Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised (...) report was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Neither secular moral theory nor religious ethics have had much place for persons in need of constant physical help and cognitive support, nor for those who provide care for them. Writing as the father of a fourteen-year-old daughter with multiple disabilities, I will explore some of moral issues that arise here, both from the point of view of the disabled child and from that of the child's caretaker(s).

This work seeks to shift the focus of medical practice from disease to people, emphasizing a person's need to be recognized, understood and treated with respect and sensitivity. It also tackles questions about ethical considerations and the recognition of human values.

With a global commitment to scaling up AIDS care and treatment in resource-poor settings for some of the most HIV-affected countries in Africa, availability of antiretroviral treatment is no longer the principal obstacle to expanding access to treatment. A shortage of trained healthcare personnel to initiate treatment and manage patients represents a more challenging barrier to offering life-saving treatment to all patients in need. Physician-centered treatment policies accentuate this challenge. Despite evidence that task shifting for nurse-centered AIDS patient (...) care is effective and can alleviate severe physician shortages that currently obstruct treatment scale-up, political commitment and policy action to support task shifting models of care has been slow to absent. In this paper we review the evidence in support of task shifting for AIDS treatment in Africa and argue that continued policy inaction amounts to unwarranted healthcare rationing and as such is ethically untenable. (shrink)

This article defends an ethics of care approach to global justice, which begins with an empirically informed account of injustices resulting from the workings and effects of contemporary neo-liberalism and hegemonic masculinities. Dominant distributive approaches to global justice see the unequal distribution of resources or ?primary goods? as the basic source of injustice. Crucially, however, most of these liberal theories do not challenge the basic structural and ideational ?frames? that govern the global political economy. Instead, they seek to ?correct? (...) unjust patterns of distribution according to an ideal theory. Subjects in these theories are generally understood as abstract, autonomous and impartial; this is in contrast to an ethics of care, which starts with an ontology of the subject as embodied, vulnerable and relational. The first part of this article explores the role and nature of theory in relation to the task of considering injustice on a global scale and offers a critique of the narrow focus in traditional theories of justice on the distribution of ?primary goods?. The second part considers the effects of neo-liberal globalization and hegemonic masculinities on global working families in order to illustrate the relationship between care and global justice. The final section sketches out a care-ethics approach to global injustice, focusing on three features: first, care as a relational approach; second, the focus in care ethics on intersecting structures of injustice; and third, care as a multi-scalar approach to global injustice. (shrink)

The Human Genome Project is expected to increase dramatically our ability to predict the likelihood of genetic disease in an individual. It is important to reject the myth of genetic determinism—i.e., the simple-minded belief that such complex outcomes as heart disease, cancer, or autoimmune diseases are caused exclusively by particular genes. But it is equally important to acknowledge that genes may play a role in making a person more or less susceptible to such diseases. The ever-increasing prospect of genetic prediction, (...) spurred by the Human Genome Project, has implications for social practices such as insurance, in which predicting the risk of disease or death plays a crucial role. Concerned that improved genetic prediction might have unfortunate social consequences unless the impact of such predictions were anticipated, the U.S. Human Genome Project's Working Group on Ethical, Legal, and Social Issues established a Task Force on Genetic Information and Insurance in May 1991. -/- The Task Force met seven times over its two-year life. By the end of the first year, it had reached several tentative conclusions. Most importantly, we became convinced that the problem posed by increased genetic prediction in insurance was a genuine and important one. When we began, the danger seemed plausible but far from certain. The information we gathered in the first year persuaded us that genetic prediction of disease was in one sense already with us and, in another sense, likely to grow massively in the foreseeable future. (shrink)

