Caring extends and challenges recent debates over feminist ethics by taking issue with accounts of the ethics of care which try to pin down the "principles" of caring, rather than understanding the practice of caring. It explores four main caring practices: mothering, friendship, nursing and citizenship. Bowden's consideration of the differences and similarities in these working practices reveals the complexity of the ethics of caring.
The basic relationship between people should be care, and the caring life is the highest which humans can live. Unfortunately, care that is not thoughtful slides into illegitimate intrusion on autonomy. Autonomy is a basic good, and we should not abridge it without good reason. On the other hand, it is not the only good. We must sometimes intervene in the lives of others to protect them from grave harms or provide them with important benefits. The reflective person, therefore, (...) needs guidelines for caring. Some contemporary moralists condemn paternalism categorically. This work examines weaknesses in their arguments and proposes new guidelines for paternalism, which it calls "parentalism" to avoid the patriarchal connotations of the old term. Its antiparentalism is more moderate than standard antipaternalism based on an exaggerated respect for autonomy. The work explores implications for both the personal sphere of interactions between individuals, such as friends and family members, and the public sphere of institutions, legislation, and the professional practices. (shrink)
In this short essay I express my own deep sympathy with Nel Noddings's ethic of care and applaud her stubborn resistance in Happiness and Education to what John Dewey would have called false dualisms, such as those between intelligence and emotion, theory and practice, or vocation and academic studies. However, I question whether the sort of caring relation she depicts so beautifully in this and many other books is sufficiently robust to alone carry the weight of the moral life (...) that she supports, and whether her suspicion of community, while sounding important cautions, does not leave us with an ethical vision that is too thin to deliver the sort of education she prescribes. To this end, I argue that she judges Victor Frankl's conception of freedom too harshly and his response to human suffering with an uncharacteristic lack of charity. Following well-known communitarian arguments of Michael Walzer and Charles Taylor I suggest that some account of a situated human agent who can choose freely to enter into relation is necessary to sustain the role of caring in education that has been Noddings most significant philosophical contribution. (shrink)
How is the concept of patient care adapting in response to rapid changes in healthcare delivery and advances in medical technology? How are questions of ethical responsibility and social diversity shaping the definitions of healthcare? In this topical study, scholars in anthropology, nursing theory, law and ethics explore questions involving the changing relationship between patient care and medical ethics. Contributors address issues that challenge the boundaries of patient care, such as: · HIV-related care and research · the impact of new (...) reproductive technologies · preventative healthcare · technological breakthroughs that are changing personal-caring relationships. Chapters range from a consideration of the practicalities of nursing and family healthcare to a debate about ‘universal human needs’ and patients’ rights. This book is a provocative exploration of the ways in which healthcare models are socially constructed. It will be of interest to policy-makers, medical practitioners and administrators, as well as students of sociology, anthropology and social policy. (shrink)
An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children are likely to become involved in the caring process (...) and informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care and the subsequent impact on the care recipient and formal- and informal care providers. (shrink)
Virginia Held assesses the ethics of care as a promising alternative to the familiar moral theories that serve so inadequately to guide our lives. The ethics of care is only a few decades old, yet it is by now a distinct moral theory or normative approach to the problems we face. It is relevant to global and political matters as well as to the personal relations that can most clearly exemplify care. This book clarifies just what the ethics of care (...) is: what its characteristics are, what it holds, and what it enables us to do. It discusses the feminist roots of this moral approach and why the ethics of care can be a morality with universal appeal. Held examines what we mean by "care," and what a caring person is like. Where other moral theories demand impartiality above all, the ethics of care understands the moral import of our ties to our families and groups. It evaluates such ties, focusing on caring relations rather than simply on the virtues of individuals. The book proposes how such values as justice, equality, and individual rights can "fit together" with such values as care, trust, mutual consideration, and solidarity. In the second part of the book, Held examines the potential of the ethics of care for dealing with social issues. She shows how the ethics of care is more promising than Kantian moral theory and utilitarianism for advice on how expansive, or not, markets should be, and on when other values than market ones should prevail. She connects the ethics of care with the rising interest in civil society, and considers the limits appropriate for the language of rights. Finally, she shows the promise of the ethics of care for dealing with global problems and seeing anew the outlines of international civility. (shrink)
This essay seeks to explain a morally important class of psychological incapacity—the class of what Bernard Williams has called “incapacities of character.” I argue for two main claims: (1) Caring is the underlying psychological disposition that gives rise to incapacities of character. (2) In competent, rational adults, caring is, in part, a cognitive and deliberative disposition. Caring is a mental state which disposes an agent to believe certain considerations to be good reasons for deliberation and action. And (...)caring is a mental state which structures an agent’s practical deliberation, by establishing presumptive boundaries on the landscape of possibilities over which her deliberative imagination ranges. Incapacities of character are a consequence of the structure which these presumptive boundaries give to an agent’s deliberation. (shrink)
: Care theorists have made significant gains over the past twenty-five years in establishing caring as a viable moral and political concept. Nonetheless, the concept of caring remains underdeveloped as a basis for a moral and political philosophy, and there is no fully developed account of our moral obligation to care. This article advances thinking about caring by developing a definition of caring and a theory of obligation to care sufficient to ground a general moral and (...) political philosophy. (shrink)
