Selected as Outstanding Academic Book by Choice magazine.

After offering an opening consideration of the hazards of neoliberalism, I address the general shape of the crisis of care that has evolved under its auspices. Two aspects of this crisis require greater attention: the moral precarity of caregivers and the relational harms of neoliberal capitalism. Thus, I first consider the moral precarity that caregivers experience by drawing on a concept that originates in scholarly work on the experiences of healthcare workers and combat veterans, namely, moral injury. (...) Through this concept, we can see how caregivers in late-stage capitalism face a seemingly unavoidable violation of their own significant moral beliefs. Second, I examine how the crisis of care results not only in individual harms of moral injury but also in harms to relationships themselves, as I continue to track the impact of moral injury on our intrapersonal and interpersonal lives. Ultimately, I argue that an important facet of the crisis of care is how it operates as a crisis of relationality in which our intrapersonal and interpersonal connections are placed under practical and moral strain. In taking a broader view, we can see how the fraying of particular intrapersonal and interpersonal connections can accumulate, resulting in the unraveling of wider webs of interdependency, just when we need them most. Throughout the paper, I zero in on the moral implications of the crisis of care driven by neoliberalism, featuring the damages that caregivers and their relationships sustain when situated in morally precarious ways. In doing so, I drive home the point that the crisis of care under neoliberalism is as much a moral and relational crisis as it is a political and economic one. (shrink)

Providing a model for the transformative work that is required going forward, The Crisis of US Hospice Care illustrates the potential of hospice for facilitating a new way of living our last days and for having the best death possible.

The role of ethics in organizational crisis management has received limited but growing attention. However, the majority of research has focused on applications of ethical theories to managing crisis events after they have occurred, as opposed to the implications of ethical theories for the primary prevention of these situations. The relationship between concepts derived from a contemporary ethic of care, pp. 141–158, Gilligan, C.: 1990, ‘Preface’, in C. Gilligan, N. P. Lyons and T. J. Hanmer, pp. 6–29, (...) Gilligan, C.: 1991, ‘Women’s Psychological Development: Implications for Psychotherapy’, in C. Gilligan, A. G. Rogers and D. L. Tolman, pp. 5–32), and, concepts derived from a classic theory of organizational decline and recovery ) is described. The relevance of these notions for signal detection and uptake in organizational crisis prevention is discussed. Implications for prevention are highlighted through consideration of a case involving organizational crisis, the explosion of the space shuttle Challenger. Directions for both business practice and future research are identified. (shrink)

Among the far-reaching impacts of COVID-19 is its impact on care systems, the social and other systems that we rely in to maintain and provide care for those with “illness.” This paper will examine these impacts through a description of the influence on palliative care systems that have arisen within this pandemic. It will explore the impact on the meaning of care, how care is performed and identified, and the responses of palliative care systems (...) to these challenges. It will also highlight the current and potential future implications of these dynamics within the unfolding crisis of this pandemic. (shrink)

Volume 20, Issue 7, July 2020, Page 167-169.

During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to (...) categorically exclude certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 2-2, September‐October 2021.

Hastings Center Report, Volume 51, Issue 5, Page 53-55, September‐October 2021.

Hastings Center Report, Volume 51, Issue 5, Page 30-41, September‐October 2021.

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails (...) a commitment to both distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision‐making related to their interests, including in crisis planning before, during, and after a pandemic like Covid‐19. (shrink)

We propose to understand the global financial crisis of 2008 as an historical event marked by public decisions, economic evaluations and ratings, and business practices driven by a sense of subjugation to powerful others, uncritical conformity to serendipitous rules, and a levelling down of all meaningful differences. The crisis has also revealed two important things: that the free-market economy has inherent problems highlighting the limits of (financial) business, and, consequently, that the business organisation is not as strong as (...) is usually assumed. We reconstruct some of the most dramatic events of that time by using the narratives of two former Lehman Brothers insiders. We then provide an interpretation of that world by using Heidegger’s notions of being and care. Our investigation uncovers persistent inauthentic relationships nourished by the public structure of the financial market, which, drawing on Heidegger, we call the they. In the financial market the what of the world becomes more important than authentic being and self. But a hitch-free switch to authenticity becomes possible through anxiety and the call of conscience. (shrink)

This article outlines current safe harbors in the law for healthcare practitioners who work in a disaster setting. It reviews available legal protection in crisis situations with respect to the Emergency Medical Treatment and Labor Act (EMTALA), criminal liability, and licensure.

