Bioethics has increasingly become a standard part of medical school education and the training of healthcare professionals more generally. This is a promising development, as it has the potential to help future practitioners become more attentive to moral concerns and, perhaps, better moral reasoners. At the same time, there is growing recognition within bioethics that nonideal theory can play an important role in formulating normative recommendations. In this chapter we discuss what this shift toward nonideal theory means for ethical curricula (...) within healthcare education. In particular, we contend that more attention to the particularities of historical and social context needs to be incorporated into bioethics training. To make this argument, we focus on two examples: teaching units on race and medicine and those that focus on stigma and coercion in mental health. For both, we show how a pedagogical approach in which educators focus on social injustice could influence how practitioners engage in ethics in the clinic. This chapter, then, demonstrates what a commitment to nonideal theory can mean practically when it comes to bioethics education. (shrink)

There is a consensus that the effects of medical brain drain, especially in the Sub-Saharan African countries, ought to be perceived as more than a simple misfortune. Temporary restrictions on the emigration of health workers from the region is one of the already existing policy measures to tackle the issue—while such a restrictive measure brings about the need for quite a justificatory work. A recent normative contribution to the debate by Gillian Brock provides a fruitful starting point. In the first (...) step of her defence of emigration restrictions, Brock provides three reasons why skilled workers themselves would hold responsibilities to assist with respect to vital needs of their compatriots. These are fair reciprocity, duty to support vital institutions, and attending to the unintended harmful consequences of one’s actions. While the first two are explained and also largely discussed in the literature, the third requires an explication on how and on which basis skilled workers would have a responsibility as such. In this article, I offer a vulnerability approach with its dependency aspect that may account for why the health workers in underserved contexts would have a responsibility to attend to the unintended side effects of their actions that may lead to a vital risk of harm for the population. I discuss HIV/AIDS care in Zimbabwe as a case in point in order to show that local health workers may have responsibilities to assist the population who are vulnerable to their mobility. (shrink)

How ethics in human services is a political activity, shaping social relationships, is explored through the examination of two opposing discourses, a principle-based and a situated/relational narrative. Factors such as neo-liberalism, managerialism, and the risk-aversive society give a context for the reasons that the principle-based discourse has been the predominant influence, and what interests are served by this trope taking center stage. A delineation and critique of both perspectives are provided, including an explanation of the epistemological underpinnings of these discourses. (...) The piece ends with what needs to be done to strengthen ethics. (shrink)

: International instruments now defend a "right to the truth " for victims of political repression and violence and include truth telling about human rights violations as a kind of reparation as well as a form of redress. While truth telling about violations is obviously a condition of redress or repair for violations, it may not be clear how truth telling itself is a kind of reparations. By showing that concerted truth telling can satisfy four features of suitable reparations vehicles, (...) I defend the idea that politically implemented modes of truth telling to, for, and by those who are victims of gross violation and injustice may with good reason be counted as a kind of reparations. Understanding the doubly symbolic character of reparations, however, makes clearer why truth telling is unlikely to be sufficient reparation for serious wrongs and is likely to be sensitive to the larger context of reparative activity and its social, political, and historical background. (shrink)

We expand on Della Croce’s ambition to interpret “epistemic injustice” as a specification of non-maleficence in the use of the influential four-principle framework. This is an alluring line of thought for conceptual, moral, and heuristic reasons. Although it is commendable, Della Croce’s attempt remains tentative. So does our critique of it. Yet, we take on the challenge to critically address two interrelated points. First, we broaden the analysis to include deliberations about hermeneutical injustice. We argue that, if due consideration of (...) epistemic injustice is to require more than negative ethical obligations in medicine, dimensions of hermeneutical injustice should be explored as an avenue to arrive at such positive duties. Second, and relatedly, we argue that this may encompass moral responsibilities beyond the individual level, that is: positive obligations to take action on a structural level. Building on Dotson’s concept of “contributory injustice” and Scheman’s concept of “perceptual autonomy,” we suggest that the virtues of testimonial and hermeneutical justice may provide additional content not only to negative prohibitions of action (i.e. non-maleficence) but also to positive requirements of action, like respecting patient autonomy. (shrink)

