A rising number of patients require continuing or palliative services and this means that they will need to transition from one model of healthcare delivery to another. If it is generally recognised that patient vulnerability to inadequate services increases when the setting in which patient receives care changes, it is usually taken to be the result of poor coordination of services or personnel. Recognising that an integrated system is essential to adequate access, the point that I put forward in this (...) paper is that the centrality of acute care services affects the way in which chronic and palliative services are structured and, consequently, their availability. I argue that the problem originates in the manner in which some of the foundational concepts of the acute care model are imported into the other models of care delivery. In order to make this case, I review the three main models of healthcare service delivery by focusing my analysis along three axes: the goal of the care model; the predominant understanding of autonomy implicit in the model; and, the main actors in the care relationship. By examining how the various concepts translate from one model to the next, I discuss what I identify to be one of the main conceptual obstacles to less problematic transitioning, the notion of autonomy and the corresponding view of the patient as an isolated agent. (shrink)

In post-Fordist economies, the nature of laboring activities can no longer be subsumed under a Taylorized model of labor, and the service sector now constitutes a larger share of the market. For Maurizio Lazzarato, Michael Hardt, Antonio Negri, and other theorists in the post-Marxist tradition, labor has changed from a commodity-producing activity to one that does not produce a material object. For these authors, this new type of labor is immaterial labor and entails communicative acts as well as added worker (...) agency. This paper reflects on this new paradigm of labor by examining the paid practices of care defined as the activities performed by individuals who have a mandate to help another adult accomplish the tasks of self-care. Because care workers take care of other bodies, care labor exemplifies an embodied practice. I make use of the corporeality of care to put forward the notion of thin and thick embodiment in order to examine critically the meaning of immaterial labor and to support my claim that immaterial labor, as conceptualized by Hardt and Negri, erases both the materiality and relationality of care labor. Furthermore, typifying care labor as immaterial only serves to maintain its marginalized status.Care Assistant. Required to work within a private residential center to assist nursing staff. Experience desirable, qualifications an advantage, but caring and understanding more important than either. Must have good English to understand instructions and be co-operative to work in a friendly team environment (Toynbee 2007, 220). (shrink)

Recent research points to the fact that new medical technological innovations are just as relevant in the context of long‐term care or chronic care as they are in the context of acute care. In the spirit of the Nuffield Foundation recommendations, this paper explores the possibilities of using robotic aides in long‐term care and identifies the tensions that must be considered and addressed if robotics is to be introduced successfully in nursing homes. Our examination is two‐pronged. First, we delve into (...) a fundamental issue surrounding AI, namely that of consciousness. We argue that automation will always have only a limited use in caregiving since caregiving as an activity requires the use of human‐type, that is, organic, consciousness. We support the thesis that the emergence and formation of human‐type consciousness require feelings such as empathy and the sense of touch, which, in turn, create the sense of kinship with fellow human beings. And second, we examine the benefits as well as risks of using robotic aides such as ZORA and PARO in long‐term care facilities. More specifically, we look at ZORA's use in a group setting, and PARO's use in an individual setting. We emphasize that long‐term care is one‐on‐one care, including but not limited to intimate care. Crucially, we argue that touch is at the heart of this type of care. We argue that some of the tensions with the use of robotic aides are generated precisely because of the lack of human touch. (shrink)

This essay examines the citizen's apparent agelessness that is foundational to liberal democratic theories. By engaging the notion of citizenship rights, Lanoix challenges this assumed perpetual adulthood and argues for a new way of conceptualizing the citizen. The broader notion of citizen as cohabitant allows for the changing relationship a citizen will have with her citizenship rights and accommodates individuals who are not self-governing but who, nonetheless, share a democratic space.

: This essay examines the citizen's apparent agelessness that is foundational to liberal democratic theories. By engaging the notion of citizenship rights, Lanoix challenges this assumed perpetual adulthood and argues for a new way of conceptualizing the citizen. The broader notion of citizen as cohabitant allows for the changing relationship a citizen will have with her citizenship rights and accommodates individuals who are not self-governing but who, nonetheless, share a democratic space.

Nancy Jecker (2013) makes a compelling argument for using a capabilities approach to resolve the issue of the fair allocation of health care resources across various age groups. This question has b...

