BackgroundIn our globalizing world, caregivers are increasingly being confronted with the challenges of providing intercultural healthcare, trying to find a dignified answer to the vulnerable situation of ethnic minority patients. Until now, international literature lacks insight in the intercultural care process as experienced by the ethnic minority patients themselves. We aim to fill this gap by analysing qualitative literature on the intercultural care encounter in the hospital setting, as experienced by ethnic minority patients.MethodsA systematic search was conducted for papers published (...) between 2000 and 2015. Analysis and synthesis were guided by the critical interpretive synthesis approach.ResultsFifty one articles were included. Four dimensions emerged, describing the intercultural care encounter as a meeting of two different cultural contexts of care, in a dynamic and circular process of balancing between the two cultural contexts, which is influenced by mediators as concepts of being human, communication, family members and the hospital’s organizational culture.ConclusionsThis review provides in-depth insight in the dynamic process of establishing intercultural care relationships in the hospital. We call for a broader perspective towards cultural sensitive care in which patients are cared for in a holistic and dignity-enhancing way. (shrink)

This study describes the ways in which professionals in two contexts of health care: general practice and homeopathic consultations, respond to patients' affective expressions of a trouble or a problem. The focus is on the turns of professionals that display understanding, compassion or agreement with the patient's account. Different types of affiliative turns are described and their consequences for the following interaction are scrutinized in relation to the institutional task of solving the patients' health-related problems. It is shown that in (...) both contexts, affiliation is oriented to as working towards closing the sequence of troubles-telling and serves to shift back to problem-solving activity, whilst in homeopathy, it may also serve as a means to problem-solving and thus help to complete the institutional task at hand. Some implications of these observations for professional—client interaction will be described. To conclude, the role of emotion in institutional interaction will also be discussed. (shrink)

The mounting ecological catastrophe and its negative effects on humanity and future generations of life, demand proactive actions. The ongoing crises of deforestation, air and water pollution, land degradation and many other ecological predicaments are critical global moral and justice issues. Although postcolonial Africa’s economic theories undermine the integrity of Creation, Africans are equally responsible. Following Pope Francis’ invitation to Creation care, I argue that the lwiindi [the annual rain-calling ceremony] illustrates ecological concerns and possesses ecological insights that can aid, (...) inform and positively transform Africa’s ecological actions. The article opens with a brief discussion on the growing ecological consciousness in global Christianity and Africa. It employs the lwiindi to illustrate the ecological role of ancestors as guardians of the land. It is from this perspective that the Enlightenment influenced concept of ‘progress’, is examined. The article concludes with some critical reflections on the environment and Tonga culture. (shrink)

Computer technology as well as the need to conduct research in primary care settings, has stimulated the creation in the U.S. of information networks linking private physicians' offices and other primary care practice sights. These networks give rise to several problems which have philosophic interest. One is a numerator problem created by the difficulty in primary care of using the more complicated or invasive diagnostic technologies commonly employed in tertiary care research. Another is a denominator problem arising from the difficulties (...) in determining which and how many patients constitute the population from which a practice is drawn. Finally, this mode of research raises questions about the social construction of medical reality and how objective medical truth is actually based on carefully selected patient experience. All these questions combine to challenge the gold standard view on medical research: the idea that some sorts of medical knowledge are epistemologically privileged and can serve as a bench-mark to determine whether new data are valid. (shrink)

Care ethics takes as central the discerning of needs in those being cared for and attempts to meet those needs. Perceptive caring agents are more likely to be able to identify needs in those for whom they are caring. The identification of needs is no small matter, not least in teaching encounters. This paper modestly proposes that at least some of the needs a caring agent should attempt to meet are a function of the identity of (...) the patient of caring action. Taking Nel Noddings’ account of care ethics as representative, I present it in outline. This leads to the needs-identification problematic. Following this I turn to Soran Reader’s account of needs. I interpret this to offer what I designate as identity as ‘what-ness’. Such an understanding of identity-based needs is a starting point for the caring agent but a more nuanced account, of identity as ‘who-ness’, is argued to be preferable. Identity as ‘who-ness’, as expressed in Paul Ricoeur’s work, advances the discussion, culminating in his concept of the ‘capable human being’. Having brought this aspect of Ricoeur’s thought into conversation with care ethics, I offer an account of identity-based needs conducive to the broader aims of the care ethical project. Finally, I consider what this bolstered account of care ethics might say about a brief and illustrative teaching encounter. (shrink)