The traditional organizational boundaries between healthcare, social work, police and other non-profit organizations are fading and being replaced by new relational patterns among a variety of disciplines. Professionals work from their own history, role, values and relationships. It is often unclear who is responsible for what because this new network structure requires rules and procedures to be re-interpreted and re-negotiated. A new moral climate needs to be developed, particularly in the early stages of integrated services. Who should do what, with (...) whom and why? Departing from a relational and hermeneutic perspective, this article shows that professionals in integrated service networks embark upon a moral learning process when starting to work together for the client’s benefit. In this context, instrumental ways of thinking about responsibilities are actually counterproductive. Instead, professionals need to find out who they are in relation to other professionals, what core values they share and what responsibilities derive from these aspects. This article demonstrates moral learning by examining the case of an integrated social service network. The network’s development and implementation were supported by responsive evaluation, enriched by insights of care ethics and hermeneutic ethics. (shrink)

For the past several years patients have been expected to play a key role in their recovery. Self management and disease management have reached a hype status. Considering these recent trends what does this mean for the division of responsibilities between doctors and patients? What kind of role should healthcare providers play? With findings based on a qualitative research project of an innovative practice for people with Chronic Obstructive Pulmonary Disease (COPD) we reflect on these questions. In-depth interviews conducted with (...) people with COPD, physiotherapists and a pulmonologist show that shifting responsibilities require a supportive attitude from healthcare providers and a dialogical communication between patients and professionals. Our findings show more is needed in order to motivate people with COPD to take responsibility and become co-owners in a process of recovery. The case example illustrates that people with COPD need support from fellow patients to learn to accept their disabilities. Awareness that COPD is more than just a lack of air, that mind and body interact, is a first step to investigate other potential problems and to enhance one’s quality of life. (shrink)

This essay focuses on the value of self-doubt in moral inquiry and in moral education. Using John Patrick Shanley’s play, Doubt: A parable, as illustration, it shows how self-doubt initiates and extends moral inquiry, highlights one’s epistemic fallibility and connects the inquirer to the virtue of humility. The essay draws on the work of Charles Sanders Peirce, Hullett, Nussbaum, Thayer-Bacon and Elbow to support the idea that the question ‘Am I wrong?’ is important for moral inquiry and for moral education.

In his famous ‘Integrity Objection’, Bernard Williams condemns utilitarianism for requiring us to regard our projects as dispensable, and thus precluding us from being properly committed to them. In this paper, I argue against commitment as Williams defines it, drawing upon insights from the socialist tradition as well as mainstream analytic moral philosophy. I show that given the mutual interdependence of individuals (a phenomenon emphasised by socialists) several appealing non-utilitarian moral principles also require us to regard our projects as dispensable. (...) This means that those who endorse those principles cannot appeal to Williams’s argument against utilitarianism. It also puts pressure on his thought that moral theories ought to permit commitment – in fact, it suggests that they ought not. Regarding one’s projects as dispensable may be alienating, and this may motivate us to hang onto commitment and reject these non-utilitarian principles along with utilitarianism. However, commitment also threatens a kind of alienation – from other people. Drawing upon the socialist tradition again, I argue that avoiding this form of alienation is necessary for proper engagement with our projects, and thereby with ourselves. (shrink)

This introduction to the special issue on ‘Ricoeur and the ethics of care’ is not a standard editorial. It provides not only an explanation of the central questions and a first impression of the articles, but also a critical discussion of them by an expert in the field of care ethics, Joan Tronto. After explaining the reasons to bring Ricoeur into dialogue with the ethics of care, and analyzing how the four articles of this special issue shape this dialogue, the (...) authors give the floor to Tronto. She focuses on the central issue at stake: what may be the value of a more abstract, conceptual approach for the ethics of care as a radically practice-oriented way of thinking? She argues that the four contributions too easily frame this value in terms of Ricoeur’s relational anthropology. Instead she points out that if the ethics of care is a kind of practice, it makes sense to think of such practices as necessarily building upon one another, expanding constantly the context and relationships upon which practices are built. In the final section the authors respond to Tronto’s framing of ‘practices all the way up’ by arguing that this approach need not be at odds with one inspired by Ricoeur’s conceptual thinking. Rather the two can be seen as different movements—upwards and downwards—that both contribute constructively to the shaping of the important intermediary zone between the practices and the abstract ideals. (shrink)

