This chapter contains sections titled: Notes.

In this chapter we argue that the four principles of medical ethics -- beneficence, non-maleficence, respect for autonomy and justice (Beauchamp & Childress, 2001; Gillon, 1985), a new Family Interest Principle (introduced below) and a consideration of ‘capacity’ provide a reasoned practice guide for work with mothers experiencing health problems, focussing here on mental health when a parent is a patient. Our concern is the relationship of the clinician with a parent and through the parent their child. Ethics of (...) service provision or services planning (e.g. Culyer, 2001; McLachlan, 2005; see also Newbigging and Paul, chapter xxx), or the provision of other services (e.g. education, child protection) although intensely relevant to this area are not addressed in this chapter nor will we deal with the complex aspects of medical ethics relating to the treatment of children (Baines, 2008). We use the term ‘parent’ to refer to any adult person who fulfils a substantive parental role with a child. Defining what counts as a family will in certain circumstances be contentious. There are diverse patterns of family arrangements that may be influenced by cultural, political economic and temporal factors. For the purposes of our discussion, we define a family in terms of its role in childrearing, as a group of at least one adult and at least one child, living together in long term relationships on an ongoing basis with vested interest in the well being of each of the family members. (shrink)

Concern for and interest in research integrity has increased significantly during recent decades, both in academic and in policy discourse. Both in terms of diagnostics and in terms of therapy, the tendency in integrity discourse has been to focus on strategies of individualisation. Other contributions to the integrity debate, however, focus more explicitly on environmental factors, e.g. on the quality and resilience of research ecosystems, on institutional rather than individual responsibilities, and on the quality of the research culture. One (...) example of this is the Bonn PRINTEGER Statement. This editorial to the LSSP thematic series entitled Addressing integrity challenges in research: the institutional dimension invites authors to contribute to the research integrity debate. Notably, we are interested in submissions addressing issues such as institutional responsibilities, changes in the research climate, duties of research managers and research performing or research funding organisations as well as new approaches to integrity education. (shrink)

Publicity for (and laterly increased economic stringency which makes more likely), failures of care in the NHS engender concern for care quality while its assurance remains the subject of a fragmented and unhelpful literature. A selective attempt is made to examine some underlying principles by posing and answering three questions. What is the quality of care? What basic principles must be followed in defining `standards'? How then may quality be assured? Any definition of care must be multi-faceted and in (...) common use pervaded with the patients' pre-occupation with a search for cures. Nevertheless, it is argued that there are gains in restricting the technical use of the term `care' to those systematic processes of health services and their culture which impinge on the personal experience of patients and which fashion their response. In contemporary society care ought to be designed to restore and enhance the independence, dignity and choice of the patient. Although there is a contrary tendency to abandon problems of care to the professionals, standards for care should be judged ultimately not from the specialised professional but from the viewpoint of lay people whose behaviour in the outside world fashions those norms by which independence, dignity and choice are judged. A number of difficulties in identifying and securing improvements in care are discussed. In particular, it is argued that such is the interdependence of the style of management of an institution and the style of care it provides that enforcement of high quality care is likley to be a contradiction in terms. Only trained and sensitive staff can act intuitively and pre-emptively to prevent even incipient deterioration in care. They cannot carefully foster at all times the independence and dignity of their patients unless they are treated in a similar way as professional employees. As an initial step in improving the quality of care a simple start is urged upon implementing an inventory of checks. These are designed to establish the identification and operation of health care policies and practices which give appropriate recognition to the characteristics of care that patients and public expect, coming as they do from a lay rather than professional world. The article concludes with an appropriate inventory of questions to be put to professionals by those laymen who are increasingly imported into health care management through community representation (in CHCs) and staff participation (in joint consultation) and whose interest and concern should be harnessed appropriately. (shrink)