This study focuses on the meaningful encounters of patients and next of kin, as seen from their perspective. Identifying the attributes within meaningful encounters is important for increased understanding of caring and to expand and develop earlier formulated knowledge about caring relationships. Caring theory about the caring relationship provided a point of departure to illuminate the meaningful encounter in healthcare contexts. A qualitative explorative design with a hermeneutic narrative approach was used to analyze and (...) interpret written narratives. The phases of the analysis were naïve interpretation, structure analysis on two different levels (narrative structure, and deep structure through metaphors) and finally a dialectic interpretation. The narratives revealed the meaning of the meaningful encounter as sharing, a nourishing fellowship, common responsibility and coming together, experienced as safety and warmth, that gives, by extension, life‐changing moments, a healing force and dissipated insight. The meaningful encounter can be seen as a complex phenomenon with various attributes. Understanding the meaningful encounter will enable nurses to plan and provide professional care, based on caring science, focusing on patient and next‐of‐kin experiences. (shrink)

The aim of this study was to get a deeper understanding of student nurses’ experiences of personal caring ethics by reflection on caring encounters with patients in clinical practice, ethical caring ideals, ethical problems, and sources for inner strength that give courage to practice good caring. In all, 24 Scandinavian student nurses participated voluntarily in an interview study. The interviews were analyzed within a phenomenological–hermeneutical approach and revealed three themes. The students found themselves in two (...) different states of vulnerability: one in which they were overwhelmed by their vulnerability and began to suffer themselves and the other where their vulnerability became a source of development with focus on the patient. The students’ ethical caring ideals served as fixed reference points in their ethical development, but their ideals were at risk of decline. The students reflected on the barriers for performing ethical care and nurtured their ethical ideals by providing ethical care in secret. Caring in secret occurred also when student nurses did not experience a shared ethos. (shrink)

Historically, the care of hospitalized children has evolved from being performed in isolation from parents to a situation where the parents and the child are regarded as a unit, and parents and nurses as equal partners in the child’s care. Parents are totally dependent on professionals’ knowledge and expertise, while nurses are dependent on the children’s emotional connection with their parents in order to provide optimal care. Even when interdependency exists, nurses as professionals hold the power to decide whether and (...) to what extent parents should be involved in their child’s care. This article focuses on nurses’ responsibility to act ethically and reflectively in a collaborative partnership with parents. To illuminate the issue of nurses as moral practitioners, we present an observation of contemporary child care, and discuss it from the perspective of the Danish moral philosopher KE Løgstrup and his book The ethical demand. (shrink)

Ethnomethodology research has systematically investigated discursive practices of categorisation, looking at the various ways by which social actors ascribe both themselves and others to identity categories to accomplish various kinds of social actions. Drawing on a data corpus of oncological visits collected in an Italian hospital, involving both native and non-native patients, the present work analyses how participants in these intercultural medical encounters invoke and make relevant social identity categories by the marking of collective pronouns in their talk. Our (...) results showed that whilst institutional identities prevailed, categorial formulations related to cultural or linguistic identities were rarely displayed in interactions with non-native patients. Conversational participants made very little of their linguistical or cultural background and when they did so, their cultural and linguistic identities were deployed for rhetorical and pragmatical aims, such as testing and negotiating common knowledge and epistemic authority. This study shows how even speakers’ minimal lexical choices, such as marked pronouns, impact the negotiation of meanings and activities in life-saving sites such as oncological visits. (shrink)

Phenomenology, Uncertainty and Care in the Therapeutic Encounter is the latest in a series of books where Mark Leffert explores the therapeutic encounter as both process and situation; looking for evidence of therapeutic effectiveness rather than accepting existing psychoanalytic concepts of theory or cure without question. Phenomenology, Uncertainty and Care in the Therapeutic Encounter contributes a new understanding of familiar material and brings a new focus to the care-giving and healing aspects of psychoanalysis and psychotherapy leading to a shift in (...) the analyst's identity from that of one who analyses to one who cares for and heals. This book will be of interest to Psychoanalysts and psychotherapists, neuroscientists and academics in the fields of psychiatry, comparative literature and literature and the mind. (shrink)

Breast Cancer (BC) is a debilitating disease with the global mortality rate of 13.0 per 100,000 of population (Globocan, 2018). BC affects the physical, mental, and emotional well-being and quality...

Scholars increasingly point toward schools as meaningful contexts in which to provide psychosocial care for refugee children. Collaborative mental health care in school forms a particular practice of school-based mental health care provision. Developed in Canada and inspired by systemic intervention approaches, collaborative mental health care in schools involves the formation of an interdisciplinary care network, in which mental health care providers and school partners collaborate with each other and the refugee family in a joint assessment of child development and (...) mental health, as well as joint intervention planning and provision. It aims to move away from an individual perspective on refugee children’s development, toward an engagement with refugee families’ perspectives on their migration histories, cultural background and social condition in shaping assessment and intervention, as such fostering refugee empowerment, equality, and participation in the host society. Relating to the first stage of van Yperen’s four-stage model for establishing evidence-based youth care, this article aims to engage in an initial exploration of the effectiveness of a developing school-based collaborative mental health care practice in Leuven, Belgium. First, we propose a detailed description, co-developed through reflection on case documents, written process reflections, intervision, an initial identification of intervention themes, and articulating interconnections with scholarly literature on transcultural and systemic refugee trauma care. Second, we engage in an in-depth exploration of processes and working mechanisms, obtained through co-constructed clinical case analysis of case work collected through our practice in schools in Leuven, Belgium. Our descriptive analysis indicates the role of central processes that may operate as working mechanisms in school-based collaborative mental health care and points to how collaborative mental health care may mobilize the school and the family-school interaction as a vehicle of restoring safety and stability in the aftermath of cumulative traumatization. Our analysis furthermore forms an important starting point for reflections on future research opportunities, and central clinical dynamics touching upon power disparities and low-threshold access to mental health care for refugee families. (shrink)

