This paper reviews briefly the main approaches in the literature on ethics of war and suggests the need to move beyond an _ethic of justice_ towards an _ethic of care_. The analysis problematizes dominant understandings of “just war” and “just peace” in the literature and highlights that incorporating elements of an ethic of care, our understanding of ethics of war and peace can be redefined, sharpened, and redeployed through an enlarged ethical lens. The author suggests that scholars and practitioners (...) in different fields of study and domains of social and political life can make important contributions by defining, elucidating, and advocating why both perspectives, those of ethic of justice and care, _together_ allow us to capture the prospects of a broader understanding and the practice of peace. (shrink)

In this article I attempt to transcend the mainstream conception of health care ethics, including nursing ethics, by bringing into the foreground a tension between a sense of life and an industrial-bureaucratic style of health care, with its emphasis on the systematic and procedural work culture necessary for mass production. I use the concept of ‘a sense of life’ to draw attention to the wisdom, sensitivity and responsibility that is necessary for the authentic care of (...) others to be given a chance in the development of modern health care. I emphasize the mindfulness that the professional requires for genuine care, and how the systematic organization of modern health care, on the whole, ignores, obstructs and even suppresses such mindfulness. (shrink)

Drawing on a qualitative study of women who cared for their elderly mothers, this article explores women's experiences of feeling responsible for elderly relatives. The minimal provision of public services for old people and the relative absence of brothers and husbands from family caregiving emerge as material constraints shaping women's sense of obligation. This is affirmed by ideologies and assumptions about women's association with caring and family ties that permeate subjects' accounts of their situations. Translating their sense of (...) obligation into their lives is a contradictory process characterized by ambivalence and guilt that stifle complaint. Further exploration of the social processes that sustain the inequitable division of caring labor can contribute to interpretations, practices, and policies that benefit rather than constrain women. (shrink)

In nursing practice, awareness of ethical inner values and a common understanding of nursing and caring are needed. It is therefore important to highlight ideas of caring in nursing practice. The aim of this paper was to illuminate nursing, caring and ethical inner values in caring and caring in nursing practice. By being attentive, open, respectful and treating the patient as a person, nurses can enhance both their own and the patient's sense of personal meaning in the caring relationship. (...) Nurses can use self‐reflection to create an awareness of nursing, caring and ethical inner values in caring. (shrink)

How do I know that I am the person who is moving? According to Wittgenstein (1958), the sense of agency involves a primitive notion of the self used as subject, which does not rely on any prior perceptual identification and which is immune to error through misidentification. However, the neuroscience of action and the neuropsychology of schizophrenia show the existence of specific cognitive processes underlying the sense of agency—the ‘‘Who'' system (Georgieff & Jeannerod, 1998) which is disrupted in (...) delusions of control (Frith, 1992). Yet, we have to be careful in the interpretation of such clinical symptoms, which cannot be so easily reduced to deficit of action monitoring or to lack of action awareness. Moreover, we should refine the definition of the sense of agency by distinguishing the sense of initiation and the sense of one's own movements. A conceptual analysis of the empirical data will lead us to establish the taxonomy of the different levels of action representations. (shrink)

The aim of this study was to assess attitudes of intensive care nurses to selected ethical issues related to end-of-life decisions in paediatric intensive care units. A self-administered questionnaire was distributed in 2005 to intensive care nurses at two different scientific occasions in Turkey. Of the 155 intensive care nurse participants, 98% were women. Fifty-three percent of these had intensive care experience of more than four years. Most of the nurses failed to agree about withholding (...) (65%) or withdrawing (60%) futile treatment. In addition, 68% agreed that intravenous nutrition must continue at all costs. In futile treatment cases, the nurses tended to leave the decision to parents or act maternalistically. The results showed that intensive care nurses could ignore essential ethical duties in end-of-life care. We suggest that it is necessary to educate Turkish intensive care nurses about ethical issues at the end of life. (shrink)

Pregnancy and childbirth have become a dangerous journey for Black women as harrowing stories of death and near‐death experiences resonate within Black communities. While the causes of pregnancy‐related morbidity and mortality are well documented, little is known about how Black Canadian women feel protected from undesirable maternal health outcomes when accessing and receiving pregnancy and intrapartum care. This critical qualitative inquiry sheds light on Black women's perceived sense of safety in accessing pregnancy and intrapartum care. Twenty‐four in‐depth (...) interviews were conducted with Black women who were pregnant or had given birth. Five interconnected themes were generated through thematic analysis: (1) There is a lot of prejudice towards us, (2) We are treated as sick bodies, (3) There is a lot of stereotypes towards us, (4) Our care is lacking in quality, and (5) We feel unsafe in the healthcare system. These themes highlight the perils faced by Black women accessing pregnancy and intrapartum care. The right to safe motherhood and equitable care for Black women should be a national priority in Canada to avert a looming crisis. (shrink)