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

In lieu of an abstract, here is a brief excerpt of the content:Working on the Clinton Administration's Health Care Reform Task ForceNancy Neveloff Dubler (bio)This narrative is based on my understanding of the elements of the Health Security Act that may have ethical implications. I have reconstructed these elements from my experience on the Health Care Reform Task Force and they are part of the health care plan that the President presented to Congress. (At the (...) time this article went to press, the actual legislation, which should answer my remaining specific questions more clearly, had not yet been released.) I perceive the most important features of the plan to be:• The legislation will create a "right" to health care for all citizens—access to care will be universal;• The plan will involve some form of managed competition in which groups of providers (called Approved or Accredited Health Plans (AHPs)) will offer comparable benefit packages at slightly (or widely) different costs;• The AHPs will negotiate with the Health Alliance (HA) to determine the price that they will charge their consumer-patients;• There will be open enrollment with no barriers to coverage, such as exclusions for pre-existing conditions;• Community rating will be in effect in different localities and enrolled persons in any AHP will pay the same premium;• The coverage for any enrolled person will be portable;• The overall structure will be a cooperative federal/state enterprise in which the states will have quite extensive abilities to fashion variations of the basic plan to meet their particular needs;• Primary care will be encouraged and incentives for physicians to train in primary care specialties provided;• Non-physician providers will be central to the functioning of the health care plans;• Efforts will be made to develop a "person power" pool so that people with an abstract "right" to health care will have real access to providers, in their localities, who can fulfill the promise that the right creates; [End Page 421]• The goal of cost containment will be central to the organization and regulation of the system;• Administrative simplicity and quality protections will be central.Co-chairing the Bioethics Working Group (BWG) of the White House Task Force on Health Care Reform was a unique experience. Approximately 40 Task Force working groups were established by Hillary Rodham Clinton, the President, and the senior Task Force staff. Various members of the President's office and other knowledgeable members of the Executive Branch selected the participants. In our group, appointments were made largely on the recommendations of the co-chairs. The BWG, among the last of the groups formed, carried the official name "The Working Group on the Ethical Foundations of the New System" and was jointly led by me and Marion Gray Secundy, a Professor of Bioethics at Howard University. The fact that the leadership of the Task Force saw fit to establish such a group, thereby confirming that bioethics is a player in the arena of health care policy, was in itself significant and was made no less so by the lack of clarity regarding the group's aims and goals.The working groups of the Task Force were organized into clusters, determined by the relatedness of the somewhat distinct, but always overlapping, content of their investigations. Separate clusters and working groups, for example, looked at mental health, long term care, and the benefit package and coverage for low-income and non-working families. On this last issue there was also a working group that explored health policy initiatives for underserved populations. This multiple focus on related issues proved to be an excellent method for ensuring that the complexity of these topics was sufficiently explored. There was a published schedule for when these groups met together, and members of other groups who had similar or overlapping concerns were invited to attend and to participate.Every week or so, all of the working groups reported to the Task Force leadership, under the direction of Ira Magaziner, in a process called a "tollgate." Prior to the tollgate, the working groups were required to submit formal written analyses of the problems they had most recently been considering. Copies of these documents were placed in a special room so that those who were interested could review... (shrink)

As healthcare providers engage in the politics of reforming and humanizing our immigration and asylum “system” it is critical that they are able to refer their patients whose health is directly impacted by our immigration laws and policies to experts who can help them navigate the system and obtain the healthcare they need.

The discussion about robots in elderly care is populated by doom scenarios about a totally dehumanized care system in which elderly people are taken care of by machines. Such scenarios are helpful as they attend us to what we think is important with regard to the quality elderly care. However, this article argues that they are misleading in so far as they (1) assume that deception in care is always morally unacceptable, (2) suggest that robots (...) and other information technologies necessarily deceive elderly people by creating a “virtual” world as opposed to a “real” world, (3) assume that elderly people of the future have similar ICT skills and interests as the elderly people of today, and (4) assume a simplistic view of technologies. The article suggests an approach to evaluating care robots and ICT in health care which acknowledges and addresses a number of ethical problems raised by robotic care—for instance disengagement problems—while taking into account that some elderly people may need care that does not treat them as (empirically) autonomous, that many the elderly of the future are likely to be digital natives, and that the task of evaluating technologies in care is more complicated than the discussion of deception suggests. (shrink)

When is it ethically acceptable to use artificial agents in health care? This article articulates some criteria for good care and then discusses whether machines as artificial agents that take over care tasks meet these criteria. Particular attention is paid to intuitions about the meaning of ‘care’, ‘agency’, and ‘taking over’, but also to the care process as a labour process in a modern organizational and financial-economic context. It is argued that while there is in (...) principle no objection to using machines in medicine and health care, the idea of them functioning and appearing as ‘artificial agents’ is problematic and attends us to problems in human care which were already present before visions of machine care entered the stage. It is recommended that the discussion about care machines be connected to a broader discussion about the impact of technology on human relations in the context of modernity. (shrink)