The patient’s home is a common setting for palliative care. This means that we need to understand current palliative care philosophy and how its goals can be realized in home‐care nursing encounters (HCNEs) between the nurse, patient and patient’s relatives. The existing research on this topic describes both a negative and a positive perspective. There has, however, been a reliance on interview and descriptive methods in this context. The aim of this study was to explore planned HCNEs in palliative (...) care. The design was a multiple case study based on observations. The analysis includes a descriptive and an explanation building phase. The results show that planned palliative HCNEs can be described as a process of co‐creating possibilities for the patient to reach vital goals through shared knowledge in a warm and caring atmosphere, based on good caring relations. However, in some HCNEs, co‐creation did not occur: Wishes and needs were discouraged or made impossible and vital goals were not reached for the patients or their relatives. Further research is needed to understand why. The co‐creative process presented in this article can be seen as a concretization of the palliative care ideal of working with a person‐centered approach. (shrink)

Being attentive to the needs of others, feeling responsible for each other, and taking care are necessary elements for the good life. Care, however, is a fragile activity: it is hard to predict its results. In this article, Homer's story of the Phaeacians bringing Odysseus back to Ithaca is interpreted to investigate what care could be when we admit the fragility of care. We consider two theoretical perspectives on care to interpret the story, namely Martha Nussbaum’s Aristotelian ethics, and the (...) Ethics of Care approach of authors like Ruddick, Sevenhuijsen, Tronto, Verkerk and others. In the first approach, the emphasis is on the attitude of care; in the second, on care as a social practice. Following Nussbaum, the caring response of the Phaeacians can be understood as an example of what Aristotle called ‘practical rationality’. The unexpected result of their care – they come into conflict with Poseidon – shows the fragility of human life and the tragic condition of humanity. According to Nussbaum, one should take responsibility for the fact that choosing for the one implies neglecting the other . From the perspective of Ethics of Care, the caring response is not so much the result of individual virtues; it is rather an element of a care practice that motivates people to act in conformity with basic values like solidarity and responsibility. The fragility of care is regarded as an ordinary quality of praxis and humanity rather than something essentially tragic. In the process of caring, misfortunes can never be totally prevented. Whenever they happen, they should be used as a way to learn and develop more adequate ways of handling the situation. The comparison of the two perspectives, both inspired by Aristotle's philosophy, gives rise to a richer view of the fragility of care. (shrink)

BackgroundPsychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients’ opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real (...) work situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity.MethodsAll staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives.ResultsThe majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.•Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.•Autonomy; 1) respecting the patient’s right to self-determination and information, 2) respecting the patient’s integrity and 3) protecting human rights.•Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients.ConclusionsPaternalism clearly appeared to be the dominant perspective among the participants, but there was also awareness of patients’ right to autonomy. Despite a normative trend towards reciprocity in psychiatry throughout the Western world, identifying it proved difficult in this study. This should be borne in mind by clinics when considering the need for ethical education, training and supervision. (shrink)

Background Decision making regarding the treatment of neonates with poor prognoses is difficult for healthcare staff working in the neonatal intensive care unit. This study aimed to investigate the attitudes of physicians and nurses about the value of life and ethical decision making when encountering neonates with poor prognosis in the NICU. Methods This cross-sectional study was conducted in five NICUs of five hospitals in Tehran city, Iran. The attitudes of 144 pediatricians, gynecologists and nurses were assessed using the questionnaire (...) of attitude toward the value of life and agreement on intensive care management based on three hypothetical case scenarios of neonates with poor prognosis. Data were analyzed using descriptive and inferential statistics via the SPSS software. Results The negative agreement on the no initiation of intensive care measures and the discontinuation of resuscitation in neonates with poor prognosis was more than the positive agreement. Also, various factors influenced the participants’ decision making for the provision of care to neonates. Regarding the case scenarios, the participants agreed on the provision of aggressive, conservative, and palliative care with various frequencies. This study confirms the importance of healthcare providers’ perspectives and their impacts on ethical decision making. The participants favored the value or sacredness of life and agreed on the use of all therapeutic measures for saving the lives of neonates with poor prognosis. Conclusion More studies are required to improve our understandings of factors influencing ethical decision making by healthcare providers when encountering neonates with poor prognosis in NICUs. (shrink)

