Dependencycare is an asymmetric good; everyone needs to receive it, but it is not the case that we all have to provide it. Despite ethicists’ of care’s theorizing about the importance of dependencycare, it has yet to be theorized within a form of liberalism. This paper theorizes two components of a liberal theory of dependencycare. First, it advances a liberal justification to include the receipt of dependencycare among (...) the benefits of social cooperation. Then, it advances an autonomy-based principle to guide how care should be provided (“strong proceduralism”). Strong proceduralism is based on an account of autonomy that incorporates the significance of a person’s skills when he parses options. Strong proceduralism consequently requires educational efforts to teach care-giving skills to groups who have not previously possessed them. I hypothesize that strong proceduralism will secure adequate care provision as the outcome of autonomous choice, but if an inadequate number of people choose to provide care, then a secondary stage of deliberations will be necessary. If the outcome of those secondary deliberations is that people want to have their care needs met, then a fair process for distributing infringements on autonomy must be devised. (shrink)
Because Levinas understands ethical response as a response to the radical alterity of the other, he contrasts it with justice, for which alterity becomes a question of equality. Drawing upon the practice of dependency work and the insights of feminist care ethics, I argue that the opposition between responding to another's singularity and leveling it via parity-based principles is belied in the experience of care. Through a hermeneutic phenomenology of caring for my post-stroke grandfather, I develop an (...) account of dependency work as a material dialectic of embodied response involving moments of leveling, attention, and interruption. Contra much of response ethics’ and care ethics’ respective literatures, this dialectic suggests that they complement each other in ways that productively illuminate themes of each. I conclude by suggesting that when response and care ethics are thought together through the experience of dependency work, such labors produce finite responsibility with infinite hope. (shrink)
How do we theorize the experiences of caregivers abused by their children with autism without intensifying stigma toward disability? Eva Kittay emphasizes examples of extreme vulnerability to overturn myths of independence, but she ignores the possibility that dependents with disabilities may be vulnerable and aggressive. Instead, her work over-emphasizes caregivers' capabilities and the constancy of disabled dependents' vulnerability. I turn to Judith Butler's ethics and her conception of the self as opaque to rethink care amid conflict. Person-centered planning approaches, (...) pioneered by disability rights activists, merge Butler's analysis of opacity with Kittay's work on embodied care, while also inviting a broader network of people to both interpret needs and change communities. By expanding our conceptions of dependency, feminist disability studies can continue the aim of both Kittay and Butler: to humanize unintelligible lives. (shrink)
The fight for emancipation takes place on different levels, and one of them is the level of contemporary financial capitalism as debt-economy. Debt can be a major tool of control and exploitation in that it produces subordinate subjects situated in exchange relations of debt and credit. Recent work on financial debt and the debt-economy has, however, not taken gender adequately into account in philosophical definitions of indebted subjects. Gender analysis discloses how the debtor–creditor relationship is based on a contractarian idea (...) of the indebted subject as an autonomous moral agent, and on a masculine, that is, a-relational understanding of what counts as debt and what does not in the contemporary debt-economy. In contrast to atomistic notions of the subject in liberal, contractarian theories, relational notions of the subject as advanced in care ethics are a better point of departure for capturing the interdependence of subjects within a debt-economy as a core feature of a nonsustainable monetary system. On the basis of such analysis, care ethics also offers means for imagining ways of emancipation from private and public problem credit in order to make financial systems more sustainable and more just. (shrink)
In this review essay, I assess The Subject of Care (eds. Eva Feder Kittay and Ellen K. Feder) as a collection that does compelling work in identifying dependency as a fact of life and demonstrating its importance philosophically. At a minimum, the collection builds a case against four tenets of traditional liberalism, which I shall represent as follows: (Tl) Dependency can be avoided by adults and equals. (T2) Dependency should be avoided by adults and equals. (T3) (...) Independence can be achieved by adults and equals. (T4) Independence should be achieved by adults and equals. The remarkable effect of the volume is the inescapable sense that we are all dependents and that the above four tenets are problematic ideals at best. This raises at least two questions, however. First, it is not clear to me whether I am correct that this is the intended effect; that is, do the contributors mean to make the case that we are all dependents, or merely that dependency is philosophically important? Second, I am interested in determining whether it is correct that we are all dependents; even if the volume does not make this case, perhaps the ideas within could contribute to establishing universal dependency. Both questions hinge on the definition of dependency, which is my focus in this essay. (shrink)
