Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised (...) report was prompted by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Neither secular moral theory nor religious ethics have had much place for persons in need of constant physical help and cognitive support, nor for those who provide care for them. Writing as the father of a fourteen-year-old daughter with multiple disabilities, I will explore some of moral issues that arise here, both from the point of view of the disabled child and from that of the child's caretaker(s).

With a global commitment to scaling up AIDS care and treatment in resource-poor settings for some of the most HIV-affected countries in Africa, availability of antiretroviral treatment is no longer the principal obstacle to expanding access to treatment. A shortage of trained healthcare personnel to initiate treatment and manage patients represents a more challenging barrier to offering life-saving treatment to all patients in need. Physician-centered treatment policies accentuate this challenge. Despite evidence that task shifting for nurse-centered AIDS patient (...) care is effective and can alleviate severe physician shortages that currently obstruct treatment scale-up, political commitment and policy action to support task shifting models of care has been slow to absent. In this paper we review the evidence in support of task shifting for AIDS treatment in Africa and argue that continued policy inaction amounts to unwarranted healthcare rationing and as such is ethically untenable. (shrink)

This work seeks to shift the focus of medical practice from disease to people, emphasizing a person's need to be recognized, understood and treated with respect and sensitivity. It also tackles questions about ethical considerations and the recognition of human values.

In lieu of an abstract, here is a brief excerpt of the content:Working on the Clinton Administration's Health Care Reform Task ForceNancy Neveloff Dubler (bio)This narrative is based on my understanding of the elements of the Health Security Act that may have ethical implications. I have reconstructed these elements from my experience on the Health Care Reform Task Force and they are part of the health care plan that the President presented to Congress. (At the (...) time this article went to press, the actual legislation, which should answer my remaining specific questions more clearly, had not yet been released.) I perceive the most important features of the plan to be:• The legislation will create a "right" to health care for all citizens—access to care will be universal;• The plan will involve some form of managed competition in which groups of providers (called Approved or Accredited Health Plans (AHPs)) will offer comparable benefit packages at slightly (or widely) different costs;• The AHPs will negotiate with the Health Alliance (HA) to determine the price that they will charge their consumer-patients;• There will be open enrollment with no barriers to coverage, such as exclusions for pre-existing conditions;• Community rating will be in effect in different localities and enrolled persons in any AHP will pay the same premium;• The coverage for any enrolled person will be portable;• The overall structure will be a cooperative federal/state enterprise in which the states will have quite extensive abilities to fashion variations of the basic plan to meet their particular needs;• Primary care will be encouraged and incentives for physicians to train in primary care specialties provided;• Non-physician providers will be central to the functioning of the health care plans;• Efforts will be made to develop a "person power" pool so that people with an abstract "right" to health care will have real access to providers, in their localities, who can fulfill the promise that the right creates; [End Page 421]• The goal of cost containment will be central to the organization and regulation of the system;• Administrative simplicity and quality protections will be central.Co-chairing the Bioethics Working Group (BWG) of the White House Task Force on Health Care Reform was a unique experience. Approximately 40 Task Force working groups were established by Hillary Rodham Clinton, the President, and the senior Task Force staff. Various members of the President's office and other knowledgeable members of the Executive Branch selected the participants. In our group, appointments were made largely on the recommendations of the co-chairs. The BWG, among the last of the groups formed, carried the official name "The Working Group on the Ethical Foundations of the New System" and was jointly led by me and Marion Gray Secundy, a Professor of Bioethics at Howard University. The fact that the leadership of the Task Force saw fit to establish such a group, thereby confirming that bioethics is a player in the arena of health care policy, was in itself significant and was made no less so by the lack of clarity regarding the group's aims and goals.The working groups of the Task Force were organized into clusters, determined by the relatedness of the somewhat distinct, but always overlapping, content of their investigations. Separate clusters and working groups, for example, looked at mental health, long term care, and the benefit package and coverage for low-income and non-working families. On this last issue there was also a working group that explored health policy initiatives for underserved populations. This multiple focus on related issues proved to be an excellent method for ensuring that the complexity of these topics was sufficiently explored. There was a published schedule for when these groups met together, and members of other groups who had similar or overlapping concerns were invited to attend and to participate.Every week or so, all of the working groups reported to the Task Force leadership, under the direction of Ira Magaziner, in a process called a "tollgate." Prior to the tollgate, the working groups were required to submit formal written analyses of the problems they had most recently been considering. Copies of these documents were placed in a special room so that those who were interested could review... (shrink)

난민 사태에 대한 윤리적 접근은 배려와 책임의 연결 지점에서 출발될 필요가 있다. 난민에 대한 배려 윤리적 측면의 접근은 사회 정책적 측면에서 배려의 연쇄효과(care chains)를 통해 개별 행위자 및 국내 수준의 난민에 대한 배려 논의로부터 국제적 수준의 담론으로 확장이 이루어지도록 하는 것을 목표로 한다. 따라서 배려를 제공하는 선진국의 측면에서는 단순한 공감으로 끝나는 것이 아니라 난민을 지지하고 부양하기 위해 사회경제적 비용을 부담하는 실질적 노력이 보다 강화될 필요가 있다. 또한, 배려를 받는 관계자로서 난민들은 지지와 성원을 이끌어내도록 하기 위하여 시민사회의 구성원으로서 합당한 면모와 (...) 그에 따른 자세를 지니는 것이 필요하다. 현상으로 드러난 유럽 난민 문제의 본질에는 윤리적 관점에서만 분석될 수 있는 원인들이 존재하며, 이러한 접근을 통해 해결의 시작이 이루어져야 할 것이다. (shrink)

