Joan Tronto’s new paradigm of caring democracy bases citizenship on the need to ensure that all people receive and provide care equitably. But how exactly are citizens motivated to take up these caring responsibilities? The writings of Alcoholics Anonymous (AA) co-founder William ‘Bill’ Wilson provide one answer: he pathologizes the alcoholic – dooming him to inevitable relapse and death – to compel AA members to accept shared vulnerability and mutual care as the bedrock of sobriety and AA society. (...) Wilson returns repeatedly to the threat of death to convince AA members to carry out their newfound caring and democratic responsibilities. We use Wilson’s thinking, as well as Michel Foucault’s work on biopower, to forward the concept of biocaring democracy, in which the acceptance of shared pathology compels people to care for each other but also limits their democratic responsibilities. More broadly, our analysis suggests how hinging democracy to shared vulnerability may constrain the radical possibilities that Tronto envisions. (shrink)

The essence of caring for those in need of help consists in a certain relationality, in giving and receiving a certain relationship. The relationship as such is the protagonist of the care. Material help is always necessary, at least for the time it has to be dedicated. However, the material aspect takes on meaning from the relationship between the one who helps (caregiver) and the one who receives the help (care receiver). It is a lifeworld relationship. What is (...) lacking in today’s society is not so much material and technological resources, but rather the relational skills of welcoming, supporting and socially integrating people in difficulty. The care of the Other is increasingly entrusted to new technologies and impersonal welfare mechanisms, while interpersonal social relationships become increasingly weak, liquid and unavailable. The consequences are evident in the loss of social solidarity and in the degradation of the human condition. Situations of need due to fragility, hardship, marginalization are spreading. We need a social change, first of all cultural, which brings out, rather than concealing, the relational character of human needs and, correlatively, of the necessary response. (shrink)

Definition of the problem The COVID-19 pandemic poses a considerable challenge to the capacity and functionality of intensive care. This concerns not only resources but, above all, the physical and psychological boundaries of nursing professionals. The question of how care for others and self-care of nurses in intensive care units are related to each other in the context of the COVID-19 pandemic has not been addressed in public and scientific discourse so far. Arguments The present (...) contribution reflects this relationship with reference to the Code of Ethics of the International Council of Nurses, particularly considering principlism and the Care Ethics according to Joan Tronto. As a result, it shows a corridor of ethically justifiable care with several borders, above all: self-care must not be given up completely for the benefit of care for others, and a categorical subordination of care for others to self-care is ethically not justifiable. Conclusion The article makes an important contribution to a differentiated ethical consideration of the rights and responsibilities of intensive care nurses as moral actors within the pandemic in Germany. It, thus, provides a first starting point for a broad social and political discourse which is urgently needed not only during but also after the pandemic in order to improve the situation of intensive care nurses and those who are cared for. (shrink)

To mitigate the potentially devastating effects of the COVID-19 pandemic, it is vital to identify psychosocial and moral resources. The care, preservation, protection, and well-being of social communities are attributes of prosocial behavior that can be such a resource. The purpose of the study is to identify the features of prosocial orientation of Russian youth during the COVID-19 pandemic, as well as to identify strategies for prosocial behavior during the COVID-19 pandemic. The sample consisted of 447 people. The study (...) was conducted in May 2020 in the form of an online survey of subjects using Google Forms (“Moral Foundations Questionnaire method” and “Portrait Values Questionnaire”). The research made it possible to establish that Russians were dominated by norms of care, fairness, purity; values of benevolence-universalism, security, and self-direction. During the COVID-19 pandemic, the prosocial orientation of Russians may manifest itself in the following behavioral strategies: proactive prosocial strategy of “caring for others” (true altruism, expressed in forms of volunteering, helping a stranger, and charity despite the risk of contracting a coronavirus infection); egoistic strategy of prosocial behavior “self-care through caring for others” (volunteering based on self-development; helping a stranger to improve your own psychological well-being); conventional prosocial strategy “self-care” (self-isolation and preventive behavior). In the long run, it is necessary to identify personal and environmental resources that allowed people to effectively implement a prosocial self-isolation strategy during the COVID-19 pandemic, as well as various forms of volunteerism. (shrink)

