A problem for natural scientific accounts, psychology in particular, is the existence of value. An ecological account of values is reviewed and illustrated in three domains of research: carrying differing loads; negotiating social dilemmas involving agreement and disagreement; and timing the exposure of various visual presentations. Then it is applied in greater depth to the nature of language. As described and illustrated, values are ontological relationships that are neither subjective nor objective, but which constrain and obligate all significant animate activity (...) physically, socially, and morally. As an embodied social activity, conversational dialogue is characterized in terms of values, pragmatics, and presence rather than in terms of syntactic and semantic rules. In particular the nature of dialogical arrays is explored, and the hypothesis that language is an action system, a perceptual system, and a caring system is explored. Language expands horizons and makes it possible for humans to realize their calling as culture makers and caretakers. (shrink)

Over the last four decades, both ecofeminism and care ethics have profoundly theorized the link between oppression and what is viewed as Others, such as women, non-human animals and nature. After uncovering and analyzing some important commonalities and differences between these two branches of feminist ethical theories and their critiques of dominant Western philosophy and ethics, Tove Pettersen also identifies some clear thematic and methodological overlaps with Arne Johan Vetlesen’s philosophy. She explores three topics in particular where ecofeminism and (...) care ethics may benefit from an exchange, and which is also relevant to Vetlesen’s scholarship: the relationship between reason and emotion, the relational ontology, and the emphasis on lived experience. In addition to challenging traditional conceptualizations of reality, conventional value hierarchies, and established power configurations, ecofeminism and care ethics also propose alternatives to oppressive arrangements and new ideals for the future, which are also discussed in this chapter. By integrating ecofeminism and care ethics into one conversation, Pettersen argues, these theories can enhance each other’s philosophical foundations and provide a powerful framework for analyzing the interconnection between the unjustified domination of women, other Others, and nature. They can also contribute toward kindling the radical shift in mindset and urgent action that Arne Johan Vetlesen calls for in his environmental philosophy. (shrink)

Aim: This study explores experiences of patients suffering from Korsakoff’s syndrome. It contributes to improved reflection on the value of patient knowledge. Background: An ethics of care perspective states the importance of moving to patients in their vulnerable state of being, and to figure out patients’ individual needs necessary to provide good care. The information given by patients suffering from Korsakoff’s syndrome might be mistaken, invented and even not true. The value of these patients’ experiences and knowledge had (...) not been researched to date. Method: Data from six in-depth interviews were analysed concurrently through the constant comparative method. Ethical considerations: The principles of voluntariness, confidentiality and anonymity were respected during the research process. Findings: Four important themes within patients’ knowledge emerged: health condition, involuntary admission into the nursing home, the daily routine and interpretation of the caring abilities of healthcare professionals. The findings show that our respondents were able to provide a window into their inner perspective. Conclusion: This study deepens our understanding of the value of patient knowledge in situations where patients see the world in a different manner as do healthcare professionals. The conversations revealed personal subjective knowledge which our respondents create and live by. Healthcare professionals are encouraged to discover and affirm the understandings of these patients, and not be prepossessed due to the diagnosis or general nursing home rules. Understanding patients’ unique knowledge through appreciation of the complexity and richness of different views on the situation can assist to give a more humane response to individual needs and pain. Health staff in healthcare institutions are encouraged to evaluate the – unintended – effect of rigidly applied nursing home rules, and the government is challenged to rethink its policy about care, and provide more resources permitting relational care that nurtures the dignity of patients suffering from Korsakoff’s syndrome. (shrink)

: As the twentieth century closes, marked by triumphal strides in medical advances, the American society has yet to ensure that each person has access to affordable health care. To correct this injustice, this article calls on the nation's political and corporate leaders, providers, and faith-based groups to join all Americans in a new national conversation on systemic health care reform. The Catholic faith tradition is one that compels both a proclamation to ministry values and a commitment to (...) speak out against the challenges or threats to what are essential to the well-being of individuals and society. The Catholic health ministry must therefore be both a voice for the voiceless and an agent of transformation. The nation's goal should be to "reposition" health care from its status as an important, but ultimately optional building block to one that is essential. (shrink)

This paper examines how middle managers in the long term care sector use the discourse of professionalism to create ‘appropriate’ work conduct of care workers. Using Watson’s concept of professional talk, we study how managers in their daily work talk about professionalism of vocationally skilled care workers. Based on observations and recordings of mundane conversations by middle managers, we found four different professional talks that co-exist: appropriate looks and conduct, reflectivity about personal values and ‘good’ (...) class='Hi'>care, methodical work methods, competencies. Jointly, these professional talks constitute an important discursive resource for middle managers to facilitate change on the work floor. Change involves the reconfiguration of care work and different managerial-worker relations. Middle managers use professional talks in both enabling and disenabling ways vis-à-vis care workers. Based on these findings, we suggest a more nuanced portrayal of the relationship between managers and professionals. Rather than being based on an intrinsic opposition, i.e. ‘managers versus professionals’, this relationship is flexibly reconstructed via professional talk. (shrink)

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the (...) other pillars of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

When read as a theory that is supposed to mirror, represent or fit some collection of historical data, critics argue that Kuhn’s theory of paradigm shift in Structure of Scientific Revolutions fails by cherry-picking and underdetermination. When read as the ground for a socio-epistemological conception of rationality, critics argue that Kuhn’s theory fails by either the naturalistic fallacy or underarticulation. This paper suggests that we need not view Structure as a historian’s attempt to accurately depict scientific theory change or a (...) philosopher’s attempt to suggest, more normatively, the factors we ought to consider in theory choice. Instead, we might use Kuhn’s theory as a metaphilosophical frame through which to better understand the limits of otherwise intractable philosophical debates. We can focus on Kuhn’s theory not as a proposition or model to confirm, but as something we might use as a tool for understanding. Philosophers have discussed the justice and care orientations in ethics as two theories for which there will be some common, constraining set of intuitions to confirm one theory over the other, to demonstrate that protecting rights is fundamentally more valuable that fulfilling needs or that fulfilling needs is fundamentally more valuable that protecting rights. Instead of conceptualizing this conversation as a choice between two theories, this paper looks to Ian Hacking’s interpretation of Kuhn’s paradigm concept to suggest that working in the world of justice is very different than working in the world of care, as each orientation is a paradigm with its own cognitive and contextual standards of theory assessment. To start, after Larry Laudan, each has its own ontology, methodology, aims and values. But moreover, after Ian Hacking, each has an even larger, entrenched collection of projectible predicates. Though Carol Gilligan herself uses the metaphor of gestalt shift in a few places to characterize the move from the justice to the care perspective, the insight—that what many assume to be a standard exercise in theory choice is really more of a paradigm shift—has been under theorized by ethicists and ignored by philosophers of science. This paper brings the full resources of Structure and its secondary literature to this metaethical issue, while making the larger point that Structure has an important pragmatic role to play, when it comes to the understanding philosophical debates, even if we cannot secure the truth of Kuhn’s theory. (shrink)

Abstract:Jane Addams’ short book The Long Road of Woman’s Memory, which has largely been ignored by philosophers, identifies two important powers of memory. In addition to consoling the elderly and enabling them to make meanings of their pasts, memories also have the power to calcify into stories that reinforce shared moral values and incite moral progress. These observations serve as the starting point for a conversation on narrative medicine and its potential for improving medical treatment for patients receiving end-of-life (...) class='Hi'>care. In addition to filling in one of the many gaps that exists in the literature surrounding Addams’ work, I also aim to contribute to the growing scholarship on person-centered end-of-life care in the field of bioethics. (shrink)

Philosophy has a complicated relationship with nursing practice. Selected concepts from Hans‐Georg Gadamer's Truth and Method specifically prejudice, conversation, and language are articulated. An exemplar involving nursing practice at an outpatient clinic for women seeking pre‐ and postbreast cancer care is offered to explicate these concepts. We considered the fit of Gadamer's philosophy, particularly the concept of conversation, within a public health nursing practice context in home and community settings of the client/family and offered tentative conclusions. To extend the (...) discussion of the relationship between philosophy and nursing practice, we posed questions developed to provide deeper insight into this complicated relationship. (shrink)