Nurses have traditionally been regarded as clinicians that deliver compassionate, safe, and empathetic health care (Nurses again outpace other professions for honesty & ethics, 2018). Caring is a fundamental characteristic, expectation, and moral obligation of the nursing and caregiving professions (Nursing: Scope and standards of practice, American Nurses Association, Silver Spring, MD, 2015). Along with caring, nurses are expected to undertake ever‐expanding duties and complex tasks. In part because of the growing physical, intellectual and emotional demandingness, of nursing as (...) well as technological advances, artificial intelligence (AI) and AI care robots are rapidly changing the healthcare landscape. As technology becomes more advanced, efficient, and economical, opportunities and pressure to introduce AI into nursing care will only increase. In the first part of the article, we review recent and existing applications of AI in nursing and speculate on future use. Second, situate our project within the recent literature on the ethics of nursing and AI. Third, we explore three dominant theories of caring and the two paradigmatic expressions of caring (touch and presence) and conclude that AI—at least for the foreseeable future—is incapable of caring in the sense central to nursing and caregiving ethics. We conclude that for AI to be implemented ethically, it cannot transgress the core values of nursing, usurp aspects of caring that can only meaningfully be carried out by human beings, and it must support, open, or improve opportunities for nurses to provide the uniquely human aspects of care. (shrink)

The Human Genome Project is expected to increase dramatically our ability to predict the likelihood of genetic disease in an individual. It is important to reject the myth of genetic determinism—i.e., the simple-minded belief that such complex outcomes as heart disease, cancer, or autoimmune diseases are caused exclusively by particular genes. But it is equally important to acknowledge that genes may play a role in making a person more or less susceptible to such diseases. The ever-increasing prospect of genetic prediction, (...) spurred by the Human Genome Project, has implications for social practices such as insurance, in which predicting the risk of disease or death plays a crucial role. Concerned that improved genetic prediction might have unfortunate social consequences unless the impact of such predictions were anticipated, the U.S. Human Genome Project's Working Group on Ethical, Legal, and Social Issues established a Task Force on Genetic Information and Insurance in May 1991. -/- The Task Force met seven times over its two-year life. By the end of the first year, it had reached several tentative conclusions. Most importantly, we became convinced that the problem posed by increased genetic prediction in insurance was a genuine and important one. When we began, the danger seemed plausible but far from certain. The information we gathered in the first year persuaded us that genetic prediction of disease was in one sense already with us and, in another sense, likely to grow massively in the foreseeable future. (shrink)

Health Care Law by Jonathan Montgomery has much to recommend it. It is a comprehensive account of the law relating to health care in its broadest sense. From the outset, Montgomery sets his face against a narrow construction of his task; as he recognises, health care law is so much more than the "law relating to what doctors do".

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 task of aligning the philosophical and clinical perspectives on ethics is a challenging one. Clinical practice informs philosophy, not merely by supplying cases, but through shaping and testing philosophical concepts in the reality of the clinical world. In this paper we explore several aspects of the relationship between the philosophical and the clinical within a framework of palliative care for people living with Alzheimer's disease. We suggest that health professionals have a moral obligation to question previous assumptions (...) concerning the quality of life among people with Alzheimer's, and to address the question: does the concept of palliative care properly embrace people with severe dementia? We propose an ethic of palliative care for people with Alzheimer's that is based, not on the traditionally understood principle of autonomy, but on the need to listen to those living with the disease, acknowledging their profound loss of cognitive abilities, with a focus on preventing and relieving suffering, and improving the individual's quality of life. (shrink)

Cleaning the floor, stripping the bed, arranging a bouquet of flowers—such tasks are essential to keeping a hospital room clean and creating a pleasant atmosphere. They usually fall under the purview of female* nurses, cleaning staff and housekeepers. In everyday hospital life, the demands for hygienic cleanliness commingle with the imperatives of economization, marketing logic, and attention to the affective and emotional needs of the actors in these rooms. Although the standards of clinical hygiene are based on medical knowledge, the (...) division of labor and the demands for cleanliness at various hierarchical levels also reveal gendered and partly racialized ideas that point beyond the clinical context. This blending of imperatives in the hospital environment invites deeper consideration of the history of bacteriology: The logic and language of defense against infection in science and everyday life is also interwoven with social markers of difference.Drawing on the findings of an ethnography on cleanliness and cleaning work in hospitals, as well as a history of knowledge approach, the article links the question of (feminized) care for the environment with the question of the atmosphere of clinical rooms. In what ways, and to what effect, does scientific knowledge about medical hygiene also carry with it cultural and aesthetic perceptions of beautiful and pleasant cleanliness that reveal feminine connotations rooted in the nineteenth century? (shrink)

