Recent literature shows that ethics of care can be used as a theoretical basis to add a new, important dimension to social issues. Th.

Patient-centered care is now recognized as a clinical method and ideal model for patient – health professional relationships, and many definitions have influenced its evolution. Overall the patient-centered care literature has provided relatively little to define patient-centered care at the level of the patient-professional relationship. Additionally, patient-centered care lacks grounding in ethical theory. This thesis asserts that theoretical concepts from the ethics of care can provide a stronger conceptual basis for patient-centered care.This thesis (...) begins with a critical interpretive review of the patient-centered care literature, yielding 12 articles that previously introduced new theoretical and definitional work on patient-centered care and patient-centered communication. Six common themes and ideas were discovered, and include Engaging the Patient as a Whole Person, Recognizing and Responding to Emotions, Fostering a Therapeutic Alliance, Promoting an Exchange of Information, Sharing Decision Making, and Enabling Self-Management and Patient Navigation. These elements were then compared to key elements of the ethics of care. This thesis argues that feminists have good reason to consider care as a type of moral duty, and it describes how this duty functions. This thesis also argues that a duty to care is triggered when caregivers are presented with particular substantive forms of vulnerability. Specifically, this thesis argues that vulnerable subjects whose constitutive needs are at risk require particular moral obligations. The links between the ethics of care and patient-centered care are discussed, including how an ethics of care response ought to function in the health care context. Finally, the cases of J.J. and Makayla Sault, two aboriginal girls who refused chemotherapy in favour of traditional aboriginal healing practices, are analyzed. This thesis offers a short scoping review of the bioethics discourse surrounding these cases. A review of this discourse revealed several common themes, which included the peripheral importance of culture and history, the equating of best interests with survival, the supremacy of science-based medicine, and the impartial application of ethical principles. This thesis recommends that health care professionals apply an ethics of care approach to similar ethical dilemmas in the future, which involves shifting one's ethical focus to the central relationships of the case, understanding the unique perspective of the patient's narrative, and promoting a care-based rather than a justice-based approach to problem-solving. (shrink)

In the last few decades, the ethics of care as a feminist ethic has given rise to extensive literature, and has affected moral inquiries in many areas. It offers a distinctive challenge to the dominant moral theories: Kantian moral theory, utilitarianism, and virtue ethics. This chapter outlines the distinctive features and promising possibilities of the ethics of care, and the criticisms that have been made against it. It then examines the ethics of care’s (...) recognition of human dependency and of the importance of responding to needs; its interpretation of the roles of emotion and reason in moral understanding; and its critique of liberal individualism and development of a conception of the person as relational. The ethics of care contrasts care with justice, tries to integrate them, and reconceptualizes public and private life and morality. (shrink)

The broad success of the 2018–2019 #RedforEd movement in achieving more equitable outcomes for not only teachers but also other constituents in the community has generated interest in the role of teacher strikes in defending the common good. My article contributes to this conversation by interpreting the demands made by teachers and paraprofessionals and school-related personnel in the 2019 Chicago Public Schools strike through an ethics of care. Enlisting the notions of caring-for, completion, and competence from care (...) ethics, this analysis elucidates the strike demands–namely, smaller class sizes, more bilingual education teachers and special education teachers, and adequate staffing of PSRPs providing wraparound services for high-needs students–as aiming at securing conditions for CPS faculty to provide better care for their students. This article also brings to light the varied and complex requirements placed on CPS faculty in their caring work in schools and as such, proposes an educator’s ethical commitment to care for students as one plausible reason for some educators to leave the classroom for the picket line. I suggest, further, that educators, by striking, are enacting a political form of caring termed caring-with alongside fellow citizens and advocating collective responsibility in caring for all persons as care receivers and care givers. The 2019 CPS strike can therefore be seen as a response not only to disinvestment in public schools and teachers, but to the broader crisis of care deficit and democratic deficit in society. (shrink)

The practice of relational leadership is essential for dealing with the increasingly urgent and complex social, economic and environmental issues that characterize sustainability. Despite growing attention to both relational leadership and leadership for sustainability, an ethical understanding of both is limited. This is problematic as both sustainability and relational leadership are rife with moral implications. This paper conceptually explores how the moral theory of ‘ethics of care’ can help to illuminate the ethical dimensions of relational leadership for sustainability. (...) In doing so, the implications of ethics of care more broadly for the practice of relational leadership development are elaborated. From a caring perspective, a ‘relational stance’ or logic of effectiveness can be fostered through engaging in a reflective process of moral education through conversation. In starting this dialogue, we can begin to build capacity for relational leadership for sustainability and, thus, support the development of individual well-being and organizational and societal flourishing. (shrink)

This book makes the case for the news media to take the lead in combatting key threats to American society including racial injustice, economic disparity, and climate change by adopting an "ethics of care" in reporting practices. Examining how traditional news coverage of race, economics and climate change has been dedicated to straightforward facts, the author asserts that journalism should now respond to societal needs by adopting a moral philosophy of the "ethics of care," opening (...) the door to empathetic yet factual and fair coverage of news events, with a goal to move public opinion to the point that politicians are persuaded to take effective action. The book charts a clear path for how this style of ethics can be applied by today's journalists, tracing the emergence of this empathy-based ethics from feminist philosophy in the 1980s. It ultimately urges ethical news organizations to adopt the ethics of care, based on the human emotion prioritized by Scottish Enlightenment philosopher David Hume, and to pursue a more pro-active, solutions-seeking coverage of current events. This is an invaluable text for students and academics in the fields of journalism ethics, media ethics and media law, as well as for media professionals looking for a fresh perspective on practicing ethical journalism. (shrink)