This introduction to the special issue on ‘Ricoeur and the ethics of care’ is not a standard editorial. It provides not only an explanation of the central questions and a first impression of the articles, but also a critical discussion of them by an expert in the field of care ethics, Joan Tronto. After explaining the reasons to bring Ricoeur into dialogue with the ethics of care, and analyzing how the four articles of this special issue shape (...) this dialogue, the authors give the floor to Tronto. She focuses on the central issue at stake: what may be the value of a more abstract, conceptual approach for the ethics of care as a radically practice-oriented way of thinking? She argues that the four contributions too easily frame this value in terms of Ricoeur’s relational anthropology. Instead she points out that if the ethics of care is a kind of practice, it makes sense to think of such practices as necessarily building upon one another, expanding constantly the context and relationships upon which practices are built. In the final section the authors respond to Tronto’s framing of ‘practices all the way up’ by arguing that this approach need not be at odds with one inspired by Ricoeur’s conceptual thinking. Rather the two can be seen as different movements—upwards and downwards—that both contribute constructively to the shaping of the important intermediary zone between the practices and the abstract ideals. (shrink)

"Making Sense of Nonsense: Trivial Remarks on the Nature of Language" is an inquiry into the nature and significance of nonsense for philosophers and other human beings. Philosophers have been accused of indulging in nonsense. Wittgenstein complains that philosophers take language on holiday. If an utterance is nonsense in virtue of being on holiday, we might expect meaningful utterances to be meaningful in virtue of their being at work, at home. When we look at language at home, we find (...) that, despite the tribute philosophers of language ordinarily pay to the a priori, meaning is a most contingent and subjective family of phenomena. On the rough ground of everyday discourse, we find language stamped with the desires and agendas of certain groups of mammals. Language shows us its rough edges when we clear away the unarticulated presuppositions smuggled in by dominant philosophical methodology. There are a number of strategies for attaining an unclouded vantage point on language. One is to imagine oneself into the position of someone to whom our language and way of life is unfamiliar. Another is to actually occupy a point of view from which the language and way of life we take for granted begins to seem strange. ;The theory of meaning that emerges from the kind of attention to language here described can be stated thus: meaning is grounded in concernful engagement with the world. Or, to put it another way: we talk about what we care about. As a result, language can serve as a deep reserve of human history. What it tells us about ourselves is not always pleasant. As the language reveals the concerns and agendas of speakers, it reveals the imbalances and abuses of power among those speakers. Insofar as language constructs the worlds we inhabit, the injustices and prejudices we find in language are mirror images of reality as we know it. The good news is the liberatory potential of our realization of the extent to which meaning, and hence reality, are "man-made." This potential is realized in the work of many radical lesbian feminist philosophers. (shrink)

We are concerned in this paper with the question of what more there is to human nature than cognition, with what it is to be a person in the sense of something that would justify our sympathy. We examine pain, emotion, and the abrogation of values as sources of our sympathy for one another. We further argue that our sympathy over each of these unfortunate events is connected with our sense that they are beyond a person' s will. (...) Computers, we suggest, ought not to engage our sympathy not because of their limited cognitive capacity, and not because they lack intent, but because their wills are too free. (shrink)

ArgumentThe main contribution of the Alfred P. Sloan and Russell Sage Foundations' behavioral economics program (1984–1992) was not the resources it provided, which were relatively modest. Instead, the program's contribution lay in catalyzing “a sense of mission” in the collaboration between psychologists Daniel Kahneman and Amos Tversky, economist Richard Thaler, and their associates. Partly this reflected the common strategy of American foundations to pick an individual or small group of scientists and stick with them until scientific success had been (...) achieved. But moreover, it was a consequence of the careful management of the program's director Eric Wanner. The various actors involved in the behavioral economics program constructed a new behavioral economic sub-discipline in economics by tapping into existing missionary sentiments in the economic and psychological disciplines, while at the same time actively shaping this sense of mission. (shrink)

The Five Senses of Haiti discusses a series of medical mission trips by physicians and medical students to the Central Plateau of Haiti delivering care in the outpatient setting. Practitioners describe their experiences through the use of their five senses to draw contrast between modern health care and medical practice in the developing world. Physicians in a resource poor setting are left without the usual diagnostic armamentarium and the safeguards and distractions of the modern hospital setting. This deficit (...) creates an opportunity to devote time and focus to individual patients. Practicing medicine in this context clinicians use a heightened sense of awareness and increase their reliance on physical exam findings. Global medicine creates an opportunity for medical students to learn and physicians out of training to practice overlooked physical exam skills in the modern era. Physical exam findings and patient care yield diagnoses and fosters the bonds of the doctor-patient relationship. (shrink)

