This paper explores the possibilities of the recognition and valuation of care by implementing an unconditional basic income and presents a feminist redefinition of the concept of a UBI. The author proposes the notion of a caring revolutionary transformation as a process of institutionalising the social and economic conditions for recognition of care which is a cornerstone of struggles for women’s emancipation and gender equity. It is a process of practically realisable transformative steps which together with their combined (...) and mutually reinforcing effects enable more radical social changes beyond a mere reform. The author argues that these transformative steps have to address two conditions embedded in the institutionalised structures of late modern capitalist society: the limited understanding of meaningful work as paid employment; and the liberal ideal of the independent and autonomous individual. Whereas a UBI can challenge the first condition, a public model of care questions the second condition by shifting the primary responsibility of care from the family towards a social solidarity. While insufficient when introduced separately, the combination of these two remedies has the potential to radically alter social structures on which gendered inequalities rest. (shrink)

The World Professional Association for Transgender Health’s Standards of Care, now in its seventh edition, is a frequently cited, internationally recognized, evidence-based document that details a comprehensive framework for gender-related care of trans people. However, the WPATH SOC still relies heavily in some cases on gatekeeping practices, dubbed “triadic therapy,” or a process where a trans patient is encouraged to seek out psychotherapy, and hormone therapy, and only then be able to engage in surgical options for transitioning. I (...) use G. Alan Marlatt’s harm reduction framework to argue that the triadic process creates its own set of harms that trans people have to contend with, especially insofar as it focuses on resolving gender dysphoria in a demanding, moralizing, and top-down way as opposed to enriching trans lives by reducing harms that prevent us from flourishing. Using Marlatt’s criterion that harm reduction ought to be bottom-up, low threshold, and not moralizing, I develop a list of suggestions for what ought to be centrally considered in treating trans patients. (shrink)

Chronic childhood disease brings psychological challenges for families and carers as well as the children. Roger Bradford explores how they cope with these challenges, the psychological and social factors that influence outcomes and the ways in which the delivery of services can be improved to promote adjustment. Drawing on concepts from health psychology and family therapy, the author proposes a multi-level model of care which takes into account the child, the family and the wider care system and how (...) they interrelate and influence each other. (shrink)

In 2012, chief nursing officers (CNO) in England published a policy on compassion in response to serious criticisms of patients’ care. Because their objective is fundamentally to shape nursing, this study argues, following Popper, that the policy should be analysed. An appraisal tool, developed from Popper, Gadamer, Jauss and Thiselton, is the framework for this analysis. The CNO policy document identified six values and behaviours, termed ‘6Cs’, required by all nurses, midwives and care staff. The document contains no (...) data, references or acknowledgements, but is similar to the 6Cs defined by the Canadian nursing nun, Sister M. Simone Roach, in her theory of caring published 30 years earlier. Roach considered caring and the components of it, including compassion, to be moral virtues, an inner motivation to care. This study suggests that without explicit reference to Roach's ideas, and her underlying theoretical base, the CNO requirement has the effect of turning virtues into commodities and a form of external control, described by Ritzer as a McDonaldized dehumanization. This study, which has international relevance beyond England and the UK, suggests that the CNO revise their policy by acknowledging Roach's 6Cs and openly discuss the implications of her work for their policy. (shrink)

The predominant model of the body in modern western medicine is the machine. Practitioners of the biomechanical model reduce the patient to separate, individual body parts in order to diagnose and treat disease. Utilization of this model has led, in part, to a quality of care crisis in medicine, in which patients perceive physicians as not sufficiently compassionate or empathic towards their suffering. Alternative models of the body, such as the phenomenological model, have been proposed to address this (...) crisis. According to the phenomenological model, the patient is viewed as an embodied person within a lived context and through this view the physician comes to understand the disruption illness causes in the patient’s everyday world of meaning. In this paper, I explore the impact these two models of the patient’s body have had on modern medical practice. To that end I first examine briefly the historical origins of the biomechanical and phenomenological models, providing a historical context for the discussion of each model’s main features in terms of machine-world and life-world. Next, I discuss the impact each model has had on the patient–physician relationship, and then I examine briefly the future development of each model. The meaning of illness vis-à-vis each model of the patient’s body is finally examined, especially in terms of how these two models affect the patient’s interpretation of illness. The paper concludes with a discussion of the biomechanical and phenomenological models, in terms of the quality of care crisis in modern western medicine. (shrink)