Special volume of "Thaumàzein - Rivista di Filosofia" dedicated to the theme of Socratic Eudaimonia and care for others. It is a multilingual volume comprising twenty papers divided into six sections with an introduction by Linda Napolitano. Edited by Santiago Chame, Donald Morrison, and Linda Napolitano. -/- Despite the appearances given by certain texts, the moral psychology of Socrates needs not imply selfishness. On the contrary, a close look at passages in Plato and Xenophon (see Plato, Meno 77-78; (...) Protagoras 358; Gorgias 466-468; Euthydemus 278; Lysis 219; Xenophon, Memorabilia III 9, 4-5) suggests that the “egoist”’s welfare depends upon the welfare of others (i.e. family, friends or the whole city). Since the welfare of his family, friends and city is part of his own eudaimonìa, the “egoist” (phìlautos) has a direct and intrinsic motive to promote the welfare of these others. -/- This multilingual issue explores the role that other peoples’ welfare plays in Socratic ethics. Special attention is paid to test-cases in which the principle that moral action is always good only for the agent seems to have no validity. I.e., under which circumstances is the self-sacrifice for the sake of others (such as the soldier’s self-sacrifice on the battlefield) good for the agent (as in Alcibiades I 115a-116d)? Essays deal with contradictions or tensions of this sort, and relate them to more general views on eudaimonìa held within Socratic literature. Comparison between different Socratic authors is used as a means to identify the distinctive features of Socratic eudaimonìa if compared to other Greek theories of happiness, such as the Aristotelian theory of philautìa (NE IX, 1166a-1166b; 1168a-1169b). (shrink)

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

Caring for Liberalism brings together chapters that explore how liberal political theory, in its many guises, might be modified or transformed to take the fact of dependency on board. In addressing the place of care in liberalism, this collection advances the idea that care ethics can help respond to legitimate criticisms from feminists who argue that liberalism ignores issues of race, class, and ethnicity. The chapters do not simply add care to existing liberal political frameworks; rather, they (...) explore how integrating dependency might leave core components of the traditional liberal philosophical apparatus intact, while transforming other aspects of it. Additionally, the contributors address the design of social and political institutions through which care is given and received, with special attention paid to non-Western care practices. This book will appeal to scholars working on liberalism in philosophy, political science, law, and public policy, and it is a must-read for feminist political philosophers. (shrink)

This book describes constructive realism in the intercultural world.

Caring can be viewed as a set of specific activities and relations in the context of health care, social solidarity and interpersonal relations. On the other hand, caring can also be considered as a general attitude and structure of all our activities. Martin Heidegger developed an ontological analysis of “Sorge” as the foundational structure of our being in the world. The paper explains Heidegger’s concept of “Sorge” and confronts it with the criticism of Emmanuel Levinas who formulates an alternative (...) view on caring as responsibility for the vulnerability of the other. Vulnerability is a key notion to understand caring as an ethical and non paternalistic relation to all beings. The paper applies the notions of caring and vulnerability to the sphere of economics. It distinguishes between caring as philanthropy and caring as relational economy. Today, civil economy is represented in different types of cooperative entrepreneurship, but its potential is not restricted to specific juridical forms of cooperation. All types of entrepreneurship based on trust and cooperation imply a logic of caring that precedes and corrects the logic of profit maximization. (shrink)

During the last decades there has been an upsurge in research on xenophobic populist parties, mirroring their political successes. In the Swedish context, characterised by neoliberal restructuring, issues of ‘race’, citizenship and belonging have been important elements of the public debate. These issues have unfolded in parallel with the presence of a neo-Nazi social movement and the emergence of two new parliamentary parties in which cultural racism has been central. Research has especially focused on the xenophobic content and how to (...) relate these parties to the wider research on party politics in western liberal democracies. While there have been some studies focusing on gendered differences in voting and activism highlighting the peripheral role of women, there are still very few studies analysing the worldview of women active in these parties, and the role of gender as metaphor, identity and policy within these parties. Inspired by feminist, postcolonial and Marxist research, the authors of this article are interested in analysing the worldview of women activists. The material is composed of 20 in-depth interviews with female Sweden Democrat politicians complemented by party texts and participant observation. The aim of the article is to explore how women within a Swedish version of these parties, the Sweden Democrats, name and reflect upon their experiences, especially focusing on how a care rhetoric is used in their narratives. These women have chosen to represent a racist party. What inspires them? What visions of gender evolve from their worldview? (shrink)

Ferrarese develops our thinking about the social conditions of caring for others, while arguing for an understanding of morality that is materialist and political - always-already political.

