BackgroundHuman infection studies (HIS) are valuable in vaccine development. Deliberate infection, however, creates challenging questions, particularly in low and middle-income countries (LMICs) where HIS are new and ethical challenges may be heightened. Consultation with stakeholders is needed to support contextually appropriate and acceptable study design. We examined stakeholder perceptions about the acceptability and ethics of HIS in Malawi, to inform decisions about planned pneumococcal challenge research and wider understanding of HIS ethics in LMICs.MethodsWe conducted 6 deliberative focus groups and 15 (...) follow-up interviews with research staff, medical students, and community representatives from rural and urban Blantyre. We also conducted 5 key informant interviews with clinicians, ethics committee members, and district health government officials.ResultsStakeholders perceived HIS research to have potential population health benefits, but they also had concerns, particularly related to the safety of volunteers and negative community reactions. Acceptability depended on a range of conditions related to procedures for voluntary and informed consent, inclusion criteria, medical care or support, compensation, regulation, and robust community engagement. These conditions largely mirror those in existing guidelines for HIS and biomedical research in LMICs. Stakeholder perceptions pointed to potential tensions, for example, balancing equity, safety, and relevance in inclusion criteria.ConclusionsOur findings suggest HIS research could be acceptable in Malawi, provided certain conditions are in place. Ongoing assessment of participant experiences and stakeholder perceptions will be required to strengthen HIS research during development and roll-out. (shrink)