This article argues that the social quality approach can be usefully applied to studying “models of elderly care“ that enhance the wellbeing of the elderly and empower them to participate in social activities. Examining three cases in Japan and another three cases in e Netherlands, the study identifies actors, institutions and processes that have provided services for the elderly, highlighting the importance of history and culture in influencing the “social“ of the elderly. The article deals with a range (...) of opportunities and possibilities for optimizing care for the elderly, both as individuals and as a group, through promoting their social inclusion, social cohesion, socio-economic security and social empowerment. Grounded in community networks, as well as in social and intergenerational interaction, these “models“ demonstrate how care-givers, including nurses and family members, are also empowered in these processes. These discussions, reflecting empirical reality and conceptual insights, provide the basis of sustainable welfare policies that improve the social quality of the elderly. (shrink)

Machine learning (ML) trains itself by discovering patterns of correlations that can be applied to new inputs. That is a very powerful form of generalization, but it is also very different from the sort of generalization that the west has valorized as the highest form of truth, such as universal laws in some of the sciences, or ethical principles and frameworks in moral reasoning. Machine learning’s generalizations synthesize the general and the particular in a new way, creating a multidimensional model (...) that often retains more of the complex differentiating patterns it has uncovered in the training process than the human mind can grasp. Particulars speak louder in these models than they do in traditional generalizing frameworks. This creates an odd analogy with recent movements in moral philosophy, particularly the feminist ethics of care which rejects the application of general moral frameworks in favor of caring responses to the particular needs and interests of those affected by a moral decision. This paper suggests that our current wide-spread and justified worries about ML’s inexplicability—primarily arising from its reliance on staggeringly complex patterns of particulars—may be preparing our culture more broadly for a valorizing of particulars as at least as determinative as generalizations, and that this might help further advance the importance of particulars in ideas such as those put forward by the ethics of care. (shrink)

Notwithstanding the EU endorsement, so far Responsible Research and Innovation (RRI) is discussed as regards its definition, its features and its conceptual core: innovation and responsibility. This conceptual indeterminacy is a source of disagreements at the political level, giving rise to a plurality of outcomes and versions upheld within the same model of governance. Following a Charles Taylor’s suggestion, this conceptual opening of the RRI model can be explained by the existence of plural, clashing moral frameworks: discourse ethics, Aristotelian ethics, (...) care ethics, dignitarian ethics, rights-based moralities etc. Given the diffusion in the RRI literature of references to care ethics and its justification of participation and responsibility, I will compare the conceptual premises of this philosophical line with those of ethics of rights, which have been criticised by advocates of care ethics. I will argue that public engagement based on only needs cannot lead to responsible outcomes since it produces however the exclusion of some needs, covered instead by rights. In order for participation to be effective, rights or an alliance between the two perspectives is required. (shrink)

Starting from two paintings by Salvador Dalì (The Enigma of William Tell and Autumnal Cannibalism), the article explores Sigmund Freud and Carl Gustav Jung’s idea of erotic cannibalism. The fear of being eaten is an archetype of the collective unconscious, as fairy tales clearly reveal. Following Jacques Derrida’s reflections, the author suggests that the fear of being eaten is not limited to anthropophagic cultures, because there is a sort of symbolic cannibalism which has to do with the capacity for annihilation. (...) The petrifying gaze of Medusa, described by Jean Paul Sartre, is a good example of this symbolic cannibalism. On the opposite side of the spectrum, compared to the petrifying gaze, we find the recognizing look of a mother toward her child. For the child, the mother embodies the good subject, which is reassuring and nonthreatening (the fairy who stands in contrast to the devouring ogre in fairy tales). Sara Ruddick explicitly refers to this motherhood model in her book Maternal Thinking, where she lays out the methodology for the ethics of care. The maternal, or recognizing gaze, as the opposite of Medusa’s gaze portrayed by Sartre, is well described in a compelling text by the Italian novelist Luigi Pirandello. At the same time, it plays an important role in Georg Wilhelm Friedrich Hegel’s The Phenomenology of the Spirit. Finally, the article returns to Salvador Dalì, showing how in his life, the artist experienced the Other’s gaze in both forms: the objectifying one, represented by the artist’s father (portrayed in The Enigma of William Tell), and the recognizing one, embodied by his partner Gala (portrayed in Autumnal Cannibalism). (shrink)