Summary Care and cure have been described as different kinds of ethical approaches to clinical situations. Female concerns in nursing care have been contrasted with masculine, cure orientated physician's attitudes. Ethics in such different voices may have sociologic determinants, but they do not represent intrinsic distinctions. Medicine has shown a divergent development, on the one hand stressing cure in a deterministic and instrumental way, on the other hand being aware that disease is as much a pathographic as a (...) biographic, care‐requiring existential situation. Disease is a breakdown of the living organism, to be cured by therapeutic efforts, but it is also the distressing failure of the lived body, requiring concern and care. Based on Lévinas’ ethics of encounter, it is suggested that any interpersonal relatedness is based on concern for the other, being grounded on an essentially ethical interaction. The clinical encounter is a paradigm of such ethics‐based relationships, which necessarily builds on awareness of the other qua other, and is concerned with fulfilling the therapeutic mandate. Caring for the other means doing one's best to help her/him, so that care and cure are inextricably interwoven, although care is the more fundamental form of human relatedness. Thus, neither gender nor professional tasks can allow for a caring attitude to develop without curing concerns, just as trying to cure without caring is unthinkable. (shrink)

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses (...) hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development of home‐care nursing. (shrink)

The concept of care can be explained in various ways, and it can present a different meaning to each person. Nurses are increasingly aware that good nursing care consists of ‘more’ than the competent performance of a number of caring activities. For many nurses it is less clear what this ‘more’ means and what importance it has in nursing. This article will develop a view concerning care considered as a moral attitude. It is argued that care (...) can be considered as a foundational normative concept in the ethics of the nursing profession. The aim is to clarify that nurses do not derive their specific caring identity just from the set of tasks that they perform but also from the way in which they commit themselves to the caring process. (shrink)

Our challenge for the twenty-first century consists in showing how to construct a global ethics and in trying to discover a rational foundation for it, which may be used as guidance for action and as a norm for the criticism of specific situations. I argue that four tasks must be accomplished to construct a global ethics: Construct that global governance or that world government that makes cosmopolitan citizenship possible. Foster the joint work of bioethics, economic and business ethics, and development (...) ethics – areas of applied ethics, each one of which on its own has reached the global level. Discover a rational basis for a global ethics, which has a universal normative force, but assumes cultural differences. Develop and promote a dilaogical ethics of cordial reason, which renders one capable of compassion and care. (shrink)

Development is concerned with the transformation of people to foster their health, wholeness and growth. The link between health and development points to religion as potential social capital for development. There is an ongoing debate about the role of pastoral care as a religious resource in global healthcare contexts. This is unfortunately not the case in Africa, as pastoral care has not received sufficient attention for its role in healthcare and development in development discourses. The limited research on (...) pastoral care in healthcare contexts in Africa has implications for African healthcare systems, pastoral care and the delivery of an effective, holistic and quality healthcare service. Taking as its point of departure a thesis about the potential of religion as a social capital resource for development, the article argues for pastoral care as a viable religious resource for healthcare and development. Osmer’s theological task of good practice is employed as an interdisciplinary engagement in dialogue with selective perspectives in the disciplines of development and health and social sciences for appropriate analysis. (shrink)

The concept of care can be explained in various ways, and it can present a different meaning to each person. Nurses are increasingly aware that good nursing care consists of ‘more’ than the competent performance of a number of caring activities. For many nurses it is less clear what this ‘more’ means and what importance it has in nursing. This article will develop a view concerning care considered as a moral attitude. It is argued that care (...) can be considered as a foundational normative concept in the ethics of the nursing profession. The aim is to clarify that nurses do not derive their specific caring identity just from the set of tasks that they perform but also from the way in which they commit themselves to the caring process. (shrink)

The task of aligning the philosophical and clinical perspectives on ethics is a challenging one. Clinical practice informs philosophy, not merely by supplying cases, but through shaping and testing philosophical concepts in the reality of the clinical world. In this paper we explore several aspects of the relationship between the philosophical and the clinical within a framework of palliative care for people living with Alzheimer's disease. We suggest that health professionals have a moral obligation to question previous assumptions (...) concerning the quality of life among people with Alzheimer's, and to address the question: does the concept of palliative care properly embrace people with severe dementia? We propose an ethic of palliative care for people with Alzheimer's that is based, not on the traditionally understood principle of autonomy, but on the need to listen to those living with the disease, acknowledging their profound loss of cognitive abilities, with a focus on preventing and relieving suffering, and improving the individual's quality of life. (shrink)

Health Care Law by Jonathan Montgomery has much to recommend it. It is a comprehensive account of the law relating to health care in its broadest sense. From the outset, Montgomery sets his face against a narrow construction of his task; as he recognises, health care law is so much more than the "law relating to what doctors do".

