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

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

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

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

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

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

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

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

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

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

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

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

Our goal was to explore self‐care practices among men who have sex with men in the context of Mpox in Brazil. This study used qualitative research methods, including interviews and thematic analysis, to collect and analyze data from male participants across the Brazilian territory. The narratives unveil men's perspectives on self‐care, risk reduction, and health beliefs during the Mpox pandemic. Our findings highlight a multifaceted approach to self‐care among men, encompassing hygiene, physical contact management, (...) mask usage, skin lesion vigilance, and adherence to official guidelines. Men's attitudes toward sexual behaviors emphasize the importance of reducing sexual partners, practicing safe sex, and combating misinformation through accurate information dissemination. The development of these behaviors and self‐care practices can be facilitated by nurses guided by Dorothea Orem's Self‐Care Theory, supported by patient‐centered care, with strategies to address and confront the stigma associated with the disease and provide emotional support. Thus, the study underscores the pivotal role of self‐care in mitigating infection risks, especially in the context of emerging infectious diseases. It acknowledges the impact of socio‐cultural factors and healthcare policies on men's preventive measures. However, it also recognizes limitations, such as potential bias due to stigma concerns and a nonrepresentative sample. Ultimately, the research advocates for tailored education, promotion of gender equity, and healthcare empowerment to effectively manage health risks in such contexts. (shrink)

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

This study is based on the self-reporting by circus artists’ concerning their injuries. We refer to the theoretical framework of emersiology and argue that circus artists may be able to soothe their distress and pain by learning through their body. We will draw further on the comparison between our therapeutic approach and the techniques of self-care introduced by Michel Foucault in his History of Sexuality.

Self‐care, or self‐management, is presented in healthcare policy as a precursor to patient empowerment and improved patient outcomes. Alternatively, critiques of the self‐care agenda suggest that it represents an over‐reliance on individual autonomy and responsibility, without adequate support, whereby ‘self‐care’ is potentially unachievable and becomes ‘care left undone’. In this sense, self‐care contributes to a blame culture where ill‐health is attributed to personal behaviours or lack thereof. Furthermore, self‐care (...) may represent a covert form of rationing, as the fiscal means to enable effective self‐care and supplement, or replace, self‐care capacities, is not provided. This paper explores these arguments through a contemporary ethical analysis of the self‐care agenda. The terms self‐care and self‐management are used interchangeably throughout whereby self‐management is understood as a point in the wider self‐care continuum. (shrink)

IntroductionPalliative care is an emotionally and spiritually high-demanding setting of care. The literature reports on the main issues in order to implement self-care, but there are no models for the organization of the training course. We described the structure of training on self-care and its effects for a Hospital Palliative Care Unit.MethodWe used action-research training experience based mostly on qualitative data. Thematic analysis of data on open-ended questions, researcher’s field notes, oral and written (...) feedback from the trainer and the participants on training outcomes and satisfaction questionnaires were used.ResultsFour major themes emerged: “Professional role and personal feelings”; “Inside and outside the team”; “Do I listen to my emotions in the care relationship?”; “Death: theirs vs. mine.” According to participants’ point of view and researchers’ observations, the training course resulted in ameliorative adjustments of the program; improved skills in self-awareness of own’s emotions and sharing of perceived emotional burden; practicing “compassionate presence” with patients; shared language to address previously uncharted aspects of coping; allowing for continuity of the skills learned; translation of the language learned into daily clinical practices through specific facilitation; a structured staff’s support system for emotional experiences.DiscussionSelf-care is an important enabler for the care of others. The core of our intervention was to encourage a meta-perspective in which the trainees developed greater perspicacity pertaining to their professional role in the working alliance and also recognizing the contribution of their personal emotions to impasse experienced with patients. (shrink)

Alice Dunbar-Nelson is mostly remembered as a poet, activist, and ex-wife of Paul Laurence Dunbar. Her volume The Goodness of St. Rocque and Other Stories (1899) has been largely overshadowed as a result. Yet, the collection contains a portfolio of heroines analogous and contemporaneous to the famed New Woman figure of the fin de siècle. In this article, I consider Dunbar-Nelson’s heroines in light of their New Woman-esque agency and autonomy as they find remedies and power in objects and materials (...) steeped in New Orleans’s cultural heritage. Ceded neither social nor political self-governance nor domestic comfort, this article reads these transcendental, metaphysical objects as sources of self-care. With close analysis of “The Goodness of St. Rocque,” “Tony’s Wife,” and “Little Miss Sophie,” I argue that Dunbar-Nelson’s protagonists exert influence over their lives, specifically in the negotiation of romantic relationships, through voodoo charms, Catholic candles, tarot cards, sewing machines, and knitting needles. Covering courtship, break-ups, and unhappy marriages, I demonstrate the ways in which these empowering spiritual objects respond to health concerns, including malnutrition and domestic violence, in turn, situating them as alternatives to patriarchal and historically racist medical institutions. Valorizing the cultural milieu of New Orleans and the customs of the Caribbean and European heritage, and thereby conveying Dunbar-Nelson’s resistance to white and male supremacist ideologies in late-nineteenth-century Southern America, the article ultimately assesses the parallels with (predominantly white) New Woman fiction, through shared themes of fraught heterosexual dynamics and women’s declining health. (shrink)

