An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children are likely to (...) become involved in the caring process and informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care and the subsequent impact on the care recipient and formal- and informal care providers. (shrink)

Background: Palliative care is acknowledged as an appropriate approach to support older people in nursing homes. Ethical issues arise from many aspects of palliative care provision in nursing homes; however, they have not been investigated in this context. Aim: To explore the ethical issues associated with palliative care in nursing homes in the United Kingdom. Design: Exploratory, sequential, mixed-methods design. Methods: Semi-structured interviews with 13 registered nurses and 10 healthcare assistants (HCAs) working in 13 nursing homes (...) in the United Kingdom were used to explore ethical issues in palliative care. The ‘Ethical Issues in Palliative Care for Nursing Homes’ instrument was used to measure the frequency and level of distress arising from ethical issues through a cross-sectional survey with 69 registered nurses and 129 healthcare assistants. Data collection occurred between December 2014 and November 2015. Ethical considerations: Ethical approval was granted by Queen’s University’s School of Nursing and Midwifery Research Ethics Committee and governance sought from each nursing home’s manager. Findings: The interviews revealed three themes: ethical issues in practice; relational issues; and organisational issues. No significant differences between registered nurses and healthcare assistants were evident, confirming the patterns emerging from the interviews. Relational issues, primarily issues with residents and families, occurred most frequently and caused greater distress. Conclusion: The shared environment is key in the experience of ethical issues; therefore, multidisciplinary education is needed for ethical decision making in palliative care. Addressing staff knowledge and service organisation may reduce ethical issues locally and provide a benchmark for global change. (shrink)

According to Asha Bhandary, there is a liberal (Rawlsian) justification for including “the receipt of dependency care among the benefits of social cooperation” (“Liberal Dependency Care,” 43). The novelty is to claim that such care is among the Rawlsian circumstances of justice. I argue that liberalism does not support this extremely strong claim. Dependency care is indeed among the goods generated by social cooperation, broadly speaking—but so are virtually all goods, such as pizza provision, scarcely (...) any of which are among the circumstances of justice. Most of us have ample inclination toward caring for dependents—but neither is this extended to everyone else’s dependents, nor is it mostly a legal duty, as indeed having children at all is not. Nor should it be on liberal principles. Neither of the two Rawlsian Principles support general dependency care. And, Bhandary’s “strong proceduralism,” calling for the training of all persons in care-giving skills, would edge up toward totalitarianism—hardly a welcome outcome of liberalism. (shrink)

The concept of solidarity has achieved relatively little attention from philosophers, in spite of its signal importance in a variety of social movements over the past 150 years. This means that there is a certain amount of preliminary philosophical work concerning the concept itself that must be undertaken before one can ask about its potential use in arguments concerning the provision of health care. In this paper, I begin with this work through a survey of some of the (...) most prominent bioethical, political philosophical and intellectual historical literature concerned with the project of determining a philosophically specific and historically perspicacious meaning of the term ‘solidarity’. This provides a conceptual foundation for a sketch of a four-tiered picture of social competition and cooperation within the nation-state. Corresponding to this picture is a four-tiered account of health care provision. These two models, taken together, provide a framework for articulating the conclusion that, while there are myriad examples of solidarity in claiming health care for some, or even many, the concept does not provide a basis for claiming health care for all. (shrink)

Between the 14 and 18 March 2016, the Institute for Ethics, History and Theory of Medicine, in cooperation with the Institute for Sociology at Ludwig-Maximilians-University, Munich, hosted an interdisciplinary workshop on migrant and refugee health in Germany and the UK. Fifteen participants from four countries met to discuss ethical issues surrounding the health of migrants and refugees in Europe, with particular emphasis on a comparison of the different approaches taken by Germany and the UK. This report provides an overview of (...) the structure and purpose of the workshop, an outline of the topics discussed, its outcomes, and its objectives moving forward. (shrink)

In July 1993, the Scottish Highlands Centre for Human Caring sponsored a conference with the title Exploring the Spirituality in Caring. The papers given at the conference and included in this volume are offered as a contribution to the debate that must take place in nursing and in the wider context of health care provision. Ann Bradshaw's paper puts the debate in context arguing that nursing is fundamentally a loving response to the human being created in the image (...) of God. (shrink)