The pandemic period has placed the organizations in a state of great tension. It has generated a situation of confusion, lack of rules, and production-related criticalities that have called into question the very existence of many productive realities. This article aims to highlight the dimensions of care and ethics put in place by HR managers in COVID-19. The objective that animated the authors have focused on the HRM level of medium and large companies in Italy to highlight the protective (...) actions toward people and the organization in the period COVID 19, highlighting what were the ethical values and actions of care put in place. In this article, we wanted to give voice to managers who had management tasks in their organizations by asking them to tell us how they dealt with the challenges imposed by the emergency. In the research, we start from a way of understanding workplaces understood as a “process of ongoing social relationship” within which the HR function is dedicated to the care of the quality of relationships. HR managers have to manage a complex role of mediating between the interests of people and employers by trying to find good mediations. (shrink)

Ethics consultation in institutions of the healthcare system has been given a standard form based on three pillars: education, the development of guidelines and concrete ethics consultation in case conferences. The spread of ethics committees, which perform these tasks on an organizational level, is a remarkable historic achievement. At the same time it cannot be denied that modern ethics consultation neglects relevant aspects of care ethics approaches. In our essay we present an “ethics of care” approach as well (...) as an empirical pilot project—“Ethics from the bottom up”—which organizes ethics consultation based on this focus. Findings and philosophy of the project will be discussed as far as relevant for ethics consultation in the healthcare system. (shrink)

Welfare states are in a care crisis both in the sense of a practical care gap and in the new movement to limit care to mere rehabilitation. Few political theorists pay attention to these developments, and those who do say little about the potential limits to care. This article discusses Philip Pettit’s theory of social justice in relation to questions of public care provisions. Pettit’s theory has been praised by feminists for its attention to social (...) injustices and because it highlights fair limits to care. The article examines how Pettit builds up his argument involving the idea of a gateway good, heuristics and a set of constraints. Although the article points to the value of Pettit’s theory, Pettit’s arguments to limit the state’s care tasks depend on the false assumption that a theory of justice considers able-minded adults only. This article argues that Pettit’s assumption that we leave out children and not-so-able-minded elderly leads to a general neglect o... (shrink)

Edmund Husserl. Infinite tasks -- Universality and spatial form -- Universality in the making -- Martin Heidegger. Singular essence -- The strangeness of beginnings -- The originary world of tragedy -- Jan Patoka. Care of the soul -- The genealogy of Europe-responsibility -- Jacques Derrida. European memories -- This little thing that is Europe -- De-closing the horizon.

There are various grounds on which one may wish to distinguish a right to health care from a right to health. In this article, I review some old grounds before introducing some new grounds. But my central task is to argue that separating a right to health care from a right to health has objectionable consequences. I offer two main objections. The domestic objection is that separating the two rights prevents the state from fulfilling its duty to (...) maximise the health it provides each citizen from its fixed health budget. The international objection is that separating a human right to health care fails the moral requirement that, for any given moral human right, the substance to which any two right-holders are entitled be of an equal standard. (shrink)

This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature of nursing ethics any different from that of medical ethics?' It is suggested that rather than develop nursing ethics as a separate field writers in nursing ethics should take a lead in making the patient the central focus of health care ethics. The case is made for empirical work in health care ethics and it is suggested that a good way of setting (...) about this is to ask practising nurses about the real ethical problems they encounter. (shrink)