We propose six guideposts that states and hospitals should follow to respect disability rights when designing policies for the allocation of scarce, lifesaving medical treatments. Four relate to criteria for decisions. First, do not use categorical exclusions, especially ones based on disability or diagnosis. Second, do not use perceived quality of life. Third, use hospital survival and near-term prognosis (e.g., death expected within a few years despite treatment) but not long-term life expectancy. Fourth, when patients who use ventilators in their (...) daily lives (e.g., home ventilation) present to acute care hospitals, their personal ventilators should not be reallocated to other patients. Fifth, designate triage officers to assess patients individually on the basis of objective medical evidence, not stereotypes or assumptions. Sixth, include disability rights advocates in policy development and dissemination. (shrink)

Continence is a key moment of care that can tell us about the wider care of people living with dementia within acute hospital wards. The spotlight is currently on the quality of hospital care of older people across the UK, yet concerns persist about their poor treatment, neglect, abuse, and discrimination within this setting. Thus, within hospitals, the care of people living with dementia is both a welfare issue and a human rights issue. The challenge of (...) continence care for people living with dementia can be seen as the ‘canary in the coal mine’ for the unravelling of dignity within the acute setting. This paper draws on an ethnographic study within five hospitals in England and Wales, selected to represent a range of hospital types, geographies and socio‐economic catchments. Observational fieldwork was carried out over 154 days in acute hospitals known to admit large numbers of people living with dementia. This paper starts to fill the gap between theory and data by providing an in‐depth ethnographic analysis examining the ways in which treatment as a person is negotiated, achieved or threatened. We examine how the twin assaults on agency of a diagnosis of dementia and of incontinence threaten personhood. The acute threats to this patient group may then act to magnify perils to treatment as a person. Our findings suggest that personal dignity and the social construction of moral personhood are both threatened and maintained in such a setting. We show how empirical ethnographic data can lend weight to, and add detail to, theoretical accounts of moral personhood and dignity. (shrink)

Extracorporeal membrane oxygenation (ECMO) is a form of life support for cardiac and/or pulmonary failure with unique ethical challenges compared to other forms of life support. Ethical challenges with ECMO exist when conventional standards of care apply, and are exacerbated during periods of absolute ECMO scarcity when “crisis standards of care” are instituted. When conventional standards of care apply, we propose that it is ethically permissible to withhold placing patients on ECMO for reasons of technical futility (...) or when patients have terminal, short-term prognoses that are untreatable by ECMO. Under crisis standards of care, it is ethically permissible to broaden exclusionary criteria to also withhold ECMO from patients who have a low likelihood of recovery, to maximize the overall number of lives saved. Unilateral withdrawal of ECMO against a patient’s preferences is unethical under conventional standards of care, but is ethical under crisis standards of care to increase access to ECMO to others in society. ECMO should only be rationed when true scarcity exists, and allocation protocols should be transparent to the public. When rationing must occur under crisis standards of care, it is imperative that oversight bodies assess for inequities in the allocation of ECMO and make frequent changes to improve any inequities. (shrink)