In his work on internality, identification, and caring, Harry Frankfurt attempts to delineate the organization of agency peculiar to human beings, while avoiding the traditional overintellectualized emphasis on the human capacity to reason about action. The focal point of Frankfurt’s alternative picture is our capacity to make our own motivation the object of reflection. Building upon the observation that marginal agents (such as young children and Alzheimer’s patients) are capable of caring, I show that neither caring nor (...) internality need to depend on the phenomena of reflectiveness. I develop alternative interlocking accounts of caring and internality that are independent of both reflectiveness and evaluation, but that can still do justice to the central role of carings in the organization of agency characteristic of human persons. (shrink)
What is it to "value" something, in the semi-technical sense of the term that Gary Watson establishes? I argue that valuing something consists in caring about it. Caring involves not only emotional dispositions of the sort that Agnieszka Jaworska has elaborated, but also a distinctive cognitive disposition – namely, a (defeasible) disposition to believe the object cared about to be a source of agent-relative reasons for action and for emotion. Understood in this way, an agent's carings have a (...) stronger claim to "speak for" her as her values than do other attitudes that have been proposed for this role. In particular, an agent's carings establish more robust psychological continuities and cross-temporal connections than do self-governing policies of the sort that Michael Bratman has described; and they forge diachronic coherence not just in her deliberation and action, as self-governing policies do, but also in her cognitive and emotional life. An agent's carings thus help to constitute her identity as a temporally persisting subject . Self-governing policies are at best ersatz -values, which an agent may choose to adopt when she finds that her proper values – her cares – leave her course underdetermined. (shrink)
Nel Noddings is arguably one of the premier philosophers of moral education in the English?speaking world today. Although she is outside the mainstream theory, research, and practice traditions of cognitive?developmentalism (the Kohlberg legacy) and of character education (which is in public ascendancy), her body of work is unrivalled for originality of insight, comprehensiveness and coherence. Whilst Carol Gilligan's In a different voice (1982) introduced the ethic of caring into academic and public discourse, it is Noddings ?who has done most (...) to outline a specific feminist position on moral education? (McClellan, 1999, p. 104), and whose influence extends to educational practice. This essay explicates Noddings's vision in sufficient depth to make the foregoing claims credible. Thematic focus is given to her attention to the ethical self or ethical ideal. The paper also examines Noddings's perspective on character education and the need to incorporate a morality of evil into any serious educational philosophy or practice. It is less a critical appraisal of that vision and perspective than an invitation to others to more fully engage with Noddings's writings.1. (shrink)
I develop two different epistemic roles for emotion and desire. Caring for moral ends and people plays a pivotal though contingent role in ensuring reliable awareness of morally salient details; possession of various emotions and motives is a necessary condition for autonomous understanding of moral concepts themselves. Those who believe such connections compromise the "objective" status of morality tend to assume rather than argue for the bifurcated conception of reason and affect this essay challenges.
Care theory offers a way to overcome a weaknessof liberalism – its reluctance to intervene inthe private lives of adults. In caring for thehomeless, we must sometimes use a limited formof coercion, but our intervention is alwaysinteractive, and the process of finding asolution is one of negotiation between theneeds expressed by the homeless and the needswe infer for them.
The likelihood of nurse reflection is examined from the theoretical perspectives of Habermas' Theory of Communicative Action and Moral Action and Sumner's Moral Construct of Caring in Nursing as Communicative Action, through a critical social theory lens. The argument is made that until the nurse reaches the developmental level of post-conventional moral maturity and/or Benner's Stage 5: expert, he or she is not capable of being inwardly directed reflective on self. The three developmental levels of moral maturity and Benner's (...) stages are presented with discussion on whether or not there can be self-reflection because of an innate vulnerability that leads to self-protective behaviours. It is only when the confidence from mastery of practice has been achieved can the nurse be comfortable with reflection that enables him or her to become enlightened, emancipated, and empowered. The influences and constraints of the knowledge power between nurse and patient are acknowledged. The power hierarchy of the institution is recognized as constraining. (shrink)
What does it mean to be a “just” and “caring” society in meeting the health care needs of the terminally ill when we have only limited resources to meet virtually unlimited health care needs? That question is the focus of this essay. Put another way: relative to all the other health care needs in our society, especially the need for lifesaving or life-prolonging health care, how high a priority ought the health care needs of persons who are terminally ill (...) have? On the one hand, we might see the terminally ill as being among the “medically least well off” and therefore deserving very high priority. On the other hand, we might see them as squandering vast medical resources for marginal medical benefits, thereby denying needed resources to others who would benefit much more. We begin the essay by making a number of morally relevant distinctions with regard to the category of “being terminally ill.” We note, given contemporary medicine, that individuals may be terminally ill several times in the course of a life. Not all such circumstances make equal just claims to needed health care. We also note that our conceptions of health care justice are ultimately incapable of making very fine-grained, morally justified rationing judgments in complex medical circumstances. We conclude that we must finally rely upon fair processes of rational democratic deliberation to articulate such judgments for our own future, possibly terminally ill selves, thereby undercutting the rhetoric of “death panels.”. (shrink)
: This essay breaks new ground in defending the view that contemporary care-based ethics and early Confucian ethics share some important common ground. Luo also introduces the notion of relational virtue in an attempt to bridge a conceptual gap between relational caring ethics and agent-based virtue ethics, and to make the connections between the ethics of care and Confucian ethics philosophically clearer and more defensible.