Welfare states are in a care crisis both in the sense of a practical care gap and in the new movement to limit care to mere rehabilitation. Few political theorists pay attention to these developments, and those who do say little about the potential limits to care. This article discusses Philip Pettit’s theory of social justice in relation to questions of public care provisions. Pettit’s theory has been praised by feminists for its attention to social (...) injustices and because it highlights fair limits to care. The article examines how Pettit builds up his argument involving the idea of a gateway good, heuristics and a set of constraints. Although the article points to the value of Pettit’s theory, Pettit’s arguments to limit the state’s care tasks depend on the false assumption that a theory of justice considers able-minded adults only. This article argues that Pettit’s assumption that we leave out children and not-so-able-minded elderly leads to a general neglect o... (shrink)

Pentecostals can be understood as contemporary Christian mystics, and doing so can aid one in both understanding and caring for them. The task of understanding them is facilitated by this category in that it allows one to inhabit a different mindset from what is typical in contemporary settings. Pentecostalism and charismatic movements work out of distinct, fundamental claims that together work as a kind of worldview, one that operates from a hyperawareness of God’s presence and a sensed empowerment of (...) the mystic’s self. The task of caring for them should honor these claims all the while being open to the Spirit’s presence and work. (shrink)

The concept of care can be explained in various ways, and it can present a different meaning to each person. Nurses are increasingly aware that good nursing care consists of ‘more’ than the competent performance of a number of caring activities. For many nurses it is less clear what this ‘more’ means and what importance it has in nursing. This article will develop a view concerning care considered as a moral attitude. It is argued that care (...) can be considered as a foundational normative concept in the ethics of the nursing profession. The aim is to clarify that nurses do not derive their specific caring identity just from the set of tasks that they perform but also from the way in which they commit themselves to the caring process. (shrink)

Summary Care and cure have been described as different kinds of ethical approaches to clinical situations. Female concerns in nursing care have been contrasted with masculine, cure orientated physician's attitudes. Ethics in such different voices may have sociologic determinants, but they do not represent intrinsic distinctions. Medicine has shown a divergent development, on the one hand stressing cure in a deterministic and instrumental way, on the other hand being aware that disease is as much a pathographic as a (...) biographic, care‐requiring existential situation. Disease is a breakdown of the living organism, to be cured by therapeutic efforts, but it is also the distressing failure of the lived body, requiring concern and care. Based on Lévinas’ ethics of encounter, it is suggested that any interpersonal relatedness is based on concern for the other, being grounded on an essentially ethical interaction. The clinical encounter is a paradigm of such ethics‐based relationships, which necessarily builds on awareness of the other qua other, and is concerned with fulfilling the therapeutic mandate. Caring for the other means doing one's best to help her/him, so that care and cure are inextricably interwoven, although care is the more fundamental form of human relatedness. Thus, neither gender nor professional tasks can allow for a caring attitude to develop without curing concerns, just as trying to cure without caring is unthinkable. (shrink)

The discussion about robots in elderly care is populated by doom scenarios about a totally dehumanized care system in which elderly people are taken care of by machines. Such scenarios are helpful as they attend us to what we think is important with regard to the quality elderly care. However, this article argues that they are misleading in so far as they (1) assume that deception in care is always morally unacceptable, (2) suggest that robots (...) and other information technologies necessarily deceive elderly people by creating a “virtual” world as opposed to a “real” world, (3) assume that elderly people of the future have similar ICT skills and interests as the elderly people of today, and (4) assume a simplistic view of technologies. The article suggests an approach to evaluating care robots and ICT in health care which acknowledges and addresses a number of ethical problems raised by robotic care—for instance disengagement problems—while taking into account that some elderly people may need care that does not treat them as (empirically) autonomous, that many the elderly of the future are likely to be digital natives, and that the task of evaluating technologies in care is more complicated than the discussion of deception suggests. (shrink)