Some argue that it is ethically justifiable to unilaterally withdraw life‐sustaining treatment during crisis standards of care without the patient's consent in order to reallocate it to another patient with a better chance of survival. This justification has been supported by two lines of argument: the equivalence thesis and the rule of the double effect. We argue that there are theoretical issues with the first and practical ones with the second, as supported by an experiment aimed at exploring (...) whether the Knobe effect, which affects the folk concept of intention, applies to situations of unilateral withdrawal. Fifty‐two critical care physicians from one university were asked to ascribe intention in two hypothetical scenarios A and B in which outcomes differ—the patient from whom life‐sustaining treatment is withdrawn dies in scenario A but survives in scenario B—but the intention, to save the other patient regardless of the outcome of the other, is the same. The survey was administered via a web‐based survey and all answers were anonymous. A paired proportion test was used to compare responses to both questions. All 52 surveyed individuals responded in scenario A and 30 (57.7%) ascribed intention when outcomes were unfavorable, whereas 50 responded in scenario B and 8 (16%) ascribed intention when outcomes were favorable, a difference that was statistically significant (p < 0.001). There are theoretical and practical issues with the arguments proposed to justify the unilateral withdrawal of life‐sustaining treatment based on the equivalence thesis and the rule of double effect. (shrink)

The Nuclear Threat Initiative focuses on preventing catastrophes related to weapons of mass destruction, with a wide range of attacks including nuclear, biologic, radiologic, chemical and cyb...

The unique mix of modern Western and traditional Confucian values in Singapore presents young people with contradictory views on duties to aging parents. It remains to be seen whether the changing demands of modern life will result in new generations giving up Confucian family ethics or whether the Confucian dynamic will find a way to adapt to the new pressures. It is the opinion of this author that the Confucian family structure has mixed potential for the growing crisis of (...) elder care. Alone, both Confucian traditions and typical Western institutional approaches toward elder care fall short of what is necessary for intergenerational social justice, yet a hybrid of the two has great potential for the growing aging crisis. To demonstrate this, I first give a brief account of the history of filial piety in Confucianism as well as the social environment from which it originated. Then I turn my attention to the present issues of an aging population and elder care that face much of the developed world in the twenty-first century. Finally, I show how adherence to Confucian filial traditions can both help to address many of these issues and how it can potentially leave unjust gaps in elder care. Ultimately, I conclude that the crisis of elder care may be best dealt with through a hybrid of Confucian values and Western approaches. (shrink)

This paper reflects on the social consequences of biotechnological control of population for values and ethics of care within the family household in rural north India. Based on long-term ethnographic research, it illustrates the manner in which social practices intermingle with reproductive choices and new reproductive technologies, leading to a systematic elimination of female foetuses, and thus, imbalanced sex ratios. This technological fashioning of populations, the paper argues, has far-reaching consequences for the institutions of family, marriage and kinship in (...) north India particularly in relation to care circulation within the family-household leading to a shifting local ethics of care. (shrink)

This paper draws on the ethics of care to investigate how citizens grappled with ethical tensions in the mundane practice of grocery shopping at the height of the Covid-19 pandemic. We use this case to address the broader question of what it means ‘to care’ in the context of a crisis. Based on a qualitative longitudinal cross-country interview study, we find that the pandemic transformed ordinary shopping spaces into places fraught with a sense of fear and vulnerability. (...) Being forced to face one’s own vulnerability created an opportunity for individuals to relate to one another as significant others through a sense of “response-ability”, or the capacity of people to respond to ethical demands through situated ethical reasoning. We argue for a practical ethos of care in which seemingly small decisions such as how often to go shopping and how much to buy of a particular product serve as a means to relate to both specified and generalized others—and through this, ‘care with’ society. Our study contributes to displacing the continuing prevalence of an abstract and prescriptive morality in consumption ethics with a situated and affective politics of care. This vocabulary seems better suited to reflect on the myriad of small and unheroic care acts in times of crisis and beyond. (shrink)