ABSTRACT People who are paid to provide basic care for others are frequently undervalued, exploited and expected to reach often unrealistic standards of care. I argue that appropriate social recognition, support and fair pay for people who provide care for those who are disabled, frail and aged, or suffering ill health that impedes their capacity to negotiate daily activities without support, depends on a reconsideration of the paradigm of the citizen or and moral agent. I argue that (...) by drawing on the ideas of human vulnerability and dependency as central to our personhood, a more realistic conception of selves, citizens and persons can be developed that better recognises the inevitability of human dependency and the social value of care work. I also indicate the significance of this vulnerability‐focussed view for ethical evaluation of the emotional aspects of care relationships. (shrink)

One cannot fail to be aware of the ‘human rights’ that are vividly thrust into our living rooms by the world’s media; but, what are human rights and are they of relevance to British nursing practice? In a democratic state such as the UK, human rights infringements or violations are not typified as occurring in a health care system outwardly appearing to safeguard the interests of the patient/person. This paper examines some of the issues and concludes that the notion (...) of human rights remains inconspicuous and peripheral to the ‘real world’ of clinical nursing practice. It challenges British nurses to reflect on their practice and outwardly demonstrate that nursing’s contemporary language of human rights does not remain simply rhetorical in nature. (shrink)

Financial incentives and disincentives are fundamental to a category of proposals, usually characterised as forms of managed care, whereby the pecuniary interests of health care providers are directly affected by their clinical decision-making. Presently, Australian health care administrators and private insurers are adopting financial incentives as a means of ensuring provider compliance with ‘health outcome ’ and cost-constraint objectives. To the extent that this has occurred, health-care relationships are transformed to emulate, more closely, a commercial transaction.This (...) paper questions the ideological assumptions which inform the use of financial incentives in the health care domain and raises concerns with regard to the potential for financial incentives to undermine the moral integrity of clinical decision-making. It also challenges the legitimacy of rationing health care resources through the use of this measure, particularly when adopted by private insurers of health care. (shrink)

Introduction Numerous guidelines and policies for ethical research practice have evolved over time, how this translates to global health practice in resource-constrained settings is unclear. The purpose of this paper is to describe how the concept of ancillary care has evolved over time and how it is included in the ethics guidelines and policy documents that guide the conduct of research in the global south with both an international focus and providing a specific example of Malawi, where the first (...) author lives and works, as a case study. Methods Discourse analysis was conducted on 34 international ethics guidelines and policy documents. Documents were purposively selected if they contained a set of key terms that reflect the concept of ancillary care. Following a process of inductive discourse analysis, five key interrelated text phrases relating to ancillary care were extracted from the documents. The evolution of these phrases over time was explored as they represented the development of the concept of ancillary care as a component of ethical health research guidance and practice. Results We found key interrelated phrases that represent discourses regarding the evolution of ancillary care including participant protection; provide care as appropriate; supererogation; patient needs prevail over science; and ancillary care as an obligation. Arguments for the provision of ancillary care were characterised by safeguarding the safety, health rights and well-being of study participants. However, despite the evolution of discourse around ethical obligations to provide ancillary care, this is rarely made explicit within guidance documents, leaving interpretive space for differential application in practice. Conclusion While there have been major changes to the ethics guidance that reflect significant evolution in the ethical conduct of research, the specific vocabulary or language used to explain the ethics of researchers' ancillary care obligations to the health needs of their research participants, lacks clarity and consistency. As a result, the concept of ancillary care continues to be under-represented in local ethical guidelines and regulations, with no clear directives for country-level research ethics committees to apply in regulating ancillary care responsibilities. (shrink)