BackgroundYouth are increasingly aware of the negative effects of climate change on the planet and human health, but this knowledge can often come with significant affective responses, such as psychological distress, anger, or despair. Experiencing major “negative” emotions, like worry, guilt, and hopelessness in anticipation of climate change has been identified with the term eco-anxiety. Emerging literature focuses on adults' experience; however, little is known about the ways in which children and youth experience eco-anxiety.ObjectivesThe aim of this review was to: (...) identify the available evidence on the topic of eco-anxiety in children, clarify the mental health consequences brought by the awareness of climate change in this population, and identify knowledge gaps in the literature and considerations for future research.MethodsGiven that the research on the topic of eco-anxiety in children is limited, that there are very few randomized controlled trials, and that the goal is not to analyze individual studies in-depth, a scoping review was used. Keywords pertaining to the themes of eco-anxiety, climate change and children were used as search terms in five databases. Journal articles using qualitative and quantitative methods, as well as gray literature were examined by two independent reviewers. A descriptive-analytical method was used to chart the data that emerged from the literature. Eighteen articles were considered in the final analysis.ResultsEvidence confirms that children experience affective responses and eco-anxiety in reaction to then awareness of climate change. Mental health outcomes include depression, anxiety, and extreme emotions like sadness, anger, and fear. Youth from vulnerable communities, like indigenous communities, or those who have strong ties to the land are often identified as being emotionally impacted by climate change. The literature analyzed also describes how children and youth are coping with eco-anxiety, including maladaptive and adaptive responses. Preliminary considerations for parents, teachers and educators, mental health care providers, school systems, adults and people of power include adding age-appropriate climate education to the school curriculum, considering youth's emotions, and promoting healthy coping through empowerment. Important gaps exist in the definition of eco-anxiety in youth, as various characterizations of this emerging concept are found across articles. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"To make a difference...":Narrative Desire in Global MedicineByron J. Good and Mary-Jo DelVecchio GoodIf, as Arthur Frank (2002) writes, "moral life, for better and worse, takes place in storytelling," this collection of narratives written by physicians working in field settings in global medicine gives us a glimpse of some aspects of moral experience, practice, and dilemmas in settings of poverty and low health care resources. These essays (...) are written from the midst of practice, in diverse settings in Africa, South Asia, Latin America, the Caribbean, and the United States. The majority of the writers are practitioners of contemporary 'global medicine'—physicians from North America or Europe who spend part of their lives flying into settings of poverty or special need to practice medicine and work with on-going collaborative clinical and public health systems—while a smaller number are working in the societies in which they were born. Although a few work for classic humanitarian organizations or have developed their own local NGO's, the great majority are engaged in the 'hybrid life' described by Robert Riviello and noted by Renée Fox, moving between academic medical centers and distant health care systems that are supported by local governments, major international organizations and funding agencies, and international NGO's like Partners in Health. These diverse forms of practice have become a common model for contemporary clinicians engaged in what has emerged as a new discipline of global health or global medicine, and these narratives give us a glimpse of some of the enduring, as well as newly emerging, forms of moral practice and ethical dilemmas characteristic of today's global medicine.Many of these stories are filled with the tension and pathos that makes clinical narratives powerful to read. Physicians are forced to make unfathomable decisions about whether to resuscitate and keep a baby alive, using all means available, or to let the infant die, whether to carry out a procedure that will save an infant in birth but would put the mother at risk, about how to deal with a cancer found in a very advanced state. However, virtually all of the stories transcend these classical stories of the decisions physicians are forced to make by being placed in settings of great scarcity of resources, which stand in particular contrast to the academic medical settings in North America or Europe where many of these global medicine specialists have trained and many continue to practice. The unspeakable inequality of resources emerges throughout these narratives as a kind of master theme, as the underlying moral, as opposed to plot, which gives meaning and sense to the stories. For those who practice medicine in such settings, global inequalities and scarcity of medical resources are deeply felt. They produce the rage that Jeffrey Deal describes. ("I learned to despise American churches during that time, a time when my world encompassed a dying newborn in Sudan, as well as the air conditioned padded seats [End Page 121] of our affluent suburban church.") They produce the distinctive experiences of helplessness and pain felt by clinicians who cannot separate how they would be able to treat such a patient at home from how they have to practice in these settings. For those clinicians working in their own societies, scarcity of resources often produces deep anger at the corrupt governments that fail to support basic human services for the great majority of their population. ("We were temporary actors performing in the cynical play of scarcity on permanent display in Port-au-Prince," writes Haitian physician Paul Pierre about his experience prior to joining Partners in Health.)But for those who regularly travel back and forth across the divide between rich and poor, whether across national boundaries or within their own society, the challenge to live a moral life is unendingly complicated. While becoming a part of a struggle for global justice with colleagues and advocates from both sides of the divide, few of the narrators can avoid personal feelings of ambivalence and guilt at being able to easily move from one side of that divide to the other back home. Many fantasize about giving up their lives in the north to devote themselves... (shrink)

Although he had intermittently toiled over his translation of Hegel's Science of Logic for nearly half a century without finding a publisher, Henry Conrad Brokmeyer, the petulant visionary of St. Louis Hegelian fame, concluded it was naive to expect an infant nation to devote itself to philosophical reflection while it was "carving civilization out of wilderness." Brokmeyer's difficulties may have had more to do with his disdain for the grammatical and spelling conventions of the English language than he cared to (...) admit.1 Nonetheless, his observation about the culture of his adopted homeland brings into sharp relief a tension between high intellectual pursuits and more practical concerns. Brokmeyer's juxtaposition of "civilization" and "wilderness" also highlights the... (shrink)

This article deals with nurses’ ethical concerns raised by the consequences of changes in governmental and institutional policies on nursing practice and patient care. The aims of this project were to explore perspectives of registered nurses who provide or manage direct patient care on policies that affect nursing and patient care, and to provide input to policy makers for the development of more patient-centred policies. Four focus groups were conducted with a total of 36 registered nurse participants. (...) The project team identified major themes that emerged in the analysis of transcripts of the focus group discussions. The four major themes were: effects of policy focused on cost containment, effects on quality of care, effects on patient education and access to needed services, and effects on nurses and nursing. The participants identified primarily negative effects of changes in national health policy and legislation that influence institutional policies on patient care and nursing practice. The effects of identified policy changes raised concerns about meeting nurses’ ethical obligations to patients and families. Participants specified key points for consideration by legislators and other policy makers. They viewed nurses who are involved in direct patient care as a critical resource for legislators and other policy makers in the development of public and institutional policies that affect nursing and patient care. (shrink)