Concern for and interest in research integrity has increased significantly during recent decades, both in academic and in policy discourse. Both in terms of diagnostics and in terms of therapy, the tendency in integrity discourse has been to focus on strategies of individualisation (detecting and punishing individual deviance). Other contributions to the integrity debate, however, focus more explicitly on environmental factors, e.g. on the quality and resilience of research ecosystems, on institutional rather than individual responsibilities, and on the quality (...) of the research culture. One example of this is the Bonn PRINTEGER Statement. This editorial to the LSSP thematic series (article collection) entitled Addressing integrity challenges in research: the institutional dimension invites authors to contribute to the research integrity debate. Notably, we are interested in submissions addressing issues such as institutional responsibilities, changes in the research climate, duties of research managers and research performing or research funding organisations (RPOs and RFOs) as well as new approaches to integrity education. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:MATERNAL COMPASSION IN THE THOUGHT OF RENÉ GIRARD, EMIL FACKENHEIM, AND EMMANUEL LÉVINAS Ann W. Astell Purdue University l;ike empathy, compassion is a word that seldom occurs in the /writings of René Girard,' who prefers to answer to Martin Heidegger's "anxiety" [Die Sorge] before death by speaking instead of a "concern for victims" [le souci des victims].2 Maternal corn-passion does enter Girardian analysis directly, however, in (...) his discussion ofthe biblical good harlot, a compassionate mother whom Girard calls "the most perfect figura Christi that can be imagined" (1978, 241). In this paper I focus on the neglected theme of maternal compassion in the writings of Girard, letting them enter into conversation, first, with Emil Fackenheim's reflections on the plight and actions of Jewish mothers during the Holocaust and, second, with themes sounded in the philosophy of Emmanuel Lévinas. I argue that maternal compassion is actually central to Girard's understanding of the unveiling of the victimage mechanism, because it sees goodness in the very life of every potential victim, regardless ofwhat that person has done or is capable ofdoing, simply because he or she exists, has a face. The "innocence" of every victim is reducible to the innocence of the infant, because an infant within a sacrificial system can substitute for every other possible victim. The infant and, even more, the unborn bring us back to the very origins of life, to the Creator. There 1 On empathy and Girard, see my "Saintly Mimesis, Contagion, and Empathy." " See James William's comment on this topic in René Girard, ISee Satan Fall Like Lightning (177, note 4). The locus classicus for Martin Heidegger's "anxiety" is his Being and Time, sections 39-42. 16Ann W. Astell is, as Plato asserts and Lévinas reminds us, a "Good beyond being" that, on a transcendent plane, constitutes the "innocence" ofevery human being that lives, protesting against any one's murder. To illustrate the triangulation of desire, the rivalry of doubles, the mimetic crisis, and its possible outcome in victimage, René Girard turns to the famous biblical story ofthe judgment of Solomon in 3 Kings 3:16-28. In that story two women, two harlots, approach the king, each claiming to be the mother ofa single, living infant, over whom they are fighting. "The symmetry is obvious," Girard writes, "and it represents the very essence of human conflict" (1978, 238). Unable to determine the truth ofthe case on the basis of their conflicting testimonies, the wise king tests them by proposinga sacrificial solution that parodies distributivejustice. He decides to cut the baby in half, giving each woman an equal share, the symmetrical division ofthe victim mirroring the symmetry between the litigants. "The Latin word decidere," Girard notes, "mean etymologicalIy to divide by the sacrificial knife, to cut the throat of a victim" (1978, 238). The proposed sacrifice is averted because its horrific promise of an equal apportionment of parts of the baby's body—a sameness that would confirm the two as doubles—reveals a significant difference between the two women. According to the usual reading of the passage, one of the mothers, having (either deliberately or accidentally) killed her own baby by smothering him, lacks any genuine love for the other woman's infant. As Girard explains, "The only thing that counts for her ispossessing what the other onepossesses. In the last resort, she is ready to accept being deprived ofthe child as long as her opponent is deprived of it in the same way.... All that counts is her fascination with her hated model and rival" (1978, 239). The other woman, however, filled with yearning for the life ofthe child to whom she has given birth, reveals herself to be its true mother by renouncing her maternal rights in a passionate plea: "I beseech thee, my lord, give her the child alive, and do not kill it" (3 Kings 3:26). Commenting on the passage, Girard characterizes the values of the false mother as sacrificial, those ofthe good mother as anti-sacrificial. With reference to the child whose fate hangs in the balance, the distinction is clear enough. The true mother begs for the baby... (shrink)

Adversities in pregnancy, including poor diet and stress, are associated with increased risk of developing both metabolic and mental health disorders later in life, a phenomenon described as fetal programming or developmental origins of disease. Predominant hypotheses proposed to explain this relationship suggest that the adversity imposes direct changes to the developing fetus which are maintained after birth resulting in an increased susceptibility to ill health. However, during pregnancy the mother, the developing fetus, and the placenta are all exposed to (...) the adversity. The same adversities linked to altered offspring outcome can also result in suboptimal maternal care, which is considered an independent adverse exposure for the offspring. Recent key experiments in mice reveal the potential of prenatal adversity to drive alterations in maternal care through abnormal maternal–pup interactions and via alterations in placental signaling. Together, these data highlight the critical importance of viewing fetal programming holistically paying attention to the intimate, bidirectional, and reiterative relationship between mothers and their offspring. (shrink)