In this paper, I argue that addressing the medical needs of older persons warrants expanding the array of insured services as described by the Canada Health Act to include home care. The growing importance of chronic care supports my call for federally regulated home care services as the nature of disease management has changed significantly in the last decades. In addition, if the values of equity, fairness and solidarity, which are the keystone values of the CHA, are to be upheld (...) within the current social and demographic context, then Canada’s health care system should adapt accordingly. I focus my argument on the services provided to older persons for two main reasons. First, the changing nature of disease management is best seen in this population. If it is to be successfully argued that the transformations in medicine warrant an expansion of insured services covered by the CHA, it will be best illustrated by looking at the needs of older persons. Second, with the demographic shift looming large in the policy agenda, an exploration of this issue is not only crucial but timely. (shrink)

This essay examines paid care labor that typically assists older adult individuals in performing the activities of daily living. I make the case that emotional labor is constitutive of ancillary care and that some emotion-based utterances are communicative actions in the sense intended by Jürgen Habermas. However, communicative action is undermined because of the manner in which ancillary care is organized. I discuss why this is problematic and suggest ways to enhance the goals of ancillary care by granting communicative action (...) a greater role within caregiving. (shrink)

The World Economic Forum has called dementia one of the biggest global health crises of the 21st century. In this paper, I make the case that unpaid caregiving by family or close others of persons living with dementia should be a matter of public health. Shaji and Reddy proposed this in 2012 in the context of dementia care in India. They explicitly acknowledge the influence of Talley and Crews’ 2007 article on caregiving as an emerging public health concern. However, they (...) narrow their proposal to caregiving for persons living with Alzheimer’s disease and related dementias (ADRD), which I take to be an important first step in building an argument for putting caregiving more firmly on a public health agenda. In order to support my claim, first, I establish that caregiving is a social determinant of health. Second, I counter objections to the addition of caregiving for persons living with ADRD to a public health agenda, as it would lead to public health mission creep. I then argue that a broad understanding of public health can be inclusive of this type caregiving and is preferable as it highlights an issue of health equity, the gendered nature of caregiving. Finally, I make the case that a definition of public health inclusive of the social determinants of health and caregiving is more adequately suited to address the health consequences of the current changing demographic patterns. My argument adds support to writings on migration calling for broadening the scope of public health. (shrink)

Monique Lanoix | : Over three decades ago, Carol Gilligan’s seminal book In a Different Voice provided feminist theorists with a powerful new approach to address the shortcomings of traditional moral theories. With a focus on concrete situations, an ethics of care can attend to the specifics of moral dilemmas that might otherwise be glossed over. As feminist reflection on moral and political philosophizing has progressed, another challenge has emerged. Recent feminist scholarship proposes non-ideal theories as preferable action-guiding (...) theories. In this paper, I examine Kittay’s call for a version of care ethics as a naturalized ethics that comes from lived experience, in order to draw out the salient characteristics of the caring agent. This allows me to show how Kittay’s key assertion that “we are all some mother’s child” resonates with Ricoeur’s framing of self-esteem, which is, in turn, anchored on a notion of solicitude. Secondly, I make the case that care ethics can benefit from Ricoeur’s little ethics as it helps buttress the goal of good caring practices. Finally, care ethics, with its emphasis on the universality of care needs, helps to strengthen the central role of solicitude for the political sphere. | : Il y a plus de trente ans, le livre fondateur de Carol Gilligan, In a Different Voice, fournissait aux théoriciennes féministes une nouvelle approche permettant d’affiner la critique des théories morales traditionnelles, particulièrement en ce qui concerne leur universalisme. Focalisant sur les situations concrètes, l’éthique du care chez Gilligan permet de recentrer l’attention sur les spécificités d’un dilemme moral qui, autrement, risquent de rester dans l’ombre. La réflexion féministe en philosophie morale et politique a progressé depuis, s’attelant à de nouveaux défis. La recherche récente suggère qu’une théorie morale non idéale est préférable aux théories dites idéalistes. Dans cet article, j’examine l’éthique du care selon Eva Feder Kittay, soit à titre d’éthique naturalisée, afin de mettre en relief les caractéristiques saillantes de l’agent.e caring. Cela me permettra ensuite de montrer comment l’affirmation clé de Kittay selon laquelle « nous sommes tou.te.s l’enfant d’une mère » fait écho à la pensée ricoeurienne de l’estime de soi qui est, en retour, ancrée dans la notion de sollicitude. Deuxièmement, je soutiens que la « petite éthique » ricoeurienne peut enrichir les éthiques du care, précisément en ce qui a trait au telos du care. Ce faisant, les éthiques du care, qui placent l’accent sur l’universalité des besoins en cette matière, pourront mieux ancrer la sollicitude dans la sphère politique. (shrink)