Different ethical frameworks have been proposed as appropriate for integrating into crisis management strategies. This study examines an ethic of care approach to crisis management analysing the case of Northern Rock bank which was at the centre of the recent financial crisis in the UK. The development and maintenance of relationships is fundamental to an ethic of care approach and the research recognises this by examining the bank–stakeholder relationship both before and after the crisis. (...) Considerable anger was directed at the bank post-crisis and, subsequently, the management team resigned. An important contention is that because an ethic of care approach had not been followed external parties judged that management should have foreseen the crisis and the harm caused was deemed intentional, even though predicting the crisis would have been difficult and it is improbable any harm was intended. Additionally, this negative reaction was heightened due to three facets of Northern Rock’s history: (i) its previous existence as a building society, (ii) the ‘local’ nature of the bank and (iii) the creation of The Northern Rock Foundation. These historical factors caused local stakeholders to presume a ‘caring’ relationship between themselves, and the bank had continued to exist post-demutualisation. The events of the crisis compelled stakeholders to re-appraise this presumption, amplifying the post-crisis anger. (shrink)

Public health emergencies invariably entail difficult decisions among medical and emergency first responders about how to allocate essential, scarce resources. To the extent that these critical choices can profoundly impact community and individual health outcomes, achieving consistency in how these decisions are executed is valuable. Since the terrorist attacks on September 11, 2001, however, public and private sector allocation plans and decisions have followed uncertain paths. Lacking empirical evidence and national input, various entities and actors have proffered multifarious approaches on (...) how best to allocate scarce resources to protect the public's health. Though beneficial in some jurisdictions, these approaches fail to clarify how the type and amount of care delivered in major emergencies might be curtailed. This is due, in part, to a lack of meaningful guidance on shifting standards of care in major emergencies. (shrink)

Popular depictions of values around care for the elderly in the media generate nostalgia for a value-rich past, in which caring practices were considered a family affair. The physical absence of family members for providing care is portrayed as a pathological symptom of contemporary society. The study, through analysis of cinematic representations, explains the cultural need for the nostalgia of virtuous intergenerational relations. Such nostalgia instils a need to reaffirm values yet at the same time in the shadows (...) of the nostalgic trope in films, possibilities for a new value system and alternate forms of care can be gauged. These possibilities would eventually bridge the dichotomy between ‘traditional’ and ‘modern’ values related to ageing parents. The relevance of such a ‘nostalgic gaze’ becomes important in the context of rising elderly abuse. Society reflexively evaluates the situation of value transformation. Through the nostalgia, used in this study as an analytical tool, new definitions and practices of care, new kinds of socialities and relations are seen to emerge. In this scenario, the substance of values asserts itself in a malleable form awaiting constant, rapid modification in present times. (shrink)

Lowering the standard of care in a pandemic is a recipe for inferior care and discrimination. Wealthy white patients will continue to get “standard of care” medicine, while the poor and racial mino...

This article seeks to explore institutional psychotherapy’s politically informed practice by highlighting two key concepts: crisis and resistance. It first briefly sketches a conceptual overview of the two concepts, paying particular attention to the complicated interactions between their political and therapeutic meanings. Following each conceptual elaboration there is a discussion exploring the ways in which the concept has been used by two key members of the institutional psychotherapy movement, Frantz Fanon and Félix Guattari.

Despite the importance of ethics in corporate crisis management, they have received limited attention in the academic literature. This article contributes to the evolving conversation on ethics in crisis management by elucidating the ethics of "justice" and "care" and distinguishing between them. Examples of the two approaches are offered through consideration of cases in corporate crisis management, including the alleged glass contamination case faced by Gerber Products Company, and, the shooting tragedy at San Ysidro faced by (...) McDonald''s Corporation. It is argued that both an ethic of justice and an ethic of care can be appropriate approaches in corporate crisis management. Areas for future research are discussed. (shrink)