We care for our own future experiences. Most of us, trivially, would rather have them pleasurable than painful. When we care for our own future experiences we do so in a way that is different from the way we care for those of others (which is not to say that we necessarily care more about our own experience). Prereflectively, one would think this is because these experiences will be ours and no one else's. But then, (...) of course, we need to explain what it means to say that a future experience will be mine and how knowledge of this fact renders it rational for me to care for this experience in a special way. Indeed most philosophers take this route. But in doing so, they quickly stumble on insuperable problems. I shall argue that the problem of egocentric care, as it is sometimes called, can be solved by turning things upside down: it is much more fruitful to think that the special kind of care we feel for some future experiences (and not others) is part of what makes them ours should they occur. This requires an explanation of egocentric care for future experiences that does not draw in a theory of personal identity, but rather contributes to one. I will attempt to provide this explanation by making use of the idea of a diachronic mental holism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Caring for Landscapes of Justice in Perilous Settler EnvironmentsMishuana Goemanindians are the "singing remnants" or "graffiti," in the words of Leanne Betasamosake Simpson ("i am graffiti"). The forms this graffiti takes, our inscriptions on the landscape, are as numerous as our Nations, abundant as our ancestors who loved, lived, and passed down knowledge of our lands and histories. "You are the result of the love of thousands," writes Linda (...) Hogan, who beseeches us to listen to the environment surrounding us (159). Deborah Miranda (Coastal Esselen and Chumash) reminds us that we are also the result of violent histories, in her tribal memoir Bad Indians, a book that relishes the tales of her ancestors who resist and act out to survive. This harm, genocide, and settler mapping of worlds also must be attuned to in our surroundings and in "our bodies [that are] bridges over which our descendants cross, spanning unimaginable landscapes of loss" (Miranda 74). Visual cartographic mapping has been part and parcel of the erasure of California Indians, relegated to the small, contained, and past temporal space of a romanticized mission.This paper centers on the NDN Collective's work and the photography of Cara Romero's project Tongvaland and the works of Gabrielino Tongva artist Mercedes Dorame. The setting of these projects is in the sprawling landscape of Los Angeles, or the homelands of the Gabrielino Tongva people, who call it Tovaangar. I will examine the anti-colonial aesthetics and care practices mapped out in the work rather than presenting a "true" Indigenous map or alternative map. Mapping a history of the landscape by creating a "new" narrative or "true" narrative is not enough. As Maori scholar Linda Tuhwi Smith states, "[w]e believe that history is also about justice, that understanding history will enlighten our decisions about the future. Wrong. History is also about power. In fact, history is mostly about power. … [A] thousand accounts of the truth will not alter the fact that indigenous peoples are still marginal [End Page 50] and do not possess the power to transform history into justice" (34). The Gabrielino Tongva, who comprise an estimated 2,300 people, do not possess the population power and cannot access the form of voting or democracy to make the changes needed just by telling their truth. Across California, people know about the raw deal, the embezzlement, the genocide, and the so-called lost treaties. In fact, under Eisenhower, recompense was paid out in small amounts to Tongva families of the dispossessed. Instead, to continue with the words of Smith, "[i]t is also about reconciling and reprioritizing what is really important about the past with what is important about the present" (111). What Romero and the NDN Collective—made up of numerous tribal leaders, scholars, and other artists—did was relay and prioritize how they wanted to be seen in their homelands. These billboards invite us in, in a gift of sharing, or what tribal cultural leader Craig Torres related to me as a spirit of Maxxa, a sharing, gifting, or swapping of knowledge. Dorame's beautiful and critical installations in public art spaces reflect Maxxa—they invite the viewers to think through land from her curious arrangements. As artists, part of their practice is not that of a Western version of a tortured genius but instead is energized by pulling in community and creating a collective practice. They undo settler space together and with us. The cartographic practices of these California Indians' creative arts exemplify communities of care that must be considered when we think through the unmapping of settler terrains. This question requires an approach of radical care. As Hi'ilei Hobart and Tamara Kneese make clear, the notion of care is "inseparable from systemic inequalities and power systems" (Hobart and Kneese 1).The work of the NDN Collective and Dorame counters a settler-based, commercial map of Los Angeles. Indigenous people, relegated by the settler state as expendable and erasable graffiti, confront capitalist and state ordinances at various scales. Rather than understand this as a subjugated positionality, I posit that graffiti is the critique necessary and valuable to understanding interlocking structures of oppression. In the following words of Leanne... (shrink)