This essay examines the citizen's apparent agelessness that is foundational to liberal democratic theories. By engaging the notion of citizenship rights, Lanoix challenges this assumed perpetual adulthood and argues for a new way of conceptualizing the citizen. The broader notion of citizen as cohabitant allows for the changing relationship a citizen will have with her citizenship rights and accommodates individuals who are not self-governing but who, nonetheless, share a democratic space.

We discuss how a novel can illuminate the moral dimensions of science and healthcare. The critical distance afforded by the novel pro.

As individuals grow older, they usually require assistance with the daily tasks of self-care. This type of assistance, ancillary care, is essential to maintaining the health of those who need these services. In his prudential lifespan account, Norman Daniels includes access to such services making his account an attractive proposal given the current demographic shift. In this paper, I examine the prudential lifespan account through the lens of old age and I focus on the two concepts on which the lifespan (...) account relies. I show that these two concepts, normal species functioning and opportunity cannot buttress Daniels’s lifespan account; at least it cannot do so for older persons. The tensions that I identify in the prudential lifespan account in relation to aging are instructive for the more recent proposals to include aging in a theory of health and health justice. In addition, my analysis allows me to demonstrate that Daniels’s view of opportunity is irreconcilable to capabilities, the latter being more adaptable to the realities of aging. If capabilities appear more promising, it is nonetheless imperative that the specificities of extended care, such as the need for unpaid caregiving, be taken into consideration. (shrink)

The political self is a concept which is fundamental to political theory. This work focuses an liberal democratic theory because this type of political theory privileges the individual. It is ideal ground for rethinking a concept of the political self. ;I propose to look at abstractions and idealizations which are theoretical tools used in determining a concept of the political self. These: valuable theoretical manoeuvres are not value-neutral. A critical stance must always be taken when such conceptualizations are undertaken. The (...) conception of the political person in the theory of John Rawls will be examined through the lens of the concepts of autonomy and difference. This will focus our attention to the particular theoretical endeavours which-have excised certain features from the concept of the political person. I argue that the fiction of the 'persons in the original position' in Rawls's theory has been extended to an ideal of the political person which excludes certain individuals. This extension is unwarranted and detrimental to some individuals. ;I analyze the categories of the public-private since these are tied to a notion of the self. I claim that profound difference cannot be accommodated within the public realm of traditional liberal theory; it forces the concerns of certain individuals, such as care givers and persons with severe incapacities, into the private realm. These individuals are relegated to the private sphere only and consequently suffer from a devalued moral status. This devalued moral status within political society comes from the fact that they can not approximate the ideal of a fully cooperating member of society. This, I argue, goes against the ideal of a just society which values selves as individuals of equal moral worth. ;Finally, I suggest that our theorisation has always involved a certain detachment from bodily concerns. These have been erased from our theoretical considerations; I claim they have theoretical import. I suggest that we need to think of the political self as a whole self. The liberal focus on interests or goods should be supplemented by an understanding of needs. The latter address our interdependency as well as our vulnerability. The call for political presence is more than just a call to be heard, it's a call to be seen and recognized in the flesh. (shrink)

During the first wave of the pandemic, nursing homes in Quebec were hit particularly hard. The media was replete with images of residents inside the homes holding their hands to glass windows as their loved ones pressed theirs from the outside. Because families were not allowed to visit, Zoom sessions were introduced in order to mitigate the isolation of residents. As I participated in these sessions, I came to realize how the absence of touch affects relationships. In my mind's eye, (...) I saw my arms and hands extending out while the person I was trying to touch was receding into the background, engulfed by the pandemic. This reminded me of Walter Benjamin's "Theses on the Philosophy of History" inspired by Paul... (shrink)