This article attends to the intimate contradictions that differentially shape and limit caring capacities and relations in a violent world, and the embodied ethical and political transformations at the heart of learning to care otherwise. From manifestos calling for ‘universal care’ in defiance of the state-sanctioned horrors of the pandemic era, to the abolitionist politics of care developed by BLM organizers through movement building and healing, and the proliferation of mutual-aid infrastructures to meet needs and distribute resources (...) in the face of overwhelming crisis and neglect—these examples and so many others illustrate with undeniable clarity that radical care is finally on the agenda. In what follows, I hope to contribute to this urgent conversation by pointing to how care is shaped in fundamentally contradictory ways under conditions of entrenched structural violence, and the limitations of normative frameworks when confronting this reality. To unambiguously valorize care in ethical and political life is to risk occluding the constitutive violence of existing social structures and norms, its impact on the intimacies of caring relations, and ultimately the ways that communities mobilize alternate economies and practices of care towards healing and social change. While it is crucial to value care and work for a more caring society, I claim that efforts to transform patterns of relational harm and develop new sensibilities should also be highlighted as integral components of radical caring praxis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:158 Feminist Studies 46, no. 1. © 2020 by Feminist Studies, Inc. María Fernanda Olarte-Sierra and Tania Pérez-Bustos Careful Speculations: Toward a Caring Science of Forensic Genetics in Colombia Feminist Science and Technology Studies (STS) has recently opened up the question of care as a set of practices related to the sustainability of life.1 The field of feminist studies more broadly has extensively 1. This literature mostly comes (...) from Northern contexts and started to flourish with the seminal work of María Puig de la Bellacasa, “Matters of Care in Technoscience: Assembling Neglected Things,” Social Studies of Science 41, no. 1 (2010): 85–106. This essay gathers scattered feminist STS reflections on these issues and looks at them through the lens of care, including authors such as Susan Leigh Star, Donna Haraway, Isabelle Stengers, Hilary Rose, and Annemarie Mol. The concept of care orienting this exercise of rereading these authors is proposed by Berenice Fisher and Joan Tronto, “Toward a Feminist Theory of Caring,” in Circles of Care: Work and Identity in Women’s Lives, ed. Emily K. Abel and Margaret K. Nelson (Albany: State University of New York Press, 1990), 35–62. Before and after that essay came out, Puig de la Bellacasa published several other papers related to this issue, including “Touching Technologies, Touching Visions. The Reclaiming of Sensorial Experience and the Politics of Speculative Thinking,” Subjectivity 28, no. 1 (2009): 297–315; “‘Nothing Comes without Its World’: Thinking with Care,” The Sociological Review 60, no. 2 (2012): 197– 216; “Ethical Doings in Naturecultures,” Ethics, Place & Environment 13, no. 2 (2010): 151–69; “Making Time for Soil: Technoscientific Futurity and the Pace of Care,” Social Studies of Science 45, no. 5 (2015): 691–716; and Matters of Care: Speculative Ethics in More than Human Worlds (Minneapolis: University of Minnesota Press, 2017). All these publications have been widely cited by other authors, particularly in a special issue of Social Studies of Science on the politics of care published in 2015 (volume 45, issue 5). Other examples María Fernanda Olarte-Sierra and Tania Pérez-Bustos 159 studied how care, and associated practices such as transnational care chains, are feminized and precarious—involving an ethos embodied by those who actively work to maintain or preserve another’s life. Feminists have focused on the politics of care embedded in invisible jobs related to aesthetics, domestic work, child and elder care, and sexual activities and see all these tasks as related to the reproduction of life and culture.2 Central to this conceptualization of care is the understanding that these jobs are typically women’s work. There is a common association between this care and notions of “motherhood” as it relates to values such as compassion, love, and respect, which have been constructed as universally feminine. However, the main goal of feminist studies of care has been to deconstruct this association, particularly because it is imbued with the white, wealthy, heteronormative ideal of femininity that underlies a gendered division of labor. The reality is that class, race, nation, and gender determine who cares for whom, whether or not labor is paid, and to what extent care is exploitative. One strand of recent research problematizes both valorizing and criticizing care practices on the grounds that they are based on a rather homogeneous understanding of the feminine. Instead, these scholars seek to resurrect valuable feminist work without relying on essentialism of authors contributing to this discussion on care as an ethos for science include Ruth Müller and Martha Kenney, “Agential Conversations: Interviewing Postdoctoral Life Scientists and the Politics of Mundane Research Practices,” Science as Culture 24, no. 4 (2014): 537–59; Charis Thompson, Good Science: The Ethical Choreography of Stem Cell Research (Cambridge, MA: MIT Press, 2013); and Carrie Friese, “Realizing Potential in Translational Medicine: The Uncanny Emergence of Care as Science,” Current Anthropology 54 (S7): S129-S138. 2. From Latin America, see, for example, Luz Gabriela Arango Gaviria, Adira Amaya Urquijo, Tania Pérez-Bustos, and Javier Pineda Duque, eds., Género y cuidado: teorías, escenarios y políticas (Bogotá: Universidad Nacional de Colombia, 2018); Pascale Molinier and Luz Grabriela Arango Gaviria, eds., El trabajo y... (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)

Background: While sustainability is a key concept in many different domains today, it has not yet been sufficiently emphasized in the healthcare sector. Earlier research shows that ethical values and evidence-based care models create sustainability in care practice. Objective: The aim of this study was to gain further understanding of the ethical values central to the realization of sustainability in care and to create an ethical practice model whereby these basic values can be made perceptible and active (...) in care practice. Research design: Part of the ongoing “Ethical Sustainable Caring Cultures” research project, a hermeneutical application research design was employed in this study. Participants: Dialogues were used, where scientific researchers and co-researchers were given the opportunity to reflect on ethical values in relation to sustainability in care. Findings: An ethical practice model with ethos as its core was created from the results of the dialogues. In the model, ethos is encircled by the ethical values central to sustainability: dignity, responsibility, respect, invitation, and vows. Discussion: The model can be used as a starting point for ethical conversations that support carers’ reflections on the ethical issues seen in day-to-day care work and the work community, allowing ethical values to become visible throughout the entire care culture. Conclusion: It is intended as a tool whereby carers can more deeply understand an organization’s common basic values and what they entail in regard to sustainability in care. (shrink)

While researchers have examined the types of ethical issues that arise in long-term care, few studies have explored long-term care nurses’ experiences of moral distress and fewer still have examined responses to initial moral distress. Using an interpretive description approach, 15 nurses working in long-term care settings within one city in Canada were interviewed about their responses to experiences of initial moral distress, resources or supports they identified as helpful or potentially helpful in dealing with these situations, (...) and factors that hindered nurses in their responses. Using a thematic analysis process, three major themes were identified from the nurses’ experiences: (i) the context of the situation matters; (ii) the value of coming together as a team; and (iii) looking for outside direction. The work of responding to initial moral distress was more fruitful if opportunities existed to discuss conflicts with other team members and if managers supported nurses in moving their concerns forward through meetings or conversations with the team, physician, or family. Access to objective others and opportunities for education about ethics were also identified as important for dealing with value conflicts. (shrink)

Background Patient-centeredness, respect for patient autonomy, and shared decision-making have now made it to center stage in discussions on quality of care. Knowing what actually counts in care and how it should be accomplished from the patients’ and nurses’ perspective seems crucial. Aim To explore how patients and their nurses perceive the importance and enactment of values in their healthcare. Research design An observational, cross-sectional study using a self-developed questionnaire, consisting of 15 items related to seven values (e.g. (...) uniqueness, autonomy, professionalism, compassion, responsiveness, partnership, and empowerment) as described in the taxonomy of Bastemeijer et al. Participants and research context The survey was completed by 384 patients and 81 nurses. Participants were recruited on eight internal medicine wards of a 1000-bed university hospital in Belgium. Ethical considerations This study was approved by the ethical committee of the Ghent University Hospital (B670201836799). Findings (1) Patients and nurses prioritize values of care differently; (2) nurses report not being able to enact the values they prioritize in actual practice as much as one would like to; and (3) there is a gap in experienced delivery of a comprehensible explanation of all treatment options, a conversation based on equality, making shared decisions, and being non-judgmental between nurses and patients. Discussion Our findings challenge nurses’ overemphasis on professional compassion and uniqueness while arguing for increased attention on authentic shared decision-making and empowerment. The first step to a patient-centered culture truly involving patients in their healthcare is communication and information provision, rather than focusing on tangible and normative constructs. Conclusion Our findings revealed differences in prioritization and actual enactment of values in care between patients and nurses. This was especially so for values related to communication, provision of complete unbiased information, and shared decision-making. Nurses should prioritize providing comprehensible information and using conversations based on equality to make decision together with patients. (shrink)

The African proverb ‘it takes a village to raise a child’ has been compromised and exposed by the migration of Unaccompanied Refugee Minors from Zimbabwe to South Africa. Written from African women’s perspective, this article explores the response and approach of Bishop Paul Verryn to URMs. The article theologises Verryn’s response to URMs in conversation with African values, themes or sayings that relate to childcare, mainly from a Zimbabwean Ndebele context, and through the lens of the African saying ‘It takes (...) a village to raise a child’. In the findings, three crucial socio-ecclesial themes emerge from Verryn’s response which I refer to as the three Cs, namely, collaboration, consultation and contextuality. These are discussed through the lens of African women’s theology in relation to African values of childcare and its implications for pastoral care in a context of displaced children, and accompanied or unaccompanied minors. (shrink)