This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan (...) Bernheim, independent from but together with British expatriates, were among the founders of what was probably the first palliative care service in Europe outside of the United Kingdom. In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority view among the wider Belgian public, palliative care workers, other health professionals, and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services. It is argued that this synergistic development was made possible by public confidence in the health care system and widespread progressive social attitudes that gave rise to a high level of community support for both palliative care and euthanasia. The Belgian model of so-called integral end-of-life care is continuing to evolve, with constant scrutiny of practice and improvements to procedures. It still exhibits several imperfections, for which some solutions are being developed. This article analyses this model by way of answers to a series of questions posed by Journal of Bioethical Inquiry consulting editor Michael Ashby to the Belgian authors. (shrink)

The practice around informed consent in clinical medicine is both inconsistent and inadequate. Indeed, in busy, contemporary health care settings, getting informed consent looks little like the formal process developed over the past sixty years and presented in medical textbooks, journal articles, and academic lectures. In this article, members of the Society of Teachers of Family Medicine (STFM) Collaborative on Ethics and Humanities review the conventional process of informed consent and its limitations, explore complementary and alternative approaches to doctor‐patient (...) interactions, and propose a new model of consent that integrates these approaches with each other and with clinical practice. The model assigns medical interventions to a consent continuum defined by the discrete categories of traditional informed consent, assent, and nondissent. Narrative descriptions and clinical exemplars are offered for each category. The authors invite colleagues from other disciplines and from the academic ethics community to provide feedback and commentary. (shrink)

The ideal moral standard for surgical informed‐consent calls upon surgeons to carry out a disclosure dialogue with patients so they have as full as possible an understanding of the procedure before they sign the informed‐consent form. This study is the first to empirically explore patient preferences regarding disclosure dialogue. Twelve Israelis who underwent life‐saving surgeries participated in a narrative study. Three themes emerged from the analysis: objectification of patients, anxiety provoking processes and information, and lack of information that was essential (...) for patients. Findings contribute to existing debates among surgeons regarding the scope and importance of some disclosure components. Analysis led to our formulation of an augmented subjective model of information disclosure that participants prefer, which extends beyond the immediate present of the surgery to the period after discharge, and until return to routine. Surgeons should be aware of patient preferences in disclosure, and gaps between perceptions of surgeons, and preferences and needs of patients. (shrink)

I argue that the principle of care, developed in care ethics, can be a better ground for civic solidarity than that of civic friendship. To make my argument, I present a preliminary categorization of extant discussion on civic solidarity as either falling under the commonality model or the relationship model. I argue that the reciprocity model of civic friendship proposed by Danielle Allen and Sibyl Schwarzenbach serves as a synthesis of the two models, constructing the most compelling (...) theory of civic friendship available.Despite the many virtues of the reciprocity model of civic friendship, I argue that the principle of care is practically prior and more appealing as a model of civic solidarity than that of civic friendship. In unpacking this argument, I present the concept of care as a political principle developed in care ethics and compare and contrast it with the concept of civic friendship. (shrink)

The concepts of health and disease are crucial in defining the aim and the limits of modern medicine. Accordingly it is important to understand them and their relationship. However, there appears to be a discrepancy between scholars in philosophy of medicine and health care professionals with regard to these concepts. This article investigates health care professionals’ concepts of health and disease and the relationship between them. In order to do so, four different models are described and analyzed: (...) the ideal model, the holistic model, the medical model and the disjunctive model. The analysis reveals that each model has its pros and cons, and that health care professionals appear to apply more than one models. Furthermore, the models and the way health care professionals’ use them may be helpful for scholars in philosophy of medicine with regard to developing theories and communicating them to health care professionals. (shrink)

Growing evidence suggests the presence of a female leadership advantage (FLA), such that women leaders tend to be associated with more effective outcomes in uncertain conditions. However, mechanisms linking women's leadership to effective outcomes are less well understood. We integrate FLA insights with ethics of care philosophical framework to conceptualize how women leaders achieve effective outcomes in the context of the urban revitalization crisis in the United States. We propose and empirically test the mediating role of ethics of (...) class='Hi'>care leadership in the relationship between women mayors and economic health of their cities. We used data from the Urban Institute that includes 272 United States cities and measures of variables in our conceptual model at five points in time spanning 36 years (_n_ = 1185 city-year observations). We capture ethics of care leadership focused on racial inclusion with an index measure of a city’s racial spatial segregation, homeownership gap, poverty gap, and education gap, and we capture economic health with an index measure of a city’s employment growth, unemployment rate, housing vacancy rate, and median family income. We found that female-led cities were associated with better economic health, and this association was mediated by female-led cities’ association with greater racial inclusion. Ethics of care leadership appears to be one pathway through which a FLA manifests itself in the context of the urban revitalization crisis. This underscores the importance of city leadership that balances social and economic prerogatives. Implications are discussed. (shrink)