In the Alcibiades I, Socrates argues for the importance of self-knowledge. Recent interpreters contend that the self-knowledge at issue here is knowledge of an impersonal and purely rational self. I argue against this interpretation and advance an alternative. First, the passages proponents of this interpretation cite—Socrates’ argument that the self is the soul, and his suggestion that Alcibiades seek self-knowledge by looking for his soul’s reflection in the soul of another—do not unambiguously support their reading. (...) Moreover, other passages, particularly Socrates’ cross-examination of Alcibiades, suggest the contrary reading, that self-knowledge includes knowledge of qualities peculiar to the individual. (shrink)

In presenting self-preservation as the most general law of nature, set at the summit of the structure of the natural world, Francis Bacon characterized the universal appe- tite for self-preservation as an innate instinct which, in the case of living beings, is primarily associated with the emotion of fear. Bacon’s philosophy offers several tech- niques of self-care to manage the fear of accidents of fortune from which the existence and well-being of the self is under (...) constant threat. This article reconstructs Bacon’s treatment of divinatory arts and their contributions to self-care. We will explore how he adopts traditional divinatory arts and reforms them: oneirocritics, physiognomy, and astrology. We will contend that Bacon’s approach to divinatory arts as techniques for self-care and the management of fortune shows some salient points shared with his natural philosophy: in both cases, the approach is hermeneutical, with the goal of exerting human power. With regard both to nature and to fortune, however, our power to modify the state of things extends only so far. The range of decisions we can make is not unlimited but encompasses only what is “in our power,” that is, what depends on us. (shrink)

Psychologists, as well as other mental health professionals, face unique demands in the workplace that create increased risk for burnout. This article discusses burnout prevalence and detection, including issues of complexity regarding diagnosis and assessment. An ethical lens is utilized to explore problems that may arise due to burnout, and the ethical responsibility of practicing self-care. Recommendations for graduate clinical training programs as well as practicing professionals are suggested, including strategies for monitoring self and others for warning (...) signs of burnout and implementing self-care. (shrink)

The article focuses on the impact of the concept of self-care on persons who are understood as incapable of self-care due to their physical and/or mental ‘incapacity’. The article challenges the idea of this health care concept as empowerment and highlights the difficulties for persons who do not fit into this concept. To exemplify this, the self-care concept is discussed with regard to persons with Alzheimer’s disease (AD). In the case of persons with (...) AD, self-care is interpreted in many different ways—depending on the point of view, for instance as an affected person or a carer. To prevent a marginalisation of the growing group of elderly persons with dementia, the article argues that concepts such as those of personhood, wellbeing, autonomy, rationality and normality have to be re-thought with regard to an increasingly ageing population. Taking into account that AD as a socio-medical construct has to be understood in the context of power relations, the article focuses on the mutual influence between the concepts of self-care and of AD and its possible impact on governing dementia and AD in particular. Michel Foucault’s considerations on ‘technologies of the self’ provide the basis for the discussion of the self-care concept within existing societal power relations. (shrink)

I wish to take up the subject ... in relation to a set of practices in late antiquity. Among the Greeks, these practices took the form of a precept: epimeleisthai sautou, "to take care of yourself," to take "care of the self," "to be concerned, to take care of yourself."The precept of the "care of the self" [souci de soi] was, for the Greeks, one of the main principles of cities, one of the main (...) rules for social and personal conduct and for the art of life. For us now, this notion is rather obscure and faded. (Foucault, TS, 19). (shrink)

Recently, an article by Toshiko Tanaka, Takao Yamamoto, and Masahiko Haruno garnered a fair bit of media attention; in “Brain response patterns to economic inequity predict present and future depression indices”, they reported research that purported to show that “pro-social” individuals were more upset by unequal outcomes that didn’t directly disadvantage them than were “individualists.” Further, being pro-social was associated with a higher chance of developing depression. They linked this research with research showing that economic inequality is associated with poor (...) health outcomes, including higher rates of depression. (They cite the epidemiologists Richard Wilkinson and Kate Pickett’s 2006 work... (shrink)