The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, (...) tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen–Taylor Hand Function Test ], ipsilesional grip strength, contralesional arm impairment level [Fugl–Meyer Assessment ], and functional independence [Functional independence measure ]. Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study. (shrink)

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and (...) methodologies have emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry. (shrink)

When is it ethically acceptable to use artificial agents in health care? This article articulates some criteria for good care and then discusses whether machines as artificial agents that take over care tasks meet these criteria. Particular attention is paid to intuitions about the meaning of ‘care’, ‘agency’, and ‘taking over’, but also to the care process as a labour process in a modern organizational and financial-economic context. It is argued that while there is (...) in principle no objection to using machines in medicine and health care, the idea of them functioning and appearing as ‘artificial agents’ is problematic and attends us to problems in human care which were already present before visions of machine care entered the stage. It is recommended that the discussion about care machines be connected to a broader discussion about the impact of technology on human relations in the context of modernity. (shrink)

The literature on organizational ethics has paved the way for a situated and intersubjective understanding of ethics through caring practices. In this article, we try to extend this perspective by looking beyond the interactions of caregivers among themselves or with care seekers to reveal ethics as the ongoing collective accomplishment of a variety of actors. We do so by mobilizing Strauss’s theoretical perspective of articulation work in the context of healthcare. Based on an ethnography, we show how actors of (...) care (e.g., nurses, caregivers, or doctors) operate within care arrangements that need to be frequently rearticulated to face ethical threats and protect their patients’ well-being. We distinguish three types of rearticulation corresponding to different degrees of rearticulation, individual actor stance, and specific ways of working things out. We discuss their implications for the maintenance of organizational ethics. (shrink)

This article analyzes how the recent call for accounting in health care interferes with daily care practice and raises the question of how accounting practices relate to the aim of good care. The most influential accounting methods in the Netherlands suggest ways for professionals to legitimize their activities. The analysis of washing patients in long-term mental health care shows that different styles of accounting evaluate and legitimize care while structuring notions of what good (...) care is. A specific style of accounting enforces certain values but does not tell about the tragic or unexpected effects that come with it, nor does it provide a repertoire to deal with these. Thus, care practices incorporating specific styles of accounting remain dependent on forms of care that are not accountable or ask for new forms of reflexivity. (shrink)

This study articulates the relational constituents of good care beyond techno‐rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical‐surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members (...) and 11 staff. Data were analysed iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity. (shrink)

In The Ethics of Care, Virginia Held explores what values of care might fulfil normative criteria for evaluating the moral worth of relations. Held identifies seven potential values: attentiveness, empathy, mutual concern, sensitivity, responsiveness, taking responsibility, and trustworthiness. Though Held’s work is helpful as a starting point for conceptualizing some normative criteria, two problems need addressing. First, Held does not provide sufficient justification for why these potential values ought to be considered genuine values in the care ethical (...) framework. Second, Held overlooks two other potential values cited in the care literature: competence and respect. This paper builds upon Held’s work to offer a more coherent understanding of the values of care. It does so by scrutinizing and conceptually organizing the above nine potential values. Of these nine, only four are considered genuine values: attentiveness, mutual concern, responsiveness, and trustworthiness. It is concluded that good caring relations are those that exemplify the four values of care in their deliverance of caring practices. (shrink)