The purpose of this study was to analyze the attitude of a group of cardiologists on the ethical conducts they would accept or adopt when encountered with different hypothetical situations of medical practice. Between August and September of 2011, 700 Argentine cardiologists were surveyed in situations which posed ethical dilemmas in the patient-physician relationship, among colleagues or involving financial agreements with employers or the pharmaceutical industry. Ethical conflicts were evidenced in a series of inappropriate conducts such as differential fees, trips (...) and meals sponsored by laboratories, splitting fees, overbilling, self-referral, charging for patient referral, financial compensation for ordering medical procedures, and various situations derived from the relationship with employers. In general, financial compensation from the pharmaceutical industry was more accepted than the conflictive situations which directly involved patients, colleagues or employers. The rejection of these conducts, the physicians' deontological education and the improvement of financial and organizational conditions in medical practice will help to encourage better medical professionalism and avoid unseemly behaviors. (shrink)

The crisis of Covid‐19 has forced us to notice two things: our human interdependence and American society's tolerance for what Nancy Krieger has called “inequalities embodied in health inequities,” reflected in data on Covid‐19 mortality and geographies. Care is integral to our recovery from this catastrophe and to the development of sustainable public health policies and practices that promote societal resilience and reduce the vulnerabilities of our citizens. Drawing on the insights of Joan Tronto and Eva Feder Kittay, (...) we argue that the ethics of care offers a critical alternative to utilitarian and deontological approaches and provides a street‐ready framework for integration into public health deliberations to anchor public policy and investments concerning the recovery and future well‐being of America's citizens and society. (shrink)

Contemporary issues such as euthanasia, surrogate motherhood, organ transplantation and gene therapy, which occupy the minds of ethicists in the industrialized countries are, for the moment, irrelevant in most developing countries. There, the ethics of scarcity, sacrifice, cross-cultural research, as well as the activities of multinational companies, are germane. In this article, only the ethics of scarcity and sacrifice will be discussed. Structural adjustment programmes, designed to solve the economic problems of the developing countries, muddied the waters. The (...) dilemma confronting practitioners in developing countries is how to adhere to the basic principles of medical ethics in an atmosphere of hunger, poverty, war and ever-shrinking and often non-existent resources. Nowhere else in the world is the true meaning of scarcity portrayed as vividly as in the developing countries. Consequently, the doctor's clinical freedom may have to be sacrificed by the introduction of an essential drugs list and practice guidelines. The principle of greater good, while appealing, must be carefully interpreted and applied in the developing countries. Thus, while health promotion and disease prevention must be the primary focus, health planners should avoid pushing prevention at the expense of those currently sick. Health care reform in developing countries must not merely re-echo what is being done in the industrialized countries, but must respond to societal needs and be relevant to the community in question. (shrink)

In her Nobel speech in 2019, Olga Tokarczuk presented the category of tenderness as a new way of narrating the contemporary world. This article is a proposal for the analysis and interpretation of tenderness in ethical and aesthetic terms. (1) From an ethical perspective, tenderness is interpreted as an extension and complement of feminist relational ethics, i.e., the ethics of care. In the proposed approach, tenderness is a broader and more universal quality than care in (...) the feminist understanding. This article opens with a brief discussion of feminist interventions in ethics, with particular emphasis on the ethics of care. Next, the differences between care and tenderness are enumerated and described, in order to show how tenderness can serve as an extension and complement of the feminist ethic of care. These considerations are guided by the question of why tenderness is a better—more appropriate and more responsive to contemporary challenges—moral guidepost than care. (2) From the aesthetic perspective, tenderness is the negation of a contemplative, distanced, impersonal, and rational view of reality. As an aesthetic imperative, tenderness implies engaged experience of the beauty of reality in all of its manifestations. Therefore, in the last part of the article, existential tender attunement is described in aesthetic terms, as a position serving to sensitize others to the beauty and complexity of the post-anthropocentric world. (shrink)

Evidence suggests that psychedelics bring about their therapeutic outcomes in part through the subjective or qualitative effects they engender and how the individual interprets the resulting experiences. However, psychedelics are contraindicated for individuals who have been diagnosed with certain mental illnesses, on the grounds that these subjective effects may be disturbing or otherwise counter-therapeutic. Substantial resources are therefore currently being devoted to creating psychedelic substances that produce many of the same biological changes as psychedelics, but without their characteristic subjective effects. (...) In this article, we consider ethical issues arising from the prospect of such potential “nonsubjective” psychedelics. We are broadly supportive of efforts to produce such substances for both scientific and clinical reasons. However, we argue that such nonsubjective psychedelics should be reserved for those special cases in which the subjective effects of psychedelics are specifically contraindicated, whereas classic psychedelics that affect subjective experience should be considered the default and standard of care. After reviewing evidence regarding the subjective effects of psychedelics, we raise a number of ethical concerns around the prospect of withholding such typically positive, meaningful, and therapeutic experiences from most patients. (shrink)