Our challenge for the twenty-first century consists in showing how to construct a global ethics and in trying to discover a rational foundation for it, which may be used as guidance for action and as a norm for the criticism of specific situations. I argue that four tasks must be accomplished to construct a global ethics: Construct that global governance or that world government that makes cosmopolitan citizenship possible. Foster the joint work of bioethics, economic and business ethics, and development (...) ethics – areas of applied ethics, each one of which on its own has reached the global level. Discover a rational basis for a global ethics, which has a universal normative force, but assumes cultural differences. Develop and promote a dilaogical ethics of cordial reason, which renders one capable of compassion and care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Health Care Ethics: A Comprehensive Christian Resource by James R. ThobabenPaul D. SimmonsHealth Care Ethics: A Comprehensive Christian Resource by James R. Thobaben Downers Grove, IL: Intervarsity Press, 2009. 429pp. $28.00In recent years, a stir has been created by the vocal and aggressive involvement of evangelicals in such issues as abortion, homosexuality, and end-of-life decisions. James Thobaben, the dean of Asbury Seminary, provides what he calls (...) a [End Page 203] “comprehensive resource” for evangelicals, and promises better understandings of their perspectives and commitments for those who are baffled or frustrated by the actions and claims of those on the religious right.Thobaben casts a wide net when defining those he includes as “evangelicals”—Southern Baptists, members of Campus Crusade, Pentecostals, the Holiness movement, neoevangelicals, charismatics, and Anabaptists. These diverse groups are evangelicals because of their “consistency on moral choices,” doctrinal orientation, and styles of social advocacy (24). Although they differ in a number of ways, they all share having been influenced in some way by John and Charles Wesley, Jonathan Edwards, and the Reformation. All stress conversion in that “one must say yes to the divine Jesus Christ” and become identified with the community of faithful believers (57). And in recent decades, they have become a potent political force with regard to the issues of abortion and homosexuality.Thobaben covers a wide range of topics in this book: from a general discussion of theodicy and healing to bioethics, disability, sickness, family and congregational care, professional truthfulness, managing care, end-of-life decisions, assisted reproduction, organ donation, and death. Yet, although he claims to provide a “comprehensive resource” on evangelical Christian health care ethics, he fails to provide a thorough examination of his subject matter. For example, Thobaben pays little attention to the historic beginnings of the religious right. One misses any mention of political action groups or the coalitions formed with or by conservative Christian groups to pursue social reforms, or of why such disparate groups have cooperated for political or social goals under the same umbrella. He focuses solely on identifying and articulating the consensus among those who embrace certain moral values on the current scene. Thobaben’s uncritical approach to his subject matter leaves the impression that this book is essentially an apology for evangelical, right-wing Christian social thought. One searches in vain for any critical discussion of the beliefs and values he presents or any thoughtful engagement with those who might view the stances he presents as an assault against women’s rights or an attack on the rights of gays, lesbians, and transsexuals.Moreover, in a book like this, one would have expected a more careful assessment of biblical passages and historical precedents. Thobaben does not provide much rationale for his method for moving from the Bible to current social issues. For example, no prohibition against abortion is found in the Bible and the few passages about homosexual practices hardly add up to the fierce opposition to gays found among strident evangelicals. Moreover, Thobaben does not mention that in 1965 laws against contraceptives were declared unconstitutional by the Griswold vs. Connecticut decision, the Supreme Court’s rejection of a ban supported by an evangelical crusade led by Anthony Comstock. [End Page 204]It is interesting to note that Thobaben holds a strongly qualified commitment to religious liberty and only a “thin” version of the social contract basic to the Bill of Rights (37). He argues that in at least some situations “intolerance is not only morally understandable but strongly preferable,” as in the examples of the “abolition of slavery and prolife/antiabortion advocacy” (29) or, in another context—where he distinguishes between tolerance toward those outside the church and intolerance toward those within it—with regard to homosexuality and alcohol intoxication (30).The task of Christian ethics is to enlighten believers and the general citizenry by a careful exposition of the sources of wisdom available to those who want to think and think morally about issues of importance to human flourishing. That task is especially important in an age of demagogic hostility toward unpopular groups. Sadly, this book does not engage such critical questions. It may prove... (shrink)

As interest in women’s roles in agriculture increases, research on women livestock-keepers remains limited. Advances in feminist scholarship highlight farming women’s dual roles in agricultural production and biological and socio-cultural reproduction, including women’s uncompensated labor in child-bearing, child-rearing and home-making. To expand knowledge about women pastoralists’ lived experiences, we conducted life-history interviews with 25 herder women in two regions of Mongolia, following-up with participatory workshops in each region. As mothering and carework emerged as key themes, we drew on feminist (...) class='Hi'>care ethics and the anthropology of mothering and motherhood to analyze interview data and co-interpret results with workshop participants. Our findings reveal three caring conflicts experienced by Mongolian herder women: between caring for _nutag_ (homeland) and caring for herds, between caring for herds and caring for children, and between caring for family, herd and _nutag_ and caring for self. These conflicts highlight contradictions between normative Mongolian motherhood as depicted in cultural images and narratives, and the lived reality of herder mothers, and between public valorization of and incentives for motherhood and the lack of sufficient public support for mothers and carework in rural Mongolia. Unmet needs for care, resulting risks to maternal and child health, and the extraordinary workload associated with mothers’ multiple caring tasks likely contribute to rural–urban migration and increasing masculinization of the Mongolian countryside. Although Mongolian culture frames mothers as leaders who unify their communities through their wisdom, many herder-mothers today live isolated lives where their multiple caring responsibilities preclude active participation in community development and governance. (shrink)

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses (...) hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development of home‐care nursing. (shrink)

During the last two decades there has been an enormous development in treatment possibilities in the field of neonatology, particularly for (extremely) premature infants. Although there are cross-cultural differences in treatment strategy, an overview of the literature suggests that every country is confronted with moral dilemmas in this area. These concern decisions to initiate or withhold treatment directly at birth and, later on, decisions to withdraw treatment with the possible consequence that the child will die. Given that the neonate cannot (...) express his or her own will, who will decide? And on the basis of what information, values and norms? We explored some of these issues in daily practice by interviewing a small sample of health care practitioners in a Dutch university Neonatal Intensive Care Unit (NICU). It turned out that experiencing moral dilemmas is part of their daily functioning. Nurses underline the suffering of the newborn, whereas physicians stress uncertainty in treatment outcome. To make the best of it, nurses focus on their caring task, whereas physicians hope that future follow-up research will lead to more predictable outcomes. As for their own offspring, part of these professionals would hesitate to bring their own extremely premature newborn to a NICU. For the most oppressing dilemma reported – terminating an already initiated treatment – we propose the concept of ‘evidence shift’ to clarify the ambiguous position of uncertainty in decision making. (shrink)