This book examines the many ethical issues that are encountered in the Pediatric Intensive Care Unit. It supports pediatricians, nurses, residents, and other providers in their daily management of critically ill children with the dilemmas that arise. It begins by examining the evolution of pediatric critical care, and who is now impacted by this advancing medical technology. Subsequent chapters explore specific ethical concerns and controversies that are commonly encountered. These topics include how to conduct end-of-life discussions with families facing a (...) myriad of challenging choices. It goes on to explore the concept of futility, and what that does and does not mean in the pediatric ICU setting. Controversial subjects such as children as organ donors, particularly using donation after cardiac death, in addition to issues surrounding the declaration of brain death are covered. Additional chapters address resource allocation, and also analyze the use of long-term technology in chronically critically ill children. Chapters include case examples with guidance on how to work through similar difficulties and decision-making. While this book is specifically targeted for care providers at the ICU bedside, it is also of benefit to medical students, students in bioethics, practicing ethical consultants and families who are dealing with critically ill children. (shrink)

BackgroundThe intensive care unit entails working as a team in rescuing patients from life-threatening conditions. The care being given by the team could also be done by nurses and other health professionals through the coordinated use of all medical practices.ObjectiveTo determine the opinion of nurses on the ethical problems they experienced while working as a team in the intensive care units of a university hospital.MethodThe descriptive research was conducted on nurses working in intensive care units. A 56-item data collection form (...) consisting of two parts developed by the researchers was used. Frequency and median were evaluated, and statistical calculations were used for group comparisons.ResultsOut of the 82 nurses who participated in the study, 65 were university graduates. About 52 of the participants were female with a mean age of 28.12 ± 5.84; 26 had intensive care certification, and 54 had ethical training. The internal intensive care unit nurses were less satisfied with their jobs, able to use tools, said that they had the right to refuse the patient compared to the surgical intensive care unit nurses. Discussion and conclusions: It is a positive situation for the participants to score low with ethical problems based on suggestion as the probability of meeting with their teammates. However, it is important that the problems that affect the motivation of the nurses are different according to the intensive care unit and the employees. (shrink)

In almost every clinical interaction, clinicians must navigate interpersonal challenges with near‐instantaneous responses to patients. Yet medical ethics has largely overlooked these small, interpersonal exchanges, instead focusing on “big” ethical problems, such as euthanasia, brain death, or genetic modification. In 1995, Paul Komesaroff proposed the concept of microethics as a nonprinciplist approach to ethics that focuses on “what happens in every interaction between every doctor and every patient.” We aim to develop a microethics framework to guide everyday clinical encounters, (...) with a special focus on communication with patients and family members. We will advance three core insights: First, communication is an ethical act in ways seldom considered. Second, microethics is an essential lens through which to view the ethics of communication. Third, virtue can bridge reflective and automatic processes. Our intuitionist framework for microethics is thus based on this understanding of the role of virtue, and we propose six virtues that contribute to the goal of healing communication. (shrink)

Twentieth-century philosophy has often been pictured as divided into two camps, analytic and continental. This study challenges this depiction by examining encounters between some of the leading representatives of either side. Starting with Husserl and Frege's fin-de-siècle turn against psychologism, it turns to Carnap's 1931 attack on Heidegger's metaphysics (together with its background in the Cassirer-Heidegger dispute of 1929), moving on to Ayer's 1951 meeting with Bataille and Merleau-Ponty at a Parisian bar, followed by the 'dialogue of the deaf' (...) between Oxford linguistic philosophers and phenomenologists at the 1951 Royaumont colloquium, leading up to the Derrida-Searle controversy. Careful study shows that it is implausible to assume the existence of a century-old 'gulf' between two sides of philosophy. Vrahimis argues that miscommunication and ignorance over the exact content of the above encounters must to a large extent be held accountable for any perceived gap. (shrink)

Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. The purpose of this grounded theory study was to describe the process NPs use to manage moral problems common to primary care. Twenty-three NPs were interviewed, commenting on hypothetical situations depicting ethical issues common to primary care. Coding was conducted using a constant comparative method. A theory of maintaining moral integrity emerged consisting of the phases of encountering conflict, drawing a (...) line, finding a way without crossing the line, and evaluating actions. The NPs varied in their awareness and the discord encountered in conflict, and in clarity, flexibility and justification of the line drawn. A critical juncture occurred when NPs evaluated how well integrity had been maintained. Some experienced no distress while others experienced self-doubt, regret, outrage and frustration at external constraints, and attempted to reconcile through avoiding, convincing themselves, and compensating. (shrink)