The paper draws upon new conceptions of place, space, interaction and community in Geography and Media Studies to explore the possibilities of extending existing conceptions of care and caring from the context with which they are traditionally associated—face-to-face encounters within a shared physical locale. It proposes three structures of 'caring at a distance', all of which have a core element of mediated or distanciated interaction, and concludes that mass media and electronic networks play a significant role in extending (...) the scope of beneficence beyond our 'nearest and dearest' to embrace distant others. (shrink)
Since the 1990s, numerous studies on the relationship between parents and their children have been reported on in the literature and implemented as a philosophy of care in most paediatric units. The purpose of this article is to understand the process of nurses' care for children in a paediatric setting by using Noddings's caring ethics theory. Noddings's theory is in part described from a theoretical perspective outlining the basic idea of the theory followed by a critique of her work. (...) Important conceptions in her theory are natural caring (reception, relation, engrossment, motivational displacement, reciprocity) and ethical caring (physical self, ethical self, and ethical ideal). As a nurse one holds a duty of care to patients and, in exercising this duty, the nurse must be able to develop a relationship with the patient including giving the patient total authenticity in a 'feeling with' the patient. Noddings's theory is analysed and described in three examples from the paediatrics. In the first example, the nurse cared for the patient in natural caring while in the second situation, the nurse strived for the ethical caring of the patient. In the third example, the nurse rejected the impulse to care and deliberately turned her back to ethics and abandoned her ethical caring. According to the Noddings's theory, caring for the patient enables the nurse to obtain ethical insights from the specific type of nursing care which forms an important contribution to an overall increase of an ethical consciousness in the nurse. (shrink)
Rachlin uses the word “choice” 80 times, whereas “emotion” does not appear. In contrast, “Empathy: Its ultimate and proximate bases” by Preston and de Waal, uses the word “emotion” 139 times and “choice” once. This commentary compares these ways of approaching empathy and altruism, relating Rachlin's approach to Gilligan's Morality of Justice and Preston and de Waal's to the Morality of Caring.
This essay analyzes neo-liberal economic agreements and legal and political frameworks or what has been called the “new constitutionalism,” a governance framework that empowers market forces to reshape economic and social development worldwide. The article highlights some consequences of new constitutionalism for caring institutions specifically, and for what feminists call social reproduction more generally: the biological reproduction of the species; the reproduction of labor power; and the reproduction of social institutions and processes associated with the creation and maintenance of (...) communities. New constitutional governance frameworks fundamentally reshape conditions under which the care of human beings takes place. Caring institutions once governed by enabling professions geared to universal care are now determined increasingly by market values and private forces, and driven directly by the profit motive. This is one of the reasons why neo-liberalism is increasingly contested in both the North and the global South. (shrink)
A feminist ethics that bases morality on dependence or vulnerability challenges the moral priority of uniform over disparate treatment. Persons with disabilities resist equality's homogenization of moral personhood. But displacing equality in favor of caring or trust reprises the repression of those already marginalized. The ethics of difference proves an ineffective remedy for the negative consequences attendant on how historically marginalized groups are different. An historicized conception of equality resolves the dilemma.
A notable feature of post-Fordist economies is the increase in service jobs, which includes care occupations such as child care and elder care (Folbre 2001, 182). The commodification of caring activities raises issues surrounding the reception and dispensation of these services, and this is particularly salient to the focus of this paper, elder care. Because the demand for this type of care has greatly increased in recent decades (Glendinning, Schunk, and McLaughlin 1997; Kaye et al. 2006) and also in (...) recognition of the impact of caring activities on families, many countries have sought to initiate policies to provide state-funded services or to compensate family caregivers for their care work.1If help with the .. (shrink)
Nel Noddings, in Caring: A Feminine Approach to Ethics and Moral Education (1984), presents and develops an ethic of care as an alternative to an ethic that treats justice as a basic concept. I argue that this care ethic is unable to give an adequate account of ethical relationships between strangers and that it is also in danger of valorizing relationships in which carers are seriously abused.
According to care theory the good parent confronting a helpless child has an unmediated impulse to relieve his distress; that impulse grows into a prescriptive ethic of relatedness, often contrasted to the more individualistic ethic of justice. If, however, a child's nature is understood as assertive and competent as well as fragile and dependent; if, in addition, he acquires needs through socialisation and is the beneficiary of inferred needs determined by others, then an ethic of need-gratification is insufficient. Caring (...) theory, with its emphasis on empathy, compassion, and attentiveness to the child's present state undervalues the role of adult restraint and imposition in a rounded caring philosophy. Parents (and teachers) must continuously balance gratification with suppression, support with restraint, engrossment with detachment. From this process emerges a revised relational ethic in which the care/justice distinctions are collapsed. (shrink)
We explored the relationship between qualities of victims in hypothetical scenarios and the appearance of framing effects. In past studies, participantsâ feelings about the victims have been demonstrated to affect whether framing effects appear, but this relationship has not been directly examined. In the present study, we examined the relationship between caring about the people at risk, the perceived interdependence of the people at risk, and frame. Scenarios were presented that differed in the degree to which participants could be (...) expected to care about the group and the extent to which the group could be construed as interdependent. A framing effect was found only for the scenario describing the victims as the participantsâ friends who did not know each other (high caring/low interdependence), and this went in the opposite direction from typical framing effects. Finally, perceived interdependence and caring affected choice both within and across scenarios, with more risky choices made by participants with high interdependence ratings and high caring ratings. (shrink)
This article develops a theory for how caringbehavior fits into the makeup of humans andother mammals. Biochemical evidence for threemajor patterns of response to stressful orotherwise complex situations is reviewed. There is the classic fight-or-flight response;the dissociative response, involving emotionalwithdrawal and disengagement; and the bondingresponse, a variant of which Taylor et al. (2000) called tend-and-befriend. All three ofthese responses can be explained as adaptationsthat have been selected for in evolution andare shared between humans and other mammals. Yet each of us (...) contains varying tendenciestoward all of these responses. How doesdevelopment interact with genes to influencethese tendencies? How do individuals,societies, and institutions make choicesbetween these types of responses?We review the evidence, based on behavioral,lesion, single-cell, and brain imaging studies,for cortical-subcortical interactions involvedin all three of these response types, andpropose partial neural network models for someof these interactions. We propose that theorbitomedial prefrontal cortex mediates thischoice process. This area of prefrontal cortexperforms this mediation through its connectionswith areas of sensory and association cortexthat represent social contexts or stimuli, andwith areas of the hypothalamus, limbic system,and autonomic nervous system that representemotional states or classes of response patterns.The article concludes with implications of ourtheory for social interactions andinstitutions. We argue that despite the wideprevalence of fight-or-flight responses, thebonding, caring responses remain available. Weshow with historical and contemporary exampleshow social settings – whether in education,work places, families, politics, and informalsocial customs – can be designed to supportand enhance the natural caring responses of thebrain. (shrink)
It is argued that shu involves one's identification with another person while one criticizes the latter's perspective based on one's own. A mechanism is proposed for developing this sort of critique, based on some significant Confucian values. Finally, shu is applied to the context of caring actions, and it is shown how it can help to solve some of the problems arising in caring for others.