In this paper the need for valid evidence of the cost-effectiveness of treatments that have not been properly evaluated, yet are already available, albeit in short supply, are examined. Such treatments cannot be withdrawn, pending proper evaluation, nor can they be made more widely available until they have been shown to be cost-effective. As a solution to this impasse the argument put forward recently by Toroyan et al is discussed. They say that randomised controlled trials of such resources could be (...) done but only if resources are randomly allocated independently of a research context. Relevant outcome data could then be collected for research, given this opportunity. We agree. We disagree with Toroyan et al on a number of points. First, they claim that no ethical issue relating to equipoise arises. We disagree and this disagreement depends on our showing that equipoise should be maintained in a relationship that they do not consider. Secondly, they say that consent to data collection is always needed. Again we disagree. Thirdly, they claim that the previous two issues are the only possible ethical issues that could arise. We argue, instead, that there is a further conflict of interests that has ethical import. (shrink)

Despite its effectiveness, limited research has examined the provision of telemental health and how practices may vary according to treatment paradigm. We surveyed 276 community mental health providers registered with a commercial telemedicine platform. Most providers reported primarily offering TMH services to adults with anxiety, depression, and trauma-and stressor-related disorders in individual therapy formats. Approximately 82% of TMH providers reported endorsing the use of Cognitive Behavioral Therapy in their remote practice. The most commonly used in-session and between-session exercises included (...) coping and emotion regulation, problem solving, mindfulness, interpersonal skills, relaxation, and modifying and addressing core beliefs. CBT TMH providers had a higher odds of using in-session and homework exercises and assigning them through postal mail, email or fax methods, as compared to non-CBT TMH providers. TMH providers, regardless of treatment paradigm, felt that assigning homework was neither easy nor difficult and they believed their patients were somewhat-to-moderately compliant to their assigned exercises. CBT TMH providers also collected clinical information from their patients more often than non-CBT TMH providers. They reported being less satisfied with their method, which was identified most often as paper-based surveys and forms. Overall, TMH providers employ evidence-based treatments to their patients remotely, with CBT TMH providers most likely to do so. Findings highlight the need for innovative solutions to improve how TMH providers that endorse following the CBT treatment paradigm remotely assign homework and collect clinical data to increase their satisfaction via telemedicine. (shrink)

Children’s and young persons’ rights have received increasing been focus in recent decades, due in a significant degree to the UN Convention on the Rights of the Child. In Sweden, compulsory care in the social-services system is disputed, not least for the forceful measures that facility personnel have at their disposal to control children in certain conflict situations. The general aim of this article is to examine how the increased emphasis in Sweden on children’s rights is promoting resilience for (...) children and youth in youth compulsory secure-care settings. A more general question is whether the child-rights discourse leads in practice to increased resilience for children and youth in this setting, or even in general. The empirical material shows that children and young people’s perceptions of care and treatment are strongly linked to their interactions with staff and how the staff use restrictive measures. Applying Martha Fineman’s vulnerability theory in this context means that achieving resilience demands an analysis of the institutional settings in which children and young persons live their day-to-day lives, including their relationships in this setting. Comparing the legal possibilities of physical constraint with interviews of children and personnel reveals that relevant legislative frameworks and children’s-rights discourse should serve as a protection mechanism for children and youths, but in real life, these seem to have limited effect. (shrink)

This article casts its attention on acts of supplication in institutional settings. The article focuses upon institutions geared towards the provision of care, that is, sites that are designed to provide services to those in need. The article claims that every act of supplication is an act of violence deployed upon the supplicant by his/her interlocutor and the institution more broadly. This is not violence of an overt type; it is tacit and subtle and takes root at the (...) very essence of the supplicant, that is, his/her being. The article draws on Jacques Derrida’s provocative reading of the impossibility of the gift, an analysis that is indebted to Marcel Mauss’ exposition of the gift as obligatory and, thus, an existential nullity. Drawing upon both theorists, the article theorizes the violence of the gift and proceeds to read the violence in/of care/caring. The article explicates the grounding of this violence and how it is written into each request for care. (shrink)