The intersection between virtue and care ethics is underexplored in contemporary moral philosophy. This thesis approaches care ethics from a neo-Aristotelian virtue ethical perspective, comparing the two frameworks and drawing on recent work on care to develop a theory thereof. It is split into seven substantive chapters serving three major argumentative purposes, namely the establishment of significant intertheoretical agreement, the compilation and analysis of extant and new distinctions between the two theories, and the synthesis of care (...) ethical insights with neo-Aristotelianism to generate a virtue ethical theory of care. In the first two chapters, I outline virtue ethics and care ethics, and argue for considerable agreement over central premises. Chapter 2 summarises the foundational commitments of care ethics, focusing particularly on their relational ontology and its links to the other ethical claims care ethicists universally ascribe to, namely particularism, partialism, the moral salience of emotions, and the rejection of hard public/private distinctions. Chapter 3 lays out the central concepts in neo-Aristotelian virtue ethics, including eudaimonism, virtue, and character traits, and drawing a number of comparisons between virtue and care ethics specifically with regard to relational ontology and the meta-ethical commitments it underpins. In addition to doing the necessary expository work for the remainder of the thesis, Chapters 2 and 3 also argue that care ethics and virtue ethics have much more in common than is typically acknowledged – the first major contribution of this thesis to the literature. Chapters 2 and 3 to provide at least a prima facie justification for pursuit of the questions I confront in the remainder of the thesis. In Chapter 4, I ask what differentiates these two ethical theories. I survey some of the differences which philosophers in either camp have identified and offer some of my own. I suggest that several of those differences either rest on misunderstandings of one ethic or the other, or that in erecting a divide between virtue and care ethics they also disunify ethics of care. I do, however, identify two differences which seem defensible. Specifically, they are that virtue ethics seems to lack an account of care, which I define minimally as a response or responsiveness to need, and that virtue and care ethics organise their meta-ethical and normative concepts differently. This chapter thus presents a second contribution to the literature: a study of the differences between virtue ethics and care ethics. It also serves to set the trajectory for the remaining chapters, where I respond to the claim that virtue ethics lack an account of care. I spend the remainder of the thesis constructing what I take to be a satisfying foundation for a virtue ethical theory of care. In Chapter 5, I offer three initially viable means of incorporating care into virtue ethics, all of which treat care as a virtue. These are the analogical approach, according to which care is analogous to an existing virtue; the additive approach, according to which care is a novel virtue; and the bundling approach, according to which care is a bundle of virtues. I also offer and evaluate reasons to reject the claim that care is a virtue, concluding that the claim is indeed a viable one so long as the concept of care is sufficiently thick, and I contend that analogical approaches, and particularly analogies with charity, outperform the others. Chapter 5 therefore serves two ends. First, it proffers a novel meta-analysis of concepts of care as a virtue, and thus makes a third contribution to the literature. In doing so, it makes an inroad into the second: the development of a neo-Aristotelian theory of care. Chapter 6 continues this project. I attempt to show how care can be construed as an act-type and a practice. I argue in this chapter that practices are a subcategory of actions, and that care qualifies as an Anscombean act-type which aims at the meeting of needs relating to the care-recipient’s flourishing. I go on to consider the implications of this account for ethics which deploy care as a moral concept, maintaining that it not only offers a better account of consequences than theories of care which include success criteria, but also that it affords us interesting insights into the distinction between ‘caring about’ and ‘caring for’ which allow us to make sense of certain tenets of neo-Aristotelianism. This represents a contribution to both discourses, since neither care nor virtue ethicists working at the intersection of their respective normative theories have delved very deeply into the philosophy of action. Chapter 7 discusses caring relations, suggesting that a virtue ethical theory of caring relations can lean on the work care ethicists have done, and adding some necessary refinements, such as a distinction between ideal and non-ideal caring relations, and a theory of caring relations as reasons for action. This final chapter also draws these three concepts of care together by arguing that virtuous caregivers who are invested in the flourishing of those for whom they care are also sensitive to the relations those care-recipients bear to their institutional environment. I argue that because they are caring participants in caring relations, virtuous agents are characteristically motivated by states of need and dependency to engage in certain sorts of conventionally political practices. In other words, the virtue or virtues of caring characteristically manifest in certain sorts of political or social practices, relating specifically to those areas of moral life. This allows us to build upon recent work in feminist virtue ethics of the sort offered by Tessman and Friedman. I also offer a novel analysis of migration, suggesting that the account of care presenting here is analytically useful both when it comes to historical cases of migration such as the underground railroads and escapes from Nazi-occupied Europe, but also for contemporary issues such as the migrations occurring in the Southern United States and in much of Europe. I thus conclude not only that virtue ethicists ought to incorporate care into their normative framework, and that the theory of care presented here is a coherent one, but that this leads us naturally into applied topics such as virtue politics. I conclude the thesis by considering some its implications and by identifying some further avenues for research. (shrink)

While empathy is considered a critical determinant of the quality of medical care, growing evidence suggests it may be associated with both one’s own positive and negative moods among healthcare professionals. Meanwhile, sense of coherence plays an essential role in the improvement of both psychological and physical health. Reportedly, individual SOC reaches full stability after around age 30. The aim of this study was first to evaluate the mediatory role of SOC on the association between empathy and individual (...) moods among 114 healthcare professionals in a general hospital, and then to examine the moderating effect of age on this association. Participants completed a range of self-report demographic questionnaires, Empathy Process Scale, the 13-item Antonovsky’s SOC, and Profile of Mood States. Findings showed that SOC mediated the relations between empathy and both POMS-Vigor and POMS-Depression. Notably, moderated mediation analysis revealed that there was a significant interaction on self-vigor mood in healthcare professionals. The indirect effect of empathy on self-vigor mood through SOC was significant at over mean age “32.83.” Although there was no significant interaction with age regarding the indirect effect of empathy on self-depression mood, in the sub-category level analysis of empathy, we found a significant interaction item [age × empathy for other’s negative affect ] on SOC. This indirect effect was also significant at over mean age “32.83.” Taken, together, the current study highlighted the significant mediator of SOC on that empathy amplifies self-vigor mood and attenuates self-depression mood as a protective factor among the Japanese healthcare professionals. Some components of these processes may depend on the moderating role of age, indicating that we may need to consider the SOC development with age for more effective empathy performance interventions among healthcare professionals. (shrink)

