AimTo investigate the status of positive mental characters and humanistic care ability among Chinese nursing students, and confirm the association between positive mental characters and humanistic care ability.MethodsA cross-sectional survey was conducted. Nine hundred eighty-one Chinese nursing students were recruited from hospitals and community healthcare services in Changsha, Hunan, China. Three different self-reported questionnaires were applied: The Demographic Characteristics Questionnaire, Humanistic care ability of Nursing Undergraduates Assessment Scale and Positive Mental Characters Scale for Chinese College Students. Pearson (...) correlation analysis and multiple liner regression analysis were performed to analyze the association between positive mental character and humanistic care ability for Chinese nursing students.ResultsThe mean scores of nursing students' humanistic care ability and positive mental character were 125.94 ± 21.19, 233.18 ± 38.59, respectively. The Pearson correlation results showed that positive mental character was significantly associated with humanistic care ability. Multiple liner regression analysis indicated that positive mental characters, four dimensions of courage, humanity, justice and transcendence in positive mental character, care from classmates were found to be independent predictors of humanistic care ability.ConclusionPositive mental characters are important considerations in the development, implementation and evaluation of humanistic care ability interventions. (shrink)

ObjectiveWith the improvement in health awareness, humanistic care ability of nurses has become a focus of public attention. The aim of the study was to confirm the relationship between psychological capital and humanistic care ability of nurses, and to provide suggestions on improving the humanistic care ability of nurses.MethodsA cross-section survey was conducted. Three hundred thirty-nine nurses were recruited from a tertiary general hospital in Taizhou, China. Psychological capital and humanistic care ability were measured using a (...) self-reported questionnaire. Correlation analysis and stepwise multiple regression analysis were performed to analyze the correlation between psychological capital and humanistic care ability.ResultsThe psychological capital and humanistic care ability scores were 91.57 ± 13.96 and 189.08 ± 20.37, respectively. Differences in psychological capital scores across professional titles, departments, years of work, and marital status were statistically significant. There were statistical differences for the humanistic care ability scores among nurses based on marital status. The total psychological capital scores and the four sub-dimensions scores were positively correlated with the humanistic care ability scores among nurses. Self-efficacy was the main predictor of nurses’ humanistic care ability.ConclusionPsychological capital positively affected the humanistic care ability of nurses. Self-efficacy was the main predictor of humanistic care ability. Nursing managers can formulate strategies from the perspective of positive psychology to improve humanistic care ability of nurses. (shrink)

Moral questions surrounding suffering tend to focus on obligations to relieve others’ suffering. In this paper, I focus on the overlooked question of what sufferers morally owe to themselves, arguing that they have the duty to self-care. I discuss agents who have been shaped by moral luck to contribute to their own suffering and canvass the ways in which this damages their moral agency. I contend that these agents have a duty to care for themselves by protecting and expanding their (...) agency, which involves precluding further destruction of agency and ensuring the continued ability to self-care. (shrink)

This paper deals with Care of the Self under globalization. The first part refers to Johann P. Arnason’s interpretation of Jan Patočka’s work on super-civilization and shows the contradictions facing people in the Modern Era. It suggests that the concept of moderateness is an adequate point of departure for handling the various contradictions of the current epoch. The second part looks at selected aspects of Confucian philosophy in which moderateness, that is, the permanent search for a “middle position” is an (...) integral part of that philosophical tradition. The critical actualisation of Confucianism as proposed for instance by Heiner Roetz is seen as an appropriate way of developing the dialogical characteristics of Confucian philosophy. In the last part it is stressed that critical theory is of relevance when identifying various forms of suffering and because of its ability to understand and critically evaluate diverse cultural and social contexts. (shrink)

Our self-concept is how we see ourselves in our minds. The goal of this research was to discover any significant differences in the dimensions of self-concept between clinical nurses employed in an intensive care unit in Slovenia and Slovenian women from the general population, who represented the control group. The research included 603 women aged 20—40 years (mean 29.94; standard deviation ±6.0) who had a high-school education. To determine the differences between the groups statistically we used one-way analysis of variance. (...) The results revealed that clinical nurses had a more positive self-concept than members of the control group. Self-concept is very important in nursing because it is closely connected to the existing value system of individuals and their behaviour. Self-concept gives nurses a sense of how they use their abilities and how they perform in relation to patients. (shrink)

High moral standards and adherence to a moral code have long been strong tenets of the profession of medicine, even though there have been occasional lapses that have led to renewed calls for a revitalization of moral integrity in medicine. Certainly, a moral component has generally been held to be an important aspect of the concept of a physician.

In Decent People, Norman Care explores how we may understand and be reconciled to the fragility of our moral nature. In his highly original vision of what it means to be a decent person, Care claims that our moral-emotional nature pressures us to seek relief from moralized pain - pain that comes from our awareness of our own wrongdoing, the suffering of current or future people, and our experience of indifference to moral imperatives. Care argues that decent people are neither (...) 'pure' nor self-righteous and that they are vulnerable to the need for forgiveness. Decent people may take morality seriously, but they are not guaranteed success at its challenges. (shrink)

A motivation problem may arise when morally principled public policy calls for serious sacrifice, relative to ways of life and levels of well-being, on the part of the members of a free society. Apart from legal or other forms of “external” coercion, what will, could, or should move people to make the sacrifices required by morality? I explore the motivation problem in the context of morally principled public policy concerning our legacy for future generations. In this context the problem raises (...) special moral-psychological difficulties. My inquiry suggests pessimism regarding our ability to solve the motivation problem relative to what morality requires on behalf of future generations. (shrink)