While Specific Informed Consent has been the established standard for obtaining consent for medical research for many years, it does not appear suitable for large-scale biobank and health data research. Thus, alternative forms of consent have been suggested, based on a variety of ethical background assumptions. This article identifies five main ethical perspectives at stake. Even though Tiered Consent, Dynamic Consent and Meta Consent are designed to the demands of the self-determination perspective as well as the perspective of research as (...) a public good, they are still also criticized from both perspectives. In addition, criticisms based on concerns of justice, participation and democratic deliberation, and relational concerns have been levelled at each of the models. As all of these perspectives have valid points to make, the task at hand lies in balancing these ethical perspectives. What constitutes an adequate balancing depends on contextual factors. These factors include digital infrastructure and digital literacy, data safety regulation, good scientific and clinical practice, transparent debates on ethically relevant features of research, social inequalities, anti-discrimination laws and practices, trust in health care institutions and recognition of patient preferences, and consensus on unethical research. We argue that the role of context in determining acceptable models of consent puts the ethical importance of models of consent into perspective. Since altering contextual factors can help to live up to the ethical concerns at stake in debates about models of consent, opting for such a shift of focus comes without ethical loss. (shrink)

The “best interests of the patient” standard—a complex balance between the principles of beneficence and autonomy—is the driving force of ethical clinical care. Clinicians’ fear of litigation is a challenge to that ethical paradigm. But is it ever ethically appropriate for clinicians to undertake a procedure with the primary goal of protecting themselves from potential legal action? Complicating that question is the fact that tort liability is adjudicated based on what most clinicians are doing, not the scientific basis of (...) whether they should be doing it in the first place. In a court of law, clinicians are generally judged based on the “reasonably prudent” standard: what a reasonably prudent practitioner in a similar situation would do. But this legal standard can have the effect of shifting the medical standard of care—enabling a standard‐of‐care sprawl where actions undertaken for the primary purpose of avoiding liability reset the standard of care against which clinicians will be adjudicated. While this problem has been recognized in the legal literature, neither current ethical models of care nor legal theory offer workable solutions.One of the best examples of the conflict between evidence‐based medicine and common clinical practice is the use of electronic fetal monitoring. Despite strong evidence and professional guidelines that argue against the use of EFM for healthy pregnancies, the practice persists. One of the main reasons for this is often assumed to be physicians’ concerns about liability. (shrink)

This paper is about mechanisms and models, and how they interact. In part, it is a response to recent discussion in philosophy of biology regarding whether natural selection is a mechanism. We suggest that this debate is indicative of a more general problem that occurs when scientists produce mechanistic models of populations and their behaviour. We can make sense of claims that there are mechanisms that drive population-level phenomena such as macroeconomics, natural selection, ecology, and epidemiology. But talk (...) of mechanisms and mechanistic explanation evokes objects with well-defined and localisable parts which interact in discrete ways, while models of populations include parts and interactions that are neither local nor discrete in any actual populations. This apparent tension can be resolved by carefully distinguishing between the properties of a model and those of the system it represents. To this end, we provide an analysis that recognises the flexible relationship between a mechanistic model and its target system. In turn, this reveals a surprising feature of mechanistic representation and explanation: it can occur even when there is a mismatch between the mechanism of the model and that of its target. Our analysis reframes the debate, providing an alternative way to interpret scientists’ mechanism-talk , which initially motivated the issue. We suggest that the relevant question is not whether any population-level phenomenon such as natural selection is a mechanism, but whether it can be usefully modelled as though it were a particular type of mechanism. (shrink)

Microethics is about the ethics of everyday clinical practice. The subtle nuances in communication between doctor and patient (the doctor’s choice of words, tone, body language, gestures, etc.) can influence the exercise of the patient’s autonomy. The four models of the doctor- patient/physician-patient relationship (paternalistic, informative, interpretive, deliberative) weigh respect for autonomy and beneficence in varying proportions. Each model may be appropriate in certain circumstances. This article considers these models from the perspective of microethics and the unique dimensions (...) created by the doctor-child-parent relationship. In particular, the article considers the nuances to the autonomy principle created by the child’s developing maturity and the parent’s role as a co-fiduciary of the child’s interests. Ultimately, the deliberative model seems most appropriate to the paediatric setting, since it accommodates the child’s developing maturity in making healthcare-related decisions. This model infuses care into the doctor’s communication with the child and parent. (shrink)