Given the complexity of modern health care, there exists an urgent need to discover how best to resolve complex bioethical issues. Traditionally, principle based ethics provided the benchmark for guiding ethical decision-making. More recently, however, it has become apparent that this traditional approach is often inadequate in dealing with cur rent health care dilemmas. The notion of caring was advanced initially as an alternative to, then as a complement to, principle based ethics. In this article, caring is conceptual (...) ized as an attitude and is viewed as integral to the advancement of a coherent and inte grated moral approach to ethical decision-making. First, a brief historical description of bioethics is presented. Next, an evolutionary account of caring within bioethics is described. Four fundamental problems associated with the use of caring within bioethics are then outlined. Finally, caring as an attitude is delineated and a case study is used to illustrate the proposed conceptualization of caring. The case study demonstrates that a caring attitude provides for relationship and context, which are elements often neglected by traditional approaches. (shrink)

There has been a focus on policies relating to early years education and care across the developed world and particularly in Europe. In the UK, there has been a raft of policy changes alongside increased investment. However, this paper argues that these changes may not be sufficient to meet EU objectives in terms of quality or the government's policy goals of high quality, affordable and accessible early years education and care. There are major issues that appear to militate (...) against achieving these goals; these relate to the levels of government funding and to the regulatory context. There are also divergences between the providers in terms of their own objectives and underlying values which mean that quality may be variable and access to certain types of providers restricted. These factors appear to militate against the delivery of universal provision of high quality early years education and care. (shrink)

This article analyses the negative ethical impact of privatisation, alongside the ongoing marketisation of social care and social work provision for children and young people in England. It critically appraises the implications of a market-based formal social care system, which includes the risk-averse and often detached role of social workers within ever more fragmented sectors of care. Analysis begins with a discussion of background policy and context. The tendency towards ‘service user’ objectification and commodification are then (...) detailed, followed by a discussion of the limiting of choice for service users. Service and social fragmentation, and the often severely restricted ‘life chances’ of many children and young people in care, are then deliberated. The concluding discussion reiterates the ethical implications of marketisation in relation to ethical frameworks, including those associated with autonomy, informed choice, social exclusion and social justice. The tendency towards children increasingly being utilised as a means to an end within business-orientated sectors of care is highlighted, alongside moral questions asked about the State’s purpose in providing a community of support. (shrink)

1.1. A major purpose in nationalizing the provision of health care in the UK was to affect its distribution between people, and, in particular, to minimize the impact of willingness and ability to pay upon that distribution. It has never been clear, however, what alternative distribution rule is to apply. There is no shortage of rhetoric about ‘equality’ and ‘need’, but most of it is vacuous, by which I mean it does not lead to any clear operational guidelines (...) about who should get priority and at whose expense. The closest we have got so far to such explicit guidelines has been the formulae which determine the geographical distribution of NHS funds, the driving force behind which is a notion of need based on relative mortality rates and on the demographic structure. The avowed objective is to bring about equal access for equal need irrespective of where in the UK you happen to be. (shrink)

Dr Hillel Steiner in this reply to Elizabeth Telfer takes each of her arguments for different arrangements of a health service and examines them--'four positions which can be located on a linear ideological spectrum'--and adds a fifth which could have the effect of 'turning the alleged linear spectrum into a circle'. Underlying both Elizabeth Telfer's article and Dr Steiner's reply, the base is inescapably a 'political' one, but cannot be abandoned in favour of purely philosophical concepts. Whatever the attitude of (...) mind of the reader of these two papers to the provision of a health service, the stimulus to more careful assessments of our own National Health Service and its problems can only be good. (shrink)

Time-limited trials of intensive care have arisen in response to the increasing demand for intensive care treatment for patients with a low chance of surviving their critical illness, and the clinical uncertainty inherent in intensive care decision-making. Intensive care treatment is reported by most patients to be a significantly unpleasant experience. Therefore, patients who do not survive intensive care treatment are exposed to a negative dying experience. Time-limited trials of intensive care treatment in patients (...) with a low chance of surviving have both a small chance of benefiting this patient group and a high chance of harming them by depriving them of a good death. A ‘rule of rescue’ for the critically unwell does not justify time-limiting a trial of intensive care treatment and overlooks the experiential costs that intensive care patients face. Offering time-limited trials of intensive care to all patients, regardless of their chance of survival, overlooks the responsibility of resource-limited intensive care clinicians for suffering caused by their actions. A patient-specific risk–benefit analysis is vital when deciding whether to offer intensive care treatment, to ensure that time-limited trials of intensive care are not undertaken for patients who have a much higher chance of being harmed, rather than benefited by the treatment. The virtue ethics concept of human flourishing has the potential to offer additional ethical guidance to resource-limited clinicians facing these complex decisions, involving the balancing of a quantifiable survival benefit against the qualitative suffering that intensive care treatment may cause. (shrink)