Whilst care imperatives have arisen across the breadth of Western societies, within the education sector they appear both prolific and urgent. This paper explores the deployment of care discourses within education generally and draws upon the case of Australian Health and Physical Education (HPE) more specifically, to undertake a Foucauldian interrogation of care. In so doing I demonstrate the usefulness of Foucault's pastoral power lens and its capacity to provide insight into the moral and ethical work conducted by caring (...) teachers on behalf of the state (Acker, 1995). Following a brief overview of the advocacy, challenges and debates surrounding the issue of caring teaching within education, I draw on the work of Hunter (1994) and three case studies from a genealogical interrogation of HPE that employed Foucualt's ethical fourfold as a heuristic device to reveal the ethical practices and objectives of the good HPE teacher. Drawing on this genealogical work, I argue that HPE teachers and their colleagues have been purposefully incited to constitute themselves as agents of pastoral power. From this Foucauldian perspective, I conclude with an exploration of the unintended and possibly ‘dangerous’ practices of caring teaching that may emerge within the complex and messy nexus of contemporary self-constitution. (shrink)
In this essay I argue that sports at their best qualify as final ends, that is, as ends whose value is such that they ground not only the practices whose ends they are, but everything else we do as human agents. The argument I provide to support my thesis is derived from Harry Frankfurt's provocative work on the importance of the things we care about, more specifically, on his claim that it is by virtue of caring about things and (...) practices, really caring about them ? even loving them ? we are able to regard and treat them as final ends. Sports, I claim, are paradigmatic examples of practices cared about and loved in these deep ways, and as such deserve to be considered, rather than dismissed because of their supposed triviality, as one of those ends around which a life most worth living can be legitimately forged. (shrink)
Recent literature portrays caring as a psychological, social, and ethical orientation associated with female gender identity. This essay focuses on Gilligan's influential view that "care" is a broad theme of moral development which is under-represented in dominant theories of human development such as Kohlberg's theory. An alternative hypothesis is proposed portraying care development as a set of circumscribed coping strategies tailored to dealing with sexism. While these strategies are practically effective and partially "liberated," from the moral point of view, (...) they also reflect the debilitating influences of sexist socialization even at the highest level. Gilligan and her colleagues seem to misidentify these inadequacies of mature care. This alternative hypothesis is briefly related to the critical and feminist tradition. Then it is supported with Gilligan's own research and interpretive text. (shrink)
Abstract The relatively recent addition of women's voices to the study of moral development has led to the postulation of two separate moral contexts defined by gender, each with its own dominating concerns; guiding principles, forms of reasoning and hypothetical end point. While many developmental theorists agree that mature moral reasoning entails some sort of integration of these two perspectives, the exact nature of that reconciliation is a matter of considerable speculation and debate. This paper begins with the premise that (...) the mark of a moral developmental model's philosophical adequacy is its handling of the problem of moral relativism. It examines the strengths and weaknesses of the justice and caring approaches in regulating the contextual relativism inherent in genderized moralities. And it concludes by proposing that only by reframing the gender question in broader, teleological terms than present theories have attempted can the problem be resolved. (shrink)
Research on doctor-patient communication has characterized such interactions as being asymmetrical. The present article tries to shift emphasis away from the different orientations individuals bring to the communicative setting and attempts to highlight the different orientations ("voices") within a given individual. We draw on an in-depth analysis of discourse between a 2 l-year-old man who can be ascribed the roles of both patient and potential research subject and an interviewer who acts in both the role of medical staff and researcher. (...) Focusing our analysis on a limited number of linguistic forms (pronouns and demonstratives), it is argued that the use of the same form for different referents signals a conflation of two voices - the voice of health care ("caring") and the voice of "research." Furthermore, we argue that the voice of research is most likely to be interpreted by the patient/research subject within the framework of curing. As such, the present article promotes a shift in emphasis from different institutional - and as such often assumed to be preexisting - orientations between the communicating parties to differing orientations within the individual that cannot help but be misconstrued in terms of the curing voice. Our conclusion focuses on the ethical and discourse analytic implications of analyzing voices in a discussion. (shrink)
It is not wholly clear the extent to which Nel Noddings intends her ethic of caring to be an ethic that stands on its own in competition with others described by ethical theories. I argue that, given this ambiguity, Noddings' ethic of caring is a dangerous ethic because it can abet exploitation. I consider Noddings' responses to this criticism and conclude that the relational ontology of the ethic cannot rescue it from the charges of abetting exploitation.
(2013). Not Your Typical Frequent Flyer: Overcoming Mythology in Caring for Sickle Cell Disease Patients. The American Journal of Bioethics: Vol. 13, No. 4, pp. 18-20. doi: 10.1080/15265161.2013.767963.