Inequalities in expectations to receive care permeate social structures, reinforcing racialized and gendered hierarchies. Harming the people who are overburdened and disadvantaged as caregivers, these inequalities also shape the subjectivities and corporeal habits of the class of people who expect to receive care from others. With three examples, I illustrate a series of justificatory asymmetries across gender and racial lines that illustrate asymmetries in deference and attendance to the needs of others as well as assertions of (...) the rightful occupation of space. These justificatory asymmetries are cogent reasons to evaluate the justice of caregiving arrangements in a way that tracks data about who cares for whom, which can be understood by the concept of the arrow of care map. I suggest, therefore, that the arrow of care map is a necessary component of any critical care theory. In addition, employing a method called living counterfactually, I show that when women of color assert full claimant status, we are reversing arrows of care, which then elicits resistance and violence from varied actors in the real world. These considerations together contribute to further defense of the theory of liberal dependency care’s constructivism, which combines hypothetical acceptability with autonomy skills in the real world. Each level, in turn, relies on the transparency of care practices in the real world as enabled by the arrow of care map. (shrink)

This essay responds to Donna J. Haraway's (2016) provocation to ‘stay with the trouble’ of learning to live well with nonhumans as kin, through practice-based approaches to learning to care for nonhuman others. The cases examine the promotion of care for trees through mobile game apps for forest conservation, and kinship relations with city farm animals in Kentish Town, London. The cases are analysed with a view to how they articulate care practices as a means of (...) making kin. Two concepts are proposed, ‘learning from’ and ‘facing’ the Other, which are thickened through discussions of how caring takes place in each case in relation to a particular category of nonhuman other: animated tree and urban farm animal. Thus while attendant to situations of care involving a specific nonhuman subject, the cases also broker thinking on learning from and facing (the) other kinds of trees and animals, and the interspecies dynamics of which they are a part. The intersectional implications of the practice sites and participants are elaborated, to complexify and affirm situated but also reflexive approaches to caring. In doing this, the authors attend to their own positionalities, seeking to diversify Western-based ecofeminist engagements with caring, while asking what their research can do for the nonhuman other. They formulate and apply a collaborative methodological approach to the case studies, developed through cultivating attentiveness to the nonhuman subject of research. The authors consider in particular how attentiveness to the nonhuman other can facilitate practices of knowing that further a non-anthropocentric and non-innocent ethic of caring. By further interconnecting situations of caring for nonhuman animals and plants, the authors advocate for practices of care that antagonise how species boundaries are drawn and explore the implications for learning to care for nonhumans as kin. (shrink)

Introduction Compulsory care is controversial, since respect for the patient’s autonomy is a standard requirement in health care. Many psychiatrists have experienced that patients with borderline personality syndrome sometimes demand compulsory care for themselves in order not to exert self-harm—like Ulysses contracts. The aim of this study was to examine the possible existence and extent of borderline personality syndrome-patient demands for Ulysses contracts regarding compulsory care in acute psychiatry, and how external influences and demands could affect (...) the caregivers’ decisions about compulsory care. Method An anonymous questionnaire, with three questions with fixed answers, was distributed to 42 licensed medical doctors on call at the psychiatric emergency unit in the city of Stockholm. Thirty-three questionnaires were answered, giving a response rate of 79%. Results Ninety-four percent of the respondents recognized the phenomenon of borderline personality syndrome patients requesting compulsory care, 21% stated that this request had affected their clinical decision, and 55% had used compulsory care for other reasons than the patient’s best interest. Discussion The results indicate that compulsory care is sometimes given in the form of Ulysses contracts for borderline personality syndrome patients. Also, compulsory care is sometimes used for other reasons than the borderline personality syndrome patient’s best interest. Psychological mechanisms affect the decisions of both patients and caregivers. More research should be done concerning to whom, why, and with what consequences compulsory care is prescribed. (shrink)

This paper primarily aims at conceptualizing a new philosophical approach to literature education, one that we—in the vein of certain pedagogical trends—propose to call “thing-centered”. Point of departure is the ongoing confrontation with a two-sided educational problem: on the one hand, the confrontation with the steady decline of younger generations’ engagements with ‘classical’ literature; on the other hand, that with the unsatisfactory answers which either accept this development, in light of the world’s irresistible digitization, or try overcoming it through a (...) more student-centered, ‘biographical’ appropriation of literature. Beyond the more immediate didactical difficulties which this two-fold problem poses, we ask ourselves the question whether it is not time for a more fundamental renewal of our understanding of literature’s contemporary educational significance. In answering this question, for which we turn to such diverse authors as Rousseau, Deleuze and Calvino, it is argued that if education is to continue its care for both classical literacy and literary classics—and not so much against as in relation to ascending digital literacies—a more radically immanent, thing-centered perspective is likely to prove the most sustainable, in the sense of enabling truly new, ‘care-ful’ literary-educational practices to emerge. (shrink)