La croissance de la population vieillissante en Amérique du Nord a un impact significatif sur nos politiques sociales. Ainsi, l’État québécois met à la disposition des personnes âgées une aide afin de faciliter le maintien à domicile. Qui a maintenant la responsabilité de répondre aux besoins des personnes âgées; est-ce la famille ou l’État? Si la réponse peut nous aider à formuler des politiques sociales équitables, elle nous pousse aussi à repenser le lien social à la lumière de la dépendance. (...) Dans un premier temps nous nous pencherons sur l’évolution de l’éthique de la sollicitude pour ensuite analyser les apports des études sur la production du handicap. Puisque la problématique de la dépendance s’avère cruciale dans ce débat, les écrits de deux théoriciens français, Albert Memmi et Bernard Ennuyer, nous aideront à élucider la question de la dépendance. Nous verrons par la suite comment ces divers apports peuvent nous amener à reconceptualiser le lien social.In this paper I examine whether care ethics can help to conceptualize a richer social ontology which would include a variety of individuals, not only productive ones, under the auspices of justice. In the first part of the paper, I consider the reasons why care ethics has not had a profound impact in political theorizing. Next I examine the troubled relationship of care ethics and disability. Recent writings on social contract theory, in particular those of Anita Silvers and Leslie Pickering as well as Lawrence Becker, argue that social contract theory can include profoundly disabled individuals and I contrast their proposals with that of care ethicists. By examining critical writings on dependency, I show that a strategy for a more inclusive social space needs to include social structures that recognize dependency as a human reality. I argue that care ethics, even if it may not be critical enough of the foundational concept of dependence, is helpful in understanding the role of the state in facilitating the recognition and the contribution of all persons within society. (shrink)

A notable feature of post-Fordist economies is the increase in service jobs, which includes care occupations such as child care and elder care (Folbre 2001, 182). The commodification of caring activities raises issues surrounding the reception and dispensation of these services, and this is particularly salient to the focus of this paper, elder care. Because the demand for this type of care has greatly increased in recent decades (Glendinning, Schunk, and McLaughlin 1997; Kaye et al. 2006) and also in recognition (...) of the impact of caring activities on families, many countries have sought to initiate policies to provide state-funded services or to compensate family caregivers for their care work.1If help with the .. (shrink)

This paper examines the environment in which waged caregiving takes place. Because the activities of care have been predominantly performed by women in the home, a caring attitude is taken to be inherent to the persons who perform this labor. My analysis endeavors to clarify this misconception. Drawing on studies of paid caregivers who assist elderly individuals accomplish the tasks of self-care, I discuss how these workers face at least three layers of uncertainty. Paid caregiving takes place on a fragile (...) moral terrain, and I argue that the prevalent structure of paid care labor cannot acknowledge this, nor can it support caring within care labor. I use Claudia Card’s concept of gray areas to highlight the manner in which the structure of care labor inhibits the care worker from easily negotiating the moral terrain of caregiving. (shrink)

The goal of this paper is to highlight the manner in which custodial care is structured by the environment in which it takes place. For this, I analyze how formal service providers respond to custodial care needs in two locations, in the home and within long-term care facilities. While relying on an apparent objective measure of the care receiver’s needs, the formal response to care is shaped both by the location in which caregiving takes place as well as by the (...) availability of unpaid caregivers. I argue that a better understanding of custodial care would be that of a relational activity that takes into account the environment and the actors involved in the care relationship. (shrink)

This narrative symposium examines the relationship of bioethics practice to personal experiences of illness. A call for stories was developed by Tod Chambers, the symposium editor, and editorial staff and was sent to several commonly used bioethics listservs and posted on the Narrative Inquiry in Bioethics website. The call asked authors to relate a personal story of being ill or caring for a person who is ill, and to describe how this affected how they think about bioethical questions and the (...) practice of medicine. Eighteen individuals were invited to submit full stories based on review of their proposals. Twelve stories are published in this symposium, and six supplemental stories are published online only through Project MUSE. Authors explore themes of vulnerability, suffering, communication, voluntariness, cultural barriers, and flaws in local healthcare systems through stories about their own illnesses or about caring for children, partners, parents and grandparents. Commentary articles by Arthur Frank, Bradley Lewis, and Carol Taylor follow the collection of personal narratives. (shrink)

Few thinkers have left such an influence across such a diverse range of studies as Michel Foucault has. This book pays homage to that diversity by presenting a multidisciplinary series of analyses dedicated to the question of power today.