The identity of an academic discipline is essentially tied to production and reproduction of its disciplinary knowledge. This, in turn, determines the criteria of academic achievement for academicians belonging to a particular discipline. The ability of an academician to contribute to the disciplinary knowledge through publication of high-impact papers is considered to be of highest value in academic disciplines. This constitutes an essentialist paradigm of understanding academic disciplines. Such a paradigm, however, undervalues other equally important forms of academic labour, like (...) academic service, which support, develop and repair the academic world through practice of care. In his paper, the essentialist paradigm is critically appraised through Paperwinner’s Model, an adaptation of Breadwinner’s Model. Through the lens of ethics of care, specifically Joan Tronto’s responsibility-based ethics, the paper offers an alternate paradigm, the deflationary perspective on academia, to acknowledge and evaluate the significance of caring practices. The paper concludes with a formative suggestion to institutionally recognize and reward care through service-intensive positions. (shrink)

In bioethics and health policy, we often discuss the appropriate boundaries of public funding; how the interface of public and private purchasers and providers should be organized and regulated receives less attention. In this paper, I discuss ethical and regulatory issues raised at this interface by three medical practice models in which physicians provide insured services while requiring or requesting that patients pay for services or for the non-insured services of the physicians themselves or their associates. This choice for (...) such practice models is different from the decision to design an insurance plan to include or exclude user fees, co-payments and deductibles. I analyze the issues raised with regards to familiar health care values of equity and efficiency, while highlighting additional concerns about fair terms of access, provider integrity, and fair competition. I then analyze the common Canadian regulatory response to block fee models, considering their extension to wellness clinics, with regards to fiduciary standards governing the physician–patient relationship and the role of informed consent. I close by highlighting briefly issues that are of common concern across different fundamental normative frameworks for health policy. (shrink)

The aim of the article is to present the application of the lean management method as appropriate for the management of the organizational system of psychiatric care in the Zealand region of Denmark. The organizational solutions of the Danish psychiatric care system presented in this paper are individualized and adapted to the regional needs of the residents. In Denmark, there are five administrative regions, in which each independently organizes its own system of medical (psychiatric) care. This means (...) that the regions have considerable independence in choosing the acceptable and necessary methods of management, including – as is clear from the conducted research – the use of methods put-upon other areas of economy. Although the national laws in Denmark define certain conditions and guidelines for the functioning of psychiatric care (e.g. regarding the use of direct coercion/restrains for patients treated in the centres), there is a distinct separation of structures and methods of functioning throughout the whole country, which constitutes unique observation material – from the cognitive point of view. The authors of this paper conduct extensive research and analyse the systems of psychiatric care organizations in various countries (including Spain, Italy and Japan) and, as a result, the obtained results may lead to the selection of the best models from other systems (good organizational practices and management, the management methods in use), which can be applied in the currently reorganised system of the Polish psychiatric care. The choice of Denmark for the observational study is not accidental and is related not only to the fact that there is a large degree of systemic identity within the country and between the regions, but also because the country applies solutions addressed to patients with very different cultural conditions and needs, resulting from their descent, religion, and (world)-views. Denmark is one of those European countries that express a significant acceptance of diversity and tolerance, which is why communities with very different imponderables, denominations, and worldviews co-exist. In the area related to the organization of the psychiatric system, these conditions are of key importance. In the period from January 2015 to December 2017 the authors participated in study visits in Denmark, conducting research aimed at identifying the key success factors of the psychiatric care organization system in the country. The conducted analysis is also based on the analysis of literature and own and participant observations. The conclusions concerning this subject are also the result of interviews conducted with employees of the visited hospitals and system users, both professionals and patients. As the search for an optimal organizational model of psychiatric care is currently an ongoing concern in Poland, it seems justified to review the existing solutions in Europe and perform their critical analysis. A comparison of the adopted solutions was performed, in the context of, above all, the improvement of the quality of these services, their availability, and the satisfaction of patients and their families from the proposed organizational changes. The economic benefits of these solutions are also significant. (shrink)

Drawing upon contemporary virtue ethics theory, The Model of The Principled Advocate and The Pathological Partisan is introduced. Profiles are developed of diametrically opposed archetypes of public relations and advertising practitioners. The Principled Advocate represents the advocacy virtues of humility, truth, transparency, respect, care, authenticity, equity, and social responsibility. The Pathological Partisan represents the opposing vices of arrogance, deceit, secrecy, manipulation, disregard, artifice, injustice, and raw self-interest. One becomes either a Principled Advocate or a Pathological Partisan by habitually enacting (...) or embodying the virtues or vices in the context of professional practices. (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