The aim was to synthesize the findings of empirical research about the unmet nursing care needs of older people, mainly from their point of view, from all settings, focusing on (1) methodological approaches, (2) relevant concepts and terminology and (3) type, nature and ethical issues raised in the investigations. A scoping review after Arksey and O’Malley. Two electronic databases, MEDLINE/PubMed and CINAHL (from earliest to December 2019) were used. Systematic search protocol was developed using several terms for unmet (...) class='Hi'>care needs and missed care. Using a three-step retrieval process, peer-reviewed, empirical studies concerning the unmet care needs of older people in care settings, published in English were included. An inductive content analysis was used to analyse the results of the included studies (n = 53). The most frequently used investigation method was the questionnaire survey seeking the opinions of older people, informal caregivers or healthcare professionals. The unmet care needs identified using the World Health Organization classification were categorized as physical, psychosocial and spiritual, and mostly described individuals’ experiences, though some discussed unmet care needs at an organizational level. The ethical issues raised related to the clinical prioritization of tasks associated with failing to carry out nursing care activities needed. The unmet care needs highlighted in this review are related to poor patient outcomes. The needs of institutionalized older patients remain under-diagnosed and thus, untreated. Negative care outcomes generate a range of serious practical issues for older people in care institutions, which, in turn, raises ethical issues that need to be addressed. Unmet care needs may lead to marginalization, discrimination and inequality in care and service delivery. Further studies are required about patients’ expectations when they are admitted to hospital settings, or training of nurses in terms of understanding the complex needs of older persons. (shrink)

Those who would enquire into therelationship between health conceptions and health care consequences are faced with a formidable task. In order to make this challenge manageable it is necessary to define the scope of the task as precisely as possible. Are we, for instance, faced with a purely theoretical challenge; a task for applied philosophy, or must we employ multi-disciplinary methods?This paper argues that while philosophy has a central clarifying role, inquiry into the relationship between health (...) conceptions and health care organisation can be done properly only through the combined efforts of several disciplines. Unless we are to be concerned only with abstract models it is essential to take account of the reality of health care situations. Given this it is suggested that the study of health conceptions is only a part of a greater task (unless all conceptions are to count as health conceptions). What is needed is understanding of the possible and actual purposes of health care, and detailed study of their practical implications. (shrink)

According to Frantz Fanon, the psychological and social-political are deeply intertwined in the colonial context. Psychologically, the colonizers perceive the colonized as inferior and the colonized internalize this in an inferiority complex. This psychological reality is co-constitutive of and by material relations of power—the imaginary of inferiority both creates and is created by colonial relations of power. It is also in this context that violence takes on significant political import: violence deployed by the colonized to rebel against these colonial relations (...) and enact a different world will also be violent in its fundamental disruption of this imaginary. The ethics of care, on the other hand, does not seem to sit well with violence, and thus Fanon’s political theory more generally. Care ethics is concerned with everything we do to maintain and repair our worlds as well as reasonably possible. Violence, which ruptures our psycho-affective, material, and social-political realities, seems antithetical to this task. This article seeks to reconsider this apparent antinomy between violence and care via a dialogue between Fanon and the ethics of care. In so doing, this article mobilizes a relational conceptualization of violence that allows for the possibility that certain violences may, in fact, be justifiable from a care ethics perspective. At the same time, I contend that violence in any form will also eventually demand a caring response. Ultimately, this productive reading of Fanon’s political theory and the ethics of care encourages both postcolonial philosophers and care ethicists alike to examine critically the relation between violence and care, and the ways in which we cannot a priori draw lines between the two. (shrink)

Within health care systems, negative perceptions of lesbian, gay, bisexual, and transgender persons have often translated into denial of services, denial of visitation rights to same‐sex partners, reluctance on the part of LGBT patients to share personal information, and failure of workers to assess and recognize the unique health care needs of these patients. Other bureaucratic forms of exclusion have included documents, forms, and policies that fail to acknowledge a patient's valued relationships because of, for example, a narrow (...) definition of “spouse,” “parent,” or “family.” Bureaucratic exclusion has taken a particularly prominent form in the U.S. military. Until its repeal and termination in 2011, the “Don't Ask, Don't Tell” policy had for eighteen years barred openly gay men and lesbians from serving in the military. Among the effects of DADT is a dearth of information about the number and needs of LGBT service members who transition to the Veterans Health Administration for health care at the end of their military service. The long‐standing social stigma against LGBT persons, the silence mandated by DADT, and the often unrecognized bias built into the fabric of bureaucratic systems make the task of creating a welcoming culture in the VHA urgent and challenging.The VHA has accepted a commitment to that task. Its Strategic Plan for fiscal years 2013 through 2018 stipulates that “[v]eterans will receive timely, high quality, personalized, safe, effective and equitable health care irrespective of geography, gender, race, age, culture or sexual orientation.” To achieve this goal, the VHA undertook a number of coordinated initiatives to create an environment and culture that is informed, welcoming, positive, and empowering for the LGBT veterans and families whom the agency serves. (shrink)