In the wake of a pilot study that indicated that the experience of medical education appears to Inhibit moral development In medical students, increased attention needs to be given to the structure of medical education and the Influence it has on medical students. Interest in ethics and moral reasoning has become widespread in many aspects of professional and public life. Society has exhibited great interest in the ethical issues confronting physicians today. Considerable effort has been undertaken to train medical students, (...) interns, and residents In how to reason through medical-ethical dilemmas. Media attention has focused on Issues such as abortion, euthanasia, care of severely handicapped infants, organ transplantation, and so forth, producing heated debates in both the professional and lay literature over the morality of the various positions. The curriculum of medical education has paralleled and reflected this general Interest in medical ethics. Most medical schools now offer, and frequently require, course work in ethics. However, further research Is needed to better characterize and understand the relationship of medical education to moral development. (shrink)

Background The fourth section of the 1967 Abortion Act states that individuals (including health care practitioners) do not have to participate in an abortion if they have a conscientious objection. A conscientious objection is a refusal to participate in abortion on the grounds of conscience. This may be informed by religious, moral, philosophical, ethical, or personal beliefs. Currently, there is very little investigation into the impact of conscientious objection on service users in Britain. The perspectives of service users are imperative (...) in understanding the real-world consequences and potential impact of conscientious objection and should be considered when creating and reviewing policies and guidelines. This research provided a platform for women and those who can become pregnant to share their experiences and opinions at a time when these voices are largely excluded in the great tradition of Western political philosophy and law-making processes. Method Five service users were interviewed using a narrative interview approach to uncover their abortion journeys and experiences of conscientious objection. Findings The findings were presented as found poems and uncovered that doctors are not always: informing service users that they have a conscientious objection to abortion, giving service users enough information to access abortion (indirect referral), treating them non-judgmentally, and providing medically correct information. Service users did not experience burdens such as long waiting times and were still able to access legal abortion. However, service users did experience negative emotional effects, as they were often left feeling scared, angry, and hopeless when they were not referred and/or were mistreated. Conclusions Findings indicate that conscientious objection could work in practice. However, it is currently failing some individuals on an emotional level, as not all doctors are adhering to guidelines. Conscientious objection in Britain needs to be addressed, to ensure service users receive fair, impartial, non-judgmental care. (shrink)

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show that while (...) nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way they function as clinical ethicists. (shrink)

A motivation problem may arise when morally principled public policy calls for serious sacrifice, relative to ways of life and levels of well-being, on the part of the meInbers of a free society. Apart from legal or other forms of “external” coercion, what will, could, or should move people to make the sacrifices required by morality? I explore the motivation problem in the context of morally principled public policyconcerning our legacy for future generations. In this context the problem raises special (...) moral-psychological difficulties. My inquiry suggests pessimism regarding our ability to solve the motivation problem relative to what morality requires on behalf of future generations. (shrink)

The medical ethicist is a fairly recent addition to the clinical setting. The following four potential roles of the clinical ethicist are identified and discussed: consultant in difficult cases, educator of health care providers, counselor for health care providers and finally patient advocate to protect the interests of patients. While the various roles may sometimes overlap, the roles of educator and counselor are viewed as being more congruent with the education and training of medical ethicists than are the roles of (...) consultant and patient advocate. (shrink)

This paper provides a philosophical critique of professional stereotypes in medicine. In the course of this critique, we also offer a detailed analysis of the concept of care in health care. The paper first considers possible explanations for the traditional stereotype that caring is a province of nurses and women, while curing is an arena suited for physicians and men. It then dispels this stereotype and fine tunes the concept of care. A distinction between ‘caring for’ and ‘caring about’ is (...) made, and concomitant notions of parentalism are elaborated. Finally, the paper illustrates, through the use of cases, diverse models of caring. Our discussion reveals the complexity of care and the alternative modes of caring in health care. (shrink)

Following a brief consideration of two contrasting purposes for teaching the medical humanities, a description is given of a film discussion elective course. In contrast to the usual teaching of medical ethics which is primarily a cognitive activity emphasizing the development of a code of principles such as justice, autonomy, and beneficence, the film discussion elective was primarily an affective activity emphasizing the development of an ethical ideal of caring, relatedness, and sensitivity to others. The pass/fail elective, offered for one (...) credit each quarter for two quarters, met once a week for one hour for twenty-four weeks. Each week a film was shown followed by a group discussion. A wide variety of social issues were covered. The objective of the course was to increase the ethical sensitivity of the medical students through promotion of introspection and reflection on social issues. A brief discussion is given of the importance and appropriateness of using film to promote the affective focus of medicine on the relief of suffering. Examples are given of how the course achieved its objective. A detailed description of the resource materials is provided. (shrink)

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that value (...) judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

In 1991 the United Nations General Assembly adopted the Principles for Older Persons as a framework for international policy responses to population ageing. These principles promote independence, participation, care, self-fulfilment and dignity as legitimate entitlements of all older people. Although these principles, or variations of them, are embedded in standards of best-practice in residential aged care facilities, the literature shows that in reality institutional care can deny older people opportunities to exercise some of these entitlements. More specifically, residential aged care (...) facilities can deprive older people of access and support to pursue opportunities for the full development of their potential, i.e. their entitlement to self-fulfilment. This discussion article explores the influence of institutional care on older people’s ability to exercise their entitlement to self-fulfilment. We identify the characteristics of a ‘good life’ in institutional care, according to aged care residents themselves. The Eden Alternative™ is presented as a model of aged care that aims to create the conditions for a ‘good life’ and self-fulfilment for aged care residents. (shrink)