The development of nursing ethics as a field of inquiry has largely relied on theories of medical ethics that use autonomy, beneficence, and/or justice as foundational ethical principles. Such theories espouse a masculine approach to moral decision-making and ethical analysis. This paper challenges the presumption of medical ethics and its associated system of moral justification as an appropriate model for nursing ethics. It argues that the value foundations of nursing ethics are located within the existential phenomenon of human caring within (...) the nurse/patient relationship instead of in models of patient good or rights-based notions of autonomy as articulated in prominent theories of medical ethics. Models of caring are analyzed and a moral-point-of-view (MPV) theory with caring as a fundamental value is proposed for the development of a theory of nursing ethics. This type of theory is supportive to feminist medical ethics because it focuses on the subscription to, and not merely the acceptance of, a particular view of morality. (shrink)

Social scientists regularly make use of multivariate models to describe complex social phenomena. It is argued that this approach is useful for modelling the variety of cognitive and social factors contributing to scientific change, and superior to the integrated models of scientific change currently available. It is also argued that care needs to be taken in drawing normative conclusions: cognitive factors are not instrinsically more "rational" than social factors, nor is it likely that social factors, by some (...) "invisible hand of reason," generally work to produce scientific success. A multivariate model of the biasing factors within a scientific community at particular times is developed. This model, which is an example of work in social epistemology, yields normative conclusions. (shrink)

In Western industrialized countries, women report using health services, and certain medications, more often than do men. Often, analyses are based on data that exclude objective measures of morbidity and that come from cross-sectional surveys, which precludes the use of socioeconomic covariates that are endogenous to seeking care. Here, differences in objective cognitive and physical function, as well as differences in reporting on illness, propensity to seek care, and socioeconomic resources are expected to account for differences in (...) class='Hi'>care-seeking behaviour among women and men. This model is applied to the question of medication use in Ismailia, Egypt, using two waves of survey data and in-home tests of physical function from 896 adults aged 50 years and older. The results show that women use medications more often than do men, and that differences between women and men in reported morbidity and disability, observed cognitive and physical function, and economic resources account for womens and men’s care-seeking behaviour in later life. (shrink)

Recent conceptualizations of sustainable global development have reflected societal concerns not only with environmental stewardship, but also with social amelioration. However, the tripartite goals of corporate profitability, environmental protection, and social responsiveness are unlikely to be achieved through conventional models of globalization. The emergent approach known as sustainable global enterprise provides a promising strategic alternate, but requires the development of “native capability” [Hart, S. L.: 2005, Capitalism at the Crossroads: The Unlimited Business Opportunities In Solving the World’s Most Difficult (...) Problems. (Pearson Education, Inc., Publishing as Wharton School Publishing, Upper Saddle River, NJ)] that comprises specific relational competencies not typically required by traditional transnational models. This article demonstrates the usefulness of an ethic of care for enhancing understanding of the competencies comprising native capability, and, provides practical insights from a care approach on the development of those skills. (shrink)

Advance directives for withholding life-saving treatment are controversial for dementia patients whose previously expressed wishes conflict with their currently expressed desires. To illustrate this ethical dilemma, McMahan conceives a hypothetical case in which an intellectually proud creative woman signs an advance directive stipulating her refusal to receive life-saving treatment if she contracts a fatal condition with dementia. However, when she develops dementia and forgets this advance directive, she contracts pneumonia and now expresses a desire to live. In response to such (...) dilemmas, scholars like Norman Cantor have defended the moral authority of advance directives by giving credence to one’s prior competent wishes over one’s current incompetent preferences. I argue that their arguments, which are rooted in the principle of respect for autonomy, operate under ableist assumptions about incompetent persons and exclude other important features of respect. I propose an ethics of care model as an alternative moral approach that reconceptualises respect as a matter of caring about people’s contemporaneous interests, even if they are not competently conceived. It fosters the virtues of care by encouraging healthcare providers to recognise dementia patients as legitimate narrative agents capable of authoring their own evolving life story. I argue that the ethics of care model not only provides an ethical defence of the creative woman’s current incompetent desire to live despite her advance directive, but also vindicates our moral intuitions about what it means to demonstrate respect to dementia patients. (shrink)

Health care organizations are increasingly asked to show accountability about their performance. This paper proposes that accountability can best be achieved through evaluative methods that are based on evidence regarding the relationship between processes of care and expected outcomes. Root cause analysis (RCA) is used as an illustration of how a generic method of inquiring can be transformed into an ongoing monitoring, evaluation, user education and accountability strategy. The role of performance indicators, as well as patient and community (...) expectations, is discussed. (shrink)