This paper proposes a new perspective on the methodology of qualitative inquiry in ethics, especially the interaction between empirical work and theory development, and introduces standards to evaluate the quality of this inquiry and its findings. The kind of qualitative inquiry the authors are proposing brings to light what participants in practices of care and welfare do and refrain from doing, and what they undergo, in order to offer ‘stepping stones’, political-ethical insights that originate in the practice studied and (...) enable practitioners to deal with newly emerging moral issues. As the authors’ aim is to study real-life complexity of inevitably morally imprinted care processes, their empirical material typically consists of extensive and comprehensive descriptions of exemplary cases. For their research aim the number of cases is not decisive, as long as the rigorous analysis of the cases studied provides innovative theoretical insights into the practice studied. Another quality criterion of what they propose that should be called ‘N=N case studies’ is the approval the findings receive from the participants in the practice studied. (shrink)

Background Health care workers (HCWs) are susceptible to moral stress and distress when they are faced with morally challenging situations where it is difficult to act in line with their moral standards. In times of crisis, such as disasters and pandemics, morally challenging situations are more frequent, due to the increased imbalance between patient needs and resources. However, the concepts of moral stress and distress vary and there is unclarity regarding the definitions used in the literature. This study aims (...) to map and analyze the descriptions used by HCWs regarding morally challenging situations (moral stress) and refine a definition through conceptual analysis. Methods Qualitative data were collected in a survey of 16,044 Swedish HCWs who attended a COVID-19 online course in autumn 2020. In total, 643 free-text answers with descriptions of moral stress were analyzed through content analysis. Results Three themes emerged from the content analysis (1) “Seeing, but being prevented to act; feeling insufficient/inadequate and constrained in the profession,” (2) “Someone or something hindered me; organizational structures as an obstacle,” and (3) “The pandemic hindered us; pandemic-related obstacles.” The three themes correspond to the main theme, “Being prevented from providing good care.” Discussion The main theme describes moral stress as various obstacles to providing good care to patients in need and acting upon empathic ability within the professional role. The themes are discussed in relation to established definitions of moral stress and are assessed through conceptual analysis. A definition of moral stress was refined, based on one of the established definitions. Conclusions On the basis of the study results and conceptual analysis, it is argued that the presented definition fulfils certain conditions of adequacy. It is essential to frame the concept of moral stress, which has been defined in different ways in different disciplines, in order to know what we are talking about and move forward in developing prevention measures for the negative outcomes of this phenomenon. (shrink)

This study articulates the relationship between conceptualisations of time and the accounts of good care in an acute setting. Neoliberal healthcare services, with their focus on efficiencies, predominantly calculate quality care based on time‐on‐the‐clock workforce management planning systems. However, the ways staff conceptualise and then relate to diverse meanings of time have implications for good care and for staff morale. This phenomenological study was undertaken in acute medical–surgical wards, investigating the contextual, temporal nature of (...) class='Hi'>care embedded in human relations. The study interviews involved 17 participants: 11 staff, 3 previous patients and 3 family members. Data were analysed iteratively to surface the phenomenality of temporality and good care. The following constituents of the data set are explored that together illustrate the relationship between the conceptualisations of time and the accounts of good care in an acute setting: patient time as a relational journey; patient time, sovereign time and time ethics and time, teamwork and flow. The findings are clinically significant because they offer a contrasting narrative about the relationship between time and care quality. The experiences of giving and receiving good care are indivisible from how temporality is experienced and the social relations within which care is embedded. Healthcare staff experience temporality differently from patients and families, a point that healthcare participants in this study appeared to comprehend and accommodate. For all parties involved in providing care or being the recipient of care, however, the capacity to be present was valued as a humanising ethic of care. Our study reinforces the importance of not creating presumptive binaries about which temporal structures are more or less humanising—there is a place for a fast‐paced tempo, which can be experienced as being in the flow of human relations with one's team and on behalf of patients. (shrink)