We examined the management of completed advance directives including why participants completed a document, what procedures and values they chose, with whom they held end-of-life conversations, and where they stored their document. Participants elected to complete a SurveyMonkey survey that was made available to individuals who wrote an advance directive through Texas-LivingWill.org; 491 individuals elected to fill out the survey, aged 19 to 94 years. The survey asked multiple questions about why participants completed an advance directive, where they would (...) store it, and with whom they had conversations about their end-oflife wishes. A list of procedures and values allowed participants to indicate what they refused or requested in their advance directive. Advance directives are most often completed to allow patients to prepare and control the healthcare they wish to receive when dying. One-half to two-thirds of individuals refuse common end-of-life medical procedures, and the rest request the procedures. We found a correlation between the choice to refuse or request a procedure and the age of the participant. Participants reported that their end-of-life conversations most often occurred with their spouse. Respondents often reported that their advance directive was stored with their physician and power of attorney for healthcare, conversations with those individuals rarely happened. Advance directives document patients’ requests for and refusals of end-of-life care. Physicians and surrogates need to be better educated so that the documents are part of a meaningful conversation with the patient. Because patients’ choices change over their lifespan, these documents need to be revisited regularly and not completed as a onetime event. (shrink)

Like most goods‐producing sectors in the West, modern health‐care systems have been profoundly changed by globalization and the neoliberal policies that attend it. Since the 1970s, the role of the welfare state has been considerably reduced; funding and management of health systems have been subjected to wave upon wave of reorganization and assimilated to the private sector. At the same time, neoliberal policy has imposed the notion of patient empowerment, thus turning patients into consumers of health. The literature on (...) nursing has accordingly reported on the significant repercussions on all aspects of the profession, from delivery of care and treatment, through training for new nurses, to legislated policy reforms regarding the role and responsibilities of modern nurses. In light of these developments, this paper analyses and theorizes about the way the injection of neoliberal policy is linked to and affects the practice of nursing. Drawing on a number of Nietzschean arguments, we begin with an exploration of the complex effects of neoliberalism, bureaucratization, and technocratization on the health system and the practice of nursing. Our main theoretical point here is that neoliberal policy engenders and promotes a neoliberal tide, which results in the conversion of the values that drive modern nursing practice. We then examine this tide in the light of Nietzsche's concepts. Starting with an analysis based on the ontology of the will to power, we show that nurses are dominated by neoliberal values embedded in technocratic and bureaucratic ideologies. Finally, we argue that the application of neoliberal policy constitutes a form of domestication from which one might potentially be freed through the Nietzschean concept of transvaluation of values. This transvaluation, as its freeing from some of the neoliberal tide, may be accomplished in accordance with a hierarchy of specific life‐affirming values for nursing culture and practice. (shrink)

Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in (...) Basel, Switzerland. A Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives. (shrink)

The value of a company’s ethical reputation has become a focal point for management researchers. We seek to join this conversation and extend the research centered on a firm’s ethical reputation. We accomplish this by shifting our focus away from its impact on external stakeholders to its impact on internal stakeholders. To this end, we rely on signaling theory to explain why a firm’s ethical reputation matters to its employees in an effort to bridge the macro–micro research gap. Across two (...) studies, we propose and demonstrate that a firm’s ethical reputation impacts employee subjective career success in form of career opportunities and work–life balance. Given our signaling theory framework, we also identify and explain when two industry-level characteristics operate as boundary conditions that distort a firm’s ethical reputation signaling properties. Specifically, the results demonstrate that a firm’s ethical reputation is positively related to employees’ perceptions of career opportunities and work–life balance. The results of our studies also demonstrate that the relatively high levels of industry competition and industry regulation weaken the positive impact of a firm’s ethical reputation on career opportunities and work–life balance. Theoretical and practical implications are discussed. (shrink)

Background: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as ‘incompetent’ decision makers regarding their own care. Objective: The aim of the study was to deepen the understanding of stroke team members’ reasoning about truth-telling in end-of-life care due to acute stroke. Research design: Qualitative study based on individual interviews (...) utilizing combined deductive and inductive content analysis. Participants and research context: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Findings: The main findings were the team members’ dynamic movement between the categories ‘Truth above all’ and ‘Hide truth to protect’. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. Discussion: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient’s best interest first. Conclusion: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge. (shrink)

There is an urgent need to learn how to appropriately integrate technologies into dementia care. The aims of this Delphi study were to project which technologies will be most prevalent in dementia care in five years, articulate potential benefits and risks, and identify specific options to mitigate risks. Participants were also asked to identify technologies that are most likely to cause value tensions and thus most warrant a conversation with an older person with mild dementia when families are (...) deciding about their use. Twenty-one interdisciplinary domain experts from academia and industry in aging and technology in the U.S. and Canada participated in a two-round online survey using the Delphi approach with an 84% response rate and no attrition between rounds. Rankings were analyzed using frequency counts and written-in responses were thematically analyzed. Twelve technology categories were identified along with a detailed list of risks and benefits for each. Suggestions to mitigate the most commonly raised risks are categorized as follows: intervene during design, make specific technical choices, build in choice and control, require data transparency, place restrictions on data use and ensure security, enable informed consent, and proactively educate users. This study provides information that is needed to navigate person-centered technology use in dementia care. The specific recommendations participants offered are relevant to designers, clinicians, researchers, ethicists, and policy makers and require proactive engagement from design through implementation. (shrink)

The contributions of Professor Bernard Dickens to health law and bioethics span the era in which these fields have emerged as distinct domains of teaching, scholarship and professional and public conversation. Neither field exists in a vacuum. The concerns of bioethics, like the content of health law, are a product of social forces. The bureaucratization of medical care, the possibilities and uncertainties created by developments in medical technology, not to mention glaring health inequalities, have been destabilizing forces in medicine. (...) Writing in 1974, American sociologist Renée Fox noted that medicine had reached “a stage of development characterized by diffuse ethical and existential self-consciousness.” This new medical introspection was evidenced by intense engagement with issues of biomedical regulation, and with the growth of professional codes and processes for resolving value-laden issues within clinical settings.While sometimes described as a process or site for discussion and “engagement,” bioethics evolved rapidly into a domain of governance, with direct implications for clinical practice. (shrink)

Background: Engaging in end-of-life care considerations is beneficial when the time is right. The purpose of this study is to provide a valid instrument to assess peoples readiness for end-of-life conversations before they are initiated.Materials and Methods: A community sample was recruited in study one for exploratory factor analysis of a 13-item questionnaire. In study two, psychometric properties were analyzed with structural equation modeling in a population affected by cancer. Convergent and discriminant validity were assessed with questionnaires measuring (...) distress, depression, anxiety, fear of progression, and distress of death and dying.Results: In study one exploratory factor analysis resulted in three subscales readiness, communication, and values with a possible common factor for a community sample. In study two the three-factor solution with 13 items was not supported for cancer patients. Factor structure was adapted to 12 items with one common factor readiness. Model fit was good: χ2 = 59.18, p>0.05, with χ2/df = 1.184, rRMSEA = 0.053, and rSRMR = 0.072. Convergent validity was supported by moderate correlations to trait gratitude, ratings of readiness to provide a living will or talk with family about the end of life. Divergent validity was supported by no or small correlation with distress, depression, general and death anxiety and fear of progression, respectively.Conclusions: Results support usage of the REOLC Scale in different settings with adapted factor structure. The questionnaire is interpreted as valid and reliable instrument to assess objective readiness for end-of-life conversations. (shrink)

Can one coherently integrate Darwin's view of evolution with an affirmation of the value of existence? In this fresh, lean, and substantive volume, William Meyer addresses this important question. By carefully analyzing Darwin's own writings and by drawing on the philosophical perspectives of William James, Alfred North Whitehead, and others, Meyer persuasively redirects the cultural conversation about Darwin away from the retrospective question of origins toward the prospective question concerning the ultimate significance of evolutionary life. As James recognized, the question (...) about the reality of God is more critical for the forward-looking question of value than it is for the backward-looking question of origins. Darwin was a theist in search of a better theism, and because theology had not yet caught up to him, he became increasingly agnostic and caught between his mechanistic understanding of nature, on the one hand, and his affirmation of the value and beauty of the world, on the other. Whitehead's philosophy of organism offers a way to integrate Darwin's evolutionary insights with his affirmation of the grandeur of nature. Meyer's clearly written and richly argued book enables us to integrate our evolutionary understanding of the world with our experience of value within it. (shrink)