The practice of clinical medicine is inextricably linked with the need for moral values and ethical principles. The study of medical ethics is, therefore, rightly assuming an increasingly significant place in undergraduate and postgraduate medical courses and in allied health curricula. Making Sense of Medical Ethics offers a no-nonsense introduction to the principles of medical ethics, as applied to the everyday care of patients, the development of novel therapies and the undertaking of pioneering basic medical research. Written from (...) a practical rather than a philosophical perspective, the authors call upon their extensive experience of clinical practice, research and teaching to illustrate how ethical principles can be applied in different "real-life" situations. Making Sense of Medical Ethics encourages readers to understand the principles of medical ethics as they apply to clinical practice; explore and evaluate common misconceptions; consider the ethics underlying any medical decision; and as a result, to realize that a good appreciation of medical ethics will help them to practice more effectively in the future. (shrink)

In this paper phenomenological descriptions of the experiential structures of suicidality and of self-determined behaviour are given; an understanding of the possible scopes and forms of lived self-determination in suicidal mental life is offered. Two possible limits of lived self-determination are described: suicide is always experienced as minimally self-determined, because it is the last active and effective behaviour, even in blackest despair; suicide can never be experienced as fully self-determined, even if valued as the authentic thing to do, because no (...) retrospective re-evaluation from some future vantage is possible. The phenomenological descriptions of the possible scope of lived self-determination in suicidality, presented in this paper, should prove to be extremely helpful in three different fields of interest: (a) ethical debates regarding the pros and cons of autonomous or heteronomous suicide; (b) clinical day-to-day practice with respect to treating suicidal people; (c) people who suffered a suicidal crisis, attempted suicide or lost loved ones through suicides. (155 words). (shrink)

There is an urge to introduce high technology and robotics in care settings. Assisted living is the fastest growing form of older adults’ long-term care. Resident autonomy has become the watchword for good care. This article sheds light on the potential effects of care robotics on the sense of autonomy of older people in AL. Three aspects of the residents’ sense of autonomy are of particular interest: interaction-based sense of autonomy, coping-based sense (...) of autonomy, and potential-based sense of autonomy. Ethnographical data on resident autonomy in an AL facility and existing literature on care robots are utilized in studying what kind of assurances different types of robots would provide to maintain the sense of autonomy in AL. Robots could strengthen the different types of sense of autonomy in multiple ways. Different types of robots could widen the residents’ space of daily movements, sustain their capacities, and help them maintain and even create future expectations. Robots may strengthen the sense of autonomy of older persons in AL; however, they may simultaneously pose a threat. Multi-professional discussions are needed on whether robots are welcomed in care, and if they are, how, for whom, and in what areas. (shrink)

Care work may be connected with emotional and psychological exhaustion but also gratification, reward, and self-empowerment. Caregivers experience both positive and negative emotional states in caring situations, and further studies on the rewarding and energizing aspects of care may help us to broaden our understanding of how we can reduce the degree of burden while increasing the sense of satisfaction. This article shows how the focus on emotion is a necessary step to show the ambivalences and the (...) grey areas connected with the concept of care as well as to challenge the not fully explored assumption that care is often associated with burden and stress and viewed as a result of circumstances. It reports the findings of a micro-situated study of daily care activities among 80 caregivers. Care is seen as a strategic site to grasp deeper insights into the interactional mechanisms through which the emotional dynamics revolving around care produce unanticipated outcomes in terms of symbolic and practical productivity. (shrink)

We challenge Gallagher’s distinction between the sense of ownership and the sense of agency as two separable modalities of experience of the minimal self and argue that a careful investigation of the examples provided to promote this distinction in fact reveals that SO and SA are intimately related and modulate each other. We propose a way to differentiate between the various notions of SO and SA that are currently used interchangeably in the debate, and suggest a more gradual (...) reading of the two that allows for various blends of SO and SA. Such an approach not only provides us with a richer phenomenology but also with a more parsimonious view of the minimal self. (shrink)

Paul Ricœur and Jan Patočka are considered among the most important phenomenologists of the 20 th century. As with Ricœur, Patočka ’s philosophy is shaped by an enduring critical confrontation with Husserl’s phenomenology and Heidegger’s phenomenological analyses of Dasein. The present paper aims at analyzing Ricœur ’s and Patočka ’s convergences and mutual inspirations in their perspectives on the topic of history. More precisely, I will take up the question of the meaning of history in Ricœur and Patočka as profoundly (...) influenced by their readings of Husserl’s Krisis. Then, the attention will be turned to Ricœur ’s concept of historicity and Patočka ’s notion of care of the soul as concerns involved in the search for meaning in history as an open-ended mediation. In this context, I will discuss Ricœur ’s and Patočka ’s critical examination of Heidegger’s conception of thrownness and projection, that is, Dasein’s already-being-in-the-world and its disclosedness, as necessary concepts for understanding their own philosophical approaches to history. (shrink)

In this article I propose the concept of care as an organizing principle of John Stuart Mill’s theory of liberal utilitarianism. While both critics and proponents of Mill’s theory see his commitment to character development as a distinct feature of his utilitarianism, the specific type of character he promotes has received scant attention. Through a close reading of Mill’s Collected Works, with an emphasis on Utilitarianism, I argue that a commitment to caring characters is central to making sense (...) of Mill’s theory of utility and the tensions found between his individualistic commitment to the harm principle and the seemingly illiberal implications of his utilitarianism. I further argue that Mill’s concept of care, rather than being a type of sympathy, shows a close affinity to the concept of care developed in care ethics. I conclude with an observation of how Mill’s commitment to care helps explain his consistent support for Britain’s colonial endeavors, though in a direction different from conventional readings that connect his paternalistic account of human nature with the justification of colonial rule. (shrink)