This paper employs the methodological framework of linguistic analytic philosophy to explore the conceptual issues arising from a study of the different models of disorder implicit in five groups of stakeholders concerned in the community care of people with a diagnosis of long-term schizophrenia. Linguistic analysis, gives a precise fix on the nature of the practical difficulties presented by such models, suggests a powerful heuristic for displaying and comparing models, is the basis of a methodology which (...) is neutral as between users and providers of services, provides an intuitively powerful way of understanding the results of work of this kind, and facilitates the translation of research into practice. (shrink)

Background:The public domain of midwifery practice, represented by the educational and hospital institutions could be blamed for a subconscious ethical dilemma for midwifery practitioners. The result of such tension can be seen in complaints from maternity service users of dehumanised care. When expectations are not met, women report dehumanising experiences that carry long term consequences to both them and their child.Objectives:To revisit the ethical foundation of midwifery practice to reflect the feminist Ethic of Care and reframe what is (...) valuable to women and midwives during the childbirth experience.Research Design:A comprehensive literature review is presented from the midwifery and feminist ethics discourse.Ethical Considerations:Nil to report.Findings:Women are vulnerable during childbirth as they need care, yet they prioritise elements of relationship in their experience. The Ethic of Care approach equalises the relationship between the midwife and the woman, providing the space for relationship building and allowing midwives to meet the expectations of their accepted responsibility.Discussion:Some midwives manage to balance the demands of the institution with the needs of the woman. This is described as both an emotional and professionally challenging balancing act.Conclusion:Until there is a formal acknowledgement of the different ethical approach to midwifery practice from within the profession and the Institution, midwifery identity and practice will continue to be compromised. (shrink)

The “best interests of the patient” standard—a complex balance between the principles of beneficence and autonomy—is the driving force of ethical clinical care. Clinicians’ fear of litigation is a challenge to that ethical paradigm. But is it ever ethically appropriate for clinicians to undertake a procedure with the primary goal of protecting themselves from potential legal action? Complicating that question is the fact that tort liability is adjudicated based on what most clinicians are doing, not the scientific basis of (...) whether they should be doing it in the first place. In a court of law, clinicians are generally judged based on the “reasonably prudent” standard: what a reasonably prudent practitioner in a similar situation would do. But this legal standard can have the effect of shifting the medical standard of care—enabling a standard-of-care sprawl where actions undertaken for the primary purpose of avoiding liability reset the standard of care against which clinicians will be adjudicated. While this problem has been recognized in the legal literature, neither current ethical models of care nor legal theory offer workable solutions. One of the best examples of the conflict between evidence-based medicine and common clinical practice is the use of electronic fetal monitoring. Despite strong evidence and professional guidelines that argue against the use of EFM for healthy pregnancies, the practice persists. One of the main reasons for this is often assumed to be physicians’ concerns about liability. (shrink)

According to the naive theory of vagueness, the vagueness of an expression consists in the existence of both positive and negative cases of application of the expression and in the non- existence of a sharp cut-off point between them. The sorites paradox shows the naive theory to be inconsistent in most logics proposed for a vague language. The paper explores the prospects of saving the naive theory by revising the logic in a novel way, placing principled restrictions on the transitivity (...) of the consequence relation. A lattice-theoretical framework for a whole family of “tolerant logics” is proposed and developed. Particular care is devoted to the relation between the salient features of the formal apparatus and the informal logical and semantic notions they are supposed to model. A suitable non-transitive counterpart to classical logic is defined. Some of its properties are studied, and it is eventually shown how an appropriate regimentation of the naive theory of vagueness is consistent in such a logic. (shrink)

While the ethic of care has generally been regarded as an appropriate attitude for nurses, it has not received equal attention as a mode of ethical problem solving. The primary nursing model is exp...