This article defends an ethics of care approach to global justice, which begins with an empirically informed account of injustices resulting from the workings and effects of contemporary neo-liberalism and hegemonic masculinities. Dominant distributive approaches to global justice see the unequal distribution of resources or ?primary goods? as the basic source of injustice. Crucially, however, most of these liberal theories do not challenge the basic structural and ideational ?frames? that govern the global political economy. Instead, they seek to ?correct? (...) unjust patterns of distribution according to an ideal theory. Subjects in these theories are generally understood as abstract, autonomous and impartial; this is in contrast to an ethics of care, which starts with an ontology of the subject as embodied, vulnerable and relational. The first part of this article explores the role and nature of theory in relation to the task of considering injustice on a global scale and offers a critique of the narrow focus in traditional theories of justice on the distribution of ?primary goods?. The second part considers the effects of neo-liberal globalization and hegemonic masculinities on global working families in order to illustrate the relationship between care and global justice. The final section sketches out a care-ethics approach to global injustice, focusing on three features: first, care as a relational approach; second, the focus in care ethics on intersecting structures of injustice; and third, care as a multi-scalar approach to global injustice. (shrink)

Edmund Husserl. Infinite tasks -- Universality and spatial form -- Universality in the making -- Martin Heidegger. Singular essence -- The strangeness of beginnings -- The originary world of tragedy -- Jan Patoka. Care of the soul -- The genealogy of Europe-responsibility -- Jacques Derrida. European memories -- This little thing that is Europe -- De-closing the horizon.

Family care—when partners, relatives, or other proxies care for each other in case of illness, disability, or frailty—is increasingly considered an important pillar for the sustainability of care systems. For many people, taking on a caring role is self-evident. Especially in a palliative care context, however, family care can be challenging. Witnessing caregivers’ challenges may prompt compassionate nurses to undertake actions to reduce burden by adjusting tasks or activities. Using a care ethical approach, this (...) theoretical paper aims to provide nurses with an alternative perspective on caregiver burden and support. Drawing on the concepts of relationality and contextuality, we explain that family care often is not a well-demarcated or actively chosen task. Instead, it is a practice of responding to an all-encompassing “call” to care flowing from a relationship, within a social and cultural context where norms, motivations, and expectations shape people’s (sometimes limitless) care. We consider relational interdependence at the root of persisting in care provision. The question is then whether self-sacrifice is a problem that nurses should immediately solve. In ideal circumstances, self-sacrifice is the result of a conscious balancing act between values, but family care in the context of serious illness barely provides room for reflection. Yet, instant attempts to alleviate burden may overlook family caregivers’ values and the inherent moral ambiguities and/or ambivalent feelings within family care. Family care is complex and highly personal, as is finding an adequate balance in fulfilling one’s sometimes conflicting values, motivations, and social expectations. Therefore, we suggest that caregiver experiences should always be interpreted in an explorative dialogue, focused on what caring means to a particular family caregiver. Nurses do not have to liberate family caregivers from the situation but should support them in whatever overwhelms or drives them in standing-by their loved ones until the end. (shrink)

The central question in this article concerns the implications of developments in the rearrangement of tasks in health care, particularly for nurses in terms of their duties and responsibilities. Attention is focused on the transfer of medical tasks from physicians to nurses. An investigation was carried out on the impact of the rearrangement of tasks from the perspective of health care law on the legal framework of the nursing profession. From case law it can be concluded that a (...) number of specific conditions have to be met, such as mentoring, supervision and audit, orders and instructions, clear agreement about task allocation, comparing information, and making certain that the person who is given the instruction is sufficiently competent and experienced to carry it out. Although the rearrangement of tasks fits into the existing legal framework, changes in the health professions have to be met more flexibly. (shrink)

STAJDUHAR K, FUNK L, JAKOBSSON E and ÖHLÉN J. Nursing Inquiry 2010; 17: 221–230A critical analysis of health promotion and ‘empowerment’ in the context of palliative family care-givingTraditionally viewed as in opposition to palliative care, newer ideas about ‘health-promoting palliative care’ increasingly infuse the practices and philosophies of healthcare professionals, often invoking ideals of empowerment and participation in care and decision-making. The general tendency is to assume that empowerment, participation, and self-care are universally beneficial for (...) and welcomed by all individuals. But does this assumption hold for everyone, and do we fully understand the implications of health-promoting palliative care for family caregivers in particular? In this study, we draw on existing literature to highlight potential challenges arising from the application of ‘family empowerment’ strategies in palliative home-care nursing practice. In particular, there is a risk that empowerment may be operationalized as transferring technical and medical-care tasks to family caregivers at home. Yet, for some family caregivers, a sense of security and support, as well as trust in professionals, may be equally if not more important than empowerment. Relational and role concerns may also at times take precedence over a desire for empowerment. The potential implications of ‘family empowerment’ are explored in this regard. ‘Family empowerment’ approaches need to be accompanied by a strong understanding of how to best support individual palliative family caregivers. (shrink)

Ethics consultation in institutions of the healthcare system has been given a standard form based on three pillars: education, the development of guidelines and concrete ethics consultation in case conferences. The spread of ethics committees, which perform these tasks on an organizational level, is a remarkable historic achievement. At the same time it cannot be denied that modern ethics consultation neglects relevant aspects of care ethics approaches. In our essay we present an “ethics of care” approach as well (...) as an empirical pilot project—“Ethics from the bottom up”—which organizes ethics consultation based on this focus. Findings and philosophy of the project will be discussed as far as relevant for ethics consultation in the healthcare system. (shrink)

As healthcare providers engage in the politics of reforming and humanizing our immigration and asylum “system” it is critical that they are able to refer their patients whose health is directly impacted by our immigration laws and policies to experts who can help them navigate the system and obtain the healthcare they need.