Increased global attention to early childhood education and care in the past two decades has intensified attention on the education of infants and assessment of their learning in education policy. This interest is particularly evident in the focus upon infants in the early childhood curriculum frameworks developed in recent years in many countries. To date, there has been little examination of implications of this policy/curriculum emphasis in relation to its possible implications for how infants are understood. In this article, using (...) Levinas’ notion of ethical encounter, we present a critical reading of curriculum for infants. Drawing on his ideas of the ‘Other’, ‘responsibility’ and ‘unknowability’ we argue that the rapidly growing corpus of knowledge about infants and their inclusion in education policy and curricula texts, has the potential to narrowly define educators’ responsibilities and prescribe pedagogies in ways that may have unintended consequences. Using the Australian National Quality Framework (NQF) and its associated Early Years Learning Framework as examples, this article highlights the tensions inherent in a system that aims to provide equity, consistency and certainty, premised on a particular ‘knowing’ of the infant. We draw on Levinas’ ideas about ‘said’ and ‘saying’ to propose ways of working with policy and curricula texts that recognise that they can offer only partial understandings of the possibilities for infants’ learning. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted (...) by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Encounter With Enlightenment: A Study of Japanese Ethics -/- This study attempts to lay out some of the main influences in the development of ethical sensitivities in Japan. Daoism, Shintoism, Confucianism, Buddhism and Zen Buddhism all play a role. There are also individual thinkers who have made significant contributions to the way the Japanese think about ethics: Dogen, Shinran, Rikyu, Nishida Kitaro, Nishitani Keiji, Watsuji Tetsuro and many others. But ethics in Japan is, more often than not, taught through practice: (...) the Way of Tea, the Way of Flower Arranging, the Way of Landscape Gardening all have a central ethical component: they are all pathways to enlightenment and one who is enlightened is likely to view oneself as part of the greater whole. To do unnecessary harm to any part of it is to do harm to oneself. Of course, the background to all of this is the Japanese idea of Nothingness. All things arise out of this indefinite One and thus we all have a common kinship: we are all the product of Nothingness, as are all of the ten-thousand things of existence. We are all one family. Thus, the expanded self, as transformed by enlightenment, identifies with the greater whole, seeks to preserve it, cherishes it, is emotionally enraptured by it and cares about its well-being. One can see here the roots of an environmental ethic. (shrink)

Background: Nurses encounter complex ethical dilemmas in everyday nursing care. It is important for nurses to have moral courage to act in these situations which threaten patients’ safety or their good care. However, there is lack of research of moral courage. Purpose: This study describes nurses’ experiences of care situations demanding moral courage and their actions in these situations. Method: A qualitative descriptive research design was applied. The data were collected with an open-ended question in the questionnaire used in validation (...) of the Nurses’ Moral Courage Scale. The sample consisted of 286 nurses from four different clinical fields in a major university hospital in Finland, providing a total of 611 answers. Data were analyzed using inductive content analysis. Ethical considerations: The study followed the commonly recognized principles of good scientific practice. The use of data was authorized by the developer of the instrument, the data collector, and the participating hospital. Ethical approval was obtained from the university ethics committee. Findings: Nurses acted morally courageously in most situations but sometimes they failed to do so. Although situations demanding moral courage varied, they could be categorized into seven main domains relating to colleagues, physicians, patients, relatives, nurses themselves, managers, and organizations. Nurses acted in the situations in different ways. The main acts in solving the situations were verbal communication or immediate action, such as interrupting of action. Conclusion: Care situations demanding moral courage focus on good and safe patient care and the patient’s good is at the center of attention. The situations are mostly related to the activities of other healthcare professionals. Findings may be applied in developing ethical nursing care through basic and continuing nursing education. Research is needed on the moral courage of physicians and managers, as well as on patients’ and their relatives’ experiences of care situations demanding moral courage. (shrink)

Care for patients with multiple illnesses is often provided by several professionals from different parts of the health care system. In these cases, there seem to arise new demands for the communication and the cooperation between different professionals in the primary and the specialized care. In this paper, I shall describe how these challenges are met in an encounter which is a part of interventions called “Implementation Laboratories”. In these encounters, a new tool (care agreement) and a new practice (...) (care negotiation) are introduced and elaborated in internal-medicine patient care. I conceptualized the Implementation Laboratories as “border zones” where the learning processes between different communities are intensified. Learning in the Implementation Laboratories resembles learning at the Boundary Crossing Laboratory described by Engeström, Engeström &Vähäaho (1999a; 1999b). It is interwoven into the process of analyzing problems, planning and testing of solutions in order to improve the medical patient care. Learning appears as collisions between the different perspectives of the patient and professionals of different organizations, and may sometimes lead to reconstruction of boundaries. (shrink)