This paper engages with Italo Calvino’s lecture on Visibility, included in his last—and testamentary—volume Six Memos, by understanding it in an educational and pedagogical key. While the question of pedagogy is expressly addressed by Calvino himself in his lecture, the interpretation here provided is not merely an application of his tenets but an elaboration on and an autonomous development of them. In particular, in the spotlight there is the intimate bond image-cum-writing which seems to preside over Calvino’s insights and is (...) here suggested as key to tackling the challenges of the contemporary mediascape and the “tautological vision” dominating therein. While a part of the educational discourse invokes “homeostatic” pedagogical solutions, namely the (ultimately confrontational) deployment of writing to compensate for the iconic ruling regime, this paper explores the possibility of a specific kind of visual education (instantiated by comics and Otto Neurath’s Isotype), which combines the role of the image with some features traditionally attributed to the pedagogy of writing (e.g. the cultivation of abilities of abstraction, of reflection etc.). A pedagogy of figuration is, accordingly, proposed as an interruption of the tautological vision of the new media and as conducive to educating readers of the unwritten world and of the world of digital images, Mr. Palomar—the hero of Calvino’s last novel—possibly being the archetype of this kind of (new?) readership. By referring to two influential notions in the contemporary debate in educational philosophy and theory, this pedagogy is finally interpreted in term of (visual) thing-centredness rather than (visual) subjectification. (shrink)

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether (...) there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults. (shrink)

Against the backdrop of an aging global population and the increasing pressure of medical care expenditures for seniors, this paper used a fuzzy regression discontinuity model to explore the effects of retirement on the self-assessed health and objective physical and mental health of older people. Using survey data from the China Health and Retirement Longitudinal Study, our model addresses some relevant academic controversies. Our sample was comprised of male respondents from government agencies, enterprises, and public institutions. The research explored the (...) impact of retirement on lifestyle habits and included an in-depth analysis of the mechanism through which retirement influences different aspects of health. The results show that: Retirement does not have any significant impact on objective health, including depression and self-care ability, but it does cause a notable decline in subjective health assessment. Retirement shortened the sleep time of respondents, which may account for lower scores on subjective health self-evaluations, but it did not lead to any noticeable improvement in habits which are harmful to health, such as smoking and drinking. Marriage can help alleviate the problems of depression and smoking among older people, and education has a somewhat broader positive effect on their health and lifestyles; however, neither factor helps to improve the sleep problems of older people. Therefore, this paper recommends that efforts should be made to both optimize retirement policies and seek further ways to improve the health of the retired population. (shrink)

This study investigated gender related moral reasoning in student essays containing arguments on moral issues. Undergraduate students in a medical ethics course viewed two films on morally controversial issues. The students wrote brief essays about the films which were transcribed and numerically coded to conceal the author's gender from the evaluator. Using a coding scheme originated by Lyons, the evaluator classified each essay as a justice/right essay or a care/response essay or an equal response essay. Subsequently, calculations were made to (...) determine the percentage of male authored essays that were justice/rights essays or care/response essays and the percentage of female authored essays that were justice/rights or care/response essays. The males (87.7%) tended to exhibit the justice/rights moral orientation, and the females (69.4%) exhibited the care/response moral orientation. Several different calculations were made to determine various degrees of gender related orientations also. The difference in orientation was highly statistically significant (p≤0.001). These data contribute to understanding moral orientation and development. Interpretations are given to explain some differences between the genders and help explain the traditional roles in society that males and females have played historically. (shrink)

Philosophy Compass, Volume 17, Issue 4, April 2022. -/- In a moment where needs for care are acute and their provision precarious, feminist care ethics has gained new relevance as a framework for understanding and responding to necessary interdependence. This article reviews and evaluates two long-standing critiques of care ethics in light of this recent research. First, I assess what I call the pluralist feminist critique, or the dispute over the ability of care ethics to address the needs and (...) histories of a range of marginalized subjects. I identify two forms of this critique: the first disputes the biased starting points shaping the development of the theory, and the second concerns the weaponization of care in support of domination. Although these critiques are well-established, I draw attention to recent responses that move care theory in generative directions. I argue that the pluralist feminist critique demands both self-critical transformation in dialog with other feminist schools of thought and a robust account of care ethics' normative authority. I then take up critiques those levied by mainstream ethicists concerned with care theory's adequacy as an ethical approach. I show that recent work on normative authority, conceptual uniqueness, and the grounding of responsibility must be engaged before care theory can be dismissed as “under-theorized.” In articulating these two sets of critiques and evaluating recent rebuttals to them, I argue for a pluralist feminist theory of care within which strands informed by varying philosophical schools and methods can coexist. (shrink)

The power of new medical technologies, the cultural authority of physicians, and the gendered power dynamics of many patient-physician relationships can all inhibit women's reproductive freedom. Often these factors interfere with women's ability to trust themselves to choose and act in ways that are consistent with their own goals and values. In this book Carolyn McLeod introduces to the reproductive ethics literature the idea that in reproductive health care women's self-trust can be undermined in ways that threaten their autonomy. (...) Understanding the importance of self-trust for autonomy, McLeod argues, is crucial to understanding the limits on women's reproductive freedom. -/- McLeod brings feminist insights in philosophical moral psychology to reproductive ethics, and to health-care ethics more broadly. She identifies the social environments in which self-trust is formed and encouraged. She also shows how women's experiences of reproductive health care can enrich our understanding of self-trust and autonomy as philosophical concepts. The book's theoretical components are grounded in women's concrete experiences. The cases discussed, which involve miscarriage, infertility treatment, and prenatal diagnosis, show that what many women feel toward themselves in reproductive contexts is analogous to what we feel toward others when we trust or distrust them. -/- McLeod also discusses what health-care providers can do to minimize the barriers to women's self-trust in reproductive health care, and why they have a duty to do so as part of their larger duty to respect patient autonomy. (shrink)