Our response to Sara Fry's paper focuses on the difficulty of understanding her insistence on the fundamental character of caring in a theory of nursing ethics. We discuss a number of problems her text throws in the way of making sense of this idea, and outline our own proposal for how caring's role may be reasonably understood: not as an alternative object of value, competing with autonomy or patient good, but rather as an alternative way of responding (...) toward that which is of value. (shrink)
In this essay, I discuss the Chinese attitude towards caring for people within family first, using law only as a back-up. I demonstrate this both through negative/corrective applications of law, such as penal law, and positive/protective applications of law, such as those that protect human rights. I do not necessarily have a right to what is most beneficial to me, nor do I or the community necessarily benefit from the most fair punishment. In both cases, law protects fairness, while (...) a different kind of social care rooted in a smaller community enables a richer healing and nourishing of the person and community. With reference to Confucian philosophy and present scholarship, I address some differences between possessed rights and seeking a right way to care for people in situ, and between fairness and human potential. Instead of trying to show how the Chinese perspective has the seeds of a modern Western conception, I highlight a perpendicular value. (shrink)
The purpose of this paper was to enhance caring thinking of young children through the community of philosophical inquiry. To find out how young children's caring thinking is expressed in the community of inquiry, the inquiry has been conducted against 5-year old children for 12 weeks a total of 24 times and the whole process has been recorded. Then, the collected data have been thoroughly analyzed. According to the analysis, young children with the community of inquiry showed 5 (...) types of caring thinking and 38 kinds of characteristics. With increase in frequencies of discussion, various characteristics of caring thinking have been observed and a number of caring thinking-related vocabularies increased as well. As caring thinking changes, in addition, a pattern of discussion has alsochanged from teacher-child to child-child interaction. In conclusion, research findings indicated that the community of inquiry influenced the improvement of caring thinking. Through the community of philosophical inquiry, young children transformed themselves into thinking entities, showing caring thinking by discovering active meanings on problematic cases requiring care and manifesting it as behavior. (shrink)
McGovern, Kevin This article explores a Report titled 'Dementia: Ethical Issues,' which was produced by the UK Nuffield Council on Bioethics. The Report calls us to examine our attitudes towards both dementia and people with dementia, and to act in solidarity with people with dementia by seeking to include them in mainstream society, and to provide them with sufficient help and services so that they are able to enjoy a good quality of life throughout the course of their illness. It (...) also calls us to act in solidarity with the carers of people with dementia, providing them with help and services both in their caring capacity and also in meeting their personal needs. (shrink)
Rethinking Feminist Ethics bridges the gap between women theorists disenchanted with aspects of traditional theories that insist upon the need for some ethical principles. The book raises the question of whether the female conception of ethics based on care, trust and empathy can provide a realistic alternative to the male ethics based on duty and rule bound conception of ethics developed from Kant, Mill and Rawls. Koehn concludes that it cannot, showing how problems for respect of the individual arise also (...) in female ethics because it privileges the caregiver over the cared for. Drawing on Socrates' Crito , she shows how an ethic of dialogue can instill a critical respect for the view of the other and the ethical principles absent from the female ethic. (shrink)
Ethics, religion, and spirituality -- Spirituality in care -- Spirituality and ethics -- Love -- The community of care : fit for purpose -- Values, virtues, and the patient -- Challenging faith -- Spirituality and the domain of justice.
This article accepts the proposition that old people want to be treated with dignity and that statements about dignity point to ethical duties that, if not independent of rights, at least enhance rights in ethically important ways. In contexts of policy and law, dignity can certainly have a substantive as well as rhetorical function. However, the article questions whether the concept of dignity can provide practical guidance for choosing among alternative approaches to the care of old people. The article explores (...) the paradoxical relationship between the apparent lack of specific content in many conceptions of dignity and the broad utility that dignity appears to have as a concept expressive of shared social understandings about the status of old people. (shrink)
What should be the content of a package of health care services that we would want to guarantee to all Americans? This question cannot be answered adequately apart from also addressing the issue of fair health care rationing. Consequently, as I argue in this essay, appeal to the language of "basic," "essential," "adequate," "minimally decent," or "medically necessary" for purposes of answering our question is unhelpful. All these notions are too vague to be useful. Cost matters. Effectiveness matters. The clinical (...) circumstances of a patient matters. But what we must ultimately determine is what we mutually agree are the just claims to needed health care of each American in a relatively complex range of clinical circumstances. Answering this question will require a public moral conversation, a fair process of rational democratic deliberation aimed at defining both just claims to needed health care and just limits. (shrink)
Health reform must include health care rationing, both for reasons of fairness and efficiency. Few politicians are willing to accept this claim, including the Clinton Administration. Brown and others have argued that enormous waste and inefficiency must be wrung out of our health care system before morally problematic cost constraining options, such as rationing, can be justifiably adopted. However, I argue that most of the policies and practices that would diminish waste and inefficiency include implicit (and therefore morally problematic) rationing. (...) Critics of rationing see as its most morally and psychologically troubling feature that an identified individual is denied potentially beneficial care. That psychic anguish may not be eliminable, and perhaps ought not be eliminated. But if rationing protocols are fairly adopted through a process of free and informed rational democratic deliberation to which all have access, the moral objections are largely overcome. Such a process is possible only if implicit rationing is recognized and rejected. Keywords: Justice, health care rationing, health reform, democratic decision-making CiteULike Connotea Del.icio.us What's this? (shrink)
This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly hidden (...) rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flawed as a model of health rationing, it gives us worthy moral lessons for health reform at the national level, which I analyze and defend in Part III. The most significant of these lessons is the importance of rational democratic deliberation in articulating fair rationing protocols for a community. In Part IV I sketch the philosophic justification for this approach and respond to some important criticisms from Daniels. Keywords: cost containment, democratic deliberation, fairness, justice, rationing CiteULike Connotea Del.icio.us What's this? (shrink)