Care left undone, interchangeably referred to as missed care, unfinished nursing care and task incompletion, is pervasive in contemporary healthcare systems. Care left undone can result in adverse outcomes for the patient, nurse and organization. The rhetoric that surrounds care left undone infers it is a contemporary nursing phenomenon; however, a seventeenth‐century Spanish nursing treatise, Instruccion de Enfermeros (Instructions for Nurses), challenges this assumption. Instruccion de Enfermeros was an instructional guide that was written for (...) members of the Congregation of Bernardino de Obregon who worked as nurses at the Madrid General Hospital. The treatise provides a historical commentary on the daily roles, responsibilities and working conditions of the Obregonian nurses. Its content and context suggest the Obregonian nursing resource was consistently time poor due to a confluence of internal and external stressors. Consequently, the Obregonians were under considerable role strain resulting in inferior patient care. This article explores the antecedents of care left undone through a historical lens using exemplars from the 1625 edition of Instruccion de Enfermeros. Factors contributing to care left undone in Obregonian nursing will then be examined to offer insights into the similarities between what a nurse suffered 400 years ago and what exists in contemporary nursing practice. (shrink)

As interest in women’s roles in agriculture increases, research on women livestock-keepers remains limited. Advances in feminist scholarship highlight farming women’s dual roles in agricultural production and biological and socio-cultural reproduction, including women’s uncompensated labor in child-bearing, child-rearing and home-making. To expand knowledge about women pastoralists’ lived experiences, we conducted life-history interviews with 25 herder women in two regions of Mongolia, following-up with participatory workshops in each region. As mothering and carework emerged as key themes, we drew on feminist (...) class='Hi'>care ethics and the anthropology of mothering and motherhood to analyze interview data and co-interpret results with workshop participants. Our findings reveal three caring conflicts experienced by Mongolian herder women: between caring for nutag (homeland) and caring for herds, between caring for herds and caring for children, and between caring for family, herd and nutag and caring for self. These conflicts highlight contradictions between normative Mongolian motherhood as depicted in cultural images and narratives, and the lived reality of herder mothers, and between public valorization of and incentives for motherhood and the lack of sufficient public support for mothers and carework in rural Mongolia. Unmet needs for care, resulting risks to maternal and child health, and the extraordinary workload associated with mothers’ multiple caring tasks likely contribute to rural–urban migration and increasing masculinization of the Mongolian countryside. Although Mongolian culture frames mothers as leaders who unify their communities through their wisdom, many herder-mothers today live isolated lives where their multiple caring responsibilities preclude active participation in community development and governance. (shrink)

The Baby Care Scale was designed to assess the involvement of father in infant care during pregnancy and the postpartum period. This study aimed to examine the psychometric characteristics of the BCS – antenatal and BCS – postnatal versions. A sample of 100 primiparous fathers completed the BCS-AN and/or the BCS-PN and self-reported the measures of anxiety and depressive symptoms and of father–infant emotional involvement during pregnancy and the postpartum period, respectively. Good internal consistency was found for both (...) the BCS-AN and the BCS-PN. A two-factor model was found for both versions of the instrument: household tasks and infant care tasks. The BCS-AN and BCS-PN subscales revealed good internal consistency. Higher scores on the BCS-AN predicted higher scores on the BCS-PN. Significant associations were found among the BCS, depressive and anxiety symptoms, and father–infant emotional involvement, revealing good criterion validity. This study suggested that both the BCS-AN and the BCS-PN are reliable multidimensional self-report measures that assess the involvement of father in infant care during pregnancy and the postpartum period. (shrink)

The Clinton Administration stated that the list of values and moral principles generated by the Ethics group reflects "fundamental national beliefs about community, equality, and liberty" and that "these convictions anchor health reform in shared moral traditions." However, these statements are difficult to justify. There is not a moral consensus in America that would justify thorough-going health care reform. In such a context of pluralism, ethicists should seek to move society in the direction of solidarity. The participation of ethicists (...) on the Clinton Task Force was valuable because it showed that health reform is an exercise in social ethics, disseminated the work of ethicists to the entire Task Force, and expanded the experience of the ethicists involved. It may also have accelerated the moral transformation of Americans, which is needed before radical reform can take place. Keywords: American values, Clinton health plan, health care reform CiteULike Connotea Del.icio.us What's this? (shrink)

The practice of critical care medicine has long been a difficult task for most critical care physicians in the densely populated city of Hong Kong, where we face limited resources and a limited number of intensive care beds. Our triage decisions are largely based on the potential of functional reversibility of the patients. Provision of graded care beds may help to relieve some of the demands on the intensive care beds. Decisions to forego futile (...) medical treatment are frequently physician-guided family-based decisions, which is quite contrary to the Western focus on patient autonomy. However, as people acquire knowledge about health care and they become more aware of individual rights, our critical care doctors will be able to narrow the gaps between the dif ferent concepts of medical ethics among our professionals as well as in our society. An open and caring attitude from our intensivists will be important in minimizing the cross-cultural conflict on the complex issue of medical futility. (shrink)