Background:Several studies have investigated the experiences of first-generation immigrant nurses in new workplaces. Yet, little is known about how native nurses and newcomers collaborate in their care for aging residents in European nursing homes.Objective:To gain a deeper understanding of interactions between first-generation immigrant nurses and native nurses in their care for aging residents in a Dutch nursing home.Methods:Ethnography, including 105 h of shadowing immigrant and native nurses, 8 semi-structured interviews with 4 immigrant and 4 established nurses, and 2 (...) focus group discussions with 8 immigrant and 6 established nurses in a Dutch nursing home. Data were analyzed by a post-positivist grounded theory coding approach.Ethical consideration:The Medical Ethical Review Committee of the Leiden University Medical Center approved this study.Results:The interactions between established staff and newcomers were influenced by norms, rules and regulations, policies and protocols. In daily practice and institutional structure, we observed both opportunities and challenges. The strict time schedules and the requisite standards of care were opportunities related to nurses’ expectations. Residents’ needs were sometimes challenging and inhibited newcomers’ active participation. However, sometimes new practices were developed where nurses created common ground, tinkered, and formed an inclusive playing field to enact good care.Conclusion/ discussion:This study shows that despite obstacles, there was room to make small changes in the rules of the game of nursing. These moments of tinkering may be sufficient to establish a stable, inclusive workforce for first-generation immigrants and give room to the evolvement of hybrid professional identities.Implications:The findings of this Dutch study are relevant for nursing ethics related to “good care” and nurses in other cultural contexts on how the integration of immigrant nurses in European countries in general could be facilitated. (shrink)

This article concerns the issue of how an ethic of care perspective may contribute to both normative theory and mental health care policy discussions on so called Ulysses arrangements, a special type of advance directives in psychiatry. The debate on Ulysses arrangements has predominantly been waged in terms of autonomy conceived of as the right to non-intervention. On the basis of our empirical investigations into the experiences of persons directly involved with Ulysses arrangements, we argue that a (...) class='Hi'>care ethics perspective may broaden and deepen the debate on Ulysses arrangements, by introducing additional concepts, such as vulnerability, responsibility and mutuality, and by refining familiar concepts, such as autonomy. (shrink)

Medicine is about caring for people. It is a moral enterprise, not simply a technique or a pursuit. Though modern healthcare offers an amazing array of options, it has also become a complex and sometimes utterly de-humanizing system. Now, more than ever, we need guidance to navigate through the issues surrounding our medical care. Advances in medical technology have blessed many with longer and healthier lives, but they have also provided us with interventions and procedures that call for serious (...) ethical evaluation. The BioBasics series is committed to an uncompromising respect for human life that will serve as a compass through a maze of challenging questions. (shrink)

An authoethnography explores the lived experiences of patients being in control and self-managing their chronic illness among their families and friends. Findings show that the current health discourse narrows down people to mere patients and gives rise to tensions. This article indicates that people with one or several chronic illnesses or disabilities are first of all full citizens with needs, values, and drives seeking a meaningful life. Fair possibilities ought to exist to satisfy their needs to belong, to care (...) for and to matter to others since these constitute an essential aspect of being human. (shrink)

What is the responsibility of the physician when a capacitated patient assigns decision-making authority to a surrogate who does not act in the patient’s best interest?

The price for morality as the meaning of existence is the entrance of another kind of absurdity, a moral absurdity. Clearly, there is something absurd about life on The Good Place. Moral worth, both on The Good Place and in our real‐life existence, comes in degrees. Deontological views, most famously associated with Immanuel Kant, hold that the morality of an action is determined based on whether or not it adheres to a moral rule. Care requires being flexible (...) in different situations so as to best foster caring relationships with others. A care ethics approach would give some support to Eleanor's claims in The Good Place, insofar as a caring home life is essential to the development of the child in a variety of ways. The power of caring relationships is perhaps nowhere more salient than in the show's final few episodes. (shrink)

Drawing on his extensive experience as both a medical practitioner and a patient, acclaimed author, award-winning physician, and ethicist Philip Hébert creates a brave and intimate portrait of the complex ethical questions raised by revolutionary advances in medical diagnosis and treatment. Philip Hébert addresses the complex ethical questions raised by revolutionary advances in medical treatment. This work expands upon Hébert's previous book, "Doing Right," and extends his knowledge of the field beyond medical professionals to reach the patients they treat.