Physicians and families need to interact more meaningfully to clarify the values and preferences at stake in advance care planning. The current use of advance directives fails to respect patient autonomy. This paper proposes using the family covenant as a preventive ethics process designed to improve end-of-life planning by incorporating other family members—as agreed to by the patient and those family members—into the medical care dialogue. The family covenant formulates advance directives in conversation with family members and with (...) the assistance of a physician, thereby making advance directives more acceptable to the family, and more intelligible to other physicians. It adds the moral force of a promise to the obligation of respecting a patient’s preferences about end-of-life care. These negotiations between patient, family, and physician, from early planning phases through implementation, should greatly reduce the incidence of family disagreements on what the patient would have wanted. The family covenant ensures advance directive discussions within the family, promotes and respects the autonomy of other family members, and might even spur others in the family to complete advance directives through additional covenants. The family covenant holds the potential to transform moral quagmires into meaningful moral conversation. J Am Geriatr Soc 51:1155–1158, 2003. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Balancing Depth and Breadth in Our Conversations:Denver 2022 SBCS Annual MeetingSandra Costen KunzIn 2020 and 2021, due to the corona virus pandemic, the Society for Buddhist-Christian Studies (SBCS) held its annual board meeting, members meeting, and paper sessions online. This year, in 2022, we were delighted to meet face-to-face again on November 18–19 in conjunction with the annual meeting of the American Academy of Religion (AAR). Because we (...) are an AAR "related scholarly organization," all of our events were scheduled through, and publicized by, AAR's staff. President Mark Unno not only presided at the board's table but also graciously ran a video conference, primarily to accommodate board and committee members who were outside the United States or dealing with travel-prohibiting health issues.The 2020 and 2021 fully online governance meetings, led by then-president Leo Lefebure, had been well organized, well run, highly effective, and a lot of fun. But as I watched the attentive eyes around the table this year and listened to the laughter, empathetic sighs, and plans for follow-up conversations, it seemed to me that meeting in person, in some ways, more powerfully supports the society's aim to foster in-depth Buddhist-Christian dialogue and comparative studies. Mark, then vice president, had organized the 2020 and 2021 online paper sessions carefully for online audiences. We were thrilled that these beautifully crafted and moderated presentations drew audiences that were amazingly broad in terms of both size and diversity. Planned as emergency extensions of the society's efforts to create, through our blog and Facebook page, safe online spaces for Buddhist-Christian dialogue and comparative studies, these sessions drew an international audience whose breadth astounded us! Conversations that had begun in these sessions could not, however, be quickly continued over a meal or coffee. In some ways, they did not appear to me to spark the same depth of ongoing conversation that the SBCS has prompted in our four decades of face-to-face meetings.As the board continues to discuss how to balance our desires for both depth and breadth of conversation among our board, our members, and nonmembers who attend our events, we sincerely welcome the wisdom of members and other readers. You can submit suggestions to: https://www.society-buddhist-christian-studies.org/contact. [End Page 263]board of governors meetingPresident's Opening RemarksCalling this year's board meeting to order a little past 9 a.m., Mark Unno said that he sensed that his father, Taitetsu Unno, "is with us, encouraging and congratulating the society on how far we've come in the past forty years." He recalled his father's participation in the Cobb–Abe dialogues and the network that evolved into the SBCS, and that these initial conversations were often highly theological—and testy—and often involved a translator. Mark is convinced, however, that this early debate was a necessary foundation for developing a more robust mutual learning community. Describing two significant ways the society is modeling collaborative learning, he said:1. We're providing a model of interreligious engagement for other people in our various traditions.2. Although we do have impacts on scholars and general audiences through our AAR sessions, journal, and online resources, our greatest impacts as board members have been on each other! Furthermore, any impact of lasting value will come through our embodiment of deep dialogue and mutual learning.Mark explained that we'd begin with the online European Network report, move to the Japan Society's report, and then to the treasurer's and secretary's reports, both of which would be presented online.International Advisor Report from EuropeElizabeth Harris, representing the European Network of Buddhist Christian Studies, explained that since its formation in the 1990s, its main work has been to hold a conference every other year and publish the papers. EOS Verlag has now published the papers that she and Perry Schmidt-Leukel edited from the 2020 conference titled "A Visionary Approach: Lynn A. de Silva and the Prospects for Buddhist-Christian Encounter." The 2022 conference titled "Euro-Buddhism and the Role of Christianity," whose papers are now being edited... (shrink)

After many policy attempts to tackle the persistent rise in the costs of health care, physicians are increasingly seen as potentially effective resource stewards. Frameworks including the quadruple aim, value-based health care and choosing wisely underline the importance of positive engagement of the health care workforce in reinventing the system–paving the way to real affordability by defining the right care. Current programmes focus on educating future doctors to provide ‘high-value, cost-conscious care’ (HVCCC), which proponents believe (...) is the future of sustainable medical practice. Such programmes, which aim to extend population-level allocation concerns to interactions between an individual doctor and patient, have generated lively debates about the ethics of expanding doctors’ professional accountability. To empirically ground this discussion, we conducted a qualitative interview study to examine what happens when resource stewardship responsibilities are extended to the consulting room. Attempts to deliver HVCCC were found to involve inevitable trade-offs between benefits to the individual patient and (social) costs, medical uncertainty and efficiency, and between resource stewardship and trust. Physicians reconcile this by justifying good-value care in terms of what is in the best interest of individual patients–redefining the currency of value from monetary costs to a patient’s quality of life, and cost-conscious care as reflective medical practice. Micro-level resource stewardship thus becomes a matter of working reflexively and reducing wasteful forms of care, rather than of making difficult choices about resource allocation. (shrink)

An ICU and Palliative Care specialist featured in the Netflix documentary Extremis offers a framework for a better way to exit life that will change our medical culture at the deepest level In medical school, no one teaches you how to let a patient die. Jessica Zitter became a doctor because she wanted to be a hero. She elected to specialize in critical care--to become an ICU physician--and imagined herself swooping in to rescue patients from the brink of (...) death. But then during her first code she found herself cracking the ribs of a patient so old and frail it was unimaginable he would ever come back to life. She began to question her choice. Extreme Measures charts Zitter's journey from wanting to be one kind of hero to becoming another--a doctor who prioritizes the patient's values and preferences in an environment where the default choice is the extreme use of technology. In our current medical culture, the old and the ill are put on what she terms the End-of-Life Conveyor belt. They are intubated, catheterized, and even shelved away in care facilities to suffer their final days alone, confused, and often in pain. In her work Zitter has learned what patients fear more than death itself : the prospect of dying badly. She builds bridges between patients and caregivers, formulates plans to allay patients' pain and anxiety, and enlists the support of loved ones so that life can end well, even beautifully. Filled with rich patient stories that make a compelling medical narrative, Extreme Measures enlarges the national conversation as it thoughtfully and compassionately examines an experience that defines being human. (shrink)

This interview with Charles Taylor explores a central concern throughout his work, namely, his concern to ‘reenchant’ self and world through a careful examination of value as emanating from the world rather than from ourselves. It focuses especially on the status of his central doctrine of ‘strong evaluation’ against the background of mainstream meta-ethical theories, such as neo-Kantian constructivism and robust realist non-naturalism. Additionally, the relationship between Taylor’s theism and his moral–political philosophy is discussed. A key issue that is examined (...) is what ontological background picture can make sense of the strong evaluative experience of higher worth. Some other related issues that are explored revolve around Taylor’s papers ‘Disenchantment-Reenchantment’ and ‘Recovering the Sacred’, which tentatively explore the meaning of reenchantment. (shrink)

Should blood be bought and sold is in crude terms the question asked and answered by Richard Titmuss in his recent book The Gift Relationship. Dr Raymond Plant, a lecturer in philosophy at Manchester University, analyses Titmuss' arguments in a paper which we are printing in two parts. Titmuss has taken the provision of blood as his example of the gift relationship--and by extension that of health care generally. Dr Plant considers in turn each of Titmuss' arguments that blood (...) should not be a marketable commodity, the moral objections to which seem to be the erosion of freedom and of truth telling, the separation of society through the cash nexus, and its converse that the provision of health care is a means for the integration of society. Dr Plant also examines the views of other commentators on the Titmuss' theory of the value of a 'free' blood transfusion service and other medical care as a means of integration in society, and ends with his promise that in the second part of his paper he will examine Titmuss' principles not in terms of the market but rather as related to the principle of social justice. (shrink)

In this paper an economics approach to assessing community values in health care priority setting is examined. The approach is based on the concept of ‘willingness to pay’ (WTP). Eighty two parents were interviewed with regard to three aspects of provision of child health services. For each aspect a choice of two courses of action was presented. Parents were asked which course of action they preferred and what was the maximum amount of money they would be prepared to pay (...) for this rather than their less preferred option. WTP responses are acceptable to the majority of respondents and appear to ‘behave’ in accordance witha priori expectations. A method of assessing the influence of ability to pay on preferences and WTP is outlined. Preferences and WTP do not appear to have been unduly distorted by ability to pay. Use of WTP data does have the potential to provide health care purchasers and providers with information on intensity as well as direction of the preferences of members of the community. (shrink)