Genetic testing reveals information about a patient's health status and predictions about the patient's future wellness, while also potentially disclosing health information relevant to other family members. With the increasing availability and affordability of genetic testing and the integration of genetics into mainstream medicine, the importance of clarifying the scope of confidentiality and the rules regarding disclosure of genetic findings to genetic relatives is prime. The United Nations International Declaration on Human Genetic Data urges an appreciation for principles of equality, (...) justice, solidarity and responsibility in the context of genetic testing, including a commitment to honoring the privacy and security of the person tested. Considering this global mandate and recent professional statements in the context of a legal amendment to patient privacy policies in Australia, a fresh scrutiny of the legal history of a physician's duty to warn is warranted. This article inquiries whether there may be anything ethically or socially amiss with a potential future recommendation for health professionals or patients to universally disclose particular cancer predisposition genetic diagnosis to genetic family members. While much of the discussion remains applicable to all genetic diagnosis, the article focuses on the practice of disclosure within the context of BRCA1/2 diagnosis. An ‘ethic of care’ interpretation of legal tradition and current practice will serve to reconcile law and medical policy on the issue of physician disclosure of genetic results to family members without patient consent. (shrink)

This paper extends the discourse on the importance of the relationship between practitioner and young person as a defining tenet of effective youth work practice, recognising the privileged position occupied by Youth Workers in the social ecology of the young people with whom they work. Reflecting the ethical obligations inherent in this relationship, particularly its focus on enhancing young people’s agency and developmental outcomes, the paper outlines how youth work practice infused with professional love aligns with conceptualizations of an ethic (...) of care. Reporting on interviews conducted with Youth Workers practicing in different settings across one local authority area in the UK, the paper articulates how practitioners’ ethic of care shapes their work with young people, and the extent to which love features as an element of their professional practice. Practitioners describe their motivation to express care that extends beyond legalistic interpretations of their ‘duty of care’ towards young people, using the language of care, love and nurture almost interchangeably. The paper demonstrates the importance of inclusion and reciprocity as fundamental elements of ethical practice, as well as the need to infuse practice with hope, suggesting the value of an affirmative ethic to complement a focus on love and care. (shrink)

Different embodiments of technology permeate all layers of public and private domains in society. In the public domain of aged care, attention is increasingly focused on the use of socially assistive robots supporting caregivers and older adults to guarantee that older adults receive care. The introduction of SARs in aged-care contexts is joint by intensive empirical and philosophical research. Although these efforts merit praise, current empirical and philosophical research are still too far separated. Strengthening the connection between (...) these two fields is crucial to have a full understanding of the ethical impact of these technological artefacts. To bridge this gap, we propose a philosophical-ethical framework for SAR use, one that is grounded in the dialogue between empirical-ethical knowledge about and philosophical-ethical reflection on SAR use. We highlight the importance of considering the intuitions of older adults and their caregivers in this framework. Grounding philosophical-ethical reflection in these intuitions opens the ethics of SAR use in aged care to its own socio-historical contextualisation. Referring to the work of Margaret Urban Walker, Joan Tronto and Andrew Feenberg, it is argued that this socio-historical contextualisation of the ethics of SAR use already has strong philosophical underpinnings. Moreover, this contextualisation enables us to formulate a rudimentary decision-making process about SAR use in aged care which rests on three pillars: stakeholders’ intuitions about SAR use as sources of knowledge; interpretative dialogues as democratic spaces to discuss the ethics of SAR use; the concretisation of ethics in SAR use. (shrink)

In 2014, the first child in the world was born after live uterus transplantation and IVF (UTx-IVF). Before and after this event, ethical aspects of UTx-IVF have been discussed in the medical and bioethical debate as well as, with varying intensity, in Swedish media and political fora. This article examines what comes to be identified as important ethical problems and solutions in the media debate of UTx-IVF in Sweden, showing specifically how problems, target groups, goals, benefits, risks and stakes are (...) delineated and positioned. It also demonstrates how specific assumptions, norms and values are expressed and used to underpin specific positions within this debate, and how certain subjects, desires and risks become shrouded or simply omitted from it. This approach—which we label the Ethics of the Societal Entrenchment-approach, inspired by Koch and Stemerding (1994)—allows us to discuss how the identification of something as the problem helps to shape what gets to be described as a solution, and how specific solutions provide frameworks within which problems can be stated and emphasised. We also offer a critical discussion of whether some of these articulations and formations should be seen as ethically troubling, and if so, why. (shrink)

The referral is the key source of information that enables radiologists and radiographers to provide quality services. However, the frequency of suboptimal referrals is widely reported. This research reviews the literature to illuminate the challenges suboptimal referrals present to the delivery of care in radiology departments. The concept of suboptimal referral includes information, that is; missing, insufficient, inconsistent, misleading, hard to interpret or wrong. The research uses the four ethical principles ofnon-maleficence, beneficence, AutonomyandJusticeas an analytic framework.Suboptimal referrals can causeharmby (...) hindering safe contrast-media administration, proper radiation protection by justification of procedures, and compassionate patient care. Suboptimal referrals also hinder promoting patientbenefitsfrom the correct choice of imaging modality and protocol, an optimal performed examination, and an accurate radiology report. Additionally, patientautonomyis compromised from the lack of information needed to facilitate benefit–risk communication. Finally, suboptimal referrals challengejusticebased on lack of reasonable patient prioritising and the unfairness caused by unnecessary examinations.These findings illuminate how suboptimal referrals can inhibit good health and well-being for patients in relation to safety, missed opportunities, patient anxiety and dissatisfaction. The ethical challenges identified calls for solutions. Referral-decision support tools and artificial intelligence may improve referral quality, when implemented. Strategies addressing efforts of radiology professionals are inevitable, including gatekeeping, shared decision-making and inter-professional communication; thereby raising awareness of the importance of good referral quality and promoting commitment to ethical professional conduct. (shrink)