Chapter 1 Introduction This chapter briefly explains what care ethics is, what care ethics is not, and how much work there still is to be done in establishing care ethics’ scope. The chapter elaborates on care ethics’ relationship to political philosophy, ethics, feminism, and the history of philosophy. The upshot of these discussions is the suggestion that we need a unified, precise statement of care ethics’ normative core. The chapter concludes by giving an overview of (...) the chapters to come: Chapters 2 to 5 will each develop concise statement of one of four key care ethical claims, while Chapters 6 to 8 will unify, specify, and justify those four claims under a new principle : the dependency principle. -/- Chapter 2 Scepticism about Principles Care ethicists tend to be sceptical that there is any useful role for general, abstract principles or rule in moral theory and practice. This chapter assesses this scepticism. It argues for the importance of maintaining a distinction between, on the one hand, scepticism about principles as a tool in deliberation, and, on the other hand, scepticism about principles as a ground of moral rightness. It surveys and assesses the statements made by care ethicists against principles. The conclusion is that care ethicists are correct to be somewhat sceptical about the use of principles in deliberation, but that this scepticism should not extend to principles as the source of moral rightness. -/- Chapter 3 The Value of Relationships Amongst care, a special place is often made for personal relationships. This chapter delimits and justifies this. First, it distinguishes three kinds of importance personal relationships are attributed by care ethicists –as moral paradigms, as goods to be preserved, and as sources of weighty duties. Next, it suggests such ‘relationship importance’ is not justified by the nature of personal relationships or the value of their relatives. It concludes that any personal relationship has importance in proportion to the value the relationship has to its participants. Crucially, this source of importance – a relationship’s value to participants – holds also for non-personal relationships. This allows us to understand how care ethics extends relationship importance to our relations with distant others. -/- Chapter 4 Caring Attitudes Care ethics calls upon agents to care about and for others. This chapter focus on the “about” aspect of caring: on caring attitudes. Caring attitudes are defined as pro-attitudes to the fulfilment of some entity’s interests. The moral value of these attitudes—particularly in emotions like love—is elaborated upon. However, attitudes do not seem under our voluntary control, so do not seem to be something we can be morally instructed to bear. This objection is responded to, with the explanation that we have long-term control over our attitudes and that moral theories can legitimately call upon agents to do things they cannot immediately control. Ultimately, then, care ethics’ injunction that agents hold caring attitudes is both defined and vindicated. -/- Chapter 5 Caring Actions This chapter starts by comparing and assessing the numerous definitions of care found in care ethics literature—distinguishing care, good care, bad care, and non- care. Caring actions are defined as having the intention to fulfil something’s perceived interests. The moral value of such actions is interrogated and found to be a combination off the intention’s value and the action’s consequences’ value. The chapter considers whether acknowledgment of care by the care recipient adds value to caring actions. It is suggested that such ‘ care receiving’ often, but not always, adds value to caring actions, and should not be part of the definition of care. Thus, care ethics’ imploration of agents to perform caring actions is defined. -/- Chapter 6 The Dependency Principle This chapter develops the dependency principle. This principle asserts that a moral agent, A, has a responsibility when: moral person B has an important interest that is unfulfilled; A is sufficiently capable of fulfilling that interest; and A’s most efficacious measure for fulfilling the interest will be not too costly. A incurs a weighty responsibility if ¬ to are true and A’s most efficacious measure for fulfilling the interest will be the least costly of anyone’s most efficacious measure for fulfilling B’s interest. Each of components to is elaborated on in turn. We arrive at a precise, comprehensive statement of the principle that will be used to unify, specify, and justify care ethics. -/- Chapter 7 Collective Dependency Duties It is impossible to do justice to care ethics without discussing the duties of groups—especially groups such as families and nation-states. This chapter defends the claim that the responsibilities produces by the dependency principle are, in many cases, responsibilities of groups. It develops permissive conditions that a group must meet in order to be a prospective responsibility-bearer, and explains how it is that groups’ responsibilities distribute to their individual members. This model of group responsibility is applied to states. This allows us to make sense of how the dependency principle can unify a care ethics that is greatly concerned with social and political outcomes. -/- Chapter 8 Unifying, Specifying, and Justifying Care Ethics Can the abstract, formalised ‘dependency principle ’—developed in Chapter 6 – serve as a compelling justification of the heterogeneous theory of care ethics? This chapter argues that it can. Each of the four claims of care ethics—developed in Chapters 2 to 5—is assessed in turn. Three questions are asked with regard to each. First, does the dependency principle generate some responsibilities of the relevant kind? Second, does the dependency principle generate enough responsibilities of the relevant kind? And third, does the dependency principle give the right explanation of these responsibilities? The answer each time, it is argued, is “yes”. Along the way, this answer produces some new results regarding both care ethics and the dependency principle. (shrink)
This essay assess the compatibility of Eva Kittay's dependency critique with Rawlsian political liberalism. I argue for the inclusion of a modified version of Kittay's revisions within Rawlsian theory in order to yield a theory that suppports a substantial subset of dependency work. Beyond these selected changes, however, I argue that Kittay's other proposed changes should not be included because they are incompatible with Rawls, and furthermore, their incorporation does not yield a theory that includes utter dependents.