The practice of critical care medicine has long been a difficult task for most critical care physicians in the densely populated city of Hong Kong, where we face limited resources and a limited number of intensive care beds. Our triage decisions are largely based on the potential of functional reversibility of the patients. Provision of graded care beds may help to relieve some of the demands on the intensive care beds. Decisions to forego futile (...) medical treatment are frequently physician-guided family-based decisions, which is quite contrary to the Western focus on patient autonomy. However, as people acquire knowledge about health care and they become more aware of individual rights, our critical care doctors will be able to narrow the gaps between the dif ferent concepts of medical ethics among our professionals as well as in our society. An open and caring attitude from our intensivists will be important in minimizing the cross-cultural conflict on the complex issue of medical futility. (shrink)

This manuscript draws on the moral norms arising from the nuanced accounts of epistemic (in)justice and social identity in relational autonomy to normatively assess and articulate the ethical problems associated with using AI in patient care in light of the Black Box problem. The article also describes how black-boxed AI may be used within the healthcare system. The manuscript highlights what needs to happen to align AI with the moral norms it draws on. Deeper thinking – from other backgrounds (...) other than decolonial scholarship and relational autonomy – about the impact of AI on the human experience needs to be done to appreciate any other barriers that may exist. Future studies can take up this task. (shrink)

I. Liturgical practices, whether solemn or celebratory, mark our transcendence of the everyday. In liturgy, the common and the worldly fall away. Our spirit is tasked with the work dedicated to the...

Care left undone, interchangeably referred to as missed care, unfinished nursing care and task incompletion, is pervasive in contemporary healthcare systems. Care left undone can result in adverse outcomes for the patient, nurse and organization. The rhetoric that surrounds care left undone infers it is a contemporary nursing phenomenon; however, a seventeenth‐century Spanish nursing treatise, Instruccion de Enfermeros (Instructions for Nurses), challenges this assumption. Instruccion de Enfermeros was an instructional guide that was written for (...) members of the Congregation of Bernardino de Obregon who worked as nurses at the Madrid General Hospital. The treatise provides a historical commentary on the daily roles, responsibilities and working conditions of the Obregonian nurses. Its content and context suggest the Obregonian nursing resource was consistently time poor due to a confluence of internal and external stressors. Consequently, the Obregonians were under considerable role strain resulting in inferior patient care. This article explores the antecedents of care left undone through a historical lens using exemplars from the 1625 edition of Instruccion de Enfermeros. Factors contributing to care left undone in Obregonian nursing will then be examined to offer insights into the similarities between what a nurse suffered 400 years ago and what exists in contemporary nursing practice. (shrink)

According to Frantz Fanon, the psychological and social-political are deeply intertwined in the colonial context. Psychologically, the colonizers perceive the colonized as inferior and the colonized internalize this in an inferiority complex. This psychological reality is co-constitutive of and by material relations of power—the imaginary of inferiority both creates and is created by colonial relations of power. It is also in this context that violence takes on significant political import: violence deployed by the colonized to rebel against these colonial relations (...) and enact a different world will also be violent in its fundamental disruption of this imaginary. The ethics of care, on the other hand, does not seem to sit well with violence, and thus Fanon’s political theory more generally. Care ethics is concerned with everything we do to maintain and repair our worlds as well as reasonably possible. Violence, which ruptures our psycho-affective, material, and social-political realities, seems antithetical to this task. This article seeks to reconsider this apparent antinomy between violence and care via a dialogue between Fanon and the ethics of care. In so doing, this article mobilizes a relational conceptualization of violence that allows for the possibility that certain violences may, in fact, be justifiable from a care ethics perspective. At the same time, I contend that violence in any form will also eventually demand a caring response. Ultimately, this productive reading of Fanon’s political theory and the ethics of care encourages both postcolonial philosophers and care ethicists alike to examine critically the relation between violence and care, and the ways in which we cannot a priori draw lines between the two. (shrink)

Austerity in Greece resulted in poverty, political and social turmoil and intense debates about collective identities, citizenship and the future. One of the main arguments has been that the Greeks should re-evaluate their relationship with the past and their over-reliance on national narratives. The task of re-evaluation can only be accomplished in the public spheres of politics and culture, where individual and collective voices gradually transform the imaginary significations that animate the social body. One such voice is Rhea Galanaki, (...) a novelist with a long and distinguished presence in Greek and European literature. The present article draws on her 2015 novel I Akra Tapeinosi in order to flesh out a feminist political vision for the future. This vision draws inspiration from women’s struggles against patriarchy in past decades, and resonates with the concepts of vulnerability and care, contributing to thinking a compassionate alternative to the politics of despair within and beyond the Greek borders. (shrink)