Summary Care and cure have been described as different kinds of ethical approaches to clinical situations. Female concerns in nursing care have been contrasted with masculine, cure orientated physician's attitudes. Ethics in such different voices may have sociologic determinants, but they do not represent intrinsic distinctions. Medicine has shown a divergent development, on the one hand stressing cure in a deterministic and instrumental way, on the other hand being aware that disease is as much a pathographic as a biographic, care‐requiring (...) existential situation. Disease is a breakdown of the living organism, to be cured by therapeutic efforts, but it is also the distressing failure of the lived body, requiring concern and care. Based on Lévinas’ ethics of encounter, it is suggested that any interpersonal relatedness is based on concern for the other, being grounded on an essentially ethical interaction. The clinical encounter is a paradigm of such ethics‐based relationships, which necessarily builds on awareness of the other qua other, and is concerned with fulfilling the therapeutic mandate. Caring for the other means doing one's best to help her/him, so that care and cure are inextricably interwoven, although care is the more fundamental form of human relatedness. Thus, neither gender nor professional tasks can allow for a caring attitude to develop without curing concerns, just as trying to cure without caring is unthinkable. (shrink)

This paper explores multiple encounters between activist-survivors of Japanese military sexual slavery and solidarity activists. I mainly focus on the stories of two foundational figures in the ongoing justice campaign for the survivors, both of whom faced that forceful military act as teenage girls in colonized Korea, although in dramatically different ways: Yun Chung-ok, a leading scholar and activist who, having managed to escape the fate of many other peers, first spoke out about Japanese military sexual slavery, and Kim (...) Bok-dong, a survivor and human rights activist. This paper will address the multiple encounters and dialogues of memories to resituate subjects, which led to overcoming personal trauma and reaching out to others and continues to drive the redress movement. Drawing on oral history interviews, feminist ethnography, and various documented resources including survivors’ testimonies, which have been archived for around twenty years as part of my own scholar-activist work, I juxtapose these women’s lives to show how a community of responsibility has been formed to decolonize androcentric history. The women involved in the movement for the resolution of the Japanese military sexual slavery issue reinterpreted their experiences as having been formed by imperialism, colonialism, and patriarchy. While caring for and healing with one another, they suggested the possibility of a new subject formation. Through mutually constructed identities, activist-survivors broke away from social stigma and became agents who led transformation of a postcolonial society. (shrink)

This paper is a call for educators to respond to the problematics that arise from reducing the Earth to a resource for human activities. The concept of ‘Anthropocene’ is a burning invitation to rethink education by putting the human to its place. We therefore argue for a spatial-embodied conceptualization of learning, which involves the more-than-human and nonrepresentational. In this effort, we use Latour’s concept of ‘geostory’ to problematize the prevailing anthropocentrism in education. We discuss the power of experimentation by introducing (...) a learning experiment that took place at a pop-up greenhouse in Helsinki. The idea was to encourage upper secondary geography students to playfully discard their human perspective and study the city from the viewpoint of plants: to probe the presumed human/nature divide through brief but moving encounters with ‘others’. We argue that through affective encounters with nonhuman others, the Earth speaks: it tells stories with us. If humans let themselves be addressed by these encounters, geostories can temporarily re-place human-centred narrative storytelling practices (histories), voiced by the modernist ‘I’, and generate alternative forms of knowledge that emerge from our belonging together. These stories emerging from geographical experimentation entail potential to cultivate both knowing and care that exceed the human. (shrink)

The rise of the idea of the Anthropocene is promoting multiple reflections on its meaning. As we consider entering this new geological epoch, we realize the pervasiveness of humankind’s deconstruction and reconstruction of the Earth, in both geophysical and discursive terms. As the body of the Earth is marked and reshaped, so is its idea. From a hostile territory to be subjugated and exploited through sovereign commands, the Earth is now reframed as a vulnerable domain in need of protection. The (...) mode of sovereignty, which has accompanied human and legal history and practice during modernity and its project of mastery, is no longer useful. Humanity’s control of the Earth is being reimagined and reconfigured along biopolitical coordinates of thought and action. Biopolitics shifts the focus of power, changes its modalities of interventions, and rearticulates its legitimacy on the idea of taking responsibility for the Earth, for nature. A biopolitical re-orientation of law captures the fundamental aim of caring for nature, of fostering its vital possibilities and of enhancing its productive potential. Yet, biopolitics engulfs nature in its entirety under its framework of control, where protection and subjugation, vulnerability and productivity, life and death are constantly entangled in a reciprocal and inevitable relation of indistinguishability. Sovereignty becomes thus a key modality of biopolitical intervention, when nature is recalcitrant, wild, spontaneous, unpredictable, violent, dangerous. Biopolitics, thus, remains caught in an undecidable dilemma, where in order to protect the Earth, it must subjugate it; to save it, it must condemn it. In this respect, biopolitics remains utterly modern, or as argued by Roberto Esposito, modernity has always been biopolitical, insofar as modernity has emerged as a framework for the protection of life against life’s own excesses. But how can we escape the biopolitical reframing and enframing of the Earth and its total subsumption under its matrix of control? How can we rethink the encounter between law and nature without remaining entangled in the aporetic dilemma of biopolitics? An aesthetics of wonder may offer a way. (shrink)