Care ethics emphasizes responsibility as a key element for caring practices. Responsibilities to care are taken by certain groups of people, making caring practices into moral and political practices in which responsibilities are assigned, assumed, or implicitly expected, as well as deflected. Despite this attention for social practices of distribution and its unequal result, making certain groups of people the recipient of more caring responsibilities than others, the passive aspect of a caring responsibility has been underexposed by care ethics. By (...) drawing upon the work of the French phenomenologist Jean-Luc Marion, a care ethical conceptualization of responsibility can by enriched, by scrutinizing how responsibility is literally a response to something else. This paper starts with a vignette of an everyday situation of professional care. After that the current body of care ethical literature on responsibility is presented, followed by Marion’s phenomenology of givenness, using his analysis of Caravaggio’s painting The Calling of St. Matthew and resulting in his redefinition of responsibility. In the next section we present a table in which we juxtapose four distinct paradigms of responsibility, which we will describe briefly. The final section consists of an exploration of the paradigms by an analysis of the vignette and results in a conclusion concerning what Marion’s view has to offer to care ethics with regard to responsibility. (shrink)

Making better choices about future technologies that are being researched or developed is an important motivator behind lay ethics interventions. However, in practice, they do not always succeed to serve that goal. Especially authors who have noted that lay ethicists sometimes take recourse to well-known themes which stem from old, even ‘archetypical’ stories, have been criticized for making too little room for agency and decision-making in their approach. This paper aims to contribute to a reflection on how lay ethics can (...) acquire more practical relevance. It will use resources in narrative ethics to suggest that in order to be relevant for action, facilitators of lay ethics interventions need to invite participants to engage in a narrative quest. As part of a quest, lay ethicists should be asked to reflect on a specific question or choice, use diverse input which is informative about the heterogeneity of viewpoints that are defended in society and argue for their standpoints. (shrink)

A standard view in ethics is that ethical issues concern a different range of human concerns than does politics. This essay goes beyond the long-standing dispute about the extent to which applied ethics needs a commitment to ethical theory. It argues that regardless of the outcome of that dispute, applied ethics, because it presumes something about the nature of authority, rests upon and is implicated in political theory. After internalist and externalist accounts of applied ethics are described, “mixed” approaches are (...) considered that contain inevitable political dimensions. A feminist alternative, Walker’s metaethic of responsibility, shows that authority is best understood as relational and that situations of unequal power are therefore often the places where applied ethics arises. Furthermore, in a democratic society, commitments to democracy should shape the account of authority, and, thus, the nature of applied ethics as well. (shrink)

Spatial metaphors abound in feminist theory. The modest goal of this paper is to reassert the importance of temporal dimensions in thought for feminist thinking. In order to establish this general claim, several kinds of current thinking about time that are problematic for feminists are explored. First, the postmodern compression of time and space is considered from the standpoint of the changes it brings in the nature of care. Second, the privileging of the future over the past is considered in (...) light of the problems it creates for thinking about justice for historical wrongdoing. Forgiveness and remembrance require an attention to the past. (shrink)

Are social movements responsible for their unfinished agendas? Feminist successes in opening the professions to women paved the way for the emergence of the upper middle-class two-career household. These households sometimes hire domestic servants to accomplish their child care work. If, as I shall argue, this practice is unjust and furthers social inequality, then it poses a moral problem for any feminist commitment to social justice.

This author offers of narrative of hope in response to the coronavirus pandemic by viewing it as a wake-up call to lean into the adaptive moral challenge of stewardship for the future of humanity and the planet. Acknowledging the many material and social benefits of a global regime of free market urbanism built on advances in science and technology, this is a point in geohistory, the Anthropocene, when the impact of human activities on the Earth has begun to outcompete natural (...) processes. The coronavirus has illuminated systemic moral failures and new moral challenges of the Anthropocene that call for adaptive response if we are to build a hopeful future for humanity and the planet. Pointing to millennia of human adaptive response to threats and disasters, the author asserts an evolutionary hardiness attributable as much to moral capacities as rational intelligence as a singularly defining trait fueling millennia of human adaptive learning and thrival. The current pandemic is the latest point in humanity’s moral evolution of adaptive response to moments of urgent threat that have tested, expanded, and defined our character and moral capacities as a species. Rather than falter under the moral burden of the coronavirus threat and its consequences, the author views this pivotal point as an opportunity to stretch human moral horizons by taking responsibility for the urgent moral challenges we have created and inventing new ethical frameworks and tools that will lead us to new moral understandings and solutions to the moral challenges we face. (shrink)