Liberal theories of justice have been rightly criticized for two things by care theorists. First, they have failed to deal with private care relations’ inherent (inter)dependency, asymmetry and particularity. Second, they have been shown unable properly to address the asymmetry and dependency constitutive of care workers’ and care-receivers’ systemic conditions. I apply Kant’s theory of right to show that current care theories unfortunately reproduce similar problems because also they argue on the assumption that (...) good care requires only virtuous private individuals. Giving up this assumption enables us to solve the problems regarding both private care relations and systemic injustice. (shrink)
The Dutch system of obstetric care is often recommended for midwife-attended births, the high number of home deliveries, and the low rate of intervention during pregnancy and labour. In this contribution, the question is addressed whether processes of medicalization can be demonstrated in the Dutch midwife practice. Medicalization of pregnancy and childbirth is often criticized because it creates dependency on the medical system and infringement of the autonomy of pregnant women. It is concluded that medicalization is present in (...) the practice of Dutch independent midwives, however it is less clear and outspoken than in hospital policies. (shrink)
Protestant Christian ethicist Timothy Jackson and secular feminist philosopher Eva Feder Kittay each explore the relationship between love or care and justice through the lens of human dependency. Jackson sharply prioritizes agape over justice, whereas Kittay articulates a more complex and integrated understanding of the relationship of care and distributive justice. An account of Christian love and its relation to justice must account for the gratuity, mutuality, and reciprocity that pervade human existence. Such an account must integrate (...) provision for another's basic needs, a feature of agape, with a distributive justice that fairly allocates the material prerequisites of care and the burden of caring labor. Kittay's treatment of care and justice is more adequate to the realities of human embodiment and the social organization of care than Jackson's, but neither offers a fully adequate ground for the moral personhood of all human beings, including deeply dependent persons. (shrink)
BackgroundPediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians.MethodologyAn empirical ethical approach, combining a narrative review of qualitative studies on parents' and physicians' experiences of the pediatric oncology (...) research practice, and comparison of these experiences with existing theoretical ethical concepts about research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice.ResultsAnalysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician . True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the existence of a therapeutic misconception between them and parents.ConclusionDue to the integration of research and care, their different ethical perspectives become intertwined in the daily practice of pediatric oncology. Increasing awareness of what this means for the communication between parents and physicians is essential. Future research should focus on efforts that overcome the problems that the synchronicity of research and care evokes. (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)
Any real society is a caregiving and a care receiving society and we must therefore discover ways of coping with these facts of human neediness and dependency that are compatible with the self-respect of the recipients and do not exploit the caregivers. Remember the old Beatles’ refrain—will you still need me, will you still feed me when I’m 64? But what if I need you when I’m 84? What if I have congestive heart failure and arthritis and can (...) no longer bathe or cook or dress myself? What if I have Alzheimer’s disease and need basic support with almost all activities? I know Medicare will not pay for what is commonly called “custodial care.” Thus, I ask, “Will anyone be there? How will I pay for it? How .. (shrink)
True beliefs are better guides to the world than false ones. This is the commonsense assumption that undergirds theorizing in evolutionary epistemology. According to Alvin Plantinga, however, evolution by natural selection does not care about truth, it only cares about fitness. If our cognitive faculties are the products of blind evolution, we have no reason to trust them, anytime or anywhere. Evolutionary naturalism, consequently, is a self-defeating position. Following up on earlier objections, we uncover three additional flaws in Plantinga's (...) latest formulation of his argument: a failure to appreciate adaptive path dependency, an incoherent conception of content ascription, and a conflation of commonsense and scientific beliefs, which we diagnose as the ‘foundationalist fallacy’. More fundamentally, Plantinga’s reductive formalism with respect to the issue of cognitive reliability is inadequate to deal with relevant empirical details. (shrink)