Background: Within oncology and hematology care, patients are sometimes considered to have such a poor prognosis that they can receive a do not resuscitate order from the physician responsible, stipulating that neither basic nor advanced coronary pulmonary rescue be performed in the event of a cardiac arrest. Studies on do not resuscitate decisions within oncology and hematology units, focusing on the specific role of the nurse in relation to these decisions, are scarce. Objective: The aim of this study was to (...) investigate hematology and oncology nurses’ experiences and perceptions of do not resuscitate orders, in order to achieve a deeper understanding of the nurses’ specific role in these decisions. Research design: A qualitative, descriptive methodology with individual semi-structured interviews was used. Participants and research context: A total of 15 nurses from eight hematology/oncology wards in four hospitals in Sweden were interviewed individually. Ethical considerations: In accordance with national regulations, an ethical review was not required for this study. The research followed international guidelines for empirical research, as outlined in the Helsinki Declaration. Findings: The nurses strived for good nursing care through balancing harms and goods and observing integrity and quality of life as important values. Experienced hindrances for good care were unclear and poorly documented decisions, uninformed patients and relatives, and disagreements among the caregivers and family. The nurses expressed a need for an ongoing discussion on do not resuscitate decisions, including all concerned parties. Conclusion: In order to provide good nursing care, nurses need clear and well-documented do not resuscitate orders, and patients and relatives need to be well informed and included in the decisions. To increase the understanding for each other’s opinions within the medical team, regular ethical discussions are required. (shrink)

Background: Palliative care is an important part of health services. The individualized care perceptions are is critical for supporting individuality during care and providing quality nursing care. Individualized care not only has, as well as having foundation of the philosophy of nursing but also, is also related to the nurses’ empathic tendencies and professional quality of life of nurses. Aim: This study was conducted to examine the relationships between the empathic tendencies, professional quality of life, and individualized care perceptions of (...) palliative care nurses. Research design: This is a cross-sectional study. Participants and research context: The study was conducted with 141 nurses working in palliative care between December 2023 and February 2024. The data of the study were collected using a “Participant Information Form,” the “Emphatic Tendency Scale (ETS),” the “Professional Quality of Life Scale (ProQOL R-IV),” and the “Individualized Care Scale-Nurse Version A (ICS-Nurse-A).” Ethical considerations: Ethics committee approval was obtained to conduct the study. Individuals who agreed to participate in the study were informed of the purpose of the study, and their written consent was obtained. Findings: The participants had moderate levels of empathic tendencies, compassion satisfaction, and burnout, while their compassion fatigue and individualized care perceptions were high. There was a positive correlation between empathic tendencies and individualized care perceptions ( p <.01). Empathic tendency and compassion satisfaction were significant positive predictors of the individualized care perceptions of the participants and respectively explained 13% and 20% of the total variance in their individualized care perceptions. On the other hand, burnout was a significant negative predictor of their individualized care perceptions and explained 5% of the total variance in their individualized care perceptions. Conclusions: High levels of empathic tendencies and compassion satisfaction had positive effects on the individualized care perceptions of palliative care nurses, whereas high levels of burnout had a negative effect on the same variable. (shrink)

On 20 October 2010, the European Parliament proposed to give all women in the European Union (EU) minimally 20 weeks fully paid maternity leave, and to introduce a legal right for all fathers to 2 weeks fully paid paternity leave. In many other countries, individuals and groups are advocating for longer maternity leave, longer paternity leave, and/or longer parental leave. In this paper, I argue for two principles that proposals of maternity/paternity/parental leave systems should respect: the ?principle of non-discrimination? and (...) the ?principle of balancing the interests of all affected parties?. The principle of non-discrimination requires that women should receive paid leave for the number of weeks that are needed as part of their pregnancy and to recover from childbirth, but that any additional weeks should be seen as birth leave rather than maternity leave, and be given on equal terms to men and women. The principle of balancing the interests of all parties suggests that it would be good for newborns, their parents, and for employers and society at large, that parents have enough time to spend with their children. To illustrate its practical relevance, I apply these principles to the current situation in the Netherlands and to the European Parliament's proposal to introduce a minimum of 20 weeks maternity leave and 2 weeks paternity leave. (shrink)