Discover the power of loving your (Im)perfect self in an (Im)perfect world. This book dares you to experience the liberation, healing, and empowerment that come when you make a spiritual practice out of learning to love yourself. The Self-Love Superpower shares specific, hands-on action steps designed to support your journey from paralyzing self-criticism to expansive self-adoration. But this journey is a spiral and it is not without its challenges. This book is here to offer you support, personal stories, and encouragement (...) as you create a kindness alarm, conduct a self-care audit, engage in a centering and balancing meditation, heal relationship dynamics, and so much more. Each chapter contains accessible exercises, meditations, rituals, self-care practices, and journaling prompts so you can integrate the information in a experiential way, exploring themes such as: Energetic hygiene, grounding and clearing, body positivity, shielding your energy, boundaries, shadow work, clearing clutter, intuitive eating, chakras, stepping into your truth, feng shui. Whether you want to develop greater respect and belief in yourself, connect with your intuition, or regain a sense of excitement and enthusiasm for the things you care about, this guide provides the empowering boost you need to help you get there. -- back cover. (shrink)

This article addresses some ambiguities and normative problems with the concept of mature care in professional relationships and in health care priorities. Mature care has recently been introduced in the literature on care ethics as an alternative to prevailing altruistic conceptions of care. The essence of mature care is an emphasis on reciprocity, where the mature agent has the ability to balance the concerns of self with those of others and act from a principle of not causing harm. Our (...) basic claim is that the prevailing concept of mature care does not capture the real nature of professional relationships and role obligations in health care. As the focus of attention in professional care is and must be the patient’s particular medical and care needs, such care must principally be altruistic. Furthermore, we argue that mature care cannot adequately address moral conflict in health care without accepting some more principle-based approaches and a richer notion of partiality. (shrink)

When we raise children what we are typically aiming for is a kind of flourishing; we want childrento live well as children, and to grow to become adults who live well too. Undoubtedly, part of what we are aiming forwhen we aim for a child’s flourishing is that they meet their developmental milestones well, and that they succeedamong their peers. We are also generally interested in how a child regards themselves; we want children tobelieve that they have value, and that (...) what they care about has value too. We also typically want children to havean appreciation for their relative value among others; that they are important among many other important beings,and we want them to act well in that knowledge. Of course, not all persons who raise children aim for those ends.Some do not care for how a child conceives of themselves, or whether the child flourishes at all. Others care fortheir children, and how they conceive of themselves, but aim poorly. As result, some children come to believe thatthey only deserve love and kindness when they succeed at meeting a caregiver’s ends. Some children come tobelieve that they have no worth at all. And yet other children, rather than believing they are unworthy, come toregard themselves as of superior worth; as children, for example, who bully and sneer at other children for being adifferent race, a different class, gender, ability, etc. may. When a child comes to understand themselves in theseterms, we typically see it at best as morally problematic, and at worst as a tragedy. Despite our interest inchildren’s self-conceptions, and the vast literature on how to conceive of and regard children, there is relatively littleregarding how children should conceive of and regard themselves. In order to explain how children shouldconceive of themselves it is my contention that a new account of self-respect is needed for the context of childhood;one that is responsive to the moral value of children, as well as their developmental capacities to recognize thatvalue. Given that developmental psychology is complex and subject to significant variation as children develop, myaim in this paper is to offer a snapshot of what I take self-respect to amount to in early childhood. In particular, Ifocus on an account fitting for children between three to six years of age. (shrink)

While nearly all patients with a chronic disease must self-manage their condition to some extent, preparation for these responsibilities is infrequently assured in the USA. The result can be significant harm and the undermining of a patient’s ability to take advantage of life opportunities and be productive. Agreeing to care for a patient involves a moral responsibility to see that she or he receives the essential elements of care, including the ability to manage the disease on a daily (...) basis. The research base for the efficacy of self-management and for how patients can be prepared to assume it is sufficiently strong that health care professionals must advocate for its inclusion in the routine evidence-based care of individuals with chronic disease. Because patient education is central to nursing’s philosophy and practice, the profession should play a major role in removing structural barriers to self-management preparation and assuring its provision to a high standard of quality. (shrink)

The aim of this paper is to introduce a correction into the notion of self-directed adult learning by way of conjoining it with philosophically elaborated notions of autonomy, self-reflectiveness, and maturity. The basic premise of this intervention is that in andragogical theorizing, learners’ self-directedness ought not to be thought as obvious and thus beyond question. Since adult selves are not transparent but socially, culturally, and discoursively constructed, adult educators are encouraged to think of themselves as facilitators of adult learners’ self-awareness (...) and self-directedness in their learning processes. Adult learners need to be assisted in developing critical skills that can be used to eliminate distortions in their perception of social reality, in understanding their own personalities, their needs and decisions concerning continuing education. The problematization of the concept of human autonomy amid external influences, is first discussed in Immanuel Kant’s idea of maturity as an ability to use one’s understanding without guidance from another. I then turn to Habermas’s philosophy of communicative action and three knowledge-constitutive interests where the human interest in emancipation comes to the fore. Its significance for critical adult learning is further emphasized in line with Stephen Brookfield’s and Jack Mezirow’s association of self-directed learning with empowerment, understood as freeing consciousness from its dependence on hypostatized powers. Drawing on Foucault’s work, I argue that attaining the state of autonomy requires practice in “the care for oneself” which amounts to the lifelong endeavor to create and govern oneself and to learn how not to be governed. The agenda for adult education for citizenship opted for in this paper attributes essential significance to learnable skills of critical reasoning, deliberation, and self-reflectiveness which all operate within three proposed dimensions of adult education: experiential learning, literacy, and vocationalism. (shrink)