Nurses and other medical practitioners often experience moral distress: they feel an anguished sense of responsibility for what they take to be their own moral failures, even when those failures were unavoidable. However, in such cases other people do not tend to think it is right to hold them responsible. This is an interesting mismatch of reactions. It might seem that the mismatch should be remedied by assuring the practitioner that they are not responsible, but I argue that this denies (...) something important that the phenomenon of moral distress tells us. In fact, both the practitioners’ tendencies to hold themselves responsible and other people’s reluctance to hold the practitioners responsible get something right. The practitioners may be right that they are responsible in the sense of having failed to meet a binding moral requirement, even when the requirement was impossible to meet. This makes moral distress a fitting response because it correctly represents their own action as a wrongdoing. However, others may meanwhile be right that the practitioners are not responsible in the sense of being culpable and blameworthy. To blame others, or oneself, for certain failures, including those that are unavoidable, would be unfair. My claim depends on distinguishing between the fittingness and the fairness of holding someone (including oneself) responsible for moral failure. Having drawn the distinction, I suggest that moral distress should be addressed in a way that both recognizes it as a fitting response and avoids the unfairness of blame. (shrink)

I briefly introduce Moral Failure as a book that brings together philosophical and empirical work in moral psychology to examine moral requirements that are non-negotiable and that contravene the principle that “ought implies can.” I respond to Rivera by arguing that the process of construction that imbues normative requirements with authority need not systematize or eliminate conflicts between normative requirements. My response to Schwartzman clarifies what is problematic about nonideal theorizing that limits itself to offering action-guidance. In response to Kittay, (...) I defend my rejection of “ought implies can,” and consider the implications of the concept of unfair moral requirements. (shrink)

This paper draws on Claudia Card’s discussions of moral luck to consider the complicated moral life of people—described as pessimists—who accept the heavy knowledge of the predictability of the bad moral luck of oppression. The potential threat to ethics posed by this knowledge can be overcome by the pessimist whose resistance to oppression, even in the absence of hope, expresses a sense of still having a ‘‘claim’’ on flourishing despite its unattainability under oppression.

John Dewey developed a pragmatic theory of inquiry to provide intelligent methods for social progress. He believed that the logic and attitude of successful scientific inquiries, properly conceived, could be fruitfully applied to morals and politics. Unfortunately, his project has been poorly understood and his logic of inquiry neglected as a resource. Contemporary pragmatists, like Richard Rorty, for example, dismiss his emphasis on method and avoid judgments of moral progress that are in any way independent of the biases of particular (...) cultures. In this article, I argue that Dewey’s theory of inquiry indeed provides intelligent methods and intellectual criteria for engaging moral and political matters. Inquiry, as Dewey conceives it, issues in judgments that are increasingly objective, reliable and refined in application. These judgments are rooted in particular times and places, in actual ‘situations’, but are not entirely hostage to specific cultures. I then apply Dewey’s theory to two standard moral problems to demonstrate how it works. The conclusion is that Dewey’s theory of inquiry gets it just right: it provides solid ground for criticism and moral progress while remaining acutely sensitive to cultural differences and changing circumstances. (shrink)

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

People who are involuntarily childless need to use assisted reproductive technologies if they want to have a genetically related child. Yet, from an ethical point of view it is unclear to what extent assistance to satisfy this specific desire should be warranted. We first show that the subjectively felt harm due to the inability to satisfy this reproductive desire does not in itself entail the normative conclusion that it has to be met. In response, we evaluate the alternative view according (...) to which the satisfaction of this desire is regarded as a way to meet one’s presumed intermediate need for parenthood. This view presupposes that parenthood is one of those general categories of experiences and activities that contribute an irreplaceable value to people’s lives, but the central difficulty is to find those characteristics that mark out parenthood as an irreplaceable constituent of a valuable life. We go on to argue, however, that even if one assumes that parenthood is such an irreplaceable constituent that makes life more valuable, this does not necessarily entail a moral duty to satisfy the desire for genetic parenthood. We conclude that there is a pro tanto obligation to help people conceive a genetically related child (if this is what they prefer), but that this can be outweighed by other moral considerations, such as safety and justice concerns. (shrink)

In November 2004, the Swiss population voted to accept a law on research using human embryonic stem cells. In this paper, we use Switzerland as a case study of the shaping of the ostensibly ethical debate on the use of embryos in embryonic stem cell research by legal, political and social constraints. We describe how the national and international context affected the content and wording of the law. We discuss the consequences of the revised law's separation of stem cell research (...) from other forms of embryo research, its definitions of embryo and of spare embryos, and the introduction of donorship into the Swiss ethical debate on IVF. We focus on the exclusion of the potential embryo donors' voices and perspectives from the debate, and consider the effects of this exclusion on ethical discourse and the political process. (shrink)