The recent development within moral psychology has contributed to change the understanding of how people in general make moral judgements. The results suggest that moral judgements typically involve two cognitive processes, rapid emotional responses and slow acts of rational thinking, where the significance of the latter traditionally has been overemphasized. It is possible to argue that the division in moral psychology has a counterpart in an ethics of care which distinguishes between intuitive acts of natural care and (...) deliberate choices of ethical care. The purpose of this paper is thus to discuss if and how the recent development within moral psychology can be used to understand an ethics of care as a moral pedagogical model. We will argue that the findings in moral psychology can contribute to the interpretation and application of an ethics of care which can benefit the understanding of both theories in an educational context. (shrink)

This research work examines Heidegger's (1889-1976) contention that phenomenology can inspire, illuminate, motivate, reinforce and guide (human) individual's actions. It achieves this by adapting Heidegger's phenomenological approach to analyze and interpret representative everyday factical experiences of nepotism, selfishness and mass mentality in the (Nigerian) society. Doing this helps to ascertain whether these experiences have any phenomenological link with inauthenticity. Also, it provides a close reading and interpretation of Heidegger's treatment of authentic existence, and explores the possibility of complimenting it (...) with the phenomenology of Commensality, as a mode of care and a way to authenticity. In this manner, it strategically explores possible ways of inspiring individual Daseins to authenticity, and with it engendering a positive transformation of the (Nigerian) society. Presenting and elaborating the phenomenology of Commensality, the work highlights the relationship and the differences between the phenomenology of Commensality and the ontical or sociological understanding of commensality as obtained in African traditional societies. Phenomenology of Commensality argues for the 'renaissance' of Commensality, concretely expressed as Onyenkeanyi, and not just for its 'revival'. The research work further develops the phenomenology of education for Commensality, discussing the possible content and focus of its curriculum, while differentiating it from ethics. The proper implementation of phenomenology of education for Commensality could inspire and illuminate individual Daseins to authenticity, and thereby becomes an improvement strategy for the positive transformation of the (Nigerian) society. As a phenomenology, it is appropriate that the people and places analyzed take on a definite character, which is why the Nigerian society is used. However, it is expected that the implications of the findings presented here will be general and accurate enough to allow application to any number of similar situations. (shrink)

Patients in need of palliative care are often described as vulnerable. Being vulnerable can sometimes be interpreted as the opposite of being autonomous, if an autonomous person is seen as an independent, self-sufficient person who forms decisions independently of others. Such a dichotomous view can create a situation where one has experiences of vulnerability that cannot be reconciled with the central ethical principle of autonomy. The article presents a feminist ethical perspective on the conceptualisation of vulnerability in the context (...) of palliative care. It does so through the lens of the concepts of inherent and pathogenic vulnerability from the taxonomy on vulnerability suggested by Mackenzie et al. To differentiate between forms of vulnerability, is important since even though vulnerability can be regarded as a shared life condition it can be the product of practices creating harm to the patient. The article also presents an analysis of how vulnerability can be included in the interpretation of the ethical principle of autonomy, in order to be relevant in palliative care where vulnerability is salient, namely, as relational autonomy. Furthermore, two practical implications for nursing practice are suggested. Firstly, to acknowledge vulnerability as a shared life condition one needs training in order to neither be overwhelmed by one’s own vulnerability, nor become invulnerable when facing vulnerability in others. Secondly, to foster relational autonomy includes navigating between the patient exercising their autonomy within a framework of relations, and shielding the patient from paternalistic practices. Nurses could be particularly suited for this role, which includes creating an environment which is open and supportive; navigating between patient, family and staff; seeing and acknowledging the complex situation in which patient autonomy is actually played out; and promoting patient autonomy. (shrink)

Informed by a search of the literature about the usage of genetic testing information (GTI) by insurance companies, this paper presents a practical ethical analysis of several distinct public policy options that might be used to govern or constrain GTI usage by insurance providers. As medical research advances and the extension to the Human Genome Project (2016, https://en.wikipedia.org/wiki/human_genome_project_-_write) moves to its fullness over the next decade, such research efforts will allow the full synthesis of human DNA to be connected to (...) predictive health dispositions. As testing costs fall, there will be ever more pressure for citizens to disclose GTI. Genetic testing information is integral to future medical care because it can be used to better assess individually tailored medical therapies as well as to allow a more informed risk analysis by the insurance industry, which in some countries such as the USA underwrites a majority of citizen medical expenses. As discussed in this examination, the revelation of people’s uniquely personal GTI to insurers has enormous societal implications. The major contribution of the paper is to offer policy makers and concerned citizens a nuanced articulation of the basic options to regulate GTI, with a special consideration for ethical fairness and equity. As genetic-based medicine blossoms and pressures to reduce healthcare costs increase, there will be an ever greater impetus for countries to revisit their genetic testing policies. Organizations and policy makers striving to create GTI oversights perceived to be both “fair and effective” need to be aware of the ethical perspectives discussed in this paper. (shrink)