The aim of this paper is to introduce a correction into the notion of self-directed adult learning by way of conjoining it with philosophically elaborated notions of autonomy, self-reflectiveness, and maturity. The basic premise of this intervention is that in andragogical theorizing, learners’ self-directedness ought not to be thought as obvious and thus beyond question. Since adult selves are not transparent but socially, culturally, and discoursively constructed, adult educators are encouraged to think of themselves as facilitators of adult learners’ self-awareness (...) and self-directedness in their learning processes. Adult learners need to be assisted in developing critical skills that can be used to eliminate distortions in their perception of social reality, in understanding their own personalities, their needs and decisions concerning continuing education. The problematization of the concept of human autonomy amid external influences, is first discussed in Immanuel Kant’s idea of maturity as an ability to use one’s understanding without guidance from another. I then turn to Habermas’s philosophy of communicative action and three knowledge-constitutive interests where the human interest in emancipation comes to the fore. Its significance for critical adult learning is further emphasized in line with Stephen Brookfield’s and Jack Mezirow’s association of self-directed learning with empowerment, understood as freeing consciousness from its dependence on hypostatized powers. Drawing on Foucault’s work, I argue that attaining the state of autonomy requires practice in “the care for oneself” which amounts to the lifelong endeavor to create and govern oneself and to learn how not to be governed. The agenda for adult education for citizenship opted for in this paper attributes essential significance to learnable skills of critical reasoning, deliberation, and self-reflectiveness which all operate within three proposed dimensions of adult education: experiential learning, literacy, and vocationalism. (shrink)

The aim of this paper is to introduce a correction into the notion of self-directed adult learning by way of conjoining it with philosophically elaborated notions of autonomy, self-reflectiveness, and maturity. The basic premise of this intervention is that in andragogical theorizing, learners’ self-directedness ought not to be thought as obvious and thus beyond question. Since adult selves are not transparent but socially, culturally, and discoursively constructed, adult educators are encouraged to think of themselves as facilitators of adult learners’ self-awareness (...) and self-directedness in their learning processes. Adult learners need to be assisted in developing critical skills that can be used to eliminate distortions in their perception of social reality, in understanding their own personalities, their needs and decisions concerning continuing education. The problematization of the concept of human autonomy amid external influences, is first discussed in Immanuel Kant’s idea of maturity as an ability to use one’s understanding without guidance from another. I then turn to Habermas’s philosophy of communicative action and three knowledge-constitutive interests where the human interest in emancipation comes to the fore. Its significance for critical adult learning is further emphasized in line with Stephen Brookfield’s and Jack Mezirow’s association of self-directed learning with empowerment, understood as freeing consciousness from its dependence on hypostatized powers. Drawing on Foucault’s work, I argue that attaining the state of autonomy requires practice in “the care for oneself” which amounts to the lifelong endeavor to create and govern oneself and to learn how not to be governed. The agenda for adult education for citizenship opted for in this paper attributes essential significance to learnable skills of critical reasoning, deliberation, and self-reflectiveness which all operate within three proposed dimensions of adult education: experiential learning, literacy, and vocationalism. (shrink)