Ethnic minority patients face challenges concerning communication and are at higher risk of experiencing health problems and consuming fewer healthcare services. They are also exposed to disparaging societal discourses about migrants which might undermine healthcare institutions’ ambitions of equitable health care. Therefore, healthcare professionals need to critically reflect on their practices and processes related to ethnic minority patients. The aim of this article is to explore healthcare professionals’ experiences of working with ethnic minority patients by using the critical incident (CI) (...) technique. In two focus group sessions, participants discussed challenging events in their encounters with patients. The critical incidents show that healthcare professionals may experience unfamiliar situations related to their work performance, prejudice toward patients, and labeling by patients the professionals do not identify with. The professionals’ reflections are discussed in relation to social discourses on migration and their work conditions, and the possible influence on the professionals’ preconceptions and the patient–professional relationship in health care. Reflections about work experiences with ethnic minority patients and aligned societal discourses should be included in healthcare workers’ professional development. Critical incident reflections at work may contribute to better‐coping strategies for healthcare professionals and improved patient–professional relationships with ethnic minority patients. (shrink)

Background Cardiopulmonary Resuscitation (CPR) is one of the areas in which moral issues are of great significance, especially with respect to the nursing profession, because CPR requires quick decision-making and prompt action and is associated with special complications due to the patients’ unconsciousness. In such circumstances, nurses’ ability in terms of moral sensitivity can be determinative in the success of the procedure. Identifying the components of moral sensitivity in nurses in this context can promote moral awareness and improve moral performance. (...) Objective This study was conducted to explore and identify the experiences of critical care nurses about moral sensitivity components in CPR. Research design and methods This study was implemented with a qualitative approach. Data were collected via 22 in-depth semi-structured interviews held with 20 eligible participants with maximum variation. The data were then analyzed using the grounded theory approach. Participants and research context In total, thirteen clinical nurses, three head nurses, two educational supervisors, and two faculty members from different universities of Iran were interviewed. Ethical considerations This study was conducted with the ethical approval (IR.UMSU.REC.1399.337) of the Ethics Committee of Urmia University of Medical Sciences. Findings Four themes and 12 sub-themes were extracted from the analysis of the data, including “Consciously and compassionate attention to resuscitate the patient,” “Awareness of families’ anxiety,” “Understanding the teamwork and interactive guidance of the CPR process,” and “Compulsory violation of moral principles.” Discussion It is anticipated that this discussion will prompt further debate, raise awareness and help clarify the dimensions of moral sensitivity in unconscious patients especially during CPR, so that it can be more clearly named and defended as a moral authority in CPR. Conclusion identifying the components of moral sensitivity in nurses, facilitates their encounter with moral issues and can improve their moral performance and encourage right decisions. (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)

Abstract:This paper explores multiple encounters between activist-survivors of Japanese military sexual slavery (“comfort women” or halmonis, meaning “elderly women” or “grannies” in Korean) and solidarity activists. I mainly focus on the stories of two foundational figures in the ongoing justice campaign for the survivors, both of whom faced that forceful military act (between 1932 and 1945) as teenage girls in colonized Korea, although in dramatically different ways: Yun Chung-ok, a leading scholar and activist who, having managed to escape the (...) fate of many other peers, first spoke out about Japanese military sexual slavery, and Kim Bok-dong, a survivor and human rights activist. This paper will address the multiple encounters and dialogues of memories to resituate subjects, which led to overcoming personal trauma and reaching out to others and continues to drive the redress movement. Drawing on oral history interviews, feminist ethnography, and various documented resources including survivors’ testimonies, which have been archived for around twenty years as part of my own scholar-activist work, I juxtapose these women’s lives to show how a community of responsibility has been formed to decolonize androcentric history. The women involved in the movement for the resolution of the Japanese military sexual slavery issue reinterpreted their experiences as having been formed by imperialism, colonialism, and patriarchy. While caring for and healing with one another, they suggested the possibility of a new subject formation. Through mutually constructed identities, activist-survivors broke away from social stigma and became agents who led transformation of a postcolonial society. (shrink)

This paper will investigate patterns of historical periodisation with regard to public intellectual work. It will begin with a focus on educational studies and with a specific case study of the Centre for Applied Research in Education (CARE) at the University of East Anglia. The case study will highlight the roles of leading public intellectuals such as Lawrence Stenhouse and explore the genre of applied research. The notion of applied research in education explicitly sought to connect the project of public (...) education and social justice with research which was applied to these projects In this way, in an idealised form, the public intellectual and applied researcher would offer aid and sustenance, which would enhance and energise the overall project of public education for all By exploring a case study of an institution and the associated research genre I hope to elucidate the relationship between educational studies and the public intellectual and also to examine the changing prospects for such work over different historical periods. Part of the task is to delineate the changing ‘windows of opportunity’ for public intellectual work. And as we shall see, Brief Encounters are a reasonable characterisation of such patterns of possibility Using the case study as an entry point the paper goes on to discuss broader questions about public intellectuals’ prospects. These questions are embedded in the discussion of some of the work of Sandel on market societies, and Applebaum on changing patterns of democratic engagement. The paper concludes with a commentary on contemporary and future prospects for public intellectual engagement. (shrink)