The claim that, in some nontrivial sense, nursing can be identified with caring has prompted a search for the philosophical foundations of care in the nursing literature. Although the ethics of care was initially associated with Gilligan's ‘different voice’, there has more recently been an attempt – led principally by Benner – to displace the gender perspective with a Heideggerian one, even if Kant is the figure to whom both Gilligan and Benner appear most irretrievably opposed. This (...) paper represents the first half of a double-edged project: initially, to point out that Heidegger explicitly disowns any ethical implications for his ontological thinking, and to argue that no ethical theory (including an ethics of care) can be derived from Being and Time; and then to argue that Kant's categorical imperative is not only compatible with the ethics of care but actively entails it. In this, Heideggerian, part of the argument, I consider three attempts to wrest an ethics from Being and Time– those of Benner, Olafson and Guignon – suggesting that, for different reasons, they all fail. Benner systematically confuses the ontological with the ontic, not recognizing that care, concern and solicitude have ‘deficient’ modes as well as positive ones, and that Heidegger's ontology retrieves the possibility of an ethics-in-general without at any point implying an ethics-in-particular (whether of care or justice). Olafson does recognize this, and to that extent admits his failure, but his efforts to amplify Heidegger's thought in such a way as to generate an ethical theory involve both the importing of Kantian premises, and an appeal to some rather doubtful empirical observations. Guignon resorts to Heidegger's discussion of authenticity, and the idea that authentic Dasein ‘may choose its hero’, suggesting a morally reassuring list of heroes who might fit the bill. However, there is nothing in Heidegger's account of this choice that justifies his confidence, and I conclude by proposing that we should take Heidegger at his word when he says that ontology has ‘no result, no effect’. (shrink)

At least four different senses of 'meaning' need to be kept separate when describing the proper way to do the history of ideas. The first sense, communicative meaning, relies on the communicative intentions of the author and is very close to H. P. Grice's 'nonnatural meaning'. The second sense, meaning as significance or importance, is close to Grice's "natural meaning," but I focus on a type that depends on human interests; in this sense, meaning as significance is (...) always relative to a person or group and changes as the events or the interests of the person or group change. I show that Quentin Skinner in his classic article, "Meaning and Understanding in the History of Ideas," confuses these senses. While historians of ideas often focus on identifying communicative meaning, what historians care most about is the significance or importance that something had for people in the past or in the present. (shrink)

This article is intended to raise the question of whether sacrifice can be regarded as constituting a deep ethical structure in the relationship between patient and carer. The significance of sacrifice in a patient-carer relationship cannot, however, be fully understood from the standpoint of the consistently utilitarian ethic that characterizes today’s ethical discourse. Deontological ethics, with its universal principles, also does not provide a suitable point of departure. Ethical recommendations and codices are important and can serve as general sources of (...) knowledge when making decisions, but they should be supplemented by an ethic that takes into consideration contextual and situational factors that make every encounter between patient and carer unique. Caring science research literature presents, on the whole, general agreement on the importance of responsibility and devotion with regard to sense of duty, warmth and genuine engagement in caring. That sacrifice may also constitute an important ethical element in the patient-carer relationship is, however, a contradictory and little considered theme. Caring science literature that deals with sacrifice/self-sacrifice indicates contradictory import. It is nevertheless interesting to notice that both the negative and the positive aspects bring out the importance of the concept for the professional character of caring. The tradition of ideas in medieval Christian mysticism with reference to Lévinas’ ethic of responsibility offers a deeper perspective in which the meaningfulness of sacrifice in the caring relationship can be sought. The theme of sacrifice is not of interest merely as a carer’s ethical outlook, but sacrifice can also be understood as a potential process of transformation towards health. The instinctive or conscious experience of sacrifice on the part of the individual patient can, on a symbolic level, be regarded as analogous to the cultic or religious sacrifice aiming at atonement. Sacrifice appears to the patient as an act of transformation to achieve atonement and healing. Atonement then implies finding meaningfulness in one’s suffering. The concept of sacrifice, understood in a novel way, opens up a deeper dimension in the understanding of suffering and makes caring in ‘the patient’s world’ possible. (shrink)

Having a decreased sense of security leads to unnecessary suffering and distress for patients. Establishing trust is critical for nurses to promote a patient's sense of security, consistent with trauma‐informed care. Research regarding nursing action, trust, and sense of security is wide‐ranging but fragmented. We used theory synthesis to organize the disparate existing knowledge into a testable middle‐range theory encompassing these concepts in hospitals. The resulting model illustrates how individuals are admitted to the hospital with some (...) predisposition to trust or mistrust the healthcare system and/or personnel. Patients encounter circumstances increasing their emotional and/or physical vulnerability to harm, leading to experiences of fear and anxiety. Without intervention, fear and anxiety lead to a decreased sense of security, increased distress, and suffering. Nurse action can ameliorate these effects by increasing a hospitalized person's sense of security or by promoting the development of interpersonal trust, also leading to an increased sense of security. Increased sense of security results in diminished anxiety and fear, and increased hopefulness, confidence, calm, sense of value, and sense of control. The consequences of a decreased sense of security are harmful to patients and nurses should know that they can intervene in ways that both increase interpersonal trust and sense of security. (shrink)