Past ages of medical care are condemned in modern philosophical and medical literature as being too paternalistic. The normal account of good medicine in the past was, indeed, paternalistic in an offensive way to modern persons. Imagine a Jean Paul Sartre going to the doctor and being treated without his consent or even his knowledge of what will transpire during treatment! From Hippocratic times until shortly after World War II, medicine operated in a closed, clubby manner. The knowledge learned (...) in medicine was not shared with the patients, who were in general poorly educated and for the most part completely ignorant of the craft of medicine and the physicians (but not, perhaps, of folk medicine). Physicians were cautioned against telling patients too much about their Illness and/or their recovery, perhaps because physicians themselves did not have an enormous armamentarium to confront disease. (shrink)

While environmental ethicists often critique metaphors of nature, they rarely recognize metaphors of environmental practice, and so fail to submit background models of human agency to similar critique. In consequence, descriptions of nature are often shaped by unassessed metaphors of practice, and then made to bear argument for that preferred model. To relieve arguments over “nature” of this vicarious burden, models of agency can and should become a primary topic within the field. In response to some initial misgivings (...) from Eric Katz and taking suggestions from Bryan Norton, Steven Vogel, Holmes Rolston, III, and others, some minimal framing criteria can be developed to promote and facilitate a broad debate over the most appropriate metaphors and models of environmental practice. (shrink)

This article describes a qualitative study of models of ethics consultation used by ethics consultants in Canada. We found four different models used by Canadian ethics consultants whom we interviewed, and one sub-variant. We describe the lone ethics consultant model, the hub-and-spokes sub-variant of this model; the ethics committee model; the capacity-building model; and the facilitated model. Previous empirical studies of ethics consultation describe only two or three of these models.

Introduction: The COVID-19 pandemic is asking health care workers to meet extraordinary challenges. In turn, HCWs were experiencing tremendous psycho-social crisis as they have had to deal with unexpected emotional requirements arising from caring for suffering and dying patients on a daily basis. In that context, recent studies have highlighted how HCWs working during the COVID-19 outbreak manifested extreme emotional and behavioral reactions that may have impacted their mental health, increasing the risk for developing post-traumatic stress symptoms.Purpose: The aim (...) of the study was to investigate post-traumatic stress symptoms, such as intrusion symptoms, as a potential mediator of the link between ERs and crying at work, and whether rumination moderates the relationship between ERs and intrusion-based PTS symptoms among HCWs who have had to deal with patients dying from COVID-19.Methods: An online cross-sectional study design was performed. A total of 543 Italian HCWs participated in the study. Participation was voluntary and anonymous. We used the SPSS version of bootstrap-based PROCESS macro for testing the moderated mediation model.Results: ERs had an indirect effect on crying at work through the mediating role of intrusion symptoms. Results from the moderated mediation model showed that rumination moderated the indirect effect of ERs on crying at work via intrusion symptoms, and this effect was significant only for high rumination. Furthermore, when we tested for an alternative model where rumination moderates the direct effect of ERs on crying at work, this moderation was not significant.Conclusions: As the second wave of the COVID-19 pandemic is ongoing, there is an urgent need for decision-makers to rapidly implement interventions aimed at offering timely psychological support to HCWs, especially in those contexts where the risk of emotional labor associated to patients dying from COVID-19 is higher. (shrink)

To some, Rene Girard is best known for his views on sacred myth and ritual. To others, he is the eminent structuralist critic who offers challenging readings of major literary works. Still others know him for his analyses of the Bible. Central to all aspects of Girard's work is his theory of mimesis, a basic hypothesis about the structures of human motivation, Yet nowhere in his writings does Girard offer a systematic presentation of the mimetic theory. In fact, key terminology (...) shifts from work to work, resulting in considerable ambiguity in both basic concepts and explanatory claims,In Models of Desire Paisley Livingston provides the first rigorous critical reconstruction of Girard's theory of mimesis. Drawing a careful distinction between the theory itself and Girard's often ambitious claims about it, Livingston provides a systematic presentation of Girard's ideas about the role of imitation in human motivation. He surveys responses to Girard's work and compares his theory of mimetic desire with recent work in cognitive psychology and philosophy. The result is a salient theoretical alternative to the false choice--between psychoanalysis and anti-psychological doctrines--that currently dominates literary theory. (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)

The deontic model of justice and ethical behavior proposes that people care about justice simply for the sake of justice. This is an important consideration for business ethics because it implies that justice and ethical behavior are naturally occurring phenomena independent of system controls or individual self-interest. To date, research on the deontic model and third-party reactions to injustice has focused primarily on individuals’ tendency topunishtransgressors. This research has revealed that witnesses to injustice will consider sacrificing their own resources (...) if it is the only way to sanction an observed transgressor. In this paper we seek to extend this model by arguing that punishment may not be the only “deontic” reaction, and that in fact, third-party observers of injustice may engage in moral self-regulation that would lead them to conclude that the most ethical response is to do nothing. We provide preliminary evidence for our propositions using voiced cognitions data collected during a resource allocation task. Results indicate that deonance may be more complex than originally thought, and previous tests of the model conservative in nature. (shrink)