How can people from diverse and different cultural backgrounds balance and reconcile their autonomous cultural identity with the universal dictates of the global age? My approach to this question is from an East Asian perspective, in particular by addressing the issue of 'Confucian cultural identity' under four broad topics: (1) the truth and falsehood of the discourse on 'Asian Values' and 'Confucian-style Capitalism'; (2) the spread of modern science and the tragic consequences of 'Instrumental Reason'; (3) criticism of instrumental reason (...) and its encounter with Confucian virtue ethics; and (4) a reassessment of the 'Anthropocosmic Moral Metaphysics' of (Neo-) Confucianism. In conclusion, on the impending demand to cope with the crisis of our cultural identity in the age of globalisation, our project to strive for the viability of Confucian humanism in the age of globalisation, I think, should mean no other than the invocation of care-ethics that takes care of our alienated neighbours on the one hand and a thrust of an eco-friendly world view to the anthropocentric hegemony over nature, which has been appreciated by 'modern' men since the Enlightenment, on the other hand. (shrink)

ABSTRACT:It may be too late to avoid the climate crisis, likely to be humanity's most expensive, widespread, and enduring catastrophe. This is a qualitatively different kind of catastrophe, in which increased costs, decreased revenue, and no possibility of bailout force communities to harshly cut budgets, especially in health care. Little is known about making such brutal cuts fair or efficient, nor how to help the public accept them. The crisis presents an opportunity for bioethicists to play a (...) crucial role, but one for which traditional approaches are inherently inadequate. Although often dismissed as heartless, Garrett Hardin's "lifeboat ethics" started a conversation about making ethical choices in global disasters—where all options are painful and unacceptable—and may provide guidance. Bioethics during the climate crisis must focus on communities rather than individuals and help survivors grieve the terrible consequences. Because today's choices will affect many generations, with the burdens falling most heavily on poor communities, we have to construct a radical bioethics to help tomorrow's health care become green, efficient, and fair. (shrink)

Growing evidence suggests the presence of a female leadership advantage (FLA), such that women leaders tend to be associated with more effective outcomes in uncertain conditions. However, mechanisms linking women's leadership to effective outcomes are less well understood. We integrate FLA insights with ethics of care philosophical framework to conceptualize how women leaders achieve effective outcomes in the context of the urban revitalization crisis in the United States. We propose and empirically test the mediating role of ethics of (...) care leadership in the relationship between women mayors and economic health of their cities. We used data from the Urban Institute that includes 272 United States cities and measures of variables in our conceptual model at five points in time spanning 36 years (_n_ = 1185 city-year observations). We capture ethics of care leadership focused on racial inclusion with an index measure of a city’s racial spatial segregation, homeownership gap, poverty gap, and education gap, and we capture economic health with an index measure of a city’s employment growth, unemployment rate, housing vacancy rate, and median family income. We found that female-led cities were associated with better economic health, and this association was mediated by female-led cities’ association with greater racial inclusion. Ethics of care leadership appears to be one pathway through which a FLA manifests itself in the context of the urban revitalization crisis. This underscores the importance of city leadership that balances social and economic prerogatives. Implications are discussed. (shrink)

: During the past decade there has been a debate about the field of philosophy of medicine. The debate has focused on fundamental questions about whether the field exists and the nature of the field. This article explores the debate and argues that it has paid insufficient attention to the social dimensions of both philosophy and medicine. The article goes on to argue that by exploring this debate one can better understand some of the difficult questions facing contemporary medicine and (...) health care. (shrink)

The object of this essay is to explore the central role played by the ‘ethic of care’ in debates within and beyond feminist legal theory. The author claims that the ethic of care has attracted feminist legal scholars in particular, as a means of resolving the theoretical, political and strategic difficulties to which the perceived ‘crisis of subjectivity’ in feminist theory has given rise. She argues that feminist legal scholars are peculiarly placed in relation to this (...) class='Hi'>crisis because of their reliance on the social ‘woman’ whose interests are the predominant concern of feminist legal engagement. With the problematisation of subjectivity, the object of feminist legal attention disappears and it is in attempts to deflect the negative political consequences of this that the ethic of care has been invoked, the author argues, unsuccessfully. The essay concludes with suggestions as to how the feminist project in law might proceed in the wake of the crisis of subjectivity and the failure of the ethic of care to resolve it. (shrink)