Delirium, a common syndrome in terminally ill people, presents specific challenges to a good death in end‐of‐life care. This paper examines the relational engagement between hospice nurses and their patients in a context of end‐of‐life delirium. Ethnographic fieldwork spanning 15 months was conducted at a freestanding residential hospice in eastern Canada. A shared value system was apparent within the nursing community of hospice; patients’ comfort and dignity were deemed most at stake and therefore commanded nurses’ primary attention. This overarching (...) commitment to comfort and dignity shaped all of nursing practice in this hospice, including practices related to end‐of‐life delirium. The findings of this study elaborate the ways in which hospice nurses interpreted and responded to the discomfort of their patients in delirium, as well as the efforts they made to understand their patients’ subjective experiences and to connect with them in supportive ways. In addition to what is already known about clinical assessment and treatment of delirium in palliative care settings, the findings of this study offer points of reflection for nurses anywhere who are contending with the relational challenges that delirium presents in end‐of‐life care. (shrink)

The concept of care and a related ethical theory of care have emerged as increasingly important in biomedical ethics. This essay outlines a series of questions about the conceptualization of care and its place in ethical theory. First, it considers the possibility that care should be conceptualized as an alternative principle of right action; then as a virtue, a cluster of virtues, or as a synonym for virtue theory. The implications for various interpretations of the (...) debate of the relation of care and justice are then explored, suggesting three possible meanings for that contrast. Next, the possibility that care theorists are taking up the debate over the relation between principles and cases is considered. Finally, it is suggested that care theorists may be pressing for consideration of an entirely new question in moral theory: the assessment of the normative appropriateness of relationships. Issues needing to be addressed in an ethic of relationships are suggested. (shrink)

Non-therapeutic research with imminently dying patients in intensive care presents complex ethical issues. The vulnerabilities of the imminently dying, together with societal disquiet around death and dying, contribute to an intuition that such research is beyond the legitimate scope of scientific inquiry. Yet excluding imminently dying patients from research hinders the advancement of medical science to the detriment of future patients. Building on existing ethical guidelines for research, we propose a framework for the ethical design and conduct of (...) research involving the imminently dying. To enable rapid translation to practice, we frame the approach in the form of eight ethical questions that researchers and research ethics committees ought to answer prior to conducting any research with this patient population. (1) Does the study hypothesis require the inclusion of imminently dying patients? (2) Are non-therapeutic risks and burdens minimised consistent with sound scientific design? (3) Are the risks of these procedures no more than minimal risk? (4) Are these non-therapeutic risks justified insofar as they are reasonable in relation to the anticipated benefits of the study? (5) Will valid informed consent be obtained from an authorised surrogate decision maker? (6) How will incidental findings be handled? (7) What additional steps are in place to protect families and significant others of research participants? (8) What additional steps are in place to protect clinical staff and researchers? Several ethical challenges hinder research with imminently dying patients. Nonetheless, provided adequate protections are in place, non-therapeutic research with imminently dying patients is ethically justifiable. Applying our framework to an ongoing study, we demonstrate how our question-driven approach is well suited to guiding investigators and research ethics committees. (shrink)

The aim of this paper is to get from a phenomenology of birth towards an ethics of obstetric care: Human rights violations in obstetrics are currently a globally debated phenomenon. Research suggests that maltreatment is widespread and a global phenomenon. However, the prevalence cannot yet be clearly quantified. In view of this problem, it is necessary to take the subjective perspective of those affected seriously. Narrative and phenomenological accounts of birth experiences could help to foster the dialogue between (...) persons giving birth and health professionals. First, I will present narrative accounts of birth experiences recorded by feminist phenomenologists. Second, I will interpret these narrative accounts within a feminist phenomenological framework in order to contribute to a phenomenology of birth, which, in a third step, shall help to develop an ethics of obstetric care. In engaging with the phenomenology of care outlined by feminist care ethicists, I will analyze the elements and conditions of good care, and draw conclusions for an ethic of obstetric and midwifery care. Drawing additionally on the theory of relational autonomy, my paper argues for a relational implementation of self-determination in childbirth. Lastly, I will discuss to what extent the ethical ideal of care has an affinity to the midwifery model of childbirth, and how the current situation of obstetrics prevents a women-centered birth culture. (shrink)

This book is a critical examination of certain basic issues and themes crucial to understanding how ethics currently interfaces with health care and biomedical research. Beginning with an overview of the field, it proceeds through a delineation of such key notions as trust and uncertainty, dialogue involving talk and listening, the vulnerability of the patient against the asymmetric power of the health professional, along with professional and individual responsibility. It emphasizes several themes fundamental to ethics and health (...) care: (1) the work of ethics requires strict focus on the specific situational understanding of each involved person. (2) Moral issues, at least those intrinsic to each clinical encounter, are presented solely within the contexts of their actual occurrence; therefore, ethics must not only be practical but empirical in its approach. (3) Each particular situation is in its own way imprecise and uncertain, and the different types and dimensions of imprecision and uncertainty are critical for everyone involved. (4) Finally, medicine and health care more broadly are governed by the effort to make sense of the healer's experiences with the patient, whose own experiences and interpretations are ingredient to what the healer seeks to understand and eventually treat. In addition to providing a way to develop ethical considerations in clinical life and research projects, the book proposes that narratives provide the finest way to state and grapple with these themes and issues, whether in classrooms or real-life situations. It concludes with a prospective analysis of newly emerging issues presented by and within the new genetics, which, together within a focus on the phenomenon of birth, leads to an clearer understanding of human life. (shrink)