The present article reviews the state of public debate and legal provisions concerning end‐of‐life decision‐making in Italy and offers an evaluation of the moral and legal issues involved. The article further examines the content of a recent law concerning informed consent and advance treatment directives, the main court pronouncements that formed the basis for the law, and developments in the public debate and important jurisprudential acts subsequent to its approval. The moral and legal grounds for a positive evaluation of this (...) law, which attests that the patient may withhold or withdraw from life‐prolonging treatment, will be offered with reference to liberal approaches and particularly to the frameworks of care and virtue ethics; but reasons will also be offered in order to consider not only the latter but also broader range of end‐of‐life treatment decisions as morally apt options. In this light, we argue in favour of a further development of the Italian legislation to encompass forms of assisted suicide and active euthanasia. (shrink)

Abstract“Conscientious provision” refers to situations in which clinicians wish to provide legal and professionally accepted treatments prohibited within their (usually Catholic) health care institutions. It mirrors “conscientious objection,” which refers to situations in which clinicians refuse to provide legal and professionally accepted treatments offered within their (usually secular) health care institutions. Conscientious provision is not protected by law, but conscientious objection is. In practice, this asymmetry privileges conservative religious or moral values (usually associated with objection) over (...) secular moral values (usually associated with provision). In this article, we first argue for a legal right to one kind of conscientious provision: referral for procedures prohibited at Catholic hospitals. We then argue that a premise in that argument—the principle of comparably trivial institutional burdens—justifies legal protections for some additional forms of conscientious provision that include, for example, writing prescriptions for contraception or medical abortions. However, this principle cannot justify legal protections for other forms of conscientious provision, for instance, the right to perform surgical abortions or gender-affirming hysterectomies at Catholic hospitals. (shrink)

Technology and its interfaces with nursing care, patients and carers, and the home are many and varied. To date, healthcare services research has generally focussed on pragmatic issues such access to and the optimization of technology, while philosophical inquiry has tended to focus on the ethics of how technology makes the home more hospital like. However, the ethical implications of the ways in which technology shapes the subjectivities of patients and carers have not been explored. In order to explore (...) this, poststructural theory, in particular the work of Butler, Foucault, and Deleuze, is used to theorize the relationship between subjectivity and materiality as ethically mandated on producing rather than precluding the development of subjectivities in novel ways. This theoretical understanding is then utilized through a process of ‘plugged in’ as described by Jackson and Massie that aims to link empirical data, research, and philosophical inquiry. Through this process, it is suggested that power, which the empirical data demonstrate, is frequently exercised through medical discourses and restricts patients' and carers' ability to shape the material environment of the home as a place to live and be cared for in palliative stages of illness. Alternative discourses are suggested both from the empirical data as well as other research, which may offer patients and carers the possibility of reclaiming power over the home and their subjectivities. Finally, the dichotomy between the home and hospital, mediated via technology, is posited as being problematic. It is argued the dichotomy is false and should be moved away from in order to allow an ethical embrace of technology in palliative care. (shrink)

Geographical variations are documented for a wide range of health care services. As many such variations cannot be explained by demographical or epidemiological differences, they are problematic with respect to distributive justice, quality of care, and health policy. Despite much attention, geographical variations prevail. One reason for this can be that the ethical issues of geographical variations are rarely addressed explicitly. Accordingly, the objective of this article is to analyse the ethical aspects of geographical variations in the (...) class='Hi'>provision of health services. Applying a principlist approach the article identifies and addresses four specific ethical issues: injustice, harm, lack of beneficence, and paternalism. Then it investigates the normative leap from the description of geographical variations to the prescription of right care. Lastly, the article argues that professional approaches such as developing guidelines, checklists, appropriateness criteria, and standards of care are important measures when addressing geographical variations, but that such efforts should be accompanied and supported by ethical analysis. Hence, geographical variations are not only a healthcare provision, management, or a policy making problem, but an ethical one. Addressing the ethical issues with geographical variations is key for handling this crucial problem in the provision of health services. (shrink)