Nurses have traditionally been regarded as clinicians that deliver compassionate, safe, and empathetic health care (Nurses again outpace other professions for honesty & ethics, 2018). Caring is a fundamental characteristic, expectation, and moral obligation of the nursing and caregiving professions (Nursing: Scope and standards of practice, American Nurses Association, Silver Spring, MD, 2015). Along with caring, nurses are expected to undertake ever‐expanding duties and complex tasks. In part because of the growing physical, intellectual and emotional demandingness, of nursing as (...) well as technological advances, artificial intelligence (AI) and AI care robots are rapidly changing the healthcare landscape. As technology becomes more advanced, efficient, and economical, opportunities and pressure to introduce AI into nursing care will only increase. In the first part of the article, we review recent and existing applications of AI in nursing and speculate on future use. Second, situate our project within the recent literature on the ethics of nursing and AI. Third, we explore three dominant theories of caring and the two paradigmatic expressions of caring (touch and presence) and conclude that AI—at least for the foreseeable future—is incapable of caring in the sense central to nursing and caregiving ethics. We conclude that for AI to be implemented ethically, it cannot transgress the core values of nursing, usurp aspects of caring that can only meaningfully be carried out by human beings, and it must support, open, or improve opportunities for nurses to provide the uniquely human aspects of care. (shrink)

Background Health ministries in Europe are investing increasingly in innovative digital technologies. Older adults, who have not grown up with digital innovation, are expected to keep up with technological shifts as much as other age groups. This is ethically challenging, as it may threaten a sense of dignity and well-being in older adults. Research objective To clarify the phenomenon of sense of dignity experienced in older adults, concerning how their expectations and needs are met within the context of (...) digitally led healthcare in Norway. Research design A Reflective Lifeworld Research design was chosen, and purposive, in-depth interviews were conducted. Participants and research context The participants were 13 adults 75 years and older from Northern Norway, living at home and not receiving consistent assistance. Ethical considerations Followed the principles of the Helsinki Declaration. This study was approved by the Social Science Data Services in Norway (project number 916119). Interviews were conducted carefully within a safe environment chosen by the participants. Findings Older adults experience that using new digital systems in healthcare makes them become dependent with experiences of helplessness. They feel an increased sense of dependency on other people, and that recognition can assail their experience of personal dignity. Older adults not only expect digitally led healthcare to give them a feeling of safety but also experience feeling insecure concerning privacy and loss of possibilities for dialogue with healthcare providers. They are met by demands from society, which they often struggle to achieve. Conclusion The phenomenon of sense of dignity experienced in older adults, concerning how their expectations and needs are met within digitally led healthcare, indicates a sense of feeling lost in the digital world. Further, innovative healthcare lacks focus on ethical performance. This impacts their perception of dignity, as loss of dignity is noticed especially in its rupture. (shrink)

Medical Genetics is a relatively new field of scientific work that involves a lot of enthusiastic professionals, both in routine (clinical) and research (scientific projects). In either field, different geneticists feel different responsibilities for their work, either because they are different people (personal responsibility) or because they have a different rank in the respective departments (professional responsibility). This paper presents the philosophical views of several authors on the sense of responsibility from the Classical times until the present and reveals (...) the practical, daily responsibilities that are met by these professionals, in four areas of responsibility: personal, professional, scientific and sociatal framework. (shrink)

Attention to care in modern society has fallen out of view as an ethos of personal responsibility, free markets, and individualism has been in the ascendant. The Liberalism of Care argues that contemporary liberalism is suffering from a crisis of care, manifest in a decaying sense of collective political responsibility for citizens' well- being and for the most vulnerable members of our communities. The book maintains that this practical crisis stems from a theoretical one. We have (...) lost the political language of care, which, prior the 19th century, was commonly used to express these dimensions of political life. To recover that language, Shawn C. Fraistat turns to three prominent philosophers-Plato, Jean-Jacques Rousseau, and William Godwin-who illuminate the varied ways caring language and caring values have structured core debates in the history of Western political thought about the proper role of government, as well as the rights and responsibilities of citizens. The Liberalism of Care presents a distinctive vision for our liberal politics where political communities and citizens can utilize the ethic and practices of care to face practical challenges. (shrink)

The widely held assumption about what motivated On Denoting is irreconcilable with Russell's position shortly beforehand; but discarding it leaves one with a carefully worked out solution whose problem is missing. The real motivation is to be found in a notoriously obscure passage in OD, in which Russell exposes a decisive (though easily overlooked) flaw in his former theory of denoting; a flaw which also cripples Frege's theory of sense and reference. A comprehensive account of this passage is the (...) chief concern of the present paper. Recognizing the critical role of this argument of Russell's leads to a more credible account of his argumentation in that essay. It also suggests that the fundamental standpoint underlyingThe Principles of Mathematics remains intact. In this light, the appropriation of OD to the philosophy of language may be misguided. (shrink)