Maurice Blanchot is perhaps best known as a major French intellectual of the twentieth century: the man who countered Sartre's views on literature, who affirmed the work of Sade and Lautreamont, who gave eloquent voice to the generation of '68, and whose philosophical and literary work influenced the writing of, among others, Jacques Derrida, Gilles Deleuze, and Michel Foucault. He is also regarded as one of the most acute narrative writers in France since Marcel Proust. In __Clandestine Encounters__, Kevin Hart (...) has gathered together major literary critics in Britain, France, and the United States to engage with Blanchot's immense, fascinating, and difficult body of creative work. Hart's substantial introduction usefully places Blanchot as a significant contributor to the tradition of the French philosophical novel, beginning with Voltaire's _Candide _in 1759, and best known through the works of Sartre. __Clandestine Encounters_ _considers a selection of Blanchot's narrative writings over the course of almost sixty years, from stories written in the mid-1930s to _L'instant de ma mort_. Collectively, the contributors' close readings of Blanchot's novels, _recits_, and stories illuminate the close relationship between philosophy and narrative in his work while underscoring the variety and complexity of these narratives. "Blanchot's narratives are here read with the care, patience, and thoroughness they deserve. The collection sustains a remarkable intensity of engagement throughout, in so doing opening these narratives out to their necessary contexts--philosophical, of course; but also literary, political, theological, and biographical--with welcome dedication and integrity. The volume makes a timely and decisive contribution to its field, where it will form a major point of reference." --_Martin Crowley, Queens' College, University of Cambridge_ "This outstanding collection--lucid, engaging, generous--illuminates Blanchot and the very notion of 'the philosophical.' " --_Gerald Prince, University of Pennsylvania_ "This collection contains some very important pieces on a major figure of twentieth-century modernism. Blanchot now has a much wider audience in North American than he did even a few years ago when it was mostly experimental fiction writers like Paul Auster, Lydia Davis, R. M. Berry, and Steve Tomasula--not literary critics--who took an interest in Blanchot's literary writings. The focus on the 'narratives' sets this volume apart from, and makes it a good deal more stimulating than, other recent collections of essays on Blanchot." --_Gerald Bruns, University of Notre Dame _. (shrink)

This multidisciplinary book brings together a series of critical engagements regarding the notion of ethical practice. As a whole, the book explores the question of how the current neo-liberal socio-political moment, and its relationship to the historical legacies of colonialism, white settlement, and racism, informs and shapes our practices, pedagogies, and understanding of encounters in diverse settings. Drawing largely on the work of Sara Ahmed’s Strange Encounters: Embodied Others in Post-Coloniality, each chapter in this book takes up a (...) particular encounter and unravels the elements that created these meetings in specific times and spaces. Sites of encounters included in this volume range from the classroom to social work practice and from literary to media interactions, and take place both within Canada and internationally. Paramount to the discussions is a consideration of how relations of power and legacies of oppression shape self and others, and draw boundaries between bodies within an encounter. From a social justice perspective, Unravelling Encounters exposes the political conditions that configure our meetings with one another, and inquires into what it means to care, to respond, and to imagine oneself as an ethical subject. (shrink)

The article examines philosophical conceptions of responsibility found in the contributions of Martin Buber, Hans Jonas and Emmanuel Levinas. It argues that, despite the significant differences of these contributions, they all share important goals, significant structural features, and corresponding challenges. All three thinkers try to overcome the solipsistic limitations of Edmund Husserl’s phenomenology as well as the egocentrism of Heidegger’s concept of "solicitude" or "self-care." All three try to overcome the Kantian subject-object dichotomy. All three understand responsibility as a bipolar (...) relation only. In consequence, all of them face similar challenges resulting from new forms of dichotomies and the exclusion of “thirdness” that are the result of their conceptual decisions. (shrink)

Disease-mongering, or the medicalisation of aspects of daily life in an attempt to generate commercial profit for a party other than the person whose complaint is medicalised, is a newly recognized and legitimate source of concern for both consumers and deliverers of health care. The interest brought to this area by the academy has the potential to acknowledge and address the consequences of the practice. However, before disease-mongering can establish itself firmly as an area of scholarly concern, researchers must understand (...) that the critique is not just about identifying commercial intent, but also about naming the mechanism through which discourses of health, cure and self-management are positioned. In this paper, I argue that a critical reflection on the construction of disease concepts and the mongering of their cure must include discussions of the foundations of health and the clinical encounter. I identify a number of pivotal issues within these themes that should be explored in order to ensure an unambiguous and productive discussion of disease-mongering and its correlates. (shrink)