In this methodological reflection, I describe the multidisciplinary hermeneutic process of philosophizing about teacher dissatisfaction. I discuss how philosophy serves as a starting point for interpretive work based on interviews with former teachers and readings of qualitative and quantitative research on teacher attrition and dissatisfaction. The result has been a project that enabled me to offer new descriptions of phenomena and to develop concepts that can be used to interpret the moral dimensions of teacher dissatisfaction. The fact that I return (...) to language and concepts as my research outcomes is why, despite my multidisciplinary approach, I continue to describe my work as philosophical. I suggest that philosophical enquiry pursued through empirical research has the potential to inform larger empirical studies, serve as a “sensitizing instrument” for empirical analysis, and to open discursive spaces where common understandings limit interpretive possibilities. (shrink)

Moral madness is a symptom of the moral violence experienced by teachers who are expected to exercise responsibility for their students and their work, but whose moral voice is misrecognized as self-interest and whose moral agency is suppressed. I conduct a feminist ethical analysis of the figure of Cassandra to examine the ways in which teachers may be driven to moral madness.

It is not uncommon for patients with advanced disease to express a wish to hasten death. Qualitative studies of the WTHD have found that such a wish may have different meanings, none of which can be understood outside of the patient’s personal and sociocultural background, or which necessarily imply taking concrete steps to ending one’s life. The starting point for the present study was a previous systematic review of qualitative studies of the WTHD in advanced patients. Here we analyse in (...) greater detail the statements made by patients included in that review in order to examine their moral understandings and representations of illness, the dying process and death. We identify and discuss four classes of assumptions: assumptions related to patients’ moral understandings in terms of dignity, autonomy and authenticity; assumptions related to social interactions; assumptions related to the value of life; and assumptions related to medicalisation as an overarching context within which the WTHD is expressed. Our analysis shows how a philosophical perspective can add to an understanding of the WTHD by taking into account cultural and anthropological aspects of the phenomenon. We conclude that the knowledge gained through exploring patients’ experience and moral understandings in the end-of-life context may serve as the basis for care plans and interventions that can help them experience their final days as a meaningful period of life, restoring some sense of personal dignity in those patients who feel this has been lost. (shrink)

This paper argues that human rights-based approaches to human security overlook the importance of caring values, relations of care, and care work in the achievement and long-term maintenance of human security. It outlines an alternative approach to the ethics of human security which combines a feminist ontological and normative position on the centrality of caring values and practices in sustaining life with a feminist account of the gendered political economy of contemporary globalisation. Moreover, it argues that a critical, feminist ethics (...) of care can provide a comprehensive ontological and normative framework for integrating economic exclusion with violence, and thus for understanding and conceptualising human security in a way that is sensitive to the role played by gender identities and other types of power relations. This, I argue, can be achieved through an interrogation of the relationship between neoliberal globalisation and hegemonic forms masculinity in the context of contemporary global governance. (shrink)

This article develops an approach to ethical globalization based on a feminist, political ethic of care; this is achieved, in part, through a comparison with, and critique of, Thomas Pogge's World Poverty and Human Rights. In his book, Pogge makes the valid and important argument that the global economic order is currently organized such that developed countries have a huge advantage in terms of power and expertise, and that decisions are reached purely and exclusively through self-interest. Pogge uses an institutional (...) rights framework to argue that direct responsibility for global poverty and inequality lies with the citizens of developed countries, since suffering and death are caused by global economic arrangements designed and imposed by our governments. While this argument is certainly compelling, I have argued that it tells us little about the actual effects of globalization on the real people of the South - including women, children and the elderly. As a result, it can offer little in the way of real alternatives or policy prescriptions. As a moral orientation, a care ethic relies on a relational moral ontology, and leads us to consider different values in terms of human flourishing. Moreover, it pushes us to consider the normative implications of aspects of the global political economy which are usually not 'seen' at all, including the global distribution of care work and the corresponding patterns of gender and racial inequality, the underprovision of care and resources for caring work in both the developed and developing world, and the ways in which unpaid or low-paid caring work helps to sustain a cycle of exploitation and inequality on a global scale. (shrink)