The more we know about medicine, the more we realize that many health questions have no one true answer. Realizing this, and thinking carefully about how medicine asks patients to treat their conditions, leads us to some questions. How reliable are the guidelines that might form the basis of doctors’ advice? Is it wrong, after all, to base an approach to medicine on patients’ preferences? And, given that there is often a distance between the treatment a doctor advises and what (...) a patient would like to do, how do we bridge the gap—especially in a health culture of inequality, technical proficiency, and increasing costs? In practical, engaging, narrative-driven chapters about common health conditions that millions of Americans are familiar with—depression and high blood pressure, arthritis and diabetes—Dr. Zackary Berger of Johns Hopkins demystifies the often bewildering disconnect between patients and doctors and asks us all to think more clearly about how best to protect and cure the human body. (shrink)

Policy-makers have attempted to frame the ethical requirements that are relevant to the creation of human beings via reproductive technologies. Various reports and laws enacted in New Zealand, Canada, Australia, and Britain have introduced tests for how we should weigh child welfare when using these technologies. A number of bioethicists have argued that child welfare should be interpreted as a “best interests” test. Others have argued that there are ethical reasons why we should abandon this kind of test. I will (...) argue that at least some of the relevant policy can be interpreted as requiring those wishing to exercise their procreative liberty to have a reasonable plan to care and nurture any resulting child, thereby respecting the internal preconditions of that liberty. This interpretation of child welfare requirements answers some of the ethical worries about a child welfare test. (shrink)

This paper reports part of a longitudinal research project, which sought to capture students’ conceptualization of caring practice as they progressed to different levels of study in a nursing diploma programme in Hong Kong. Model emulation was found to be an effective means of focusing students’ learning processes on the moral aspects of nursing practice. The theory of model emulation from a Chinese perspective and how it is applied to create a learning context to allow students to acquire a moral (...) sense of nursing are discussed. The participating students are invited to be sincere enquirers in the pursuit of the good embedded in practice through introspective self-examination and dialogue. They are asked to describe and share their experience of positive and negative examples of nursing in written accounts. Van Kaam’s phenomenological method was adopted to explicate the good and bad constituents of nursing from these examples, with the students assuming an active role in the explication process. The explication reveals that the students were able to articulate the good and bad practices in a variety of patient care situations. (shrink)

The article is a critical discussion of "contractualism" in moral and political philosophy as developed by john rawls and applied by w. G. Runciman. It attempts to clarify the sense in which contractualism is a moral theory and to assess its powers as a normative account of moral criticism. It argues that the structure of contractualism suggests an attractive way of formulating rival moral theories but not a way of arguing for any moral theory, That this reduces the force (...) of a contractualist critique of utilitarianism, And that contractualism is incomplete as a normative account of moral criticism. (shrink)

What could it mean to be religious in a world where religion no longer retains its former authority? Posing this question for his fellow Western intellectuals who inhabit just such a world, James C. Edwards investigates the loss of religion's traditional power in a culture characterized by what he calls "normal nihilism"—a situation in which one's commitment to a particular set of values is all one really has, and in which traditional religion is only a means of interpretation used to (...) preserve what one most cares about. Recognizing the important historical role of religion in making us the people we are, he seeks to establish a viable understanding of religion without traditional beliefs and within the context of contemporary skepticism. _The Plain Sense of Things_ is a book more interested in the power of religion that in its truth and in what happens to that power when the claims to truth slacken their grip. (shrink)

Emotions and personhood are important notions within the field of mental health care. How they are related is less evident. This book provides a framework for understanding the important and complex relationship between our emotional wellbeing and our sense of self, drawing on psychopathology, philosophy, and phenomenology.

Mental health-care clinicians report that they hold patients responsible for morally objectionable behaviour but at the same time consider blaming attitudes to be inappropriate. These practices present a conundrum for all Strawsonian theories of responsibility. In response to this conundrum, Pickard has proposed severing the Strawsonian connection between being responsible and being an appropriate target of blaming attitudes. In this article I will argue that her solution fails to explain the practices at stake and provide an alternative solution that (...) uncovers an under-theorized stance we take towards those whose abilities are underdeveloped or compromised. (shrink)

According to Bayertz the core meaning of solidarity is the perception of mutual obligations between the members of a community. This definition leaves open the various ways solidarity is perceived by individuals in different communities and how it manifests itself in a particular community. This paper explores solidarity as manifested in the context of families in respect of caregiving for a family member who has become dependent because of disease or illness. Though family caregiving is based on the same perception (...) of mutual obligation as the solidarity that supports welfare arrangements in society, the manifestation of solidarity in families is different. Solidarity that underpins welfare arrangements is based on a perception of mutual obligation towards an anonymous dependent other and is enforced by the government. Solidarity in families is directed towards a concrete other and is based on free choice, albeit often accompanied by a strong sense of personal duty. In this paper we try to distinguish between solidarity as a sociological concept and as a moral concept. An important moral element of solidarity, as expressed in families, is the need for recognition of family caregivers, not only of their concrete practical efforts, but also of their own identity as caregivers and as individuals. We illustrate this argument by referring to examples in the Nuffield Council on Bioethics report Dementia : ethical issues, about the experiences of family caregivers in dementia care and the importance for them of recognition of their role. (shrink)