The central question of the essay is: How is a hermeneutic ethic possible, given that its conditions of possibility may seem in crisis if explicit criteria for normative evaluation are rejected and the interpreting subject seems fully integrated into a process of open-ended contextual understanding. The emerging possibility of a situated ethos of dialogue, however, is challenged by the administrative and instrumental destruction of tradition. In response, a careful reinterpretation of Hans-Georg Gadamer’s claim that interpretation is per se ethical (...) provides us with the normative ideal of dialogical openness. Yet Gadamer’s broad-brushed rejection of social-scientific research is replaced by the subtle proposal for a reflective co-operation between dialogical understanding and sociological thought. Now the social sciences and social theory either reconstruct empirical sources of the ethos of dialogue, or they deconstruct the forces of discursive and social power that undermine the realization of our ethical potential. (shrink)

This book presents a sympathetic yet critical treatment of the major philosophical attempts to define a viable project for philosophy in the face of historical changes. McCarthy, then, proposes a comprehensive, critical, and methodological strategy of epistemic integration that fully respects the progressive and pluralistic character of contemporary science and common sense. The programs of Frege, Husserl, Wittgenstein, Carnap, Sellers, Dewey, Quine, and Rorty are carefully presented and an assessment is made of their merits and limitations. This assessment results in (...) a defense of Lonergan’s integrative strategy — a nuanced philosophical strategy around which a gathering center could be built. McCarthy presents Lonergan’s work as containing the firm outline and partial execution of a philosophical project continuous with philosophy’s historic purposes and equal to the exigences of the present. The book examines a broad range of seminal topics and, after extended dialectical treatment of them, develops a coherent account of their interdependence. These topics include psychologism, intentionality, the limits of naturalism, semantical and epistemic realism, historical belonging, epistemic invariance, foundational analysis, the limitation of logic and of the linguistic turn, generalized empirical method, the interdependence of mind and language, the interplay of nature and history, and the critical appropriation of tradition. (shrink)

Volume 20, Issue 7, July 2020, Page 156-158.

The faith in progress that propelled the West for over four centuries is in decline due to its own success. The emergence of capitalism with its novel market imperatives has created both the poverty that causes political crises and the material growth that has destabilized the Earth’s climate. There is a growing sense that we are dominated by the technologies and social organizations that we hoped would liberate us. Individualism and secularity have left people feeling isolated and without a sense (...) of higher purpose, leading some to reject Enlightenment values in favor of traditionalisms and even neofascism. In universities, faculty struggle to prove their utility and relevance, because they cannot guarantee their graduates a decent living in a world of automation and globalized production. As a result of these trends, the West’s ability to produce responsible citizens is in question. Our students are largely inured to appeals to transcendent values because they are urged to be “practical.” Faculty are no longer encouraged to care about the character-building nature of a liberal education. United States universities are in danger of not having an independent voice, as those departments that can consistently get major external funding seek commercial applications for the products of their research. In the United States, ideologically based harassment and censorship of unpopular ideas takes place regularly and is a major deterrent to pursuing a career in higher education. Given these challenges, can intellectuals still make a difference in universities? Many have taken to social media and other ways of getting their ideas around the increasingly steep paywalls of academic publications and the de facto censorship in their institutions. Some of the most vibrant exchanges of ideas are now happening in other places, largely online. These venues draw in people who are trying their best to learn something they are unlikely to learn at universities. But are such alternatives truly sustainable or good enough? Higher education is at a crossroads in which even this “retreat and regroup” strategy is highly problematic. (shrink)

The job of a leader includes caring for others, or taking responsibility for them. All leaders face the challenge of how to be both ethical and effective in their work. This paper focuses on the requirement that leaders be present to care for their followers in times of crisis. It examines the story of Nero playing his fiddle while Rome burns. This is a tale that has been repeated in various forms by ancient historians and modern writers. The (...) fact that the story gets repeated through the ages tells us about the kind of care that people expect from their leaders. (shrink)