This pastoral-theology-based reflection on hospital chaplaincy, set within the horizon of the pastoral situation of Germany in the post-secular (!) age, introduces the perspective of a consolation-oriented ministry, as this was developed by Ignatius of Loyola. Such a pastoral care for the sick, as integrated into the basic offices of the church, presents a graded model for action: while human accompaniment is offered to all, spiritual ministry is restricted, but realized in an ecumenically encompassing sense. Spiritual and ritual (...) class='Hi'>care for members of other religions, while these members are to be addressed according to the principles laid down by Vatican II, is severely limited for reasons of identity and alterity. In all cases, however, Christianity is presented as “therapeutic religion”. (shrink)

In the mid-nineteenth century, healthcare delivery began transitioning from an individual, private payment model to a third-party payment model, dominated by the insurance industry. During the same time, productivity shifted from a transformational model, centered on the provider-patient relationship, to a transactional model, based on the distribution of services. The emergence of medical insurance and other third-party payers removed providers and patients from discussions about treatment plans, payment, and risk. This resulted in a weakening, if not fracturing, of the provider-patient (...) relationship. All healthcare providers enter their profession to care for people, yet what has most frequently been lost in the transformed relationship over the past century is context, communication, and trust—all elements of a relational ethic, or what ethicist and psychologist Carol Gilligan first described as, “the ethics of care.” This loss of relationality has led to a model of healthcare delivery that is fractured, isolated, and uncoordinated, with an epidemic of medical errors that by some estimates results in the death of approximately 400,000 individuals per year. Thus far, isolated foci on patient quality, outcomes, and safety have been feckless and unimpressive. However, new advanced payment models, such as value-based purchasing and patient-centered medical homes, have the potential to reduce medical error by addressing its root cause. In linking payment to factors such as context, communication, and trust, they bring relationality back into the healthcare system. This essay traces the historic devolution of the provider-patient relationship and the promise of new payment models to restore it. (shrink)

The future of work has become a pressing matter of concern: Researchers, business consultancies, and industrial companies are intensively studying how new work models could be best implemented to increase workplace flexibility and creativity. In particular, the agile model has become one of the “must-have” elements for re-organizing work practices, especially for technology development work. However, the implementation of agile work often comes together with strong presumptions: it is regarded as an inevitable tool that can be universally integrated into different (...) workplaces while having the same outcome of flexibility, transparency, and flattened hierarchies everywhere. This paper challenges such essentializing assumptions by turning agile work into a “matter of care.” We argue that care work occurs in contexts other than feminized reproductive work, namely, technology development. Drawing on concepts from feminist Science and Technology Studies and ethnographic research at agile technology development workplaces in Germany and Kenya, we examine what work it takes to actually keep up with the imperative of agile work. The analysis brings the often invisibilized care practices of human and nonhuman actors to the fore that are necessary to enact and stabilize the agile promises of flexibilization, co-working, and rapid prototyping. Revealing the caring sociotechnical relationships that are vital for working agile, we discuss the emergence of power asymmetries characterized by hierarchies of skills that are differently acknowledged in the daily work of technology development. The paper ends by speculating on the emancipatory potential of a care perspective, by which we seek to inspire careful Emancipatory Technology Studies. (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)

In this essay, I argue that care ethics faces a fundamental challenge in addressing structural vulnerabilities. I argue that one of its main strengths – its focus on alleviating individuals’ material needs – also generates a weakness regarding one of its other key aims – namely, respecting the voice of the concrete other. As a result, I will argue that a full application of care ethics in response to structural vulnerabilities must moderate or supplement its focus on material (...) needs. (shrink)

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of (...) advance directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)

Eva Feder Kittay's Learning from My Daughter: The Value and Care of Disabled Minds is poised to make a major contribution to the disability literature and is likely to spark controversy among disability scholars. The book's central contribution is the articulation of an ethics of care for meeting the “genuine needs” and “legitimate wants” of people with disabilities or chronic illnesses. We applaud Kittay, who is the mother of a woman with cerebral palsy who has multiple physical and (...) intellectual impairments, for sharing her story in such an eloquent, accessible, and personal manner. The question remains, however, as to whether Kittay's normative theory of care captures the ethical obligations that should exist between the carer and the cared‐for. In demanding that the cared‐for include the carer as a participant in all their interactions with others, Kittay conceptualizes what paid caregiving relationships should look like in a way we find misguided. (shrink)