This paper examines the environment in which waged caregiving takes place. Because the activities of care have been predominantly performed by women in the home, a caring attitude is taken to be inherent to the persons who perform this labor. My analysis endeavors to clarify this misconception. Drawing on studies of paid caregivers who assist elderly individuals accomplish the tasks of self-care, I discuss how these workers face at least three layers of uncertainty. Paid caregiving takes place on (...) a fragile moral terrain, and I argue that the prevalent structure of paid care labor cannot acknowledge this, nor can it support caring within care labor. I use Claudia Card’s concept of gray areas to highlight the manner in which the structure of care labor inhibits the care worker from easily negotiating the moral terrain of caregiving. (shrink)

This article will address the question: how can health care education best take seriously the task of educating for professional practice within a post-traditional, liberal democratic society? In the setting of modernity, the altered personal and professional self has to be explored and constructed as part of a reflective process of connecting personal and professional change: in essence, to develop self-knowledge. A moral life, or ‘working morality’, that evolves out of a process of ongoing dialogue and conversation is (...) required. What is advocated here is a more social model of health care education that acknowledges a social or communal dimension to knowledge and the centrality of relationships for the full development of the individual personally and professionally, fosters our capacity to identify who we are both personally and professionally, connects reason and dialogue, and educates for dialogue and dialogic relationships. (shrink)

The Ethics Working Group of Clinton's Health Care Task Force developed a list of principles and values that should govern health care reform. These principles and values are compatible with central moral and political traditions, as well as with more rigorous theoretical accounts of justice and health care, but they are "freestanding" points of agreement, not presupposing any particular theoretical background. Though imprecise and not ranked by priorities, the principles guide thinking about the fairness of alternative (...) reform proposals. Their use is illustrated by comparing alternatives on universality of access, phase-in period, the creation of unequal tiers, and the provision for wise allocation and rationing. Keywords: principles, health care reform, rationing, universal access CiteULike Connotea Del.icio.us What's this? (shrink)

The authors explore the changing dynamics of gendered familial caregiving in urban China within the context of economic reforms and the continued cultural influence of xiao. Data collected in China through interviews with 110 familial caregivers were used to examine cultural and structural influences on the caregiving behavior of adult children. Results from multiple regression analyses provide evidence of a gendered division of parental care tasks, a decline in the patrilocal tradition of caregiving, and a strong social pressure that (...) influences caregiving behavior. Structural factors linked to caregiving performance included family size, lack of pensions for elders, and caregivers’ employment status and income. Findings portend deleterious effects for the women who are now caregivers as they are likely to live longer but be more financially dependent and have fewer children available to help them. (shrink)

The expansion of the older population suggests that there will be significant numbers in need of care and support in their own home environment. Yet, little is known about the kind of situations professionals are faced with and how they intervene in the living environment of older people. Qualitative data were collected over a period of 1.5 years from a multi-disciplinary community-based geriatric team in the Netherlands, and participant observations carried out. Forty-two cases discussed within the team meetings were (...) analysed. Results demonstrate that providing care to older people is a dynamic process and revolves around various paradoxes as experienced by professionals. This is illustrated by presenting three paradoxes that emerged within the data: respecting autonomy versus preserving safety; the care needs of the care recipients versus the capacity of their informal carers to cope; and holding a formal orientation versus a tailored orientation on tasks. Providing care in the home environment of older people requires from professionals a continuous anticipation of (un)expected evolutions in situations of their care recipients. In order to optimally support older people professionals need ‘professional discretion’. They must be supported to systematically reflect on and legitimize their intervention strategies. (shrink)

Background: Caring for dying children presents special challenges, according to the children themselves, their relatives and healthcare professionals. Objective: The aim of this study was to describe caring as represented in healthcare workers’ experiences of caring for dying children. Method: A phenomenological approach was chosen, in-depth interviews were carried out and data were analysed in four steps focusing on (a) open reading, (b) meaning units, (c) constituents and (d) essence. Ethical considerations: Four nurses in a general acute paediatric care (...) setting in Sweden participated after providing written informed consent. Voluntary participation and confidentiality were ensured, and the study was ethically approved. Findings: The essence of caring for dying children was likened to a musically attuned composition, comprising five constituents: presence, self-knowledge, injustice in dying, own suffering and in need of others. Presence was found to be a prerequisite for caring when a child is dying. Self-knowledge and support from others can be of help when struggling with emotional pain and injustice. Discussion: Caring for dying children has been found to be a delicate task for healthcare workers all over the world, and the ethical dimension is emphasized in international research. In this study, emotional pain and suffering accompanied caring, but an atmosphere in which it is possible to give and get support from colleagues and to have time to grieve and time to focus on the patient’s needs may ease the burden, as can having time to process thoughts about life and death, and a possibility to grow in self-knowledge. Conclusion: Caring in ethically demanding situations may be facilitated through presence, atmosphere, self-knowledge and time. The challenge does not demand highly technological solutions; these assets are readily available, no matter where on earth. However, there is a need to further investigate these prerequisites for caring, particularly when a child is dying. (shrink)

There are various grounds on which one may wish to distinguish a right to health care from a right to health. In this article, I review some old grounds before introducing some new grounds. But my central task is to argue that separating a right to health care from a right to health has objectionable consequences. I offer two main objections. The domestic objection is that separating the two rights prevents the state from fulfilling its duty to (...) maximise the health it provides each citizen from its fixed health budget. The international objection is that separating a human right to health care fails the moral requirement that, for any given moral human right, the substance to which any two right-holders are entitled be of an equal standard. (shrink)