How can work be a genuine good in life? I argue that this requires overcoming a problem akin to that studied by Marx scholars as the problem of work, freedom and necessity: how can work be something we genuinely want to do, given that its content is not up to us, but is determined by necessity? I argue that the answer involves valuing contributing to the good of others, typically as valuing active pro-sociality – that is, valuing actively (...) doing something good for others. This makes work better in one way, and may even make work something we are genuinely glad to have in our lives. Contemporary philosophical thinking about good work tends to focus on how work can be good for the person doing it, by providing, for example, self-realization or social relationships, while underappreciating the special importance of valuing social contribution. People will typically only really want work if they want a part of their lives to be about the good of others. This also means that work may be a part of the best life, something we should take into account when discussing work-related policies and the desirability of a ‘post-work’ future. (shrink)

Palliative care is a recent branch of health care. The doctors, nurses, and other professionals involved in it took their inspiration from the medieval idea of the hospice, but have now extended their expertise to every area of health care: surgeries, nursing homes, acute wards, and the community. This has happened during a period when patients wish to take more control over their own lives and deaths, resources have become scarce, and technology has created controversial life-prolonging treatments. (...) Palliative care is therefore faced with more ethical problems that other areas of health care. This book, by a clinician, teacher, and writer on health care ethics, has been written to provide all those who care for the terminally ill--doctors, nurses, social workers, clergymen, physiotherapists--with the concepts and principles which will assist them with difficult decisions. It challenges many received doctrines of palliative care, but its well-illustrated central theme is that technical expertise must be controlled by humane, non-technical judgments. (shrink)

Distributive justice on the income and on the service aspects is the most vexing modern day problem for the creation and maintenance of an all inclusive health care system. A pervasive problem of all current schemes is the lack of effective cost control, which continues to result in increasing burdens for all public and private stakeholders. This proposal posits that the responsibility and financial obligation to achieve an ideal outcome of equal and affordable access and benefits for all citizens (...) is misplaced. The Good Samaritan demonstrated basic ethical principles, which are revisited, elaborated and integrated into a new approach to health care. The participants are limited to individual contributors and beneficiaries and organized as a citizen carried, closed, independent, and self-sufficient self-governing cooperative for their own and the benefit of a minority of disadvantaged health care consumers. The government assumes oversight, provides arbitration, enforces democratic decision making, a scheme of progressive taxation, a separate and transparent accounting system, and a balance between income and reinvestment in health care. The results are a fair distribution of cost, its effective control, and increased individual motivation to take on responsibility for personal health as a private good and a sharpened focus towards community health. At the sociopolitical level the government as well as employers are released from the inappropriate burden of catering to individual health. (shrink)

Some see health care as primarily an individual responsibility. Others see it as a public responsibility. Behind these approaches are strong conflicting beliefs about ethical matters, specifically about the kind of good that health care is. On the one side the underlying belief is that health care is no more than an individual good and hence calls for a distributive policy based on the market. On the other side the underlying belief is that it is (...) a public good and hence calls for a distributive policy based on widespread agreement.' There will be intermediate approaches which try with varying success to justify themselves by piecing together beliefs from both sides. I shall explain what is involved in calling something a public good. Then I shall try to show that, if health care is to satisfy some rather plausible criteria, it must have the character of a public good. (shrink)

This paper explores a novel philosophy of ethical care in the face of burgeoning biomedical technologies. I respond to a serious challenge facing traditional bioethics with its roots in analytic philosophy. The hallmarks of these traditional approaches are reason and autonomy, founded on a belief in the liberal humanist subject. In recent years, however, there have been mounting challenges to this view of human subjectivity, emerging from poststructuralist critiques, such as Michel Foucault's, but increasingly also as a result of (...) advances in biotechnology itself. In the face of these developments, I argue that the theoretical relevance and practical application of mainstream bioethics is increasingly under strain. Traditionalists will undoubtedly resist. Together, professional philosopher-bioethicists, public health policymakers, and the global commercial healthcare industry tend to respond conservatively by shoring up the liberal humanist subject as the foundation for medical ethics and consumer decision-making, appealing to the familiar tropes of reason, autonomy, and freedom. (shrink)