Healthcare systems across the globe are struggling with increasing costs and worsening outcomes. This presents those responsible for overseeing healthcare with a challenge. Increasingly, policymakers, politicians, clinical entrepreneurs and computer and data scientists argue that a key part of the solution will be ‘Artificial Intelligence’ (AI) – particularly Machine Learning (ML). This argument stems not from the belief that all healthcare needs will soon be taken care of by “robot doctors.” Instead, it is an argument that rests on the (...) classic counterfactual definition of AI as an umbrella term for a range of techniques that can be used to make machines complete tasks in a way that would be considered intelligent were they to be completed by a human. Automation of this nature could offer great opportunities for the improvement of healthcare services and ultimately patients’ health by significantly improving human clinical capabilities in diagnosis, drug discovery, epidemiology, personalised medicine, and operational efficiency. However, if these AI solutions are to be embedded in clinical practice, then at least three issues need to be considered: the technical possibilities and limitations; the ethical, regulatory and legal framework; and the governance framework. In this article, we report on the results of a systematic analysis designed to provide a clear overview of the second of these elements: the ethical, regulatory and legal framework. We find that ethical issues arise at six levels of abstraction (individual, interpersonal, group, institutional, sectoral, and societal) and can be categorised as epistemic, normative, or overarching. We conclude by stressing how important it is that the ethical challenges raised by implementing AI in healthcare settings are tackled proactively rather than reactively and map the key considerations for policymakers to each of the ethical concerns highlighted. (shrink)

Harry Frankfurt's conception of care and love has largely been considered a seductive theory of personality, but an untenable and irresponsible theory of moral normativity. Contrary to that interpretation, this article aims at showing that it is possible to remain faithful to Frankfurt's metaphysical premises while not falling into some moral relativism. First, by comparing Frankfurt's and Heidegger's conceptions of care, I show that Frankfurt's subordination of ethics to carology apparently commits him to a neutral foundationalism. (...) In the next step, I argue that his calling into question of the relation between rationality and morality does indeed subject moral normativity to some subjective and contingent limits. And finally, I show that the objections raised against such a conclusion can be answered by shifting Frankfurt's frontier between contingency and necessity and by exploiting his concept of wholeheartedness. (shrink)

The provision of intensive care enables the lives of neonates, infants and children to be sustained or extended in circumstances previously regarded as impossible. However, as well as benefits, such care may confer burdens that resultingly frame continuation of certain interventions as futile, conferring more harm than or any, benefit. Subsequently, clinicians and families in the paediatric intensive care unit are often faced with decisions to withdraw, withhold or limit intensive care in order to act in (...) the best interests of the child. An integral consideration in respect of these decisions is that futility is a concept that has to be contextualised for all those involved. Recent high-profile legal cases highlight the professional, clinical, legal and social conflicts that can arise when parents and clinicians have different interpretations of futility. In acknowledging the complexity of these conflicts for clinicians, this paper aims to support a better understanding of futility as an integral concept in such difficult and emotive decisions within professional practice. We utilise the concept of futility to frame how these decisions to withdraw or withhold certain invasive life-prolonging interventions are ethically and legally justifiable, even when they disagree or conflict with parental views. To support clinicians in understanding these decisions, we in part use the familiar bioethical framework of Principlism developed by Beauchamp and Childress. We suggest that understanding legal and ethical analysis of futility ultimately will help clinicians in approaching and reflecting on such decision-making. (shrink)

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

Background U.S. federal regulations require that certain ethical elements be followed to protect human research subjects. The location and clinical circumstances of a proposed research study can differ substantially and can have significant implications for these ethical considerations. Both the location and clinical circumstances are particularly relevant for research in intensive care units (ICUs), where patients are often unable to provide informed consent to participate in a proposed research intervention. Purpose Our goal is to elaborate on the updated 2013 (...) U.S. Food and Drug Administration (FDA) guidance document regarding an exemption from the requirement of obtaining informed consent from patients or their surrogates and to address certain elements within that document, thereby assisting clinicians in developing a framework for emergency research in accordance with the regulatory bodies at their own institutions and in the United States. Methods Review of the 2011 and updated FDA guidance document on exemption from informed consent. Results The current process of obtaining informed consent within ICUs needs to be revisited, especially for research in which timely informed consent is not likely. In particular, the process of obtaining informed consent may not be appropriate or even ethical for critically ill patients in extremis who require an intervention for which there is no current acceptable standard of care and clinical equipoise exists. We provide clinicians with a viewpoint that further elaborates on the FDA guidance document. Limitations The viewpoints provided herein are those of the authors and are therefore inherently limited by the personal views of a selected few. Other clinicians or researchers may not interpret the FDA guidelines in a similar manner. Moreover, the discussion of a guideline document is a limitation in and of itself. The guidelines set forth by the FDA are precisely that—guidelines. Therefore, they may not be followed as outlined in the guidance document within one’s own institution. Our goal is that, by elaborating on the guidelines for planned research involving human subjects in the ICU, institutional regulatory bodies may gain a better understanding in drafting their own document when faced with a clinician or a researcher who wishes to conduct planned research in an ICU. Conclusions We believe that the interpretations provided will allow clinicians to safely undertake planned research in ICUs without endangering the main tenets of ethical research involving human participants. This research is needed for the advancement of care in the critically ill. (shrink)