Values such as respect for autonomy, safety, enablement, independence, privacy and social connectedness should be reflected in the design of social robots. The same values should affect the process by which robots are introduced into the homes of older people to support independent living. These values may, however, be in tension. We explored what potential users thought about these values, and how the tensions between them could be resolved. With the help of partners in the ACCOMPANY project, 21 focus groups (...) were convened in France, the Netherlands and the UK. These groups consisted of: older people, informal carers and formal carers of older people. The participants were asked to discuss scenarios in which there is a conflict between older people and others over how a robot should be used, these conflicts reflecting tensions between values. Participants favoured compromise, persuasion and negotiation as a means of reaching agreement. Roles and related role-norms for the robot were thought relevant to resolving tensions, as were hypothetical agreements between users and robot-providers before the robot is introduced into the home. Participants’ understanding of each of the values—autonomy, safety, enablement, independence, privacy and social connectedness—is reported. Participants tended to agree that autonomy often has priority over the other values, with the exception in certain cases of safety. The second part of the paper discusses how the values could be incorporated into the design of social robots and operationalised in line with the views expressed by the participants. (shrink)

This article discusses the key existential stakes of implementing biometrics in human lifeworlds. In this pursuit, we offer a problematization and reinvention of central values often taken for granted within the “ethical turn” of AI development and discourse, such as autonomy, agency, privacy and integrity, as we revisit basic questions about what it means to be human and embodied. Within a framework of existential media studies, we introduce an existential ethics of care—through a conversation between existentialism, virtue ethics, a (...) feminist ethics of care and post-humanist ethics—aiming to deepen and nuance our understanding of the human behind “human-centered” AI directives. The key argument is that biometrics implicates humans through unprecedented forms of objectification, through which the existential body—the relational, intimate and frail human being—is at risk. We interrogate these risks as they become visible at three sites where embodied humans are challenged by biometrics, and thus where the existential body is challenged by the biometric body. This occurs through reductionism (biometric passports nailing bodies to identities, removing human judgment and compromising agency at the AI border), enforced transparency (smart home assistants surveying human intimacies and invading intimate spaces in the bedroom) and the breaching of bodily integrity (chipping bodies to capture sensory data, challenging the very concept of bodily integrity through self-invasive biohacking). Our existential ethics of care is importantly not a solutionist list of principles or suggestions, but a manifesto for a way of thinking about the ethical challenges of living with biometrics in today’s world, by raising the right questions. We argue that a revitalized discussion of the basic existential stakes within human lived experience is needed and should serve as the foundation on which comprehensive frameworks can be built to address the complexities and prospects for ethical machines, responsible biometrics and AI. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Teaching Ethics in the Health Care Setting Part I:Survey of the LiteratureMary Carrington Coutts (bio)The last twenty years have brought important changes to health care and health care education. Educators and students alike face an enormous number of new fields of study and new medical technologies. Health care professionals and institutions are also facing new challenges in the form of shrinking economic resources, and the (...) AIDS epidemic. They must also respond to increased patient participation in health care decisions, and public concern about abortion and euthanasia. These challenges to the health care professional have compelled educators to accommodate ethics within their already overcrowded curriculum. Those same dilemmas have influenced health care institutions to become active in health care ethics education.Medical ethics education gained a foothold in the United States during the late 1960s, when the medical schools of Pennsylvania State University, the University of Florida, and the State University of New York at Stonybrook established programs in the humanities (Pellegrino 1982). In 1978 Robert Veatch noted that formal teaching in medical ethics was rare; most institutions that taught medical ethics used "informal instruction in the apprenticeship mode" (Veatch 1978). However, by 1982 a survey by the American Medical Association (AMA) revealed that all but one of the 127 medical schools had courses that included medical ethics. Thirty eight of these had medical ethics as a required course (Pellegrino 1985). And by 1989, 43 of the 127 medical schools had separate courses in medical ethics, while 100 covered medical ethics within required courses. Medical ethics is now an accepted part of medical curriculum, though it is not fully mature, and its future remains somewhat unclear (Miles 1989).The evolution of ethics in the nursing curriculum has essentially mirrored that of the medical curriculum. A 1977 survey of baccalaureate nursing programs revealed that only 7 percent of nursing programs required courses in ethics [End Page 171] (Aroskar 1977). A decade later a second survey of undergraduate programs identified 85 percent of responding nursing schools as teaching nursing ethics either in separate ethics courses or within other required courses (Cassells and Redman 1989).Though the precise future of health care ethics may be unpredictable, there is little thought that the role of ethics will diminish in importance as the 21st century approaches. Ethics is seen as part of a larger plan to develop and enhance the health professional's human values, social conscience, and interpersonal skills. "This broader effort derives from concerns about the personal attributes and humanistic sensitivity of physicians, the recent overly 'scientized' trend in premedical education, the selection of medical students, and the socialization and cynicism engendered by medical education" (Miles 1989, p. 705).While nearly every medical and nursing school in the United States now teaches ethics in one form or another, the degree to which ethics is integrated into the curriculum varies from school to school. Some ethics courses are required elements of the students' education; some institutions require attendance at seminars and ethics grand rounds. Other schools offer an array of elective courses in topics that relate to ethics in medicine and nursing (including medical humanities, medicine and the law, literature and medicine, history of medicine, patient advocacy, and human values in nursing.) "Brown bag" seminars and journal clubs are also common.There is much debate over how health care ethics should be taught. Some argue that medical professionals should be conversant with theories of ethics and principles of biomedical ethics. Others think that a theoretical approach will alienate already over-worked medical or nursing students, and that instruction in ethical theory should be kept to a minimum. Case studies are frequently cited as a way to involve students in medical decision making, forcing them to analyze problems that they can relate to their own experiences.Additional concerns center around who should teach health care ethics. Frequently, physicians and nurses interested in ethics teach courses. Some commentators see this as the most desirable arrangement, asserting that practicing health care professionals best understand the conflicts faced by physicians and nurses-in-training. However, there is a growing pool of professionals who are undergoing training as medical ethicists. These individuals study ethical theory and bioethical... (shrink)

Which goods should we be able to buy and sell on the market and, alternatively, which goods should remain sheltered from the market? For many goods in modern societies, this has proven to be a thorny question. Moreover, it is a question that cannot be answered by way of a theoretical shortcut, that is, by attributing certain general values (or disvalues) to the market and inferring from these general attributes that the market is (or isn’t) the best institution to govern (...) the provision of a specific good. Therefore, in the first part of this work, three theoretical building blocks are proposed to frame the way we should handle the market question. First, a social theory is formulated which treats the market as one out of five main socio-economic modes of provision, the others being public provision, professional provision, informal provision and self-provision. Second, in choosing the best institutional framework for a specific good, it is argued that we should not restrict ourselves to the option of implementing one of these modes of provision only. Special attention should be paid to the option of ‘institutional pluralism’, i.e. instituting a market and a non-market alternative simultaneously for the same good. Both the attractions and the limits of such an institutional pluralism are discussed. Third, in making institutional choices about these modes of provision, we need a normative theory providing the moral criteria to guide our choices. Here a capability theory is proposed, which consists of three central principles, parallel to a distinction between three types of capabilities: those that are ‘immoral’, those that are ‘morally required’ and those that are merely ‘morally permissible’. The principles prescribe avoiding the realization of the immoral capabilities and promoting the realization of morally required and permissible capabilities. In the second part, this threefold framework is applied to three specific goods. These are security (protection against criminal threats), media (mass communication by media such as television, radio and the press) and care (caring activities provided on a structural basis to dependents such as care for children, chronically ill and elderly people). For each of these goods a capability analysis shows that the most appropriate institutional framework is institutional pluralism. In the case of security this is a pluralism of market and public provision, in the case of media a pluralism of market and professional provision and in the case of care a pluralism of market and informal provision. In the final chapter I investigate the conditions that have to be fulfilled for these institutionally pluralist arrangements to be stable, that is, to have a robust chance of survival. The main challenge to stability comes from the dynamic toward capital accumulation that is inherent in contemporary capitalism, and if left unchecked requires an ongoing conversion of non-market practices into markets. Two solutions are proposed to counter this threat: a general working time reduction which reduces capital accumulation and a strategy of publicly funded investment of accumulated capital in non-market parts of institutionally pluralist practices. (shrink)