The aim of this paper is to introduce a correction into the notion of self-directed adult learning by way of conjoining it with philosophically elaborated notions of autonomy, self-reflectiveness, and maturity. The basic premise of this intervention is that in andragogical theorizing, learners’ self-directedness ought not to be thought as obvious and thus beyond question. Since adult selves are not transparent but socially, culturally, and discoursively constructed, adult educators are encouraged to think of themselves as facilitators of adult learners’ self-awareness (...) and self-directedness in their learning processes. Adult learners need to be assisted in developing critical skills that can be used to eliminate distortions in their perception of social reality, in understanding their own personalities, their needs and decisions concerning continuing education. The problematization of the concept of human autonomy amid external influences, is first discussed in Immanuel Kant’s idea of maturity as an ability to use one’s understanding without guidance from another. I then turn to Habermas’s philosophy of communicative action and three knowledge-constitutive interests where the human interest in emancipation comes to the fore. Its significance for critical adult learning is further emphasized in line with Stephen Brookfield’s and Jack Mezirow’s association of self-directed learning with empowerment, understood as freeing consciousness from its dependence on hypostatized powers. Drawing on Foucault’s work, I argue that attaining the state of autonomy requires practice in “the care for oneself” which amounts to the lifelong endeavor to create and govern oneself and to learn how not to be governed. The agenda for adult education for citizenship opted for in this paper attributes essential significance to learnable skills of critical reasoning, deliberation, and self-reflectiveness which all operate within three proposed dimensions of adult education: experiential learning, literacy, and vocationalism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Note on Being Ability–different, Atypically–bodied... Criptastic?Emily HutcheonIn being prompted to write about my experiences with disability [alternatively written: (dis)ability, dis/ability, “disability,” disAbility], I am confronted with more questions than I have answers. Am I to reflect on that small window of time, one so small that I don’t actually remember it, when I did not know that I was different? My mom [End Page 196] (...) has recounted vivid moments where I seem to come to this realization—for example, at the age of three, when I see my twin sister and friends scrambling on a playground and I process that I am unable to join them. Realization of my differentness (my different body, my different way of moving, my different abilities) continued into my youth and adulthood (Can’t skate—check. Can’t ride a two–wheeled bike—check. Usually walk behind others, destined to be the last in a group—check. Was the smart kid in class, aka smartass–in–training—check).Eventually, I realized that my differentness was not contained to my body or my abilities. Were my mind, my self, and my relationships different as well? I seemed to empathize when others didn’t or couldn’t. I saw that certain things were just wrong, and was confused when others didn’t share my concern. I seemed to see, feel, and experience things that others did not. For instance, I had two invasive operations before the age of eleven, a handful of minor procedures and countless physiotherapy sessions. Some memories of these times are horrific. Some I cherish, including the genuine care of the health care staff. Some are hilarious, like being doped–up before invasive surgery at the age of ten and calling my favorite surgeon “So cute!!” But always, there was physical pain, pain, pain. At times, I was completely dependent on others to help me to the bathroom, the shower, to move around, and to recover. I received such tender and exquisite care from my mom during these times. The dependency, which I had no choice but to experience, the dependency that is feared by almost everyone I know (“If I am ever a burden to my family, shoot me”) is something that my mom and I constantly joke about (“Em, I will take care of you now, only if you change my diapers when I’m old, kay?”). I have come to learn that this dependency, along with those other shades of vulnerability, are an inevitable consequence of being human, and to deny this is to relinquish our capacity to connect with others.I had, and continue to have, relationships with strangers, friends and family, which are, in my best estimation, atypical. I am the recipient of staring, laughing, pointing, sympathy, disgust, empathy, tender care, curiosity, hostility, resentment, and ambivalence. While in the gym, complete strangers approach me to say, with all the kindness, enthusiasm, and obliviousness in the world: “Glad to see you out and about. Good for you!” For some, I am to be protected; for others, I am to be tiptoed around; and for others, I am to be congratulated for “overcoming my circumstance” and for being oh–so–valuable to society because of my smarts and productivity.It is a rare few who accept what Cerebral Palsy and epilepsy offer to my life and to their own, with all of their accompanying complexities, possibilities, and contradictions.It is ironic that the excellent health care and services I have received, which have probably changed my life for the better, are only made possible because of the “disability” label, which I have come to heartily dislike. I have always felt ill–at–ease with this word and concept. In my mind, it just does not describe me or others around me. Perhaps more accurately, the definitions and associations that stubbornly accompany the term (e.g., the disabled person as asexual, passive and in need of protection, the disabled person as the conquering hero) would never accurately describe me. Undoubtedly, the term is negative in its connotations. And, of course, the concept of disability relies on certain notions of “normal.” By most accounts in... (shrink)

Ageism within the context of care has attracted increasing attention in recent years. Similarly, autonomy has developed into a prominent concept within health care law and ethics. This paper explores the way that ageism, understood as a set of negative attitudes about old age or older people, may impact on an older person’s ability to make maximally autonomous decisions within health care. In particular, by appealing to feminist constructions of autonomy as relational, I will argue that the key to (...) establishing this link is the concept of self-relations such as self-trust, self-worth and self-esteem. This paper aims to demonstrate how these may be impacted by the internalisation of negative attitudes associated with old age and care. In light of this, any legal or policy response must be sensitive to and flexible enough to deal with the way in which ageism impacts autonomy. (shrink)

ArgumentThis paper brings together the history of risk and the history of DNA repair, a biological phenomenon that emerged as a research field in between molecular biology, genetics, and radiation research in the 1960s. The case of xeroderma pigmentosum (XP), an inherited hypersensitivity to UV light and, hence, a disposition to skin cancer will be the starting point to argue that, in the 1970s and 1980s, DNA repair became entangled in the creation of new models of the human body at (...) risk – what is here conceptually referred to as the vulnerability aspect of body history – and new attempts at cancer prevention and enhancement of the body associated with the new flourishing research areas of antimutagenesis and anticarcinogenesis. The aim will be to demonstrate that DNA repair created special attempts at disease prevention: molecular enhancement, seeking to identify means to increase the self-repair abilities of the body at the molecular level. Prevention in this sense meant enhancing the body's ability to cope with the environmental hazards of an already toxic world. This strategy has recently been adopted by the beauty industry, which introduced DNA care as a new target for skin care research and anti-aging formulas. (shrink)

This essay develops a new account of the work the self must perform on itself in disciplinary relations through the cultivation of resources from Foucault’s later work. By tracing the ethical self-relation from Greco-Roman antiquity to the Benedictine monastery, I am able to provide insight into the relationship of self-renunciation that underlies disciplinary docility and obedience. This self-renunciation undermines individuals’ ability to lead themselves and makes them reliant on another who has mastery of the truth through which the subject (...) must be constituted. Disciplinary relations were thus seen to be doubly efficacious in producing relations of domination: they attempt to eliminate the self- leadership of the individual which not only un- dermines the individual’s potential to resist; it leaves them in need of the dominating training that disciplinary relations institute. This insight into the activity of the individual in the produc- tion of their own docility was then used to clarify and develop aspects of two perennially enigmatic but powerful areas of Foucault’s work, his focus on “bodies and pleasures” and his turn to the “aesthetics of existence.”. (shrink)