Two potentially lifesaving protocols, emergency preservation and resuscitation and uncontrolled donation after circulatory determination of death, currently implemented in some U.S. emergency departments, have similar eligibility criteria and initial technical procedures, but critically different goals. Both follow unsuccessful cardiopulmonary resuscitation and induce hypothermia to “buy time”: one in trauma patients suffering cardiac arrest, to enable surgical repair, and the other in patients who unexpectedly die in the ED, to enable organ donation. This article argues that to fulfill patient-focused fiduciary obligations (...) and maintain community trust, institutions implementing both protocols should adopt and publicize policies to guide ED physicians to utilize either protocol for particular patients, in order to address the appearance of conflict of interest arising from the protocols' similarities. It concludes by analyzing ethical implications of incentives that may influence institutions to develop the expertise required for uDCDD but not EPR. (shrink)

This paper has five aims: it clarifies the nature of esteem and of the related notions of admiration and reputation ; it argues that communities that possess practices of esteeming individuals for their intellectual qualities are epistemically superior to otherwise identical communities lacking this practice and that a concern for one's own intellectual reputation, and a motivation to seek the esteem and admiration of other members of one's community, can be epistemically virtuous ; it explains two vices regarding these concerns (...) for one's own intellectual reputation and desire for esteem: intellectual vanity and intellectual timidity ; finally, it offers an account of some of the epistemic harms caused by these vices. (shrink)

The contemporary emphasis on vulnerability and interdependence stresses the ethical necessity of a critical care concept to undermine the individualistic paradigm of autonomy and the modern understanding of well-being regarding individual self-achievement and world mastery. This paper analyzes how the philosophical investigation of vulnerability has led to an existential, social, and ethical reflection that brought to light a fundamental interdependence among living beings. This chapter examines the nature of this interdependence and the type of relations involved in these dynamics. (...) The author argues that caring for the living involves a holistic approach of the human being that considers not only the plurality of her interpersonal relations but also her relation to the environment and her relation to her ‘self’ as a person with rights and responsibility. Moreover, speaking of interdependence also implies examining the philosophical understanding of our modern concepts of nature and culture along the lines of a philosophical critique of the immunity paradigm and cultural biology anew. Drawing on phenomenological ethics, this chapter shows that the concept of responsibility that stems from this renewed understanding of interdependence implies an ethics based on responsiveness and responsibility that articulates the dignity of human beings as persons with the care for the living they demonstrate in the ‘forms of life’ they inhabit with others. It bears consequences for contemporary issues in bioethics, such as caring for vulnerable people or determining the moral standing of our relations. (shrink)

SCHOFIELD I, TOLSON D and FLEMING V. Nursing Inquiry 2012; 19: 165–176 [Epub ahead of print]How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse AnalysisDelirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease‐based classification systems and clinical guidelines. There is (...) little systematic study of nurses’ day‐to‐day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses’ care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses’ language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person‐centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion. (shrink)

Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the (...) United States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their “experience in the NICU.” Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects. (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.

Background:When the contagious COVID-19 spread worldwide, the frontline staff faced unprecedented excessive work pressure and expectations of all of the society.Objective:The aim was to explore healthcare workers’ stress and influencing factors when caring for COVID-19 patients from an altruistic perspective.Methods:A cross-sectional, descriptive study was conducted in a tertiary hospital during the outbreak of COVID-19 between February and March 2020 in Wuhan, the capital city of Hubei province in China. Data were collected from 1208 healthcare workers. Descriptive statistics and multiple linear (...) regression were used to analyze the data.Ethical considerations:Research ethics approval (with the code of TJ-IRB20200379) was obtained from Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology. Written informed consent was also received from participants.Results:Less than 60% of participants chose moderate or severe stress on all stressors, indicating a low stress level among healthcare workers. The main source of stress among frontline healthcare workers caring for COVID-19 patients came from the fear of being infected, the fear of family members being infected, and the discomfort caused by protective equipment. Frontline staff who were nurses, were married, and had worked more than 20 days suffered higher stress, whereas rescue staff showed lower stress.Conclusion:The healthcare workers caring for patients with COVID-19 had low stress level, although they still had the fear of being infected or uncomfortable feeling caused by personal protective equipment. A low stress level among healthcare workers indicated their professional devotion and altruism during COVID-19 epidemic. Medical institutions and the government should continue to strengthen infection prevention measures and provide more comprehensive care involving families of frontline healthcare workers, especially nurses and married staff. It will be a lesson to other countries that awaking healthcare workers’ inside motivation and providing necessary support from government and society were significant. (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)