Are values and social priorities universal, or do they vary across geography, culture, and time? This question is very relevant to Asia’s emerging economies that are increasingly looking at Western models for answers to their own outmoded health care systems that are in dire need of reform. But is it safe for them to do so without sufficient regard to their own social, political, and philosophical moorings? This article argues that historical and cultural legacies influence prevailing social values with (...) regard to health care financing and resource allocation, and that the Confucian dimension provides a helpful entry point for a deeper understanding of ongoing health care reforms in East Asia – as exemplified by the unique case of Singapore. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Violent Inheritance: Sexuality, Land, and Energy in Making the North American West by E. CramNathan StormerViolent Inheritance: Sexuality, Land, and Energy in Making the North American West. By E. Cram. Oakland: University of California Press, 2022. 292 pp. Cloth $85.00, paper $34.95. ISBN: 0520379470.E. Cram’s Violent Inheritance is an exceptional work that presents a distinctive synthesis of queer, decolonial, and mixed-method scholarship. The goal of the book, Cram (...) states, is to both “reimagine the place of racialized sexualities in contemporary conversations about environment, energy, and systems of violence” and “anchor these questions in contested memories of the North American West” (5). The book does just that, drawing from many contemporary streams of thought in rhetoric as well as the environmental and energy humanities to fashion a new and subtle analytic of infrastructures of feeling, which is supported by a range of conceptual innovations. For readers of this journal, Cram’s choice to ground theory quite literally in the land will be, I suspect, highly rewarding for those with interests crossing a wide range of topics: queer studies, violence, affect, Indigenous thought, sexuality and modernity, memory studies, rhetoric and materialism, ecological thought, ambience, regionalism. The breadth of scholarly dialogues that Cram harmonizes is simply impressive, reflecting the many years and the care they have devoted to this project.The book is composed of five chapters including a conceptual first chapter followed by four separate yet reinforcing studies. These are framed by a tidy introduction that prepares the reader admirably for the synergistic work to follow and a conclusion that stresses the bonds between the chapters without compromising the particularity of each study. In that regard, Violent Inheritance is both a single work guided by several cross-cutting ideas and questions and an anthology of sorts that prompts a series of discrete, rich conversations. The careful writing is evident in every paragraph, often presenting the reader with elegant, thought-provoking formulations [End Page 199] of deep onto-epistemological problems that never feel weighted down by the complexity of dwelling on “onto-epistemic” matters.The introduction sets out the question of the book in engaging fashion. Cram asks, in the first sentence, “What does it mean to route ‘sexuality’ through modernity’s relationship to energy?” They use nineteenth-century eugenic physician John Harvey Kellogg’s Rocky Mountain climatic therapeutics to exemplify how “climate and the environment” became crucial to “the production of theories of sexuality” (3). Cram proposes energy to be “perhaps the dominant relationship between humans and the environment” and points to the ways that “racial and sexual value” have been assigned to a broad range of practices of “revitalization and exhaustion,” such that “racial and sexual vitality converge in extractivism” (3, 5, 4). In this way, the “bodily vitality” of the “normative sexual subject” demands privileged access to land and the energy that can be taken from it, be it affective or petrochemical. The emergence of sexual modernity, Cram thus contends, is inextricably tied to the regime of energy extraction. Through selected cases, Cram follows “nonlinear traces of this regime’s enduring materiality and sedimentation: the ecological, energetic, and affective inheritance that I call ‘land lines’” (6). The term “land lines” refers to how “political and economic actions tether, or forge connections, between domains of sexuality and land use,” and “names the aggregation of layers of cultural sediment or the violent inheritance of any given place.... As method, to trace land lines asks in earnest how places of memory and memorialization mediate these relationships” (6,7, emphasis original). The choice of the North American West follows from Cram having grown up there and the particular land lines that bind them to its violent inheritance, as well as the West’s stature as a colonial reservoir of myth and abundant energy.The separate chapters are saturated with meticulous detail, studied reflection, and constant insight that reward slow reading, making a synoptic view misleading. Nevertheless, chapter 1 travels through the 1893 journal of author Owen Wister (who helped create the myth of the West) to map a rhetoric of reinvigorated, masculinized settler sexuality by way of access to the West and the healing energy... (shrink)

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

Books have their origins in conversations and seek to extend and expand those conversations over time and with different audiences. The conversations that have culminated in this book were initially stimulated through a research project at The Hastings Center on the role of religious voices in the professional fields of bioethical inquiry. Those professional conversations have continued throughout my academic career as a member of various institutional ethics committees, organizational ethics task forces, and in local, state, (...) and national public policy settings. The professional context of bioethics conversations can sometimes miss the richness of conversations that occur in the classroom and with various communities, including family members, friends, and religious and civic communities. These conversations provide an experiential depth, a groundedness in the lives and stories of persons, which augments and corrects the professionalized perspectives. I have been particularly fortunate and appreciative of opportunities to bridge the academic and professional with the personalized and communal through conversations about the ethical commitments and moral culture cultivated by The Church of Jesus Christ of Latter-day Saints (LDS or Mormon). I was invited to develop an overview essay on "Bioethics in Mormonism" for the professional reference work, Encyclopedia of Bioethics (3rd ed., 2004), and some years later received my first invitation to make a presentation on "LDS Ethics" in an academic setting at the University of Virginia. This book is the outgrowth of these many conversations and seeks to advance my communal bridging. My aim in this book is to begin bridging these various intersections between the LDS religious community and its moral culture, the professional fields of bioethics, and practical decision-making. This work seeks to be a catalyst for expanding discourse within the interdisciplinary field of Mormon studies to include ethics and bioethics. Ethics has not been a well-developed area in Mormon studies, in contrast to studies in LDS history, theology, or literature. To remedy this oversight, I present a substantive interpretation of the sources, theological background, and moral principles of LDS ethics. The historical narratives and conceptual intertwining I offer of both bioethics and of LDS moral culture is intended to complement and expand the realm of Mormon studies. A further objective is to create opportunities for reciprocal dialogues between the bioethics community and LDS scholarship. This conversation has yet to occur within academic disciplines, professional communities, or in public policy deliberations. My exposition, analysis, and critiques will intertwine and contextualize LDS moral values and health care practices within the ethical inquiry undertaken in the broader professional scholarship of bioethics. My arguments will disclose some points of common ground as well as areas of divergence towards the end of establishing the LDS faith tradition as a community of moral discourse for the bioethics field and the healing professions (medicine, nursing, pharmacy, etc.) it informs. My claim is that given its emerging cultural prominence, LDS ethical scholarship should engage in bioethical literacy and bioethics should be LDS-literate. I am also engaged in an effort to initiate more reflective dialogues regarding LDS ethics and moral culture among LDS scholars, LDS health care professionals, and the interested general LDS reader. The focus of the book on the interrelationship of religion, ethics, medicine, and health care should present for these various audiences new opportunities for mindful reflection and creative scholarship on the ethical implications of faith commitments, the responsibilities of the healing professions, and religious dimensions of public policy and public bioethics. A religious community that is formed through narratives and practices of covenantal commitments of love of neighbor needs to have a robust discourse about its ethical character. I have understood my scholarship in biomedical ethics and in religious ethics through a linking metaphor of my moral culture, of medicine, and the law, of bearing witness. The witness offers moral realities, moral truths about the way things are, vocalizes and embodies moral experience, and prophetically critiques the hypocrisies of the powerful and their oppression of the vulnerable by offering a new story, a re-storying, of tradition and conventional practice. (shrink)

Books have their origins in conversations and seek to extend and expand those conversations over time and with different audiences. The conversations that have culminated in this book were initially stimulated through a research project at The Hastings Center on the role of religious voices in the professional fields of bioethical inquiry. Those professional conversations have continued throughout my academic career as a member of various institutional ethics committees, organizational ethics task forces, and in local, state, (...) and national public policy settings. The professional context of bioethics conversations can sometimes miss the richness of conversations that occur in the classroom and with various communities, including family members, friends, and religious and civic communities. These conversations provide an experiential depth, a groundedness in the lives and stories of persons, which augments and corrects the professionalized perspectives. I have been particularly fortunate and appreciative of opportunities to bridge the academic and professional with the personalized and communal through conversations about the ethical commitments and moral culture cultivated by The Church of Jesus Christ of Latter-day Saints (LDS or Mormon). I was invited to develop an overview essay on "Bioethics in Mormonism" for the professional reference work, Encyclopedia of Bioethics (3rd ed., 2004), and some years later received my first invitation to make a presentation on "LDS Ethics" in an academic setting at the University of Virginia. This book is the outgrowth of these many conversations and seeks to advance my communal bridging. My aim in this book is to begin bridging these various intersections between the LDS religious community and its moral culture, the professional fields of bioethics, and practical decision-making. This work seeks to be a catalyst for expanding discourse within the interdisciplinary field of Mormon studies to include ethics and bioethics. Ethics has not been a well-developed area in Mormon studies, in contrast to studies in LDS history, theology, or literature. To remedy this oversight, I present a substantive interpretation of the sources, theological background, and moral principles of LDS ethics. The historical narratives and conceptual intertwining I offer of both bioethics and of LDS moral culture is intended to complement and expand the realm of Mormon studies. A further objective is to create opportunities for reciprocal dialogues between the bioethics community and LDS scholarship. This conversation has yet to occur within academic disciplines, professional communities, or in public policy deliberations. My exposition, analysis, and critiques will intertwine and contextualize LDS moral values and health care practices within the ethical inquiry undertaken in the broader professional scholarship of bioethics. My arguments will disclose some points of common ground as well as areas of divergence towards the end of establishing the LDS faith tradition as a community of moral discourse for the bioethics field and the healing professions (medicine, nursing, pharmacy, etc.) it informs. My claim is that given its emerging cultural prominence, LDS ethical scholarship should engage in bioethical literacy and bioethics should be LDS-literate. I am also engaged in an effort to initiate more reflective dialogues regarding LDS ethics and moral culture among LDS scholars, LDS health care professionals, and the interested general LDS reader. The focus of the book on the interrelationship of religion, ethics, medicine, and health care should present for these various audiences new opportunities for mindful reflection and creative scholarship on the ethical implications of faith commitments, the responsibilities of the healing professions, and religious dimensions of public policy and public bioethics. A religious community that is formed through narratives and practices of covenantal commitments of love of neighbor needs to have a robust discourse about its ethical character. I have understood my scholarship in biomedical ethics and in religious ethics through a linking metaphor of my moral culture, of medicine, and the law, of bearing witness. The witness offers moral realities, moral truths about the way things are, vocalizes and embodies moral experience, and prophetically critiques the hypocrisies of the powerful and their oppression of the vulnerable by offering a new story, a re-storying, of tradition and conventional practice. (shrink)