: Discussions of ethical approaches in nursing have been much enlivened in recent years, for instance by new developments in the theory of care. Nevertheless, many ethical concepts in nursing still need to be clarified. The purpose of this contribution is to develop a fundamental ethical view on nursing care considered as moral practice. Three main components are analyzed more deeply--i.e., the caring relationship, caring behavior as the integration of virtue and expert activity, and "good care" as (...) the ultimate goal of nursing practice. For the development of this philosophical-ethical interpretation of nursing, we have mainly drawn on the pioneering work of Anne Bishop and John Scudder, Alasdair MacIntyre, Lawrence Blum, and Louis Janssens. We will also show that the European philosophical background offers some original ideas for this endeavor. (shrink)

Recent conceptualizations of sustainable global development have reflected societal concerns not only with environmental stewardship, but also with social amelioration. However, the tripartite goals of corporate profitability, environmental protection, and social responsiveness are unlikely to be achieved through conventional models of globalization. The emergent approach known as sustainable global enterprise provides a promising strategic alternate, but requires the development of “native capability” [Hart, S. L.: 2005, Capitalism at the Crossroads: The Unlimited Business Opportunities In Solving the World’s Most Difficult (...) Problems. (Pearson Education, Inc., Publishing as Wharton School Publishing, Upper Saddle River, NJ)] that comprises specific relational competencies not typically required by traditional transnational models. This article demonstrates the usefulness of an ethic of care for enhancing understanding of the competencies comprising native capability, and, provides practical insights from a care approach on the development of those skills. (shrink)

The ageing population is increasing worldwide with an increase in chronic disorders. At the same time, person‐centred care has become a policy within both health and social care. To facilitate coordination and collaboration and integrate the older adult's perspective in the decision‐making process the collaborative care planning process with the development of a written care plan can be used. In this study, the result of an interpreted analysis of four empirical studies of the collaborative care (...) planning as a person‐centred practice will be discussed and reflected on. A framework based on the French philosopher Paul Ricoeur's little ethics was used in the synthesis of the studies. The findings revealed two common threads: personhood and power asymmetry. Both challenges in achieving a person‐centred collaborative care planning. Ricoeur's dialogical thinking and description of a person served as an underpinning in discussing and reflecting upon the findings of the interpreted synthesis. Collaborative care planning is a complex process. However, Ricoeur's philosophy contributed to a greater understanding of the collaborative care planning as a person‐centred practice and accentuated that ethics, human values, and the older adults and care partners perspectives need to be given the same importance and considerations as the medical and social sciences perspectives for the collaborative care planning process to truly become person‐centred. (shrink)

In recent decades, some feminists have turned to the writings of Hannah Arendt in order to propose a truly emancipatory ethic of care or to find the principles that could lead to the political institutionalization of care. Nevertheless, the feminist interpretations of Hannah Arendt are particularly contrasted. According to Sophie Bourgault, this recourse to Hannah Arendt is deeply problematic, mainly because of her strong distinction between the private and public spheres. This article discusses the relevance of using Arendt’s (...) concepts to think about the institutionalization of care by Joan Tronto. Indeed, the most recent analyses developed on the politics of care are shaped by Arendt’s concepts such as power, amor mundi or by her conception of politics as a relationship. (shrink)

The theory and practise of care is defined and enacted differently in different national as well as cultural contexts, illuminating how differently constructed the personal and societal structures in Europe are. A common trait is however that care work paid or non-paid, private or public is identified with women. To navigate in the landscape of care and ethics requires taking into account the constitutive relation between one’s identity, embodiment and position. The author suggests conceiving (...) class='Hi'>care as an existential condition of life demanded from all human beings. This will free care from the identification with women and pave a way towards a more gender equal and just society with less gender segregation in the labour market and at the arena of education. (shrink)

How can we best identify, understand, and deal with ethical and societal issues raised by healthcare robotics? This paper argues that next to ethical analysis, classic technology assessment, and philosophical speculation we need forms of reflection, dialogue, and experiment that come, quite literally, much closer to innovation practices and contexts of use. The authors discuss a number of ways how to achieve that. Informed by their experience with “embedded” ethics in technical projects and with various tools and methods (...) of responsible research and innovation, the paper identifies “internal” and “external” forms of dialogical research and innovation, reflections on the possibilities and limitations of these forms of ethical–technological innovation, and explores a number of ways how they can be supported by policy at national and supranational level. (shrink)

Introduction -- The ethics of care and global politics -- Rethinking human security -- 'Women's work' : the global care and sex economies -- Humanitarian intervention and global security governance -- Peacebuilding and paternalism : reading care through postcolonialism -- Health and human security : gender, care and HIV/AIDS -- Gender, care, and the ethics of environmental security -- Conclusion. Security through care.

In recent years, the principle of equivalence has been accepted in many countries as the standard against which healthcare provision for prisoners should be measured. There are several ways in which this principle can be interpreted, but current policy in the UK and elsewhere seems to focus on the measurement and achievement of equivalence in the process of healthcare provision. We argue that it is not appropriate to apply this interpretation to all aspects of prisoner healthcare, as it does (...) not necessarily address the challenges inherent to the prisoner population and prison setting. Consequently equivalence of health outcomes should also be considered alongside processes in the interests of providing healthcare in prison that is equivalent to that outside prison. (shrink)

This article defends ‘relational theorizing’ in bioethics and public health ethics and describes its importance. It then offers an interpretation of solidarity and care understood as normatively patterned and psychologically and socially structured modes of relationality; in a word, solidarity and care understood as ‘practices.’ Solidarity is characterized as affirming the moral standing of others and their membership in a community of equal dignity and respect. Care is characterized as paying attention to the moral being (...) of others and their needs, suffering, and vulnerability. The wager of relational theorizing in health care and public health is that substantive ethical visions of solidarity and care will provide support for more just and egalitarian health care and public health policies. (shrink)