Background The worldwide increase in older persons demands technological solutions to combat the shortage of caregiving and to enable aging in place. Smart home health technologies (SHHTs) are promoted and implemented as a possible solution from an economic and practical perspective. However, ethical considerations are equally important and need to be investigated. Methods We conducted a systematic review according to the PRISMA guidelines to investigate if and how ethical questions are discussed in the field of SHHTs in caregiving for older (...) persons. Results 156 peer-reviewed articles published in English, German and French were retrieved and analyzed across 10 electronic databases. Using narrative analysis, 7 ethical categories were mapped: privacy, autonomy, responsibility, human vs. artificial interactions, trust, ageism and stigma, and other concerns. Conclusion The findings of our systematic review show the (lack of) ethical consideration when it comes to the development and implementation of SHHTs for older persons. Our analysis is useful to promote careful ethical consideration when carrying out technology development, research and deployment to care for older persons. Registration We registered our systematic review in the PROSPERO network under CRD42021248543. (shrink)

Parents have the autonomous right to choose or refuse a treatment for their child, even those that are life sustaining, if it is extraordinary or disproportionate and it is within the best interest and well-being of their child. Pediatric health care is practiced with the goal of promoting the best interests of the child to do so. Treatment is generally rendered under a presumption in favor of sustaining life. However, in some circumstances, the balance of benefits and burdens to (...) the child leads to an assessment that forgoing life-sustaining medical treatment (LSMT) is ethically supportable or advisable. Input from specialists in palliative care, ethics, pastoral care, and other disciplines enhances support for families and medical staff when decisions to forgo LSMT are being considered. (shrink)

This paper argues for the necessity of universal health care (as well as universal free education) using a different argument than most that have been made heretofore. It is not meant to conflict with but to strengthen the arguments previously made by others. Using the second paragraph of the Declaration of Independence and the Preamble to the Constitution we argue that universal health care in this day and age has become a necessary condition if the ideals of (...) life, liberty and the pursuit of happiness are to be more than an empty promise and if the discussion of “promoting of general welfare” in the preamble is to have any meaning. (shrink)

As human longevity increases, with people living well into their seventies and eighties, the need for long-term care for the elderly most certainly will grow. The longer people live, the more likely they fall prey to chronic disease, as well as to the standard toll the aging process takes on human bodies and psyches. In this article, I examine some of the concerns that a wide variety of governments, individuals, and families have expressed about meeting the long-term care (...) needs of large numbers of people over sixty-five. I then claim that each of these groups must do its share of long-term care for the elderly, depending on its ability to do so. Finally, I conclude that the more committed a country is to the deconstruction of ingrained notions about who should care and who should work, the more able it will be to meet the long-term care needs of the elderly and other vulnerable populations fairly. (shrink)