Herbert, Dilinie How should health professionals respond if a patient nearing the end of life expresses a wish to hasten their death? To answer this question, this article draws upon peer‐reviewed literature, the practices of palliative care, and the experiences of two palliative care physicians, Associate Professor Natasha Michael and Associate Professor Mark Boughey. The expression of a wish to hasten death does not necessarily imply a genuine desire to hasten death or to be helped to die. To (...) the contrary, almost always this means that the patient has been overwhelmed by one or more serious concerns. While inadequate pain relief may be one such factor, more typically these concerns are social and spiritual, such as loneliness, social isolation, feeling oneself to be a burden on others, hopelessness, and fears about the process of dying. If a patient expresses a wish to hasten death, health professionals should therefore discuss with them the reasons for this request, and then devise and effectively communicate an individualised care plan which begins to address these concerns. (shrink)

What does it mean to be human in the aftermath of mass trauma and violence? When victims and perpetrators of gross human rights violations live in the same country, and sometimes as neighbors, what strategies can help individuals and communities deal with trauma in a way that restores dignity to victims and enables perpetrators to be accountable for their crimes? This essay explores these questions and discusses examples that illustrate attempts to create sites for listening, for moral reflection, and for (...) initiating the difficult process of dialogue at community and individual levels after mass trauma and violence. It is argued that in the aftermath of historical trauma, restoring human bonds requires a new vocabulary of rehumanization. This new mode of being human calls for a “reparative humanism” that opens toward a horizon of an ethics of care for the sake of a transformed society. Examples drawn from two sources are discussed to explore the idea of an “ethics of care.” First, insights from the Truth and Reconciliation Commission of South Africa are discussed to show how the work of the TRC enabled dialogic spaces in which new subjectivities emerged in the encounter between victims/survivors and perpetrators. Second, the essay engages in a reinterpretation of Simon Wiesenthal’s book The Sunflower as a story that continues to pose a challenge about how to reclaim a sense of being human in the aftermath of unspeakable crimes against humanity. The essay concludes with a critical reflection on Emmanuel Levinas’s ethics of responsibility and suggests that it is a compelling vision in societies facing a violent and traumatic past. (shrink)

This paper contributes to the growing line of thought in bioethics that respect for autonomy should not be equated to the facilitation of individualistic self determination through standard requirements of informed consent in all healthcare contexts. The paper describes how in the context of donation for living related liver transplantation (LRLT) meaningful, responsible decision making is often embedded within family processes and its negotiation. We suggest that good donor risk communication in families promote “conscientious autonomy” and “reflective trust”. From this, (...) the paper offers the suggestion that transplant teams and other relevant professionals have to broaden their role and responsibility for risk communication beyond proper disclosure by addressing the impact of varied psychosocial conditions on risk interpretation and assessment for potential donors and family stakeholders. In conclusion, we suggest further research questions on how professional responsibility and role-taking in risk communication should be morally understood. (shrink)

The appropriate goal of care for a person with a traumatic brain injury is rehabilitation in the broad, etymological sense of the word. The task is to bring the person back to the conditions of the living of a life. This requires the rehabilitation of the mind—the reconstruction of a subject.

In the nursing literature, a number of qualities are associated with loving care. Reference is made to, among other things, humility, attentiveness, responsibility and duty, compassion, and tenderness. The author attempts to show that charm, in the Marcelian sense, also plays a central role. It is argued that the moral foundation of charm is a unity of agape and eros. An impartial giving of the self for others is clearly of fundamental importance in an ethic of care. (...) Including charm in the discussion points to the fact that eros also plays a crucial role. Eros produces a passion for people and for life. It is a physical and spiritual energy that animates a person in all facets of her life, including her caring work. (shrink)

The appropriate goal of care for a person with a traumatic brain injury is rehabilitation in the broad, etymological sense of the word. The task is to bring the person back to the conditions of the living of a life. This requires the rehabilitation of the mind—the reconstruction of a subject.

From a position informed by the philosophical legacy of Gilles Deleuze and Felix Guattari, this paper examines the idea of ‘care’ in nursing theory and philosophy. Deleuze and Guattari make a distinction between, on the one hand, ‘concepts’, which are the proper domain of philosophy and, on the other, ‘functives’ which are the domain of science and all other empirical matters. At first blush, this distinction and use of the word concept appears rather odd, but Deleuze and Guattari hold (...) it to be important for reasons that go beyond the acknowledged and obvious differences between philosophy and science. In Deleuzian terms, a ‘functive’ is any proposition that makes a verifiable truth-claim about actual states of affairs, whereas a ‘concept’ is a philosophical tool that, although it is used in statements that make claims and that seek to affect our thinking on states of affairs, is not a representation of them in any verifiable (functive) sense. In this respect, philosophical concepts, and the statements in which they are used, are neither true nor false. I argue that the way in which the word ‘care’ is used in much nursing theory and philosophy conflates concept (neither true nor false) with functive (either true or false) with less than productive results. I seek to persuade that if we can gain more clarity between the use of care as a would-be functive and its use as a philosophical concept, this would strengthen the purpose of the use of the idea of care in nursing theory. This is to say that I take the view that the role of ‘care’ as a philosophical concept is to be used in statements that ‘think the event’ called nursing; that seek to be ‘worthy of the event’, but without being an actual part of the event. Finally, I show how the concept of care in nursing philosophy has been, and can continue to be, reworked to achieve the permanent task of surveying the ever-shifting planes of the event and how it is described. (shrink)

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