Cleaning the floor, stripping the bed, arranging a bouquet of flowers—such tasks are essential to keeping a hospital room clean and creating a pleasant atmosphere. They usually fall under the purview of female* nurses, cleaning staff and housekeepers. In everyday hospital life, the demands for hygienic cleanliness commingle with the imperatives of economization, marketing logic, and attention to the affective and emotional needs of the actors in these rooms. Although the standards of clinical hygiene are based on medical knowledge, the (...) division of labor and the demands for cleanliness at various hierarchical levels also reveal gendered and partly racialized ideas that point beyond the clinical context. This blending of imperatives in the hospital environment invites deeper consideration of the history of bacteriology: The logic and language of defense against infection in science and everyday life is also interwoven with social markers of difference.Drawing on the findings of an ethnography on cleanliness and cleaning work in hospitals, as well as a history of knowledge approach, the article links the question of (feminized) care for the environment with the question of the atmosphere of clinical rooms. In what ways, and to what effect, does scientific knowledge about medical hygiene also carry with it cultural and aesthetic perceptions of beautiful and pleasant cleanliness that reveal feminine connotations rooted in the nineteenth century? (shrink)

This article suggests several design principles intended to assist in the development of ethical algorithms exemplified by the task of fighting fake news. Although numerous algorithmic solutions have been proposed, fake news still remains a wicked socio-technical problem that begs not only engineering but also ethical considerations. We suggest employing insights from ethics of care while maintaining its speculative stance to ask how algorithms and design processes would be different if they generated care and fight fake news. (...) After reviewing the major characteristics of ethics of care and the phases of care, we offer four algorithmic design principles. The first principle highlights the need to develop a strategy to deal with fake news on the part of the software designers. The second principle calls for the involvement of various stakeholders in the design processes in order to increase the chances of successfully fighting fake news. The third principle suggests allowing end-users to report on fake news. Finally, the last principle proposes keeping the end-user updated on the treatment in the suspected news items. Implementing these principles as care practices can render the developmental process more ethically oriented as well as improve the ability to fight fake news. (shrink)

The authors explore the changing dynamics of gendered familial caregiving in urban China within the context of economic reforms and the continued cultural influence of xiao. Data collected in China through interviews with 110 familial caregivers were used to examine cultural and structural influences on the caregiving behavior of adult children. Results from multiple regression analyses provide evidence of a gendered division of parental care tasks, a decline in the patrilocal tradition of caregiving, and a strong social pressure that (...) influences caregiving behavior. Structural factors linked to caregiving performance included family size, lack of pensions for elders, and caregivers’ employment status and income. Findings portend deleterious effects for the women who are now caregivers as they are likely to live longer but be more financially dependent and have fewer children available to help them. (shrink)

This article draws on the free‐text commentaries from trans‐Tasman studies that used the MISSCARE questionnaire to explore the reasons why nurses miss care. In this paper, we examine the idea that nurses perpetuate a self‐effacing approach to care, at the expense of patient care and professional accountability, using what they describe as the art of nursing to frame their claims of both nursing care and missed nursing care. We use historical dialogue alongside a paradigmatic analysis (...) to examine why nurses allow themselves to continue working within settings that put their professional/personal selves aside in an attempt to deliver care within constraints that make completing care an impossible task. The findings suggest an ambivalence and conflict confront nurses attempting to provide care within the New Public Management environment. This can be seen in the tensions that draw a line between care as an art, and care as a financial target, juxtaposed with the inherent clash of values arising from the way nursing care is conceptualised within two contradictory paradigms. (shrink)