This paper draws on the ethics of care to investigate how citizens grappled with ethical tensions in the mundane practice of grocery shopping at the height of the Covid-19 pandemic. We use this case to address the broader question of what it means ‘to care’ in the context of a crisis. Based on a qualitative longitudinal cross-country interview study, we find that the pandemic transformed ordinary shopping spaces into places fraught with a sense of fear and vulnerability. Being (...) forced to face one’s own vulnerability created an opportunity for individuals to relate to one another as significant others through a sense of “response-ability”, or the capacity of people to respond to ethical demands through situated ethical reasoning. We argue for a practical ethos of care in which seemingly small decisions such as how often to go shopping and how much to buy of a particular product serve as a means to relate to both specified and generalized others—and through this, ‘care with’ society. Our study contributes to displacing the continuing prevalence of an abstract and prescriptive morality in consumption ethics with a situated and affective politics of care. This vocabulary seems better suited to reflect on the myriad of small and unheroic care acts in times of crisis and beyond. (shrink)

Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an appropriate (...) response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation’s policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes. (shrink)

This essay responds to Jan Narveson’s libertarian commentary on my earlier work “Liberal Dependency Care.” There, I argued that the underlying logic of the circumstances of justice warrants adding care to a liberal theory of justice. In this essay, I rebut Narveson’s skeptical claims about the liberal credentials of my justificatory argument by identifying the extent to which my view shares the same reasonable constraints on liberty as those defended by John Stuart Mill. I also suggest that a (...) libertarian refusal to add care to the core functions of the state is plausible only if women’s labor remains invisible. Finally, I refute Narveson’s contention that my strong procedural principle of care provision is incipiently totalitarian. The case for public support to teach basic levels of attentiveness and responsiveness is analogous to the case for teaching the foundational skills of arithmetic, which are legitimately taught in primary and secondary schools. (shrink)

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

The long-running discourse on respect for human dignity and autonomy in the physician-patient relationship pertaining to persons with dementia (PwDs) is explored deeply in this paper through the use of a real-life case, to highlight the complex interplay between autonomy and best interest when it comes to a PwD's experiential and critical interests. Many scenarios and perspectives are described and applies to the case. However, there are a few perspectives, which are touched upon that could do with further scrutiny. Firstly, (...) it has been argued that rigid adherence to the advance directives of PwDs means that PwDs will be the only people who are not allowed to ever change their minds. This withdrawal of a fundamental freedom hardly accords with respect for human dignity, or for any residual autonomy that these individuals may still enjoy. Secondly, viewing this case through the lens of care ethics, and incorporating the recently proposed conceptual framework of anthropological vulnerability, may reveal valuable insights regarding care provision and caring physician-patient relationships. These perspectives would analyse the role of relational ontology, particularly in relation to significant others, significant communities, and caregivers. (shrink)

Many health care professionals (HCPs) are understandably reluctant to treat patients in environments infested with bedbugs, in part due to the risk of themselves becoming bedbug vectors to their own homes and workplaces. However, bedbugs are increasingly widespread in care settings, such as nursing homes, as well as in private homes visited by HCPs, leading to increased questions of how health care organizations and their staff ought to respond. This situation is associated with a range of ethical (...) considerations including the duty of care, stigmatization, vulnerability, confidentiality, risks for third parties, and professional autonomy. In this article, we analyze these issues using a case study approach. We consider how patients whose living environments are infested with bedbugs can receive care in the community setting in a manner that supports their well-being, is consistent with fairness in care provision, and takes into account risks for HCPs and third parties. We also discuss limits and obstacles to the provision of care in these situations. (shrink)