According to the most important theories of justice, personal dignity is closely related to independence, and the care that people with disabilities receive is seen as a way for them to achieve the greatest possible autonomy. However, human beings are naturally subject to periods of dependency, and people without disabilities are only “temporarily abled.” Instead of seeing assistance as a limitation, we consider it to be a resource at the basis of a vision of society that is able (...) to account for inevitable dependency relationships between “unequals” ensuring a fulfilling life both for the carer and the cared for.**. (shrink)
In the last few decades, the ethics of care as a feminist ethic has given rise to extensive literature, and has affected moral inquiries in many areas. It offers a distinctive challenge to the dominant moral theories: Kantian moral theory, utilitarianism, and virtue ethics. This chapter outlines the distinctive features and promising possibilities of the ethics of care, and the criticisms that have been made against it. It then examines the ethics of care’s recognition of human (...) class='Hi'>dependency and of the importance of responding to needs; its interpretation of the roles of emotion and reason in moral understanding; and its critique of liberal individualism and development of a conception of the person as relational. The ethics of care contrasts care with justice, tries to integrate them, and reconceptualizes public and private life and morality. (shrink)
This article analyzes the contribution Christian ethics might be able to make to the ethical debate on policy and caregiving in health and social care in the United Kingdom. The article deals particularly with the concepts of solidarity and subsidiarity which are essential in Christian social ethics and health care ethics, and which may be relevant for the ethical debate on health and social caregiving in the United Kingdom. An important argument in the article is that utilitarian and (...) market-driven policies in the National Health Service (NHS) and the social care system have marginalized the position of the elderly and have seriously impoverished the quality of care for the elderly. The neglect of the elderly and other vulnerable groups is also the result of widespread consumerist attitudes among patients and of libertarian models of noninterference which are affirmed by a public ethos of self-sufficiency and counter-dependency. Those who need care dare not make their need known to others and ask for help, while simultaneously those who could help are so intimidated by the public affirmation of privacy and negative rights that they do not dare to offer help except if this is explicitly demanded. This distant and standoffish attitude is in an important way responsible for the fact that the voice of those in need is altogether lost to the public forum. Christian ethics puts much emphasis on responsibility and solidarity with the needy other but is not able to have much impact on the delivery of care in a secularized society and health care system like the NHS. Nonetheless, Christianity still has a powerful and respected voice, by speaking up for those who cannot speak for themselves, such as the elderly and the handicapped. Christians can find allies in the ethics of care and other relational approaches in health care ethics in order to combat libertarianism, consumerism, and utilitarianism. (shrink)
Analyses of care work typically speak of three necessary roles of care: the care worker, the care recipient, and an economic provider who makes care materially possible. This model provides no place for addressing the difficult political questions care poses for liberal representative democracy. I propose to fill this space with a new caring role to connect the care unit to the political sphere, as the economic provider connects the care unit to (...) the economic sphere. I call this role that of the “care claimant.” The labor of claiming care consists in the development, expression, and advancement of the interests of the care unit. The argument for employing this fourth care role begins by comparing Nel Noddings's phenomenological care unit to Sara Ruddick's family-based analysis. It then moves to discuss the way Eva Kittay emphasizes the dependency of the charge and its political ramifications to illustrate the need for a care claimant. After distinguishing the care claimant from the other roles of care, I examine the power relationships in the care unit and the position of the care claimant in the public sphere. (shrink)
In this commentary on Eva Feder Kittay's Love's Labor: Essays on Women, Equality, and Dependency, I focus on Kittay's dependency theory. I apply this theory to an analysis of women's inadequate access to high-quality, cost-effective healthcare. I conclude that while quandaries remain unresolved, including getting men to do their share of dependency work, Kittay's book is an important and original contribution to feminist healthcare ethics and the development of a normative feminist ethic of care.