In this essay I examine the relevance of the vocabulary of an ethics of care to ecofeminism. While this vocabulary appears to offer a promising alternative to moral extensionism and deep ecology, there are problems with the use of this vocabulary by both essentialists and conceptualists. I argue that too great a reliance is placed on personal lived experience as a basis for ecofeminist ethics and that the concept of care is insufficiently determinate to explicate the meaning of care for (...) nature. (shrink)
I argue that the epistemological virtues of concrete thinking, self-transparency, and narrative understanding developed by care ethicists can help international development practitioners combat their own temptations to engage in “unconscious unjustified paternalism” (UUP). I develop the concept of UUP—a type of paternalism in which one party unjustifiably substitutes her judgment for another's because of difficulty distinguishing her desires for the other from the other's good. I show that the temptation to UUP is endemic to development and that care ethics contains (...) virtues for combating it. Key to my claim is a view of caregiving as a practice of negotiating conflict. (shrink)
The aim of this study was to explore and describe how Flemish nurses experience their involvement in the care of hospitalized patients with dementia, particularly in relation to artificial nutrition or hydration (ANH). We interviewed 21 hospital nurses who were carefully selected from nine hospitals in different regions of Flanders. ‘Being touched by the vulnerability of the demented patient’ was the central experience of the nurses, having great impact on them professionally as well as personally. This feeling can be described (...) as encompassing the various stages of the care process: the nurses' initial meeting with the vulnerable patient; the intense decision-making process, during which the nurses experienced several intense emotions influenced by supporting or hindering contextual factors; and the final coping process, a time when nurses came to terms with this challenging experience. From our examination of this care process, it is obvious that nurses' involvement in ANH decision-making processes that concern patients with dementia is a difficult and ethically sensitive experience. On the one hand, the feeling of ‘being touched’ can imply strength, as it demonstrates that nurses are willing to provide good care. On the other hand, the feeling of ‘being touched’ can also imply weakness, as it makes nurses vulnerable to moral distress stemming from contextual influences. Therefore, nurses have to be supported as they carry out this ethically sensitive assignment. Practical implications are given. (shrink)
This article addresses the issue of women as primary caregivers to children and the concept of "maternal practice." The idea of maternal practice guides mothers as they learn (1) how to meet their child's physical, psychological, and spiritual needs, and (2) how to make their child socially acceptable. Hindrances to maternal practice include severe poverty and disabilities of the mother. The relationship between maternal practice and the quest for health care in the U.S. is discussed. Maintaining adequate health care is (...) more difficult when parents are poorly educated and/or impoverished. Without proper health care, poor children are less likely to be able to compete with rich children in society. Dental care is also a concern, because proper dental care is fundamental in the maintenance of overall health. Dental care is not a "luxury" but medically necessary care. Solutions include increasing the awareness of such programs as CHIP and WIC, extending Medicaid benefits to more children, and compensating health care practitioners for working with Medicaid recipients. In addition, society must think more maternally and increase health and dental care accessibility, particularly to the poor in rural areas. The article concludes with the thought that if society expects mothers to care for their children, then society must care for mothers. (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).
En rapport with Jürgen Habermas, this paper argues for an environmental ethics that formalistically links the “good-for-nature” to the communicatively conceived “good-for-humanity.” This orientation guards against the possibility of humanity’s “knowledge-constitutive interest” in the instrumentalization of the environment being pressed forth as a project of limitless domination and mastery. Such an ethics is nonetheless well supplemented with Axel Honneth’s idea of an “indirect” recognitional attitude toward the world of objects, which accommodates the impulse of “care” for nature without succumbing to (...) the aporias of a naturalistic ethic. The essay contends that the categorical resources needed to avert the slide toward naturalism are dissolved in the antifoundationalist “critiques of nature” advanced by Steven Vogel and Jacques Derrida. (shrink)
End-of-life care, particularly for patients with advanced dementia, tests the medical covenant, both the integrity and aptness of what physicians have to offer and the fidelity with which they offer it. This article considers five ways of justifying the unilateral withholding of future treatment: (1) an affirmation of professional autonomy; (2) a defense of professional integrity; (3) a parentalist exercise of power on behalf of the patient and/or family; (4) a protection of the interests of third parties (footing the bill); (...) or (5) a protection of the interests of second parties (the physician or other providers). The article concludes with a sixth response to care for the stricken patient and family that seeks to attend more fully to the clinical reality of bonded humans in the throes of disease and death. (shrink)
Institutional ethics committees (IECs) in health care facilities now create moral policy, provide moral education, and consult with physicians and other health care workers. After sketching reasons for the development of IECs, this paper first examines the predominant moral standards it is often assumed IECs are now using, these standards being neo-Kantian principles of justice and utilitarian principles of the greatest good. Then, it is argued that a feminine ethics of care, as posited by Carol Gilligan and Nel Noddings, is (...) an unacknowledged basis for IEC discussions and decisions. Further, it is suggested that feminine ethics of care can and should provide underlying theoretical tools and standards for IECs. (shrink)
Newcomers and more experienced feminist theorists will welcome this even-handed survey of the care/justice debate within feminist ethics. Grace Clement clarifies the key terms, examines the arguments and assumptions of all sides to the debate, and explores the broader implications for both practical and applied ethics. Readers will appreciate her generous treatment of the feminine, feminist, and justice-based perspectives that have dominated the debate.Clement also goes well beyond description and criticism, advancing the discussion through the incorporation of a broad range (...) of insights into a new integration of the values of care and justice. Care, Autonomy, and Justice marks a major step forward in our understanding of feminist ethics. It is both direct and helpful enough to work as an introduction for students and insightful and original enough to make it necessary reading for scholars. (shrink)