Advances in genetics and genomics have raised new questions in trout restoration and management, specifically about species identity and purity, which fish to value, and where these fish belong. This paper examines how this molecular turn in fisheries management is influencing wild and native trout policy in Colorado. Examples from two small Colorado watersheds, Bear Creek and Sand Creek, illustrate how framing trout as genetic bodies can guide managers to care for or kill trout populations in the interest of (...) rectifying decades of genetic disruption caused by human activity. While trout management has typically relied on human intervention, the turn to genetic science is prompting new classifications of lineage and taxa, altering long-standing conservation priorities, and reorienting the manipulation of biological processes such as reproduction and dispersal. As a result, other social and ecological factors may be pushed to the margins of management decisions. These changes warrant greater conversation about the consequences of molecular analyses and the values embedded in trout science and conservation more broadly. (shrink)

Dignity is a fundamental concept, but its meaning is not clear. This paper attempts to clarify the term by analysing and reconnecting two meanings of dignity: humanitas and dignitas. Humanitas refers to citizen values that protect individuals as equal to one another. Dignitas refers to aesthetic values embedded in genres of sociality that relate to differences between people. The paper explores these values by way of an empirical ethical analysis of practices of washing psychiatric patients in nursing care. Nurses (...) legitimate the washing of reluctant patients with reference to dignity. The analysis shows the intertwinement of humanitas and dignitas that gives dignity its fundamental meaning. (shrink)

In 2016, the Atlanta Community Food Bank launched the Stabilizing Lives project to develop programs and policies that could better address clients’ needs as well as including clientele as part of the planning process. The ACFB partnered with a research team at the University of Georgia to conduct a participatory research project aimed at developing deeper insights into the factors contributing to both instability and stability in the lives of pantry clientele. This article describes the outcomes this research, offering both (...) a substantive contribution to scholarship on food insecurity and emergency food systems and a methodological innovation through a staged mixed-method participatory research project. Through use of a culture-centered approach, this project created discursive spaces within which to outline emergency food models that support informal networks of care. We used a range of methods, including photo elicitation, concept mapping, individual interviews, and focus groups, to facilitate conversation among agency staff, volunteers, and clientele about the effectiveness of current program models and potential new ideas. Specifically, we suggest that through such practices, food pantries and local agencies may help inform new program models that contribute to household stability, and push back against the sometimes alienating and atomizing paradigm found in current emergency food programs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Importance of What Psychiatrists Care AboutJohn M. Talmadge (bio)Keywordspost-traumatic stress disorder (PTSD), psychotherapy, Frankfurt, veteransChristopher Bailey's account of his conversation with Colin, an unhappy man who feels regret about the absence of heroism in his own life, is both poignant and evocative. The emptiness that Colin feels illustrates aspects of the human condition central to definitions of psychotherapy for the past century or so. In this brief (...) commentary, I have three observations. First, the life of the therapist intertwines, however briefly, with the life of the patient. The light brought by the therapist may be like a candle, beacon, or flashbulb. Regardless of the therapist's strategic decisions and elected action, the patient may still end up in the dark. Second, I believe that this vignette illustrates the value of Professor Harry Frankfurt's ideas as expressed in his essay, “Freedom of the Will and the Concept of the Person.” And third, the tortuous journeys of psychotherapy may frighten and excite even the most temperate, contemplative clinician. In this third realm, where therapists create strategies for conversations about life, I also want to mention the work of Otto Rank.We have only a glimpse of Colin's life, but Dr. Bailey raises an issue of universal importance in helping others. The concept of moral heroism dates from the stoics, but the twentieth century merged psychology, theology, and philosophy in addressing the importance of significance, self-affirmation, and anxiety.Colin feels as though he has missed an opportunity for heroism, and Dr. Bailey is trying to help him feel better. Setting aside the technical problems imposed by a clinical setting, let us stipulate that there are two distinct aspects of psychiatric care: one is medical, formal, and biological; and the other is interactive, personal, and philosophical. With regard to the former, the psychiatrist is uniquely qualified to assist with medication, refinement of diagnosis, and remediation of illness. Regarding the latter, the psychotherapist may see the patient as an object, treated behaviorally, which is not necessarily bad or wrong, and solutions may be fairly procedural and simple. Dr. Bailey, however, sees Colin's problem as somewhat deeper than that, and I agree.Having a theory of human nature is one thing, but being in a relationship with another person requires action as well as contemplation. Like the parable of the two monks meeting in the forest, one turns to the other and says, “I’m lost.” The other monk replies, “I am also lost!” After a moment, the first says, “I don’t know the way out, but I know some ways that don’t lead out.” The second monk thinks for a moment and adds, “Me too. Perhaps we can find the way out together.” [End Page 241]When Harry Frankfurt (1988) first wrote about the importance of what we care about, he observed that conscious beings (as opposed to young children, who have not fully developed the capacity for self-reflection) exhibit conflicts of will. The concept of the person, he says, includes more than the nature of our knowing (epistemology) and the matter of our behavior (ethics). Those who are uniquely human have the capacity to consider and understand what they really care about, what matters most. In an elegant lecture series he sums this up as “taking ourselves seriously, and getting it right.” His work is valuable, not only for his keen insights and observations, but also because his thought is so accessible to those of us who are not trained philosophers.Frankfurt rightly points out that philosophy has largely neglected the study of personality, leaving that to the psychologists and social scientists. He never ventures into the world of diagnosis and treatment, and rightly so; he defines his interests narrowly and effectively, assuming for the sake of his arguments that he is describing someone not burdened by mental disease or defect. At the same time, he engages head-on the complexity of life and personal will. He offers a way to think about human will, but he does not say what we should necessarily do, nor for that matter when we should intervene, when it comes to the will of... (shrink)

Advance care planning allows patients to articulate preferences for their medical treatment, lifestyle, and surrogate decision-makers in order to anticipate and mitigate their potential loss of decision-making capacity. Written advance directives are often emphasized in this regard. While these directives contain important information, there are several barriers to consider: veracity and accuracy of surrogate decision-makers in making choices consistent with the substituted judgement standard, state-to-state variability in regulations, literacy issues, lack of access to legal resources, lack of understanding of (...) medical options, and cultural disparities. Given these issues, it is vital to increase the use of patient and healthcare provider conversations as an advance care planning tool and to increase integration of such discourse into advance care planning policy as adjuncts and complements to written advance directives. This paper reviews current legislation about written advance directives and dissects how documentation of spoken interactions might be integrated and considered. We discuss specific institutional policy changes required to facilitate implementation. Finally, we explore the ethical issues surrounding the increased usage and recognition of clinician–patient conversations in advance care planning. (shrink)