Background Escalating levels of obesity place enormous and growing demands on Health care provision in the (U.K.) United Kingdom. Resources are limited with increasing and competing demands upon them. Ethical considerations underpin clinical decision making generally, but there is limited evidence regarding the relationship between these variables particularly in terms of treating individuals with obesity. Research aim To investigate the views of National Health Service (NHS) clinicians on navigating the ethical challenges and decision making associated with obesity management (...) in adults with chronic illness. Research design A cross-sectional, multi-site survey distributed electronically. Participants A consensus sample of nurses, doctors, dietitians and final year students in two NHS Trusts and two Universities. Ethical considerations Ethical and governance approvals obtained from a National Ethics Committee (11NIR035), two universities and two teaching hospitals. Results Of the total ( n = 395) participants, the majority were nurses (48%), female (79%) and qualified clinicians (59%). Participants strongly considered the individual to have primary responsibility for a healthy weight and an obligation to attempt to maintain that healthy weight if they wish to access NHS care. Yet two thirds would not withhold treatment for patients with obesity. Discussion While clinicians were clear about patient responsibility and obligations, the majority prioritised their duty of care and would not invoke a utilitarian approach to decision making. This may reflect awareness of obesity as a multi-faceted entity, with responsibility for support and management shared amongst society in general. Conclusions The attitudes of this sample of clinicians complemented the concept of the health service as being built on a principle of community, with each treated according to their need. However limited resources challenge the concept of needs-based decisions consequently societal engagement is necessary to agree a pragmatic way forward. (shrink)

Background Quality nursing care and ethical responses to patient pain and suffering are very important in the preoperative period. However, few studies have addressed these variables. Objective This study aimed to examine the relationship between compassionate care and preoperative anxiety from the perspective of hospitalized patients. Methods The current study was a cross-sectional descriptive one. The participants were selected using convenience sampling. The data were collected using a demographic questionnaire, Burnell Compassionate Care Tool, and Amsterdam Preoperative Anxiety (...) and Information Scale (APAIS). The collected data were analyzed with SPSS software (version 22) through descriptive and inferential statistics at a significance level of 0.05 ( p <.05). Participants and setting This study was conducted on 704 candidates for surgery in the internal and surgical wards of a large teaching hospital located in the south of Iran from December 2022 to March 2023. Ethical considerations The protocol for this study was reviewed and approved by the University Ethics Committee. Findings The patients’ average age was 36.61 ± 13.07. The average preoperative anxiety and need for information scores were 13.80 ± 2.66 and 7.44 ± 1.47, respectively. The average score of importance was 3.03 ± 0.19, and the average score of the extent of compassionate care provision was 1.22 ± 0.15. There was a significant relationship between preoperative anxiety with importance and the extent of compassionate care provision (r = 0.68, p <.001), r = −0.72, p <.001, respectively). A comparison of the demographic characteristics, need for information, importance, and provision of compassionate care showed that the extent of compassionate care provision had the greatest contribution in explaining preoperative anxiety (β = 0.50; p <.001). Conclusion Even though patients’ preoperative anxiety was high and providing compassionate care in the preoperative period had a great role in relieving their anxiety, many participants appear to have received little compassionate care. To this end, nursing managers should pay attention to the quality of compassionate care in the preoperative stage. Besides, healthcare staff should receive the necessary training in compassionate nursing care. (shrink)

This book presents the first systematic account of dependency care in a liberal theory of justice. Despite the fact that receiving dependency care is necessary for human survival, the practices with which we meet society’s care needs are seldom recognized for their functional role. Instead, norms about gender and race obscure and shape expectations about whose needs for care are legitimate as well as about whose caregiving labor more advantaged members of society will receive. These opaque (...) arrangements must be made visible if we are to remedy skewed intuitions and judgements about care. Freedom to Care develops a modified form of social contract theory with which to evaluate society’s caregiving arrangements. Building on work by feminist liberals and care ethicists, it reframes debates about care to move beyond gender with an inequality-tracking framework that can be employed in any culture. Because care provision has been enmeshed in the subordination of women and people of color, eliminating the invisibility of these forms of labor yields a critical liberal theory of justice with feminist and anti-racist aims. (shrink)