Health care professionals’ and trainees’ conceptions of their responsibilities to patients can change over time for a number of reasons: evolving career goals, desires to serve different patient populations, and changing family obligations, for example. Some changes in conceptions of responsibility are healthy, but others express moral damage. Clinicians’ changes in their conceptions of what they are responsible for express moral damage when their responses to others express a meager, rather than robust, sense of what they owe others. At least (...) two important expressions of moral damage in the context of health care are these: callousness and divestiture. Callousness describes the poor condition of a clinician's capacity for moral perception; when her capacity to accurately appreciate features of moral relevance that configure others’ needs, vulnerabilities, and desert of care diminishes, such that she fails to respond with care to those for whom she has duties to care, she is callous. Callousness has been explored in detail elsewhere,1 and so the focus of this paper is divestiture. A clinician divests when the value of responding with care to others becomes less centrally and importantly constitutive of his personal and professional identity. Divestiture has important consequences for patients and health professions education, which I will explore here. (shrink)

Traditional considerations of justice for those who require caregiving have centered on what is due to the dependent person. However, considerations of justice also bear strongly on what is due to the caregiver. I focus on unpaid dependency work, too long treated as a private matter rather than a public concern. More is owed to those who render care: the division of labor is unjust, the nature of dependency work creates vulnerabilities for caregivers, and unpaid caregivers are disadvantaged in the (...) world of paid work. Obligations to mitigate these facts are ultimately based on the truth that all members of society at some point in their lives benefit from caregiving and that noncaregivers benefit unfairly from the heavy distribution of dependency work to a small number of certain kinds of individuals. It is necessary to ask which agents of justice are responsible for remedying this state of affairs, and how. I propose a distributed scheme of obligation in which members of society and the state, as arbiter of social responsibility, share responsibility for the remedy. It is incumbent upon us as a society to refrain from making vulnerable the most essential among us, to reap benefits without sowing unjust burdens. (shrink)

ABSTRACTGiven the existing inequities in climate change, any proposed climate engineering strategy to solve the climate problem must meet a high threshold for justice. In contrast to an overly thin paradigm for justice that demands only a science-based assessment of potential temperature-related benefits and harms, we argue for the importance of attention to recognitional justice. Recognitional justice, we go on to claim, calls for a different type of assessment tool. Such an assessment would pay attention to neglected considerations such as (...) relationships, context, power, vulnerability, narrative, and affect. Here we develop a care-ethics related tool for assessing the justice of climate engineering with stratospheric aerosols, and suggest that qualitative social science methods may be required for its effective application. We illustrate the use of this tool with a case study involving interviews about stratospheric aerosol injection conducted in Kenya, the Solomon Islands... (shrink)

A decision was made at the UNFCCC, COP-18 meeting in Doha in 2012 to create a work programme on loss and damage. Part of this programme was to include the production of a technical paper to enhance the general understanding of non-economic losses from climate change. The following article looks carefully at that paper in order to discover whether it provides an adequate conceptual understanding of non-economic losses. Several shortcomings of the paper’s conceptualization of these losses are identified. An alternative (...) ethical framework with methods better suited for capturing a fuller range of non-economic losses is considered. This framework is likely to be most useful if used prospectively for the purpose of devising better adaptation policies to head off potential future losses rather than if used retrospectively for quantifying losses that have already occurred for the purposes of providing compensation. (shrink)

This paper describes the approach of empirical ethics, a form of ethics that integrates non-positivist ethnographic empirical research and philosophy. Empirical ethics as it is discussed here builds on the ‘empirical turn’ in epistemology. It radicalizes the relational approach that care ethics introduced to think about care between people by drawing in relations between people and technologies as things people relate to. Empirical ethics studies care practices by analysing their intra-normativity, or the ways of living together the actors within these (...) practices strive for or bring about as good practices. Different from care ethics, what care is and if it is good is not defined beforehand. A care practice may be contested by comparing it to alternative practices with different notions of good care. By contrasting practices as different ways of living together that are normatively oriented, suggestions for the best possible care may be argued for. Whether these suggestions will actually be put to practice is, however, again a relational question; new actors need to re-localize suggestions, to make them work in new practices and fit them in with local intra-normativities with their particular routines, material infrastructures, know-how and strivings. (shrink)