Concepts for sustainable bioeconomy systems are gradually replacing the ones on linear product chains. The reason is that continuously expanding linear chain activities are considered to contribute to climate change, reduced biodiversity, over-exploitation of resources, food insecurity, and the double burden of disease. Are sustainable bioeconomy systems a guarantee for a healthy planet? If yes, why, when, and how? In literature, different sustainability indicators have been presented to shed light on this complicated question. Due to high degrees of complexity and (...) interactions of actors in bioeconomy systems, trade-offs and non-linear outcomes became apparent. This fueled the debates about the normative dimensions of the bioeconomy. In particular, the behavior of actors and the utilization of products do not seem to be harmonized according to the environmental, social, and economic pillars of sustainability. Potential conflicts require a new conceptual framework that is here introduced. It consists of a ‘sustainability’ cylinder captured between an inner-cylinder, representing order, and an outer-cylinder for chaos, based on the laws of physics and complex adaptive systems. Such a framework permits (bioeconomy) systems to propagate in the sustainability zone only if they follow helical pathways serving as the new norms. Helices are a combination of two sinusoidal patterns. The first represents here the sustainable behavior of interacting actors and the second the balanced usage of resources and products. The latter counteracts current growth discourses. The applicability of the conceptual cylinder framework is positively verified via 9 cases in Europe, which encompass social-organizational and product-technological innovations. –. (shrink)

Un regroupement de textes qui analysent le platonisme, ainsi que l'antiplatonisme de l'époque moderne et contemporaine. [SDM].

Un regroupement de textes qui analysent le platonisme, ainsi que l'antiplatonisme de l'époque moderne et contemporaine. [SDM].

Increasing privacy concerns are arising from expanding use of aggregated personal information in health practices. Conversely, in light of the promising benefits of data driven healthcare, privacy...

Psychologists often characterize the infant’s attachment to her primary caregiver as love. Philosophical accounts of love, however, tend to speak against this possibility. Love is typically thought to require sophisticated cognitive capacities that infants do not possess. Nevertheless, there are important similarities between the infant-primary caregiver bond and mature love, and the former is commonly thought to play an important role in one’s capacity for the latter. In this work, I examine the relationship between the infant-primary caregiver bond and love. (...) I argue that while these very early attachments do not represent genuine love, a fuller understanding of them can inform extant philosophical views of love. (shrink)

The term “emotional practices” is gaining currency in the historical study of emotions. This essay discusses the theoretical and methodological implications of this concept. A definition of emotion informed by practice theory promises to bridge persistent dichotomies with which historians of emotion grapple, such as body and mind, structure and agency, as well as expression and experience. Practice theory emphasizes the importance of habituation and social context and is thus consistent with, and could enrich, psychological models of situated, distributed, and (...) embodied cognition and their approaches to the study of emotion.It is suggested here that practices not only generate emotions, but that emotions themselves can be viewed as a practical engagement with the world. Conceiving of emotions as practices means understanding them as emerging from bodily dispositions conditioned by a social context, which always has cultural and historical specificity. Emotion-as-practice is bound up with and dependent on “emotional practices,” defined here as practices involving the self , language, material artifacts, the environment, and other people. Drawing on Pierre Bourdieu's concept of habitus, the essay emphasizes that the body is not a static, timeless, universal foundation that produces ahistorical emotional arousal, but is itself socially situated, adaptive, trained, plastic, and thus historical. Four kinds of emotional practices that make use of the capacities of a body trained by specific social settings and power relations are sketched out—mobilizing, naming, communicating, and regulating emotion—as are consequences for method in historical research. (shrink)

Xenotransplantation pits clinical research ethics against public health needs because recipients must undergo long-term, perhaps life-long, surveillance for infectious diseases. This surveillance requirement is effectively an abrogation of the right to withdraw from a clinical trial. Ulysses contracts, which are advance directives for future care, may be an ethical mechanism by which to balance public health needs against limitation of individual rights.