Liberal theories of justice have been rightly criticized for two things by care theorists. First, they have failed to deal with private care relations’ inherent dependency, asymmetry and particularity. Second, they have been shown unable properly to address the asymmetry and dependency constitutive of care workers’ and care-receivers’ systemic conditions. I apply Kant’s theory of right to show that current care theories unfortunately reproduce similar problems because they also argue on the assumption that (...) good care requires only virtuous private individuals. Giving up this assumption enables us to solve the problems regarding both private care relations and systemic injustice. (shrink)
The film Gandhi expands our understanding of how the virtue of care can function in the public sphere by portraying Gandhi dealing with Indian independence from Britain, the subjugation of women and Untouchables, and strife between Hindus and Muslims. Gandhi illustrates in his social and political activism how the virtue of care is animated by benevolence and structured by the building blocks of the care perspective: responsibility and need, relationship and mutual dependency, context and narrative.
Objectives: This study attempts to analyse the ethical dilemmas arising from the microallocation of scarce health care resources, in terms of deontology and utilitarianism.Methods: A group of 395 people were interviewed in the region of Diadema, greater San Paulo, Brazil, while visiting patients in the only state hospital in town. Each interviewee was given a list of eight simulated emergencies . In each of the eight cases the interviewee had to choose which of the two patients described, both of (...) whom suffered from exactly the same problem, should receive the only hospital bed currently available. The differences between the hypothetical patients were as follows: age, gender, family dependency, and lifestyle. Each interviewee was asked to justify one of their responses. These responses were then analysed.Results: The results pointed to the co-existence of deontological and utilitarian orientations among the people interviewed. A tendency to give priority to the destitute was revealed throughout the research, contradicting the idea that society, valuing only productive people, wishes only such people to receive the most resources, thus maximising the benefits to be gained from resources. The results showed that people’s disapproval of the alcoholic was stronger than that of the nicotine abuser. (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)
Evaluation scales are used in the care of elderly people. They are useful for estimating the workload, the necessary resources, the care cost, the patient’s dependency or autonomy in daily life, and/or the patient’s needs. The large number of grids already indicates their insufficiency.This article explores the stakes implied by the evaluations, which use concepts more or less clearly defined as autonomy, dependency, deficiency, incapacity. It also questions our understanding of interdependence, vulnerability, and responsibility, and their (...) implications in the care relations with elderly people. (shrink)
São descritas Oficinas Terapêuticas conduzidas por psicólogos em um Centro de Atenção Psicossocial – álcool e drogas, direcionadas a adultos de ambos os sexos, usuários de álcool e/ou outras drogas. Seus objetivos principais eram proporcionar espaços de expressão, construção e transformação subjeti..
There are prominent resemblances between issues addressed by Simone de Beauvoir in her early essay on moral philosophy, Pyrrhus and Cineas (1944), and issues attracting the attention of contemporary feminist ethicists, especially those concerned with the ethics of care. They include a focus on relationships, interaction, and mutual dependency. Both emphasize concrete ethical challenges rooted in everyday life, such as those affecting parents and children. Both are critical of the level of abstraction and insensitivity to the situation of (...) the moral agent in utilitarianism and Kantian ethics. And both condemn the “moral point of view,” i.e. the assumption that it is possible to speak with a universal voice on behalf of humanity. These resemblances are explored in this article. (shrink)
Contemporary industrialized societies have been confronted with the fact and consequences of women's increased participation in paid employment. Whether this increase has resulted from women's desire for equality or from changing economic circumstances, women and men have been faced with a crisis in the organization of work that concerns dependents, that is, those unable to care for themselves. This is labor that has been largely unpaid, often unrecognized, and yet is indispensable to human society.