Over the last fifty years a plethora of new spiritual practices has emerged in the Church of Sweden. Many fall within a category of holistic practices, aimed at engaging body, soul, and spirit. Among these, two categories are dominant: meditations and movement-based bodily practices. Some of these practices are contested by other Christians on a theological basis. The article asks: Who are the new ritual specialists teaching these practices? Why do they teach these practices? Why in the church? By using (...) a bottom-up perspective and studying practices which lie outside the traditional Christian religious rites, which has been the focus in research on the Church of Sweden, we find that the holistic practices are framed in a culture of care, focusing on bodily and spiritual wellbeing. We suggest that the predominance of women in body-movement practices should be understood as a generational feature rather than as an expression of the feminization of the church. Many of the leaders are women who were part of new spiritual movements as well as body-mind practices and various forms of dance in gyms and yoga studios in the 1990s and early 2000s, finding an openness to bringing their knowledge into the church. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pride in Giving Care and Other Life Lessons from Certified Nursing AssistantsDelese WearMy father spent the last three weeks of his life in a hospice care facility. It's funny, now reading these narratives written by Certified Nursing Assistants (CNAs), that I can't picture him without Gloria, the CNA who worked the 7-3 shift, floating quietly in and out of his room, tending to him, tending to us, (...) speaking quietly to Dad even when he was no longer conscious, offering us conversation, often her affectionate observations of Dad and curiosity about his life, sometimes about life on the "outside," a kind of respite from total attention on Dad and our grieving. I remember the smell of the lotion she rubbed on his body. I remember no other caregivers in his room; there obviously were, but I can't picture them now, only Gloria. We never spoke directly to the medical director of the hospice. He was a phantom, rounding at 5 or 6 a.m.; we came to believe he did so to avoid speaking to families.Those three weeks led to my conceptions about CNAs—the nature of the work they do, the kinds of people who do such work, the awesome responsibilities involved in such work, and not least, the physical and emotional resiliency of those who undertake such work. My and my family's often recited, "How does she do this every day?" was answered time and again in the narratives written by CNAs in this issue of the journal.But before moving forward, I want to make note of how I will refer to the authors of these narratives. The name of one's occupation, the title one uses, and how others refer to your occupation, is obviously meaningful. If the snapshots of CNAs provided in these narratives are somewhat representative, we find those who refer to themselves and their occupation as nursing assistants, nurse assistants, Certified Nursing Assistants (CNAs), State Licensed Nursing Assistants (SLNA), or simply aides, to name a few. While it is beyond the space offered here, I want to make note of this, recognizing that titles/labels matter, and to acknowledge that status. As CNA Nanci Robinson notes, "most of us are certified... I wouldn't call an LPN a PN and leave out she's licensed." Passage of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), required each State to establish State-approved nurse aide training programs and establish requirements for nurse aide competency. Thus, I will refer to all the authors here as Certified Nursing Assistants (CNAs). I do wonder how significant of an issue these variations of titles are within the larger nursing assistant culture, and how it may contribute to disparities regarding pay schedules, duties, status, training and other relevant issues among all nursing assistants.In spite of problems, stressors, and other quality of life issues for CNAs, most of them spoke with pride and meaning regarding what was for many their "life's work," similar to what one might expect to find in other care giving occupations. Some spoke of a "love of the work," its "rewards" and "joys," [End Page 165] and the intense satisfaction of "making a difference" in patients' or residents' lives. These attitudes were not vague abstractions but were grounded throughout the narratives in rich examples of the affirming aspects of their work.It appears that much of the pleasure comes from what many refer to as the "hands on," "direct care," or "front line" nature of the work—often what other health professionals might view as things they would not want to do. And of course these other professionals—registered nurses, occupational therapists, and physicians—could make the same claim when describing the "hands-on" joys of their work. But the differences, it would seem, are profound between these other caregivers and CNAs. The CNA narratives report fundamentally intimate and often daily relationships with their clients/residents/patients. Danny Reed describes the "delight" he feels "in restoring dignity to every human in need of it regardless of cause," referring to himself as a "participant observer in a caring relationship," not as a "detached clinician." Many spoke directly... (shrink)

IntroductionThere is a significant disparity in the United States between the health care received by children with special health care needs versus physically healthy children.ObjectiveThe objective of the paper is to show that children with special needs receive less than adequate health care overall. This disparity affects the quality of life for these children and influences their ability to live their lives to their full potential.MethodsResearch was conducted by examining multiple studies with a focus on six major (...) factors that play a role in creating this disparity.ResultsThe findings show an alarming trend in the access and delivery of health care to children with special health care needs.ConclusionsSolutions to correcting the disparities are possible, but it will take a full understanding of the issues, perseverance, dedication, and hard work on the part of families, physicians, legislators, and others genuinely interested in creating an equal health care system for all children. (shrink)

What is the spirit that animates collective action? What is the ethos of democracy? _Worldly Ethics _offers a powerful and original response to these questions, arguing that associative democratic politics, in which citizens join together and struggle to shape shared conditions, requires a world-centered ethos. This distinctive ethos, Ella Myers shows, involves care for "worldly things," which are the common and contentious objects of concern around which democratic actors mobilize. In articulating the meaning of worldly ethics, she reveals the (...) limits of previous modes of ethics, including Michel Foucault's therapeutic model, based on a "care of the self," and Emmanuel Levinas's charitable model, based on care for the Other. Myers contends that these approaches occlude the worldly character of political life and are therefore unlikely to inspire and support collective democratic activity. The alternative ethics she proposes is informed by Hannah Arendt's notion of _amor mundi_, or love of the world, and it focuses on the ways democratic actors align around issues, goals, or things in the world, practicing collaborative care for them. Myers sees worldly ethics as a resource that can inspire and motivate ordinary citizens to participate in democratic politics, and the book highlights civic organizations that already embody its principles. (shrink)

Caring for older persons is both rewarding and consuming. Work with older people in Finland has been shown to be more burdensome than in the other Nordic countries. The aim of this study was to try out a Finnish version of the Stress of Conscience Questionnaire (SCQ) and explore stress of conscience in staff caring for older persons in Finland. The data were collected from the nursing staff (n = 350) working with older people in health centre wards, municipal and (...) private nursing homes, and municipal and private dementia care units in Finland. It emerged clearly from the results that Finnish nursing staff mostly felt that they did not have enough time to provide good care to patients, and this gave them a troubled conscience. They also felt that the demanding work taxed their energy, a consequence being that they could not give their own families and loved ones the attention they would have liked. (shrink)