting. He ends by stating that “all depends on whether you accept the proposition I have submitted to you—namely, that the science of medicine, even more (...) than the art, holds the promise of the future” (Burdon-Sanderson 1900, 255). Burdon-Sanderson’s proposition was actualized in the United States through the Flexner Report of 1910, which helped to universalize what medical education would come to look like in the country: the emphasis was placed squarely on science, rather than art (Flexner 1910). While there are still gaps between clinical practice and scientific research, there is no doubt that modern medicine is scientific medicine. There is also no doubt that scientific medicine leads to better health outcomes (Duffin 2010).However, some have argued that the emphasis of medicine as a science has left the art of medicine behind, to the detriment of modern medicine. Thomas Duffy, for instance, an internist at the Yale School of Medicine, states that the aftermath of the Flexner Report “created an excellence in science that was not balanced by a comparable excellence in clinical caring” (2011,276). Indeed, at the onset of our current century, many called for a reinvestment in the art of medicine so as to balance the emphasis on science (The Commonwealth Fund 2002; Committee on the Roles of Academic Health Centers in the 21 st Century 2003; Association of American Medical Colleges 2004). The burgeoning field of medical humanities—that is, the interdisciplinary field dedicated to demonstrating “how the arts and humanities inform and 2elevate the work of healing” (Campo 2005)—is evidence that such calls have been heard. While we surely want to celebrate scientific medicine, there are certain areas of medical practice where the art of medicine is as important, if not more important , as the science of medicine. We argue that one of those areas is the sphere of cancer care in which health professionals are asked not only to treat patients with cancer, but also to help them navigate through what is oftentimes one of the scariest, most vulnerable, and suffering-ridden times of their lives. Using concepts from the phenomenological tradition, we aim to provide philosophical clarity to situations in the medical setting in which health professionals must treat the whole person, rather than simply the person’s body, in order to provide proper patient care, thus highlighting an element of the art of medicine. We end by providing three principles that we think can help guide phenomenologically-informed cancer care. (shrink)

Internationally, primary health care has in recent years gained a more central position in political priorities to ensure sustainable health care for the population. Thus, more people receive health care locally and in their own homes, where home‐care nursing plays a large role. In this article, we investigate how home‐care nursing is articulated and made visible in contemporary Norwegian policy documents. The study is a Fairclough‐inspired critical discourse analysis seeking to uncover the position of nursing (...) in the prevailing political ideologies on current primary health care. In the documents, we identified several complementary and conflicting understandings about home‐care nursing. Home‐care nursing is presented as a basic part of a municipality's health services, but at the same time, its content and contribution are unclear and almost invisible. We argue that the absence of nursing leads to significant perspectives being left out and tie this to the fact that some patient groups and tasks seem to be disadvantaged. The political placement of home‐care nursing in the health‐care landscape is thus not just about nursing as a professional practice but also concerns fundamental care values in our society in relation to disadvantaged groups and work tasks. (shrink)