Testicular tissue cryopreservation aims to preserve the future option of genetic reproduction for prepubescent cancer patients who are at risk of infertility as a result of their cancer therapies. This technology is experimental and currently only offered in the research context. As TTCP moves towards becoming more widely available, it is imperative that healthcare providers recognize the complex ethical issues surrounding this technology. This scoping review study identifies and assesses the range and depth of ethical concerns related to this testicular (...) tissue cryopreservation technology. At present, no such scoping review of ethical concerns exists in the TTCP literature. The forty-three full-text articles included in this study yielded twenty-two different ethical considerations discussed in relation to TTCP. It was observed that these ethical considerations fit within a mainstream Principlism approach to bioethics. Accordingly, there are ethical gaps in the TTCP literature that can be identified with alternative moral lenses. In particular, it was found that ethical concerns related to context and relational aspects of identity were absent in nearly all ethical examinations of TTCP. Furthermore, only 9 per cent of articles reviewed in this study focused primarily on the ethics of TTCP, thus demonstrating a need for further in depth ethical analyses of this technology. The results of this study are important for supporting the ethical provision of TTCP and can contribute to policy and guideline development. The findings of this study demonstrate the need for greater depth and diversity in analyses of ethical considerations related to this technology. (shrink)

Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values and (...) responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life. (shrink)

In Dutch healthcare policy patients are seen as informed, autonomous experts and active decision makers with control over their illness and care. Healthcare professionals are expected to operate as providers of information. The purpose of this article is to argue that the consumerist approach of the patient–professional relationship is not a productive way to envision the patient–professional relationship. We argue that an interpretive/deliberative model is a more productive way to envision this relationship, especially in the care for people with a (...) chronic illness. This is illustrated with a case study. It concerns a study of the experiences of a Multiple Sclerosis (MS) patient and healthcare professionals involved in her care. The presented stories show that the participants did not act in line with the roles and responsibilities embodied in the consumerism rhetoric in Dutch healthcare policy. Expectations of patients and healthcare professionals are better met when care is redefined as mutual endeavour in which the caring abilities of healthcare professionals and the vulnerability of chronically ill patients are taken into account. (shrink)

This project draws on scholarship of feminist and womanist scholars, and on results of interviews with scientists currently involved in molecular genetics. With reference to Margaret Urban Walker's “practices of moral responsibility,” the social practices of molecular geneticists are exphred, and strategies identified through which scientists negotiate their moral responsibilities. The implications of this work for scientists and for feminists are discussed.

Disputes about theory in bioethics almost invariablyrevolve around different understandings of morality or practicalreasoning; I here suggest that the field would do well to becomemore explicitly contentious about knowledge, and start the taskof putting together a clinical epistemology. By way of providingsome motivation for such a discussion, I consider two cases ofresistance to shifts in clinical practice that are, by and large,not ethically controversial, highlighting how differentconceptions of epistemic authority may contribute to clinicians'unwillingness to adopt these changes, and sketching out (...) someinitial suggestions for epistemic analysis of clinical practice. (shrink)

In clinical moral decision making, emotions often play an important role. However, many clinical ethicists are ignorant, suspicious or even critical of the role of emotions in making moral decisions and in reflecting on them. This raises practical and theoretical questions about the understanding and use of emotions in clinical ethics support services. This paper presents an Aristotelian view on emotions and describes its application in the practice of moral case deliberation.According to Aristotle, emotions are an original and integral part (...) of (virtue) ethics. Emotions are an inherent part of our moral reasoning and being, and therefore they should be an inherent part of any moral deliberation. Based on Aristotle's view, we examine five specific aspects of emotions: the description of emotions, the attitude towards emotions, the thoughts present in emotions, the reliability of emotions, and the reasonable principle that guides an emotion. We then discuss three ways of dealing with emotions in the process of moral case deliberation. Finally, we present an Aristotelian conversation method, and present practical experiences using this method. (shrink)

Emotions play an important part in moral life. Within clinical ethics support (CES), one should take into account the crucial role of emotions in moral cases in clinical practice. In this paper, we present an Aristotelian approach to emotions. We argue that CES can help participants deal with emotions by fostering a joint process of investigation of the role of emotions in a case. This investigation goes beyond empathy with and moral judgment of the emotions of the case presenter. In (...) a moral case deliberation, the participants are invited to place themselves in the position of the case presenter and to investigate their own emotions in the situation. It is about critically assessing the facts in the case that cause the emotion and the related (moral) thoughts that accompany the emotion. It is also about finding the right emotion in a given situation and finding the right balance in dealing with that emotion. These steps in the moral inquiry give rise to group learning. It is a process of becoming open towards the perspectives of others, leading to new insights into what is an appropriate emotion in the specific situation. We show how this approach works in moral case deliberation. A physician presents a situation in which he is faced with a pregnant woman who is about to deliver multiple extremely premature infants at the threshold of viability. The moral deliberation of the case and the emotions therein leads to the participants’ conclusion that “compassion” is a more adequate emotion than “sadness”. The emotion “sadness” is pointed towards the tragedy that is happening to the woman. The emotion “compassion” is pointed towards the woman; it combines consideration and professional responsibility. Through the shift towards compassion, participants experienced more creativity and freedom to deal with the sad situation and to support the woman. The paper ends with an analysis and reflection on the deliberation process. In the conclusion we argue for more attention to emotions in clinical ethics support and offer some directions for doing this in the right way. (shrink)