A relational-self theory claims that one’s self is constituted by one’s relationships. The type of ethics that is said to arise from this concept of self is often called an ethics of care, whereby the focus of ethical deliberation is on preserving and nurturing those relationships. Some environmental philosophers advocating a relational-self theory tend to assume that the particular relationships that constitute the self will prioritize the natural world. I question this assumption by introducing the problem of artifact relationships. It (...) is unclear whether a relational-self theory recognizes relationships with the artificial world as beingmeaningful in any moral sense, and whether such relationships, if they can exist, should be accorded equal value to relationships with the natural world. The problem of artifact relationships becomes particularly apparent when the relational-self theory is linked to place-based ethics. If our ethics are to develop from our relations to place, and our place is largely an artificial world, is there not a danger that our ethical deliberations will tend to neglect the natural world? I adapt Holmes Rolston’s concept of “storied residence” to show how the inclusion of the artificial world will lead to different questions regarding one’s resident environment, and perhaps a different emphasis on what is valued. My aim in raising these questions is to challenge the optimism that writers such as Karen Warren and Jim Cheney have shown in supporting relational-self theories and place-based ethics. I conclude that the challenge to develop a relational-self/place-based ethic does not appear to have been met within Western environmental philosophy, which has perpetuated a silence on the matter of our embedment in the artificial world. (shrink)
When feminist philosophers first turned their attention to traditional ethical theory, its almost exclusive emphasis upon justice, rights, abstract rationality, and individual autonomy came under special criticism. Women’s experiences seemed to suggest the need for a focus on care, empathetic relations, and the interdependence of persons.The most influential readings of what has become an extremely lively and fruitful debate are reproduced here along with important new contributions by Alison Jaggar and Sara Ruddick. As this volume testifies, there is no agreement (...) on the important questions about the relationship between justice and care, but the debate has deepened and enriched our understanding in many ways. Justice and Care is a valuable collection of readings—an essential tool for anyone studying the state of feminist thought in particular or ethical theory in general. (shrink)
McNamara, Laurence J Person-centred care is the mantra of contemporary health and aged care. Delivering such care effectively is an enormous challenge. Much effort goes into the basics of care delivery. In an era of limited resources and financial constraints the temptation arises for aged care in particular to ignore some of the non-measurable dimensions of care. This paper puts forward a range of issues that merit greater attention as we reflect on the realities of human ageing in Australia today. (...) If taken seriously, I suggest, they will contribute to the delivery and quality of person-centred care. (shrink)
The notion of the best interest of children figures prominently in family and reproductive policy discussions and there is a considerable body of empirical research attempting to connect the interests of children to how families and society interact. Most of this research regards the effects of societal responses to perceived problems in families, thus underlying policy on interventions such as adoption, foster care and temporary assumption of custodianship, but also support structures that help families cope with various challenges. However, reference (...) to the best interest of children can also be applied to a more basic issue in family policy, namely that of what is to be considered a family in the first place. This issue does not raise any questions regarding the proper conditions for when society should intervene in or change the family context of a child. Rather, it is about what social configurations should be recognized as a potentially fitting context for children to enter into and (if all goes well) eventually develop into adulthood within /.../ such that society’s default institutional arrangements allow it to have (by sexual and artificial reproduction, adoption, and combinations of these), care for and/or guard children. [This] will frame any further discussion of /.../ policies having further implications for, for example, the practices of adoption and reproductive technology, as well as regulation of custody in the event of separation or parental disagreement. (shrink)
Introduction -- The ethics of care and global politics -- Rethinking human security -- 'Women's work' : the global care and sex economies -- Humanitarian intervention and global security governance -- Peacebuilding and paternalism : reading care through postcolonialism -- Health and human security : gender, care and HIV/AIDS -- Gender, care, and the ethics of environmental security -- Conclusion. Security through care.
In a way reminiscent of Hume's approach in the Treatise, a reviving moral sentimentalism can use the notion of empathy to ground both its normative account of moral obligation and its metaethical account of moral language. A virtuous person is empathically caring about others and expresses such feeling/motivation in her actions. But the judgment that something is right or good is also based in empathy, and the sentimentalist can espouse a form of moral realism by making use of a (...) Kripkean reference-fixer theory of the role of feelings of approval and disapproval in moral judgment. (shrink)
My task in this paper is to demonstrate, contra Nel Noddings, that Kantian ethics does not have an expectation of treating those closest to one the same as one would a stranger. In fact, Kantian ethics has what I would consider a robust statement of how it is that those around us come to figure prominently in the development of one's ethics. To push the point even further, I argue that Kantian ethics has an even stronger claim to treating those (...) closest to oneself as imperative than Noddings and sentiment-based ethical theory in general, proposes. (shrink)
Although treating the elderly occasion the same kinds of ethical issues as treating other patients, specific problems do arise when making decisions for persons, once competent, who no longer can express their values. I examine the problem of decisional incapacity and offer a critique of the principles, such as substituted judgment, and the instruments, such as advance directives, living wills, other instructional directives, as well as surrogate decision-makers.
This paper argues that the concept of care is significant not only for ethics, but for epistemology as well. After elucidating caring as a five-step dyadic relation, I go on to show its epistemic significance within the general framework of virtue epistemology as developed by Ernest Sosa, Alvin Goldman, and Linda Zagzebski. The notions of "care-knowing" and "care-based epistemology" emerge from construing caring (respectively) as a reliabilist and responsibilist virtue.
Telecare is often regarded as a win/win solution to the growing problem of meeting the care needs of an ageing population. In this paper we call attention to some of the ways in which telecare is not a win/win solution but rather aggravates many of the long-standing ethical tensions that surround the care of the elderly. It may reduce the call on carers' time and energy by automating some aspects of care, particularly daily monitoring. This can release carers for other (...)caring activities. On the other hand, remote and impersonal monitoring seems to fall short of providing care. Monitoring may be used to help elderly users retain independence. But it may also increase the amount of information which flows from users to carers, which can result in a form of function-creep that actually undermines independence. (shrink)
Crito revisited -- Blindness, narrative, and meaning : moral living -- Radical experience and tragic duty : moral dying -- Needing assistance to die well : PAS and beyond -- Experiencing lost voices : dying without capacity -- Dying young : what interests do children have? -- Caring for patients : cure, palliation, comfort, and aid in the process of dying.