Recent feminist accounts of autonomy have focused both on autonomous agents’ relationships to others and on their self-regarding attitudes or self-relations. This chapter focuses on the attitude of practical self-care, arguing that autonomous agents must care about themselves in a sense that amounts to caring about their practical reasons. While self-care is primarily a self-relation, it also implies a form of interpersonal relationality. Caring about one’s reasons requires caring about intersubjective assessments thereof, (...) and the relation of self-care thus implies openness to the reasons of others and a disposition to hold oneself answerable for one’s identity-constituting concerns. (shrink)

Self-care apps are booming. Early iterations of this technology focused on tracking health and fitness routines, but recently some developers have turned their attention to the cultivation of character, basing their conceptual resources on the Hellenistic tradition (Stoic Meditations™, Stoa™, Stoic Mental Health Tracker™). Those familiar with the final writings of Michel Foucault will notice an intriguing coincidence between the development of these products and his claims that the Hellenistic tradition of self-cultivation has much to offer contemporary (...) life. In this article, I explore Foucault’s cryptic remarks on this topic, and argue that today’s self-care developers can improve future products by paying attention to the Hellenistic exercises of self-cultivation he identifies as especially important. (shrink)

Introduction -- Healing justice and whole self-care -- Oppression, trauma, and healing justice -- Stress and the self-care revolution -- The whole self -- A skillful path of healing justice -- Holistic self-care practices and skills -- Connecting to the body -- Befriending the mind-heart -- Rediscovering spirit -- In the fabric of community -- Cultivating connections between person and planet -- Where the rubber meets the road -- The healing justice organization -- (...) Healing justice on the frontlines -- Widening the circle and coming home -- Notes -- Index. (shrink)

Background The emerging working conditions triggered by the COVID-19 pandemic have imposed numerous ethical challenges on the nurses, which, in turn, can negatively impact the nurses’ physical and mental health, and thus their work performance through intensifying negative emotions and psychological pressures. Aim The purpose of this study was to highlight the nurses’ perceptions of the ethical challenges that they faced regarding their self-care during the COVID-19 pandemic. Research design A qualitative, descriptive study with a content analysis approach. (...) Participants and research context The data were collected through semi-structured interviews with 19 nurses working in the COVID-19 wards of two university-affiliated hospitals. These nurses were selected using a purposive sampling method and the data were analyzed using a content analysis approach. Ethical considerations The study was approved by the TUMS Research Council Ethics Committee under the code: IR.TUMS.VCR.REC.1399.594. In addition, it is based on the participants’ informed consent and confidentiality. Findings Two themes and five sub-themes were identified, including ethical conflicts (the conflict between self-care and comprehensive patient care, prioritization of life, and inadequate care) and inequalities (intra- and inter-professional inequalities). Conclusion The findings demonstrated that the nurses’ care is a prerequisite for the patients’ care. Considering that the ethical challenges faced by nurses are related to unacceptable working conditions, organizational support, and lack of access to facilities such as personal protective equipment, it seems essential to support nurses and provide adequate working conditions to provide patients with quality care. (shrink)

This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral (...) and psychological considerations to support the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy. (shrink)

이 글은 누스바움의 『분노와 용서』의 중심 주제인 분노에 관하여 고찰하고 분노에 관한 누스바움의 분석에서 배제된 분노의 윤리적 의미를 찾으려는 시도이다. 누스바움은 분노를 부정적 감정이라 본다. 그는 분노가 부정적인 감정인 이유를 규범 윤리의 입장에서 분석하고 분노를 제거해야 한다고 주장한다. 나는 누스바움의 분석이 설득력이 있다고 생각하지만 일면 그가 배제하고 있는 감정 그 자체로서의 분노가 주체와의 관계에서 다른 작용을 할 수 있다고 본다. 그런 이유에서 누스바움과 다른 입장의 논의들을 살펴보기 위해 아리스토텔레스의 분노에 관한 논점을 분석한다. 또 ‘자기 배려 윤리’의 논점에서 분노를 재해석하여 분노가 (...) 윤리적 질료로 가치가 있음을 보일 것이다. 이를 위해 푸코가 해석한 세네카의 분노론을 분석하고 푸코가 포착한 세네카의 분노에 대한 다른 논점들이 무엇인지 조명할 것이다. 이를 바탕으로 분노가 자기 배려 주체에게 윤리적 질료로서 의미가 있음을 보이고, 자기 배려주체에게 윤리적 힘을 키우게 하는 주된 계기로 분노의 의의를 재발견할 수 있음을 논구한다. (shrink)

