This is a revised edition of Walker's well-known book in feminist ethics first published in 1997. Walker's book proposes a view of morality and an approach to ethical theory which uses the critical insights of feminism and race theory to rethink the epistemological and moral position of the ethical theorist, and how moral theory is inescapably shaped by culture and history. The main gist of her book is that morality is embodied in "practices of responsibility" that express our identities, values, (...) and connections to others in socially patterned ways. Thus ethical theory needs to be empirically informed and politically critical to avoid reiterating forms of socially entrenched bias. Responsible ethical theory should reveal and question the moral significance of social differences. The book engages with, and challenges, the work of contemporary analytic philosophers in ethics. Moral Understandings has been influential in reaching a global audience in ethics and feminist philosophy, as well as in tangential fields like nursing ethics; research ethics; disability ethics; environmental ethics, and social and political theory. This revised edition contains a new preface, a substantive postscript to Chapter 1 about "the subject of moral philosophy"; the addition of a new chapter on the importance of emotion in practices of responsibility; and the addition of an afterword, which responds to critics of the book. (shrink)

Abstract.This paper critiques particular aspects of the published UK government Department of Health’s proposal to promote ‘The Expert Patient’ as a way of enhancing patient autonomy and reducing reliance on limited health care resources. Although the broad aims of the report are supported the detail is criticised on the basis that lack of clarity over key terms, including ‘expert’ ‘illness’ and ‘disease’, means that there is no clear focus for action and threatens to undermine the effectiveness of the proposals.

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 book contains the unfinished manuscript and working notes of the book Merleau-Ponty was writing when he died.

ABSTRACT This article concentrates on the care for people who suffer from progressive dementia. Dementia has a great impact on a person’s well‐being as well as on his or her social environment. Dealing with dementia raises moral issues and challenges for participants, especially for family members. One of the moral issues in the care for people with dementia is centred on responsibilities; how do people conceive and determine their responsibilities towards one another? To investigate this issue we use the theoretical (...) perspective of Margaret Walker. She states that ideas about identity play a crucial role in patterns of normative expectations with regard to the distribution of responsibilities in daily practices of care. The results of this study show how the identity of a family‐member is put under pressure and changes during her loved one’s illness that leads to difficulties and misunderstandings concerning the issue of responsibility. These results offer an insight into the complexities of actual practices of responsibility and highlight the importance for those caring for people with dementia of attending carefully to how they see themselves and how they see other people involved (Who am I? Who do I want to be for the other?). Answers to such questions show what people expect from themselves and from one another, and how they, at any rate, are distributing responsibilities in a given situation. Professional caregivers should take into account that family members might have different ideas about who they are and consequently about what their responsibilities are. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

Abstract.The United Kingdom Department of Health initiative on “The Expert Patient” (2001) reflects recent trends in political philosophy, ethics and health services research. The overall objective of the initiative is to encourage patients, particularly those suffering from chronic conditions to become more actively involved in decisions concerning their treatment. In doing so there would be (perhaps) an expectation of better patient compliance and (arguably) a resultant improvement in quality of life. Despite these anticipated beneficial influences on health outcomes, there may (...) be a danger that such initiatives are being carried along by the general swell of enthusiasm for recognising and facilitating the claims of disadvantaged or discriminated against groups. What more attractive than that patients should be “liberated” from what might be seen as the oppression of medical paternalism? To a great extent the potential for success of the Expert Patient venture turns on:(a) whether and to what extent a patient can be considered truly to be an expert and (b) full acceptance by the medical and heath care professions of allowing patients a more equitable and positive role.Whilst clearly the patient is an expert in the hermeneutic sense – it is they and they alone who experience their illness – there is nevertheless a risk of confusing experience with expertise. Experience limited to an individual does not of itself give rise to the generalisations that underlie reliable clinical treatment. Neither do the vast majority of patients possess the physiological and pharmacological knowledge to fully appreciate the biological nature of their illness nor the basis, risks or limitations of therapeutic measures. Might the notion of “The Expert Patient” as informed co-decision maker become a well-meaning but rather vacuous aspiration similar to that of informed consent? Even worse, could patient “empowerment” have a deleterious effect? The paper reviews some of the major issues and concludes that the expert patient initiative could have benefits for both patients and health professionals if operated on the basis of concordance: an informed collaborative alliance that optimises the potential benefits of medical care. (shrink)

It is not uncommon that nurses are unable to meet the normative expectations of chronically ill patients. The purpose of this article is to describe and illustrate Walker’s expressive-collaborative view of morality to interpret the normative expectations of two women with multiple sclerosis. Both women present themselves as autonomous persons who make their own choices, but who also have to rely on others for many aspects of their lives, for example, to find a new balance between work and social contacts (...) or to find work. We show that their narratives of identity, relationship and value differ from the narratives that others use to understand and identify them. Since identities, relationships and values give rise to normative expectations, in both cases there is a conflict between what the women expect of their caregivers and vice-versa. The narratives also show that two similar persons with multiple sclerosis may need very different care. This implies that nurses caring for such persons should listen carefully to their stories and reflect on their own perceptions of self. (shrink)

_The Visible and the Invisible _contains the unfinished manuscript and working notes of the book Merleau-Ponty was writing when he died. The text is devoted to a critical examination of Kantian, Husserlian, Bergsonian, and Sartrean method, followed by the extraordinary "The Intertwining--The Chiasm," that reveals the central pattern of Merleau-Ponty's own thought. The working notes for the book provide the reader with a truly exciting insight into the mind of the philosopher at work as he refines and develops new pivotal (...) concepts. (shrink)

First published in 1998. Routledge is an imprint of Taylor & Francis, an informa company.

Contributors are Susan Bordo, Stanley Clarke, Erica Harth, Leslie Heywood, Luce Irigaray, Genevieve Lloyd, Mario Moussa, Eileen O'Neill, Adrianna Paliyenko, Ruth Perry, Mario Sáenz, Karl Stern, Thomas Wartenberg, and James Winders.