In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired moral attitude of physicians. In a series of three articles, three of the discussed concepts are presented in an interpretation that is meant to characterise the morally emotional part of this attitude: “empathy”, “compassion” and “care”. In the first article of the series, “empathy” has been (...) developed as a mainly cognitive and morally neutral capacity of understanding. In the second article, the emotional and virtuous core of the desired professional attitude—compassion—has been presented. Compassion as a professional attitude has been distinguished from a spontaneous feeling of compassion, and has been related to a general idea of man as vulnerable and solidary being. Thus, the dignity of the patient is safeguarded in spite of the asymmetry of compassion. In this article, the third concept of the triad—“care”—is presented. Care is conceived as an attitude as well as an activity which can be directed to different objects: if it is directed to another sentient being, it is regarded as intrinsically morally valuable; implying (1) the acceptance of being addressed, (2) a benevolent inclination to help and to foster, and (3) activity to realize this. There are different forms of benevolence that can underlie caring. With regard to the professional physician’s ethos, the attitude of empathic compassion as developed in the two previous articles is proposed to be the adequate underlying attitude of care which demands the right balance between closeness and professionalism and the right form of attention to the person of the patient. ‘Empathic compassionate care’ does not, however, describe the whole of the desired attitude of a physician, but focuses on the morally-emotive aspects. In order to get also the cognitive and practical aspects of biomedicine into the picture, ‘empathic compassionate care’ has to be combined with an attitude of responsibility that is more directed to decision-making and outcome than a caring attitude alone can be. The reconstruction of the desired professional attitude in terms of “empathic compassionate care” and “responsibility” is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions. (shrink)
One generally considered plausible way to allocate resources in health care is according to people’s needs. In this paper I focus on a somewhat overlooked issue, that is the conceptual structure of health care needs. It is argued that what conceptual understanding of needs one has is decisive in the assessment of what qualifies as a health care need and what does not. The aim for this paper is a clarification of the concept of health care need with a starting (...) point in the general philosophical discussion about needs. I outline three approaches to the concept of need and argue that they all share the same conceptual underpinnings. The concept of need is then analyzed in terms of a subject x needing some object y in order to achieve some goal z. I then discuss the relevant features of the object y and the goal z which make a given need qualify as a health care need and not just a need for anything. (shrink)
This paper offers critical reflection on the contemporary tendency to approach health care in instrumentalist terms. Instrumentalism is means-ends rationality. In contemporary society, the instrumentalist attitude is exemplified by the relationship between individual consumer and a provider of goods and services. The problematic nature of this attitude is illustrated by Michael Oakeshott’s conceptions of enterprise association and civil association. Enterprise association is instrumental; civil association is association in terms of an ethically delineated realm of practices. The latter offers a richer (...) ethical conception of the relation between person and society than instrumentalism does. Oakeshott’s conception is further illustrated by reflection on the connection between morality and religion that he explores in an early essay concerning “religious sensibility”. Religious sensibility turns on the acknowledgement of the vulnerability of the self to the vicissitudes of life. This vulnerability cannot be bargained over instrumentally without imperilling the self. Religious sensibility is thus a valuable resource for criticising instrumentalist attitudes. It allows for the cultivation of ethical self-understanding that is essential to comprehending the conditions in virtue of which genuine civil life is possible. These conditions need to be taken into account in health care. Health care is not simply about substantive wants. It also necessarily concerns the universal and constant condition of being prey to illness that is the common lot of all citizens. (shrink)
This paper raises some issues about understanding religion, religions and spirituality in health care to enable a more critical mutual engagement and dialogue to take place between health care institutions and religious communities and believers. Understanding religions and religious people is a complex, interesting matter. Taking into account the whole reality of religion and spirituality is not just about meeting specific needs, nor of trying to ensure that religious people abandon their distinctive beliefs and insights when they engage with health (...) care institutions and policies. Members of religious groups and communities form an integral part of the structure and fabric of health care delivery, whether as users or in delivery capacities. Religion is both facilitator and resistor, friend and critic, for health care institutions, providers and workers. (shrink)
This paper considers the way in which English law safeguards fundamental rights to respect for faith and belief in relation to the delivery of health care. It explores the implications of the Human Rights Act 1998 and the Equality Act 2010. It explores some of the challenges in attempting to reconcile fundamental rights to faith and belief and the delivery of health care, both now and in the future and whether this is a realistic aspiration in a state funded health (...) care service. (shrink)
What challenges must a principle of need for prioritisations in health care meet in order to be plausible and practically useful? Some progress in answering this question has recently been made by Hope, Østerdal and Hasman. This article continue their work by suggesting that the characteristic feature of principles of needs is that they are sufficientarian, saying that we have a right to a minimally acceptable or good life or health, but nothing more. Accordingly, principles of needs must answer two (...) distributive questions: when do we have sufficient and how should we prioritise among those who do not yet have a sufficiency? Furthermore, it is argued that Roger Crisp’s theory of need, which combines sufficientarianism with prioritarianism below the threshold of need, is better equipped than alternatives to answer these questions as well as meeting the challenges formulated by Hope, Østerdal and Hasman. However, Crisp’s theory faces two major challenges. First, it has to say something about the currency of distribution: a principle of need must be complemented either with a theory on the human good or a theory about the proper goals of health care. Second, it has to say something about where the threshold should be set. However, any attempt to set a threshold seems morally arbitrary in the light of the sufficientarian idea that those just above the threshold never should be given priority over those just below the threshold. (shrink)