Much of the discussion of the role of emerging technologies associated with AI, machine learning, digital simulacra, and relevant ethical considerations such as those discussed in the target article, take a relatively narrow and episodic view of a person’s healthcare needs. There is much speculation about diagnostic, treatment, and predictive applications but relatively little consideration of how such technologies might be used to address a person’s lived experience of illness and ongoing care needs. This is likely due to the (...) greater weight or priority given to acute care needs and the role of medical treatment in care provision, but it may also reflect the limitations of current technologies and our limited vision of their potential application. Such limitations are not surprising given that we are still grappling with the complexities and nuances of achieving the ethical and humanistic ideals of care, namely, care that addresses the hermeneutical, relational, contextual, temporal, and agential dimensions of a person’s health and wellbeing. (shrink)

In her 2015 article, Helena Olofsdotter Stensöta notes that ‘the ethics of care is often used as a lens to dissect the current arrangement of care provision (or rather non-care provision) in polici...

Food provisioning refers to the mental, physical and emotional labor involved in providing food for oneself and one’s family. The labor of food provisioning has been found to be made more difficult by a number of factors, including gender, socioeconomic status, age, and geography. However, little research has been done examining the labor of food provisioning among farm workers, a significantly marginalized population in the United States. In order to examine the food provisioning strategies and struggles of farm workers, we (...) have been conducting pilot research with Latinx agricultural workers in southwestern Idaho. Employing a range of qualitative and quantitative methods, we examine the various strategies that farm workers use to provide food for themselves and their families, including accessing food banks, utilizing food stamps, purchasing groceries and accepting food from friends, family and employers. We consider this from a wider lens of “caring labor”. In addition, we explore food provisioning strategies in the context of economic and demographic changes in Idaho. We observe the ways in which changing crop patterns, in particular the growth the hops industry, relates to a transition in the labor force, especially an increase in women farm workers. We have also observed a shift away from employing migrant farm labor and towards the employment of “settled” Latinx residents from surrounding communities. These changes all influence the labor of food provisioning for rural Idaho Latinx families. (shrink)

In clinical research there is a tension between the role of a doctor, who must serve the best interests of the patient, and the role of the researcher, who must produce knowledge that may not have any immediate benefits for the research participant. This tension is exacerbated in HIV research in low and middle income countries, which frequently uncovers comorbidities other than the condition under study. Some bioethicists argue that as the goals of medicine and those of research are distinct, (...) it is a mistake for researchers to assume therapeutic responsibilities while engaging in research. Others propose that there is a duty of care, but disagree as to how this is limited and specified. In this qualitative study, principal investigators from HIV prevention trials discuss their experience of providing medical benefits to participants within the context of conducting research into HIV biomedical prevention technologies. They describe the limitations imposed at times by funders and at times by infrastructure constraints, and canvass the importance of ancillary care provision and capacity building in trial communities. The views of the principal investigators are compatible with the perspective that there is a duty of care, limited by the nature of the research, the depth of the relationship between research and participant, and the capacity of the research site. The therapeutic orientation in HIV prevention trial appears to be indivisible from competent research practise by making concrete and appropriate benefits available to trial participants and their communities that support rather than compete with local infrastructure. (shrink)

The need for continuing provision of beneficial experimental interventions after research is concluded remains a controversial topic in bioethics for research. Based on the principle of beneficence, justice as reciprocity, concerns about exploitation and fair benefits, participants should be able to have continuing access to benefits beyond the research period. However, there is no consensus about whether or not post-trial provision of beneficial interventions should be mandatory for participants from developing countries. This paper summarises recommendations from international and (...) national guidelines. Ethical principles and practical issues relating to post-trial provision are also discussed. In conclusion, post-trial provision is not necessary in all situations and a set of criteria are proposed to identify the situations that beneficial interventions should be provided beyond the research period. However, mandatory post-trial supply of beneficial experimental interventions should be assured for those who still need and are able to benefit from them but have no alternative access. Mandatory provision is based on universal bioethical principles such as beneficence and justice. Furthermore, difficulties associated with implementation of post-trial provision are not unmanageable. Careful advanced planning and a comprehensive partnership among relevant parties would be very helpful in solving these difficulties in practice, which therefore should not be taken as an excuse to escape post-trial responsibility. (shrink)