Xenotransplantation is defined as “any procedure that involves the transplantation, implantation, or infusion into a human recipient of either live cells, tissues, or organs from a nonhuman animal source, or human body fluids, cells, tissues or organs that have had ex vivo contact with live nonhuman animal cells, tissues, or organs.” Xenotransplantation has been viewed by desperate patients and their surgeons as a solution to the problem of the paucity of human organs available for transplantation. Foes of xenotransplantation argue that (...) the use of animal organs degrades the human race and should be avoided.In this paper, we briefly review the cultural context of xenotransplantation and explore the infectious disease risk of xenotransplantation. The United States Code of Federal Regulations requires life-long surveillance of a xenotransplantation recipient due to the largely unknown risk of novel infectious disease transmitted across species, known as xenogeneic infectious disease. We argue that despite being in the interest of protecting the public health, the imposition of lifelong surveillance requirements on xenotransplant recipients effectively abrogates the right to withdraw from a clinical trial after the transplantation has taken place. Moreover, we argue that a waiver of the right to withdraw should be made explicit in the interest of full disclosure, out of respect for the research subject’s right of self-determination. (shrink)

Addiction and certain varieties of interpersonal attachment share strikingly similar psycho-behavioral structures. Neuroscientists, psychologists, and philosophers have often adduced such similarities between addiction and attachment to argue that many typical cases of romantic love represent addictions to one’s partner and thus might be appropriate candidates for medical treatment. In this paper, I argue for the relatively neglected thesis that some paradigmatic cases of addiction are aptly characterized as emotional attachments to their objects. This has implications for how we should understand (...) the nature of addiction and for the ethics of attachment more broadly. (shrink)

In the present research we investigated gender-specific beliefs about emotional behaviour. In Study 1, 180 respondents rated the extent to which they agreed with different types of beliefs (prescriptive, descriptive, stereotypical, and contra-stereotypical) regarding the emotional behaviour of men and women. As anticipated, respondents agreed more with descriptive than with prescriptive beliefs, and more with stereotypical than with contra-stereotypical beliefs. However, respondents agreed more with stereotypical beliefs about the emotional behaviour of women than with those about men. These results were (...) replicated in Study 2 with a sample of 75 students and 80 nonstudents. In Study 3, a sample of 279 respondents rated the extent of agreement with the same items, this time with respect to then own emotional behaviour. A similar pattern of results was obtained, although agreement rates were higher than in Study 1 and 2. (shrink)

La question du Philèbe, ce dialogue mal aimé des platonisants, est finalement la plus simple et la plus énigmatique de toutes : celle du rapport entre la vie et la pensée. La vie a l'illusion de se suffire quand elle se fait plaisir, mais cette illusion, c'est la pensée qui la dénonce et non la vie ; la pensée est certaine de se suffire quand elle pense, mais elle ne se suffit que parce qu'il y a un plaisir de pensée, (...) et la vie reprend son bien. Si la question est là, il n'y a pas à la résoudre : dans le mélange nous sommes. Mais comment le composer? Il faut alors différencier les plaisirs, les hiérarchiser, en rejeter certains et en retenir d'autres. Mais il reste que le plaisir est, de la vie, une profondeur, un éclat, que la pensée est impuissante à récupérer. L'illimitation de la vie, quand la vie fait miroiter cette promesse infinie de délices, se moque de toute dialectique. Elle est ce que la pensée ne peut que laisser échapper, en le sachant. Ce que la pensée laisse ainsi filer n'a rien de consistant, ni même d'existant, mais c'est cela aussi vivre : être séduit par le mirage de la vie. Que le mirage soit décevant ne suffit pas à le réfuter. Le plaisir est le bien tel que le désire la vie : qu'arrive-t-il à la pensée quand elle s'y confronte? Elle n'a pas le beau rôle. Elle peut au moins tenter de ne pas être morose, ou morale, de ne pas « chagriner le plaisir ». Mais elle ne peut pas parler au nom de sa vérité propre : elle ne peut que revendiquer le fait d'être au principe d'une meilleure vie. Et montrer que prendre parti pour l'illimité de la vie, c'est prendre parti pour son contraire, qui n'est même pas une mort mais une défaite et une décomposition : telle est la fêlure du plaisir. (shrink)