Task shifting is increasingly used to address human resource shortages impacting HIV service delivery in low- and middle-income countries. By shifting basic tasks from higher- to lower-trained cadres, such as Community Health Workers, task shifting can reduce overhead costs, improve community outreach, and provide efficient scale-up of essential treatments like antiretroviral therapies. Although there is rich evidence outlining positive outcomes that CHWs bring into HIV programs, important questions remain over their place in service delivery. These challenges often reflect (...) concerns over whether CHWs can mitigate HIV through a means that does not overlook the ethical and practical constraints that undergird their work. Ethical and practical guidance thus needs to become the cornerstone of CHW deployment. This paper analyzes such challenges through the lens of Ethical Principlism. We examined papers identifying substantive and ethical challenges impacting CHWs as they provide HIV services in low- and middle-income contexts. To do this, we analyzed papers written in English and published from year 2000 or later. These articles were identified using MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar databases. In total, 465 articles were identified, 78 of which met our inclusion criteria. Article reference lists and grey literature were also examined. CHWs experience specific challenges while carrying out their duties, such as conducting emotionally- and physically-demanding tasks with often inadequate training, supervision and compensation. CHWs have also been poorly integrated into health systems, which not only impacts quality of care, but can hinder their prospects for promotion and lead to CHW disempowerment. As we argue, these challenges can be addressed if a set of ethical principles is prioritized, which specifically entail the principles of respect for persons, justice, beneficence, proportionality and cultural humility. CHWs play a crucial role in HIV service delivery, yet the ethical challenges that can accompany their work cannot be overlooked. By prioritizing ethical principles, policymakers and program implementers can better ensure that CHWs are combatting HIV through a means that does not exploit or take their critical role within service delivery for granted. (shrink)

The author examines South Asian American women caregivers in two domestic violence organizations, namely Apna Ghar, the Chicago shelter for battered immigrant women, and Saheli, a support group for abuse survivors in Austin, Texas. Through informal interviews with Apna Ghar workers and Saheli volunteers and participant observation at Apna Ghar, she outlines the concept of “radical caring.” Radical caring emerges at the conjunction of individual and organizational motivations. However, radical caring is inherently contradictory; first, the caregivers’ traditional gender identities are (...) used to alter the very same gender ideologies in their racialized communities. Second, workers attempt to preserve the dignity of care receivers even as they engage in tasks that undermine their self-respect. Third, caseworkers exercise authority so that residents’ autonomy may be enhanced. The author argues that although organizations such as Apna Ghar hold the potential for social change, professionalization of shelter work along with the contradictions inherent in caregiving compromise radical caring. (shrink)

When should we use care robots? In this paper we endorse the shift from a simple normative approach to care robots ethics to a complex one: we think that one main task of a care robot ethics is that of analysing the different ways in which different care robots may affect the different values at stake in different care practices. We start filling a gap in the literature by showing how the philosophical analysis of (...) the nature of healthcare activities can contribute to robot ethics. We rely on the nature-of-activities approach recently proposed in the debate on human enhancement, and we apply it to the ethics of care robots. The nature-of-activities approach will help us to understand why certain practice-oriented activities in healthcare should arguably be left to humans, but certain goal-directed activities in healthcare can be fulfilled with the assistance of a robot. In relation to the latter, we aim to show that even though all healthcare activities can be considered as practice-oriented, when we understand the activity in terms of different legitimate ‘fine-grained’ descriptions, the same activities or at least certain components of them can be seen as clearly goal-directed. Insofar as it allows us to ethically assess specific functionalities of specific robots to be deployed in well-defined circumstances, we hold the nature-of-activities approach to be particularly helpful also from a design perspective, i.e. to realize the Value Sensitive Design approach. (shrink)

Pentecostals can be understood as contemporary Christian mystics, and doing so can aid one in both understanding and caring for them. The task of understanding them is facilitated by this category in that it allows one to inhabit a different mindset from what is typical in contemporary settings. Pentecostalism and charismatic movements work out of distinct, fundamental claims that together work as a kind of worldview, one that operates from a hyperawareness of God’s presence and a sensed empowerment of (...) the mystic’s self. The task of caring for them should honor these claims all the while being open to the Spirit’s presence and work. (shrink)