Background Professional values are important in promoting healthy work environments, patient satisfaction, and quality of care. Magnet® hospitals are recognized for excellence in nursing care and as such, understanding the relationship between nurses' values and Magnet status is essential as healthcare organizations seek to improve patient outcomes. Research question/aim/objectives The research question is: are there differences in individual values, professional values, and nursing care quality for nurses and nurse managers practicing in Magnet, Magnet journey, and non-Magnet direct (...) patient care settings? Research Design This descriptive cross-sectional study is guided and informed by the conceptual framework of the Professional Values Model including individual values, professional values, and nursing care quality. Participants and research context Convenience sampling of registered nurses and nurse managers, responsible for direct patient care, was utilized in a non-profit healthcare system in the Midwest region of the United States. Ethical Considerations Institutional review board approval was obtained. Participants were informed about the right to self-determine participation and assurance of anonymity. Findings 827 (n = 827) nurses and nurse managers responded to the survey. Significant differences were identified in individual values sub-scale: self-enhancement ( p = 0.38), professional values ( p = 0.037), practice environment: participation in hospital affairs ( p = 0.00), foundations for quality care ( p = 0.016), and resources adequacy ( p = 0.012) and in nurse sensitive HCAHPS questions: nurses explained things understandably ( p = 0.00), got help as soon as wanted ( p = 0.00), and treated with courtesy and respect ( p = 0.00). Discussion/Conclusions Findings indicate that fostering individual and professional values may impact nursing practice, regardless of Magnet designation. Promoting professional values may contribute to improved work environments, enhancing patient satisfaction. Study results offer valuable insights for organizations striving to enhance nursing values, impacting quality of care provided to patients. MeSH Terms Cross-Sectional Studies, Respect, Ethics Committees, Patient Satisfaction, Nurse Administrators, and Personal Satisfaction. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Democracy, Culture, Catholicism: Voices from Four Continents eds. by Michael J. Schuck and John Crowley-BuckSteven P. MilliesDemocracy, Culture, Catholicism: Voices from Four Continents Edited by Michael J. Schuck and John Crowley-Buck NEW YORK: FORDHAM UNIVERSITY PRESS, 2016. 350 pp. $105.00 / $35.00Democracy, Culture, Catholicism is the product of a three-year, international project that started from a less specific inspiration. Originally begun at Loyola University Chicago's Joan and Bill (...) Hank Center for the Catholic Intellectual Heritage in 2010 as a broad inquiry into the relationship between the Roman Catholic Church and politics, the project leaders eventually took a different bearing from events as diverse as the Arab Spring, the Occupy Movement, and Pope Benedict XVI's encyclical Caritas in Veritate to focus their project more squarely on democracy. Examining democracy from within the diverse experiences found in Lithuania, Peru, Indonesia, and the United States, the editors [End Page 208] present us with a valuable snapshot of where the Catholic engagement with democracy as a cultural expression finds itself today in a global perspective.Given the amount of material at play, the volume is a monumental achievement, if only for the clarity with which it presents its findings. Some essays are stronger than others. Still, the volume benefits tremendously from an apparent and unusual amount of editorial attention that sequences the essays and interrelates them with useful references to one another in such a way that Democracy, Culture, Catholicism escapes entirely the fate of so many volumes of collected essays. Here, the reader has the sensation of reading one coherent narrative, not twenty-three disparately connected, individual essays. This alone is impressive.The volume possesses other strengths. Reflections emerge throughout that engage the deeper questions of democracy. Who are these people making decisions together? How can we understand the composition of a political community? Too much democratic theory overlooks the complex interweaving of history, memory, and identity that operates like a substrate of our consciousness beneath our reason while we are presuming ourselves to be rational decision makers using democratic procedures. The book's engagement not just with democracy and Catholicism but also with culture is important. These essays treat culture not only in different local expressions but also (and in a way that is deep, serious, and sustained) as a phenomenon of consciousness.The American perspective always lurks in the narrative, threatening to dominate. This is inevitable not only because the project was managed in the United States but also because the polarizing obsessions of the church in the United States about how to acknowledge the norms of modern political arrangements have tended to dominate conversation in the church worldwide. The editors have shrewdly chosen to save the United States for the last part of this volume, allowing other voices to come forward first to claim their own space. This editorial decision, like so many others, improves the volume and keeps the narrative in good balance. Still, some questions linger in this reviewer's mind as the volume concludes.What do we mean by democracy? Throughout, the authors treat this as a question that is largely settled. Democracy is identified with democratic values that the church accepts, and in Schuck's words, what is under way is "a critical conversation with the culture of democracy" (330). Yet procedural democracy cannot be severed from these values. Are democratic norms and values vindicated when majorities choose undemocratic values? A more careful drawing of distinctions between democracy, liberalism, and republicanism would expose the inner conflicts in which Catholicism meets modern political norms.Perhaps most urgently for the subject matter of this book, are the claims of Catholic social teaching and Christian ethics a foundation for the democratic, participatory values of this secular age, as writers like Charles Taylor and David [End Page 209] Walsh have suggested? This also would raise questions about how culturally conditioned we should understand democracy to be, surely an important consideration for this very fine study.Steven P. MilliesCatholic Theological UnionCopyright © 2018 Society of Christian Ethics... (shrink)

In order to maximize human performance, defence forces continue to explore, develop, and apply human performance enhancement (HPE) methods, ranging from pharmaceuticals to (bio)technological enhancement. This raises ethical, legal, and societal concerns and requires organizing a careful reflection and deliberation process, with relevant stakeholders. We discuss a range of ethical, legal, and societal aspects (ELSA), which people involved in the development and deployment of HPE can use for such reflection and deliberation. A realistic military scenario with proposed HPE application can (...) serve as a starting point for such an iterative and participatory process. Stakeholders can discuss this application, modify its features, and design appropriate processes around it – for instance, procedures for informed consent. We propose that organizing aspects into these three categories – ethical, legal, and societal – can help involve appropriate interlocutors at different moments: legal aspects with people in strategy or management roles, from the start of a project; ethical aspects with people in operations and medical roles, during development; and societal aspects with people in communication and personnel roles, during deployment. Notably, we developed and discussed this framework and the three aspects in close collaboration with personnel from the military. (shrink)

Knowledge of others, then, has value; so does immunity from being known. The ability to extend one's knowledge has value; so does the ability to limit other's knowledge of oneself. I have claimed that no interest can count as a right unless it clearly outweighs opposing interests whose presence is logically entailed. I see no way to establish that my interest in not being known, simply as such, outweighs your desire to know about me. I acknowledge the intuitive attractiveness of (...) such a position; but my earlier discussion concluded that the value of privacy is ease, and the value of knowledge is understanding - and it's not obvious that either outweighs the other. Nor is it obvious that the freedom and autonomy which result from the power to limit what others know is more significant than the freedom and autonomy which result from the power to extend one's knowledge. I believe the intuitive attractiveness of the belief that privacy values outweigh knowledge values lies in the entirely correct belief that a society without any privacy would be unpleasant. But a society without mutual knowledge would be impossible.I conclude therefore that there is no right to privacy nor to control over it. Nevertheless, each of these things is a good, and a good made possible (given the presence of other people) by social structures. A desirable society will provide both privacy and control over privacy to some extent. Nothing in my analysis helps determine what the proper extent is, nor what areas of life particularly deserve protection. Those who would argue that privacy and control over it are entailed by respect for persons should, I think, choose instead some particular areas central to being a person, to counting as a person, and then show how one is less likely to exercise one's capacities there fully without privacy or without control over it. Although Gerstein's attempt fails because he inaccurately defines intimacy as a kind of absorption and incorrectly opposes absorption with publicity, I think it is the kind of attempt which must be made. Furthermore, he has probably chosen the right area of life - if anything has a special claim to privacy it is probably the union between people who care for one another. The value of being together alone may be more significant than the value of being alone, if only because words and actions are public while thoughts are not. But I will not try to develop that argument here.In any case both privacy and control over it are social goods; on egalitarian grounds they should, ceteris paribus, be equally available to everyone. This helps explain the “dehumanizing” effect of institutions which provide no privacy at all- prisons and some mental institutions. It is not so much that the inmates are totally known; it is rather that those who know them are not so fully known by them; further, that the staff has a great deal of control over what they disclose of themselves, and the inmates very little. The asymmetry of knowledge in those institutions is one aspect of the asymmetry of power; the completely powerless are likely to feel dehumanized.My analysis also helps account for the wrongness of covert observation. It is not simply that the observer violates the wishes of the observed, for the question is whose wishes trump. The observer is violating the justified expectations of the observed: expectations supported by weighty social conventions. These have more moral weight than simple desires do. The peeping torn is violating a convention which structures the distribution of knowledge, a convention from which he benefits. Without it his own activities might well be impossible. He might be more easily caught; or his victim, less trusting, might choose houses without windows. More deeply, the thrill of what he is doing depends on the existence of the convention. Even morally permissible excitement - the suggestiveness of some clothing- would disappear without conventions about nudity. Presumably, too, there are elements of his own personal life for which he values his privacy. He is on grounds of justice obligated to observe the rule which makes his benefits possible.(Some claims to privacy result from personal predilections, rather than from convention. Parent describes a person who is extremely sensitive about being short, for instance, and does not want his exact height to be common knowledge. Parent, p. 346. The grounds for these claims are obviously different from those I've been discussing. The grounds are the moral obligation not to cause needless pain, or, if the information was given in confidence, to keep one's promises.) Although there is no right to privacy or to control over it as such, there is a right to equality of consideration and to a just distribution of benefits and burdens. To put it another way: there is no natural human right to privacy or to control over it; but a good society will provide some of each, and justice requires that the rules of a good society be observed. This paper was written during Joel Feinberg's 1984 NEH Summer Seminar. I am indebted to NEH for funding, and to Professor Feinberg and the other members of the seminar for helpful comments. (shrink)