A large proportion of nursing home residents in developed countries come from ethnic minority groups. Unmet care needs and poor quality of care for this resident population have been widely reported. This systematic review aimed to explore social conditions affecting ethnic minority residents' ability to exercise their autonomy in communication and care while in nursing homes. In total, 19 studies were included in the review. Findings revealed that ethno‐specific nursing homes create the ideal social condition for residents to express (...) their care needs and preferences in a language of choice. In nonethno‐specific nursing homes, staff cultural competence and nursing home commitment to culturally safe care are crucial social conditions that enable this group of residents to fulfil their autonomy in communicating and in participating in their care. In contrast, social conditions that undermine residents' ability to express their care needs and preferences include low levels of staff cultural awareness and cultural desire, negative attitudes towards residents and limited organisational support for staff to improve culturally responsive and culturally safe care. In conclusion, it is important to optimise the social conditions to support ethnic minority residents to communicate their care needs and preferences. (shrink)

Jorge Luis Borges is acknowledged as one of the great Spanish writers of the twentieth century. On the broader literary scene, he is recognized as a modern master. His fascination with philosophy - especially metaphysics - sets him apart from his contemporaries. Borges appreciated and formulated rigorous philosophical arguments, but also possessed the unique ability to present the most abstract ideas imaginatively in metaphors and symbols. Borges wandered among the great masters seeking a firm purchase that he could not (...) find, and therefore expressed a nostalgia for metaphysics as he lost himself in his labyrinths. Borges and Philosophy traces Borges' philosophical concerns in his tales, essays, and poems and argues that despite his apparent skepticism in philosophical matters, a careful reading of Borges' texts reveals a coherent philosophical path that underlies his work. (shrink)

Debates over how to conceptualize the nursing role were prominent in the nursing literature during the latter part of the twentieth century. There were, broadly, two schools of thought. Writers likeHenderson andOrem used the idea of a self‐care deficit to understand the nurse as doing for the patient what he or she could not do alone. Later writers found this paternalistic and emphasized the importance of the patient's free will. This essay uses the ideas of positive and negative freedom (...) to explore the differing conceptions of autonomy which are implicit in this debate. The notion of positive freedom has often been criticized as paternalistic, and the criticisms of self‐care in the nursing literature echo criticisms from political philosophy. Recent work on relational autonomy and on the relationship between autonomy and identity are used to address these objections. This essay argues for a more nuanced conception of the obligation to support autonomy that includes both positive (freedomto) and negative (freedomfrom) dimensions. This conception of autonomy provides a moral foundation for conceptualizing nursing in something like Henderson's terms: as involving the duty to expand the patient's capacities. The essay concludes by generalizing the lesson. Respect for autonomy on the part of any health care provider requires both respect for the patient's choices and a commitment to expand the patient's ability to actualize their choices. (shrink)

The discourse around self-driving cars has been dominated by an emphasis on their potential to reduce the number of accidents. At the same time, proponents acknowledge that self-driving cars would inevitably be involved in fatal accidents where moral algorithms would decide the fate of those involved. This is a necessary trade-off, proponents suggest, in order to reap the benefits of this new technology. In this article, I engage this argument, demonstrating how an undue optimism and enthusiasm about this technology is (...) obscuring our ability to see what is at stake and explaining how moving beyond the dominant utilitarian framings around this technology opens up a space for both ethical inquiry and innovative design. I suggest that a genuine caring concern for the many lives lost in car accidents now and in the future—a concern that transcends false binary trade-offs and that recognizes the systemic biases and power structures that make certain groups more vulnerable than others—could serve as a starting point to rethink mobility, as it connects to the design of our cities, the well-being of our communities, and the future of our planet. (shrink)

Emergency care research sometimes involves incapacitated adults as research participants. The ethical principle of respect for autonomy may not necessarily apply to an incapacitated person unable to act in an autonomous manner, although it can be argued that researchers still have a duty of respect towards such people because they have moral status despite being incapacitated. Sharing some common ground with theories of moral status based on ‘humanness’ and the ability for rational thought is the notion of human dignity, (...) which features in arguments regarding researcher conduct with incapacitated patients. However, human dignity premised upon the unique ability of humans for rational thought and moral self-regulation is contingent upon these capabilities – a limitation that possibly makes dignity a less useful framework for research conduct in emergency care research. In this article, I will discuss the different conceptions of human dignity – as equality, status and virtue – and then draw on more recent literature that explains human dignity as a social constraint and as a factor influencing the conduct of healthcare professionals and researchers. I will address questions of whether dignity as a principle ought to apply only to those who have the ability to think rationally, or to all humans regardless of their condition or mental status. I will argue that, in relation to offering protection to research participants in emergency conditions, it is immaterial which view is taken. (shrink)

Self‐trust is essential to the well‐being of people with chronic illnesses and those who care for them. In this exploratory essay, we draw on a trove of health narratives to catalyze examination of this important but often overlooked topic. We explore how self‐trust is impeded at both personal and structural levels, how it can best be nourished, and how it is related to self‐advocacy. Because people's ability to trust themselves is intrinsically linked to the trust others have in them, (...) we pay particular attention to the role that allies such as clinical professionals play in the development of self‐trust, highlighting the importance of eliciting patient narratives, of curious listening, and of compassionately raising questions. We also contrast the self‐trust paradigm with that of self‐management, which tends to replace the former's attention to patients’ experiences, abilities, qualities, or judgments with a professionally dominated discourse dedicated to addressing illness through behavior changes prescribed by clinicians. We close with a call to action, exhorting readers to focus on supporting self‐trust in health care settings and on creative research in this critical yet heretofore underrepresented domain. (shrink)