This article will address the question: how can health care education best take seriously the task of educating for professional practice within a post-traditional, liberal democratic society? In the setting of modernity, the altered personal and professional self has to be explored and constructed as part of a reflective process of connecting personal and professional change: in essence, to develop self-knowledge. A moral life, or ‘working morality’, that evolves out of a process of ongoing dialogue and conversation is (...) required. What is advocated here is a more social model of health care education that acknowledges a social or communal dimension to knowledge and the centrality of relationships for the full development of the individual personally and professionally, fosters our capacity to identify who we are both personally and professionally, connects reason and dialogue, and educates for dialogue and dialogic relationships. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:158 Feminist Studies 46, no. 1. © 2020 by Feminist Studies, Inc. María Fernanda Olarte-Sierra and Tania Pérez-Bustos Careful Speculations: Toward a Caring Science of Forensic Genetics in Colombia Feminist Science and Technology Studies (STS) has recently opened up the question of care as a set of practices related to the sustainability of life.1 The field of feminist studies more broadly has extensively 1. This literature mostly comes (...) from Northern contexts and started to flourish with the seminal work of María Puig de la Bellacasa, “Matters of Care in Technoscience: Assembling Neglected Things,” Social Studies of Science 41, no. 1 (2010): 85–106. This essay gathers scattered feminist STS reflections on these issues and looks at them through the lens of care, including authors such as Susan Leigh Star, Donna Haraway, Isabelle Stengers, Hilary Rose, and Annemarie Mol. The concept of care orienting this exercise of rereading these authors is proposed by Berenice Fisher and Joan Tronto, “Toward a Feminist Theory of Caring,” in Circles of Care: Work and Identity in Women’s Lives, ed. Emily K. Abel and Margaret K. Nelson (Albany: State University of New York Press, 1990), 35–62. Before and after that essay came out, Puig de la Bellacasa published several other papers related to this issue, including “Touching Technologies, Touching Visions. The Reclaiming of Sensorial Experience and the Politics of Speculative Thinking,” Subjectivity 28, no. 1 (2009): 297–315; “‘Nothing Comes without Its World’: Thinking with Care,” The Sociological Review 60, no. 2 (2012): 197– 216; “Ethical Doings in Naturecultures,” Ethics, Place & Environment 13, no. 2 (2010): 151–69; “Making Time for Soil: Technoscientific Futurity and the Pace of Care,” Social Studies of Science 45, no. 5 (2015): 691–716; and Matters of Care: Speculative Ethics in More than Human Worlds (Minneapolis: University of Minnesota Press, 2017). All these publications have been widely cited by other authors, particularly in a special issue of Social Studies of Science on the politics of care published in 2015 (volume 45, issue 5). Other examples María Fernanda Olarte-Sierra and Tania Pérez-Bustos 159 studied how care, and associated practices such as transnational care chains, are feminized and precarious—involving an ethos embodied by those who actively work to maintain or preserve another’s life. Feminists have focused on the politics of care embedded in invisible jobs related to aesthetics, domestic work, child and elder care, and sexual activities and see all these tasks as related to the reproduction of life and culture.2 Central to this conceptualization of care is the understanding that these jobs are typically women’s work. There is a common association between this care and notions of “motherhood” as it relates to values such as compassion, love, and respect, which have been constructed as universally feminine. However, the main goal of feminist studies of care has been to deconstruct this association, particularly because it is imbued with the white, wealthy, heteronormative ideal of femininity that underlies a gendered division of labor. The reality is that class, race, nation, and gender determine who cares for whom, whether or not labor is paid, and to what extent care is exploitative. One strand of recent research problematizes both valorizing and criticizing care practices on the grounds that they are based on a rather homogeneous understanding of the feminine. Instead, these scholars seek to resurrect valuable feminist work without relying on essentialism of authors contributing to this discussion on care as an ethos for science include Ruth Müller and Martha Kenney, “Agential Conversations: Interviewing Postdoctoral Life Scientists and the Politics of Mundane Research Practices,” Science as Culture 24, no. 4 (2014): 537–59; Charis Thompson, Good Science: The Ethical Choreography of Stem Cell Research (Cambridge, MA: MIT Press, 2013); and Carrie Friese, “Realizing Potential in Translational Medicine: The Uncanny Emergence of Care as Science,” Current Anthropology 54 (S7): S129-S138. 2. From Latin America, see, for example, Luz Gabriela Arango Gaviria, Adira Amaya Urquijo, Tania Pérez-Bustos, and Javier Pineda Duque, eds., Género y cuidado: teorías, escenarios y políticas (Bogotá: Universidad Nacional de Colombia, 2018); Pascale Molinier and Luz Grabriela Arango Gaviria, eds., El trabajo y... (shrink)

The American Society for Bioethics and Humanities is to be congratulated on its updating of competency standards for ethics consultations (Tarzian and ASBH Core Competencies Update Task Force 2013)...