Attention is drawn to the movements of the body and to the ethical imperative that emerges in compelling, flowing moments of teaching. Such moments of teaching are not primarily intellectual, discursive events, but physical, sensual experiences in which the body surrenders to its own movements. Teaching is recognized momentarily as a carnal intensity embedded in and emerging from the flesh. The ethical imperative to this teaching is felt proprioceptively and kinaesthetically when one holds in self-motion the well-being of another as (...) being of the same flesh. The teaching caress offers a primary example. This gesture of intimacy discloses an embodied ethic that contrasts with the transcendental ethics of curricular prescriptions, professional codes of conduct, and the presumptions of self-monitoring behavior. It is a gesture of care for another person, without fastidious carefulness. It is a gesture of pure duration, without sanctimonious purity, in its contact with the beauty, truth and value of the teachable moment. From earliest engagements with children to the dynamics of the university classroom, what makes for good teaching is essentially attentiveness to intimate gestures, such as the caress, that guide teachers kinethically in the moment. (shrink)

In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, quality-of-life (...) determinations, the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patient 's values. In order to act in the patient 's best interests, or the patient 's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patient 's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient 's good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rights- and duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician- patient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today. (shrink)

We often speak of health care as a social good. What kind of good it is-and what of us in making it available to the members of society-depends on how society underst value of health care may be understood in many different ways within society.

This article investigates the construction of laboratory animal science as a version of “good science.” In the 1950s, a transnational community of scientists initiated large-scale standardization of animals for biomedicine, which included the standardization of care of laboratory animals as well as the development of guidelines and regulations on laboratory animal use. The article traces these developments and investigates how the standardization work took part in enacting laboratory animals as compound objects of care—and laboratory animal science as (...) being an intrinsically ethical practice—as good science. Importantly, the analysis shows how technological development is inextricably accompanied by ethics, as it is the result of complex social organization involving multiple ethical commitments. By investigating the development of laboratory animal science historically, it is possible to tease out how values, norms, and standards have been made integral to specific practices in the first place and how they have developed and been sustained over time. The article contributes to current concerns in science and technology studies about how life is made, valued, and ordered at the intersection of science and society and in biomedicine, including how certain values and positions of valuation come to count as authoritative and others not. (shrink)

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

Prior to agriculture, human societies were small, with little variation for good genes sexual selection (GGSS) to work on. Across cultures, variation in paternal care makes the benefits of GGSS highly variable. Despite these caveats, female preferences for traits like male body symmetry suggest one reason for female short-term mating is gene shopping.

A central concept in Dutch health law is the care of a good caregiver. We find this standard in various statutes and in legal doctrine. This concept is, however, vague and open and must be made more concrete in professional practice, in moral theory, and in law. In this article, we explore the implications of this complex standard and analyze what moral philosophy and jurisprudence can contribute to its clarification and implementation in professional practice and law. We start (...) with some reflections on how practitioners see this norm and try to live up to it. (shrink)

This paper is essentially concerned with defending the idea of a universal right to adequate health care coverage. It will argue for the existence of a human right grounded in Catholic social thought. At the outset, a statement of clarification is needed. This paper does not pretend to offer the panacea for all ills relating to health care provision. Rather, it is an inquiry into the kinds of value that should inform decision making relating to health policy. A (...) universal right to adequate health care cannot be established without questioning the underlying values that inform the debate and bring them firmly to the level of deliberative consciousness. It is these value concerns that structure the dynamic of health care provision and the general provision of wider resources in society. (shrink)