Background:Within nursing, the concepts of home and homelike have been used indiscriminately to describe characteristics of healthcare settings that resemble a home more than an institution.Objectives:The aim of this study was to investigate the concept of home. The main questions were as follows: What does the concept of home entail etymologically and semantically? Of what significance is the meaning of the concept to caring science and nursing?Design and methods:This study had a qualitative design with a hermeneutical approach guided by Gadamer. (...) Eriksson’s model of concept determination was partly used to determine the etymology and semantics, the essence and epistemic category of the concept of home. In this study, etymological dictionaries and 17 Swedish language dictionaries published between 1850 and 2001 were investigated.Ethical consideration:In all parts of this study, ethical guidelines have been followed concerning both gathering data from dictionaries and other sources and during the interpretation of these sources.Findings:The home, framed as the ethos of caring, can be drawn as a three-dimensional picture where the three dimensions have a common core, enclosed and inviolable. Symbolically, the picture of home can be seen as the ethos of the human being’s innermost room, the human being’s manner of being and the tone expressed in the external or abstract room where the human being lives and interacts with others.Conclusion:Based on the findings in this study, we conclude that home as ethos is an inner ethical dimension within the human being. Human beings who are in contact with their ethos, the self, feel at home and dare to follow the voice of their heart. Nurses who experience at-homeness have an ability to invite the patient into a caring relationship. The home and the feeling of being at home have significant meaning in terms of human beings’ health and well-being. (shrink)

These are strange and unprecedented times in the wake of the COVID-19 pandemic. Most frontline healthcare professionals have never witnessed anything like this before. As a result, staff may experience numerous and continuous traumatic events, which in many instances, will negatively affect their psychological well-being. Particularly, nurses face extraordinary challenges in response to shifting protocols, triage, shortages of resources, and the astonishing numbers of patients who require care in expedited time constraints. As most healthcare workers are passionate nursing professionals, frustration (...) and often a sense of powerlessness occur when they find themselves unable to provide needed care to their patients. The overwhelming number of deaths, patients isolated and dying alone, and the ever-present fear of being infected and then infecting colleagues, family, friends due to the lack of protective gear or known protocols takes its toll on emotional and psychological well-being. For nurses, the experience of this significant (hopefully once-in-a-lifetime) event can inflict on-going moral injury. Nurses affected by this trauma require education, coping tools, and therapy to help avoid or alleviate the adverse effects on their well-being. Institutions must provide these resources to tend to the well-being of their healthcare staff, during and beyond the pandemic. This article aims to investigate moral distress—considering it as a moral injury—and offer tools and recommendations to support healthcare nurses as they respond to this crisis and its aftermath. (shrink)

The complexity of registered nurses’ work in the intensive care unit places them at risk of experiencing critical incident stress. Gadamer's philosophical hermeneutics (1960/2013) was used to expand the meanings of work‐related critical incident stress for registered nurses working with adults in the intensive care unit. Nine intensive care unit registered nurses participated in unstructured interviews. The interpretations emphasized that morally distressing experiences may lead to critical incident stress. Critical incident stress was influenced by the perception of judgment from co‐workers (...) and the organizational culture. Nurses in this study attempted to cope with critical incident stress by functioning in ‘autopilot’, temporarily altering their ability to critically think and to conceal emotions. Participants emphasized the importance of timely crisis interventions tailored to support their needs. This study highlighted that critical incident stress was transformative in how intensive care unit nurses practiced, potentially altering their professional self‐identity. Work‐related critical incident stress has implications for nurses, the discipline, and the health care system. (shrink)

In recent approaches to ethics, the personal involvement of health care providers and their empathy are perceived as important elements of an overall ethical ability. Experiential working methods are used in ethics education to foster, inter alia, empathy. In 2008, the care-ethics lab ‘sTimul’ was founded in Flanders, Belgium, to provide training that focuses on improving care providers' ethical abilities through experiential working simulations. The curriculum of sTimul focuses on empathy sessions, aimed at care providers' empathic skills. The present (...) study provides better insight into how experiential learning specifically targets the empathic abilities of care providers. Providing contrasting experiences that affect the care providers' self-reflection seems a crucial element in this study. Further research is needed to provide more insight into how empathy leads to long-term changes in behaviour. (shrink)

Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial RegistrationISRCTN89993391. (shrink)

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)

The paper studies two fundamentally different forms in which the concept of care makes its comeback in twentieth-century thought. We make use of a distinction made by Peter Sloterdijk, who argues that the ancient and medieval ‘ascetic’ ideal of self-enhancement through practice has re-emerged in the nineteenth and twentieth centuries, particularly in the form of a rehabilitation of the Hellenistic notion of self-care (epimeleia heautou) in Michel Foucault’s late ethics. Sloterdijk contrasts this return of self-care with Martin Heidegger’s concept of (...) being-in-the-world as ‘total care’ (Sorge), an utterly ‘secularized’ understanding of the human being as irreducibly world-embedded that rejects the classical ascetic ideal of world-secession. We examine further the historical roots and emergence of these contrasting contemporary reappropriations of care in the Western tradition of thought and show them to be rooted in two different ontologies and ethics of the self as either world-secluded or world-immersed, autonomous or constitutively relational. The historical point of divergence of these two approaches to care, we argue, can be found in the Christian transformation of Hellenistic ethics. (shrink)