At the heart of soul care is self-care. Being able to love God and love others is rooted in how we love ourselves. Each person’s understanding of self-care is informed by their personal belief system and their implementation practices. This article will provide a multi-phasic model that describes the self-care journey and focuses on how to implement self-care practices. A key distinction of this model is that it is used in an (...) ongoing fashion. To avoid confusion between beliefs and practice, attention will be given to the decision-making process for self-care implementation. Specific activities that address the physical, mental, emotional, spiritual, and relational parts of people will be discussed. The article will also consider the nuances of assessing self-care and why it is important to value self-care, which is in keeping with the greatest commandments provided by Jesus in Mark 12:28–30. (shrink)

In an increasingly globalized world, the accessibility of healthcare and medication has expanded beyond local healthcare systems and national borders. This study aims to investigate the transnational health and self-care experiences of 11 Japanese women who have resided in South Korea for a minimum of six months and have utilized oral contraceptives, including those that were acquired over-the-counter (OTC). Data were gathered through semi-structured interviews and analyzed by utilizing the NVivo software. The analysis yielded three significant thematic categories, (...) namely (1) experiences and perceptions of obtaining and utilizing contraceptive pills, including OTC access; (2) individual and social perceptions of pills and their accessibility in Japan, insights from actual users; and (3) enhancing pill accessibility, transnational health and self-care experiences and perspectives. Participants acknowledged that oral contraceptives are a global product and experienced communication challenges with healthcare providers as a result of differing understandings of these medications. Additionally, this study identified transnational strategies, such as purchasing an adequate supply of pills just before departure and seeking pills from local families or acquaintances. This study not only highlights the implications of clinical care for transnational patients but also underscores their critical global perspectives on access to oral contraceptives. Furthermore, it proposes two models for improving accessibility within the Japanese healthcare system, even in prescription-only contexts, by introducing OTC options. (shrink)

Clinical ethics consultants are inevitably called to participate in and bear witness to emotionally challenging cases. With the move toward the professionalization of ethics consultants, the responsibility to respond to and address difficult ethical dilemmas is likely to fall to a small set of people or a single clinical ethicist. Combined with time constraints, the urgent nature of these cases, and the moral distress of clinicians and staff encountered during consultation, like other healthcare professionals such as physicians and nurses, clinical (...) ethics consultants could risk burnout. If it is true that clinical ethicists are at risk for burnout, an important strategy to avoid burnout is to develop sound self-care practices. This article reviews the goals and skills of ethics consultation and the role-specific reasons that clinical ethicists may be at risk for burnout, and argues that clinical ethicists may need to engage in self-care practices. Strategies to address burnout are reviewed and opportunities for future research are identified. (shrink)

This paper will explore both the ways in which the practices of self-care, specifically related to mental health, have emerged as responses to the increasingly precarious status of life after the economic shocks of the Global Financial Crisis, whilst also looking to the work of Silvia Federici and Kathi Weeks to propose models for immanent critique of these practices. Although it cannot be taken as a pure origin, post-GFC mental health discourse has increasingly seen mental health discussed as (...) a form of resilience to precarity. Furthermore, practices of self-care, and psychological forms of treatment such as cognitive behavioural therapy have become vehicles for the intensification of personal resilience in the face of systemic crisis. If self-care involves an inward looking and depoliticised subject, surely political emancipation lies elsewhere. The possibility of some alternative to our present state of affairs, where self-care increasingly appears as a form of ‘voluntary servitude,’ that is to say, a form of self-subjugation with serious political risks, must surely be taken as a continual project for those engaged in critical inquiry. Then again, to suggest that those engaging in self-care are simply reproducing neoliberal subjectivity would surely miss the ways in which such forms of self-preservation might appear as unavoidable for the individuals in question. Through an engagement with their work—and one that draws parallels between their strategic critiques of reproductive labour broadly speaking, and the more specific area of mental illness and neoliberal governmentality—the question of the “necessity” of self-care will be brought into alignment with the possibilities of its practicality. (shrink)