The actual “crisis of care” in western societies highlights the limits of a sex/gender based citizenship and the persistence of the subordination of women. The fact that women are responsible for the provision of care in domestic units has never been a matter of difference but a matter of subordination against which we have developed legal strategies, such as anti-discrimination law, and political strategies, such as increasing the presence of women in decision-making. The paper shows some of these (...) strategies and their limits and argues that we need to resignify citizenship in a way that includes human dependency and the webs of relationships, both local and global, this dependency creates. (shrink)
Currently, patients are expected to take control over their health and their life and act as independent users and consumers. Simultaneously, health care policy demands patients are expected to self manage their disease. This article critically questions whether this is a realistic expectation. The paper presents the auto-ethnographic narrative of the first author, which spans a period of 27 years, from 1985 to 2012. In total nine episodes were extracted from various notes, conversations and discussions in an iterative process. (...) Each of these episodes was condensed around a ‘critical moment’ as perceived by the “self”. The critical moments in the illness process vary between newly encountered problems with basic needs and mourning, to renewed strength and the desire to grow, embracing new situations. Being confronted with and living with a chronic illness involves periods of anxiety and self centredness alternating with strength and advocating the interests of peer-patients. These episodes of emotion, confusion and refinding a balance have a cyclic pattern. The narrative illustrates the vulnerability and dependency of a patient with a chronic disease. The discussion relates this to mainstream dominant views on patients ‘in control of their own life’. The narrative illustrates, that the vulnerability and dependency of the patient are key factors to take into account in health care policy. The narrative provides a counter story, challenging current thinking in terms of strength, selfmanagement, patients’ own control and independent role. (shrink)
The growing proportion of elderly people in society, together with recent advances in robotics, makes the use of robots in elder care increasingly likely. We outline developments in the areas of robot applications for assisting the elderly and their carers, for monitoring their health and safety, and for providing them with companionship. Despite the possible benefits, we raise and discuss six main ethical concerns associated with: (1) the potential reduction in the amount of human contact; (2) an increase in (...) the feelings of objectification and loss of control; (3) a loss of privacy; (4) a loss of personal liberty; (5) deception and infantilisation; (6) the circumstances in which elderly people should be allowed to control robots. We conclude by balancing the care benefits against the ethical costs. If introduced with foresight and careful guidelines, robots and robotic technology could improve the lives of the elderly, reducing their dependence, and creating more opportunities for social interaction. (shrink)
What challenges must a principle of need for prioritisations in health care meet in order to be plausible and practically useful? Some progress in answering this question has recently been made by Hope, Østerdal and Hasman. This article continue their work by suggesting that the characteristic feature of principles of needs is that they are sufficientarian, saying that we have a right to a minimally acceptable or good life or health, but nothing more. Accordingly, principles of needs must answer (...) two distributive questions: when do we have sufficient and how should we prioritise among those who do not yet have a sufficiency? Furthermore, it is argued that Roger Crisp’s theory of need, which combines sufficientarianism with prioritarianism below the threshold of need, is better equipped than alternatives to answer these questions as well as meeting the challenges formulated by Hope, Østerdal and Hasman. However, Crisp’s theory faces two major challenges. First, it has to say something about the currency of distribution: a principle of need must be complemented either with a theory on the human good or a theory about the proper goals of health care. Second, it has to say something about where the threshold should be set. However, any attempt to set a threshold seems morally arbitrary in the light of the sufficientarian idea that those just above the threshold never should be given priority over those just below the threshold. (shrink)
We analyse solidarity as a mixture of social justice on the onehand and a set of cultural values and ascriptions on the otherhand. The latter defines the relevant sense of belonging togetherin a society. From a short analysis of the early stages of theDutch welfare state, we conclude that social responsibility wasoriginally based in religious and political associations. In theheyday of the welfare state, institutions such as sick funds,hospitals or nursing homes became financed collectively entirelyand became accessible to people of (...) all denominations. Solidaritywas transformed in a more general category, related to the statusof Dutch citizenship. Responsibility was transformed tocollective responsibility.Financial pressures on the Welfare State have resulted in adebate on choices in health care and in a number of systemreforms, so far relatively small. In the surrounding discourse,justice was linked to private responsibility. Both fromgovernment officials and from participants in the societaldebate, moralistic overtones could be heard concerning the threatof overburdening of the health care system by citizens.In this paper, we develop a concept of reflexive solidarity thatlinks elements of social justice to conceptualisations ofresponsibility that address policy makers and health careinstitutions as well as citizens, in their role of carereceivers. A short analysis of the phenomenon of personal budgetsin care services should prove that our concept of reflexivesolidarity is not empty. Linked to, but beyond the concept ofjustice, issues of social responsibility can be addressed withoutmoralistic overtones. (shrink)
In this article I wish to show how care ethics puts forward a fundamental critique on the ideal of independency in human life without thereby discounting autonomy as a moral value altogether. In care ethics, a relational account of autonomy is developed instead. Because care ethics is sometimes criticized in the literature as hopelessly vague and ambiguous, I shall begin by elaborating on how care ethics and its place in ethical theory can be understood. I shall (...) stipulate a definition of care ethics as a moral perspective or orientation from which ethical theorizing can take place. This will mean that care ethics is more a stance from which we can theorize ethically, than ready-made theory in itself. In conceiving care ethics in this way, it becomes possible to make clear that, for instance, a moral concept of autonomy is not abandoned, but instead is given a particular place and interpretation. In the final part of this article I will show how ârelational autonomyâ can be applied fruitfully in the practice of psychiatric care. (shrink)
Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). (...)Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)