The Psychological Ethics and National Security (PENS) task force was assembled by the American Psychological Association (APA) to guide policy on the role of psychologists in interrogations at foreign detention centers for the purpose of U.S. national security. The task force met briefly in 2005, and its report was quickly accepted by the APA Board of Directors and deemed consistent with the APA Ethics Code by the APA Ethics Committee. This rapid acceptance was unusual for a number (...) of reasons but primarily because of the APA's long-standing tradition of taking great care in developing ethical policies that protected anyone who might be impacted by the work of psychologists. Many psychological and non-governmental organizations (NGOs), as well as reputable journalists, believed the risk of harm associated with psychologist participation in interrogations at these detention centers was not adequately addressed by the report. The present critique analyzes the assumptions of the PENS report and its interpretations of the APA Ethics Code. We demonstrate that it presents only one (and not particularly representative) side of a complex set of ethical issues. We conclude with a discussion of more appropriate psychological contributions to national security and world peace that better respect and preserve human rights. (shrink)

Advance care planning (ACP) is considered a pivotal aid in the decision‐making process, especially for many people living with dementia, who inevitably will lose the capacity to make decisions at the end of life. In Italy, ACP has been recently regulated by law 219/2017, leading to the investigation of how physicians deal with ACP in dementia. In order to comprehend the perception of physicians who provide care for patients with dementia regarding ACP and to describe their difficulties and (...) needs, this study presents the results of a qualitative research study performed within a local health authority in northern Italy. Data were collected by semi‐structured interviews with 11 physicians dealing with patients with dementia and were analysed using interpretative phenomenological analysis. Four superordinate themes were identified, describing both the difficulties and challenges perceived by physicians in performing shared ACP in their daily activities. This study demonstrates that physicians experience troubles synchronizing the time of shared ACP with the more rapid development of dementia. Results also suggest that further training about communication on ACP is urgently required to ease the implementation of shared ACP. A broader involvement of institutions and other professionals is also important in spreading ACP among healthcare institutions. (shrink)

This paper advances a Millian concept of care by re-evaluating his defense of the “common arrangement,” or a gendered division of labor in marriage, in connection with his views about traditionally feminine capacities, time use, and societal expectations. Informed by contemporary care ethics and liberal feminism, I explicate the best argument Mill could have provided in defense of the common arrangement, and I show that it is grounded in a valuable concept of care for (...) class='Hi'>care-givers. This dual-sided concept of care theorizes care-giving both as a domain of human excellence and as labor with accompanying burdens. Liberal feminists should adopt this Millian concept of care, which can then inform principled thinking about distributive arrangements. (shrink)

The aim of this study was to explore ethically problematic situations in the long-term nursing care of elderly people. It was assumed that greater awareness of ethical problems in caring for elderly people helps to ensure ethically high standards of nursing care. To obtain a broad perspective on the current situation, the data for this study were collected among elderly patients, their relatives and nurses in one long-term care institution in Finland. The patients (n=10) were interviewed, while (...) the relatives (n=17) and nurses (n=9) wrote an essay. Interpretation of the data was based on qualitative content analysis. Problematic experiences were divided into three categories concerning patients’ psychological, physical and social integrity. In the case of psychological integrity, the problems were seen as being related to treatment, self-determination and obtaining information; for physical integrity, they were related to physical abuse and lack of individualized care; and for social integrity, to loneliness and social isolation. This study provided no information on the prevalence of ethical problems. However, it is clear from the results that patient integrity warrants more attention in the nursing care of elderly patients. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law (...) and medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (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)

In personal relationships, we conceive of the related person as an individual who is more than a combination of qualities, a bearer of claims or a role-occupant. She is envisaged as a distinct and irreplaceable particular. We have immediate concerns for her that are not mediated by consideration of principles such as the promotion of welfare or the fulfillment of duty. The aim of my dissertation is to analyze and defend this particularistic concern and show how it is anchored in (...) what I call an engaged perspective. Recent critics of Kantianism and utilitarianism claim that these theories endorse only an objective or impersonal perspective, which ignores the particularity of individuals. I contrast this with an engaged perspective which I explicate by building on insights embodied in the Confucian account of role-ethics in the period 550 B.C.-290 B.C. I argue that although Confucian ethics has been rightly interpreted to stress the way in which social role mediates between relationships, nonetheless its ideal concerns socially-mediated relations of love between individuals. ;I first examine the cardinal Confucian virtue of jen, or loving, and other role virtues such as filial piety, and show how they help create connectedness and mutuality. People are connected when they share their emotional world and care for each other. And they share an exclusive mutuality when they generate a unique history of reciprocation and participate in the common good of their relationship. In addition, particularity functions as a structural factor to govern the caring, reciprocity, and emotions of love. Consequently, an engaged agent considers her beloved and the relationship she is engaged in as irreplaceable particulars. The engaged perspective is a distinctive "we" perspective arising from the awareness of such connectedness and mutuality. I also contrast the engaged perspective with the personal perspective. ;Finally, I analyze the motivational structure of a Confucian agent by examining the influence of propriety, emotions, thinking and will on Confucian agency. This confirms my analysis of the engaged perspective and further informs us about the type of agency required in engagement. (shrink)