This study is considered as a proposal to identify some metaphysical support of the self-care for a patient suffering from a chronic disease, as an extension of the bio-psycho-social paradigm. The methodology is dominated by a phenomenological perspective, supported by a hermeneutic conceptual analysis of the care of the self in Michel Foucault, focused on the Socratico-Platonic period and pervaded by the intention of having a translation and application to self-care. Foucault pleads for an (...) aesthetics of the self, called subjectivity, in which the subject is self-constituted through the so-called technologies of the self. The care of the self comes from the resignification of the philosophy as a way of life in which the subject is objectified. The translation and the applicability of the care of the self at the idea level to self-care are identified precisely in the acquisition of some important principles of the philosophy of care of the self from the Greek Antiquity: the role of awakener of consciousness of the one who is concerned about oneself as the first moment of the metaphor of awakening from the sleep, the ēthos as a way of being, a way of behaving and a life model. The pair self-knowledge – care of oneself justifies informing the former by the latter, in which being concerned about oneself means knowing oneself. Nevertheless, knowledge means care of the self where the self is synonymous with the soul and moreover, with the divine element in man. (shrink)

Burnout among health professionals is at epidemic proportions. In response, many health institutions have emphasised the importance of self-care, relying particularly on the idea that doctors who are burned out provide worse care for their patients. Although not made explicit, this suggests that doctors might have a responsibility to their patients (and perhaps others) to practice self-care. This chapter explores the potential grounds for such an obligation. We suggest that while there is potential for a (...) limited obligation of self-care, institutional emphasis on this risks instrumentalising doctors' well-being, minimising institutional responsibilities and workers' rights, and being excessively demanding for individuals. (shrink)

Black girls regularly experience gendered, racial structural violence, not just from formal systems of law enforcement, but throughout their daily lives. School is one of the most central and potentially damaging sites for Black girls in this regard. In this paper, I draw attention to the role of the beauty salon as a space of renewal for Black women and girls as they navigate systems of oppression in their daily lives and report on the ways in which a specific beauty (...) salon in Chesterfield County, Virginia, supported a group of Black high school girls. The study focuses on the exposure of Black girls to carceral measures in school settings and speaks to the role of African-American beauty salons as spaces where collective care from violence can manifest and strategies to interrupt racialized gendered violence against Black girls can emerge. As Co-Investigator of this study funded by the Department of Justice, I created the “scholar-artist-activist lab,” consisting of a small group of undergraduate and graduate students facilitating workshops with a mixed gender group of Black high-school students, to discuss, interact, and participate in social justice-centered exercises. I focus here on the experiences of the Black girls who participated in the study. (shrink)

Although Nietzsche scholars have paid close attention to his aphoristic and rhetorical style, few have focused on his practice of writing prefaces. In this paper, I engage in a close reading of Nietzsche’s prefaces and identify five themes present in his earlier and later prefaces: (1) he speaks directly to his readers, (2) he stresses the necessity of slow and careful reading, (3) he encourages readers to trust themselves, (4) he refers to himself as a herald, and (5) he uses (...) combative and polemical language to describe his work. Given these themes, I conclude that Nietzsche’s preface writing project constitutes a practice of self-care as described by Foucault in “Technologies of the Self” and “The Ethics of the Concern for Self as a Practice of Freedom.”. (shrink)

BackgroundSocial support plays an important role for health outcomes. Support for those living with chronic conditions may be particularly important for their health, and even for their survival. The role of support for the survival of cancer patients after receiving an allogeneic hematopoietic cell transplant is understudied. To better understand the link between survival and support, as well as different sources and functions of support, we conducted two studies in alloHCT patients. First, we examined whether social support is related to (...) survival. Second, we examined who provides which support and which specific support-related functions and tasks are fulfilled by lay caregivers and healthcare professionals.MethodsIn Study 1, we conducted a retrospective chart review of alloHCT patients and registered availability of a dedicated lay caregiver and survival. In Study 2, we prospectively followed patients after alloHCT from the same hospital, partly overlapping from Study 1, who shared their experiences of support from lay caregivers and healthcare providers in semi-structured in-depth interviews 3 to 6 months after their first hospital discharge.ResultsPatients with a dedicated caregiver had a higher probability of surviving to 100 days than patients without a caregiver, OR = 2.84, p = 0.042. Study 2 demonstrated the importance of post-transplant support due to patients’ emotional needs and complex self-care regimen. The role of lay caregivers extended to many areas of patients’ daily lives, including support for attending doctor’s appointments, managing medications and financial tasks, physical distancing, and maintaining strict dietary requirements. Healthcare providers mainly fulfilled medical needs and provided informational support, while lay caregivers were the main source of emotional and practical support.ConclusionThe findings highlight the importance of studying support from lay caregivers as well as healthcare providers, to better understand how they work together to support patients’ adherence to recommended self-care and survival. (shrink)

1. At the beginning of 2014, when I was two years into my ethnographic research on sexuality among survivors of war-rapes in Bosnia-Herzegovina, my mental health deteriorated. I had spent a good am...