In this paper, we argue that ‘good care’ in residential nursing homes is enacted through different care practices that are either inspired by a ‘professional logic of care’ that aims for justice and non-maleficence in the professional treatment of residents, or by a ‘relational logic of care’, which attends to the relational quality and the meaning of interpersonal connectedness in people’s lives. Rather than favoring one care logic over the other, this paper indicates how important aspects of care are constantly (...) negotiated between different care practices. Based on the intricate everyday negotiations observed during an ethnographic field study at an elderly nursing home in Germany, the paper puts forth the argument that care is always a matter of tinkering with different, sometimes competing ‘goods’. This tinkering process, which unfolds through ‘intuitive deliberation’, ‘situated assessment’ and ‘affective juggling’ is then theorized along the conceptualization of a ‘practical ethics of care’: an ethics which makes no a priori judgments of what may be considered as good or bad care, but instead calls for momentary judgments that are pliable across changing situations. (shrink)

In his 1987 paper “Truth or Consequences,” Dan Brock describes a deep conflict between the goals and virtues of philosophical scholarship and public policymaking: whereas the former is concerned with the search for truth, the latter must primarily be concerned with promoting good consequences. When philosophers are engaged in policymaking, he argues, they must shift their primary goal from truth to consequences—but this has both moral and methodological costs. Brock’s argument exemplifies a pessimistic, but not uncommon, view of the possible (...) shape and nature of applied philosophy. The present paper paints a richer and more optimistic picture. It argues that the difference between theoretical philosophy and applied philosophy is not best understood as a choice between truth and consequences. On the contrary, applied philosophers engage in forms of truth‐seeking that are properly concerned with consequences—including the consequences of philosophical practice itself. (shrink)

O artigo tem como objetivo inicial apresentar, a partir de um panorama geral, alguns elementos centrais da concepção de moral no pensamento de Simone de Beauvoir, bem como suas articulações com outros conceitos pertinentes. A partir disso, pretende-se considerar determinadas apropriações e críticas de teóricas feministas recentes, buscando avaliar as possíveis contribuições do pensamento de Beauvoir à filosofia moral de viés feminista.

At no time in recent decades has more attention been paid to ethical issues in pregnancy. Particularly riveting—and alarming, to many—was the passage of Senate Bill 8, a Texas law banning abortion...

I argue for the merits of studying historical moral revolutions to inform moral and political philosophy. Such a research program is not merely of empirical, historical interest but has normative implications. To explain why, I situate the proposal in the tradition of naturalized epistemology. As Alison M. Jaggar and other scholars have argued, a naturalistic approach is characteristic of much feminist philosophy. Accordingly, I argue that the study of moral revolutions would be especially fruitful for feminist moral and political philosophers.

Implicit in feminist and other critiques of ideal theorizing is a particular view of what normative theory should be like. Although I agree with the rejection of ideal theorizing that oppression theorists (and other theorists of justice) have advocated, the proposed alternative of nonideal theorizing is also problematic. Nonideal theorizing permits one to address oppression by first describing (nonideal) oppressive conditions, and then prescribing the best action that is possible or feasible given the conditions. Borrowing an insight from the "moral (...) dilemmas debate"— namely that moral wrongdoing or failure can be unavoidable—I suggest that offering (only) action-guidance under non-ideal conditions obscures the presence and significance of unavoidable moral failure. An adequate normative theory should be able to issue a further, non-action-guiding evaluative chim, namely that the best that is possible under oppressive conditions is not good enough, and may constitute a moral failure. I find exclusively action-guiding nonideal theory to be both insufficiently nonidealizing (because it idealizes the moral agent by falsely characterizing the agent as always able to avoid moral wrongdoing) and meanwhile too strongly adapted to the nonideal (because normative expectations are lowered and detrimentally adapted to options that, while the best possible, are still unacceptable). (shrink)