This paper examines the construction of maternal responsibility in transgenerational epigenetics and its implications for pregnant women. Transgenerational epigenetics is suggesting a link between maternal behaviour and lifestyle during pregnancy and the subsequent well-being of their children. For example, poor prenatal diet and exposure to maternal distress during pregnancy are linked to epigenetic changes, which may cause health problems in the offspring. In this field, the uterus is seen as a micro-environment in which new generations can take shape. Because epigenetics (...) concerns how gene expression is influenced by the social realm, including a range of environmental conditions such as stress, diet, smoking, exercise, exposure to chemicals, pollution, and environmental hazards, the research findings in this area have direct policy relevance. For policy makers, rather than controlling this complex range of determinants of health, isolating and targeting maternal body and responsibilising mothers for the control of this micro-environment might seem feasible. Yet, examining the maternal body in isolation as a powerful environment to shape the health of next generations not only responsibilises women for the environment that they cannot control but also makes them a target for intrusive and potentially exploitative biomedical interventions. Even though ‘social factors’ are increasingly considered in epigenetics writing, the phrase is usually taken as self-explanatory without much elaboration. Drawing on the Covid-19 pandemic, this paper moves the current debate forward by providing consolidated examples of how individuals, including pregnant women, have little control over their environment and lifestyle. As evidenced by the pandemic’s disproportionate effects on people with low socioeconomic or poor health status, some pregnant women bore considerable physical and psychological stress which combined with other stress factors such as domestic violence. (shrink)

Background: Compassion is seen as a core professional value in nursing and as essential in the effort of relieving suffering and promoting well-being in palliative care patients. Despite the advances in modern healthcare systems, there is a growing clinical and scientific concern that the value of compassion in palliative care is being less emphasised. Objective: This study aimed to explore nurses’ experiences of compassion when caring for palliative patients in home nursing care. Design and participants: A (...) secondary qualitative analysis inspired by hermeneutic circling was performed on narrative interviews with 10 registered nurses recruited from municipal home nursing care facilities in Mid-Norway. Ethical considerations: The Norwegian Social Science Data Services granted permission for the study (No. 34299) and the re-use of the data. Findings: The compassionate experience was illuminated by one overarching theme: valuing caring interactions as positive, negative or neutral, which entailed three themes: (1) perceiving the patient’s plea, (2) interpreting feelings and (3) reasoning about accountability and action, with subsequent subthemes. Discussion: In contrast to most studies on compassion, our results highlight that a lack of compassion entails experiences of both negative and neutral content. Conclusion: The phenomenon of neutral caring interactions and lack of compassion demands further explorations from both a patient – and a nurse perspective. (shrink)

This article analyzes articles appearing in True Story from 1920 to 1985 that concern women's grief after pregnancy and child loss. They are discussed as a historical link between nineteenth-century consolation literature and current psychological and academic discussions of grief. True Story is a confession magazine marketed for working-class women, whose reproductive losses have generally been minimized or ignored by previous literary and current professional and journalistic treatments of maternal grief. Articles are examined within the constructs of confession literature (...) and within the larger context of women's popular literature. Like working-class women's experiences of reproductive loss, these areas have been largely overlooked, dismissed, or denigrated by literary scholars and sociologists. The moral tone of True Story gives women's first-person narratives about infant death and pregnancy an ambiguous prescriptive quality, in that both self-empowerment and self-blame are recommended. True Story reinforces traditional notions of motherhood and femininity, but subtly challenges patriarchal class relations in American society. (shrink)

Compassion in healthcare has received significant attention recently, on an international scale, with concern raised about its absence during clinical interactions. As a concept, compassionate care has been linked to nursing. We examined historical discourse on this topic, to understand and situate current debates on compassionate care as a hallmark of high‐quality services. Documents we looked at illustrated how responsibility for delivering compassionate care cannot be consigned to individual nurses. Health professionals must have the right environmental circumstances to (...) be able to provide and engage in compassionate interactions with patients and their relatives. Hence, although compassionate care has been presented as a straightforward solution when crisis faces health services, this discourse, especially in policy documents, has often failed to acknowledge the system‐level issues associated with its provision. This has resulted in simplistic presentations of ‘compassion’ as inexpensive and the responsibility of individual nurses, a misleading proposal that risks devaluing the energy and resources required to deliver compassionate care. It also overlooks the need for organisations, not just individuals, to be charged with upholding its provision. (shrink)

Background Confidentiality is one of the central preconditions for clinical ethics support (CES). CES cases which generate moral questions for CES staff concerning (breaching) confidentiality of what has been discussed during CES can cause moral challenges. Currently, there seems to be no clear policy or guidance regarding how CES staff can or should deal with these moral challenges related to (not) breaching confidentiality within CES. Moral case deliberation is a specific kind of CES. Method Based on experiences and research into (...) MCD facilitators’ needs for ethics support in this regard, we jointly developed an ethics support tool for MCD facilitators: the Confidentiality Compass. This paper describes the iterative developmental process, including our theoretical viewpoints and reflections on characteristics of CES tools in general. Results The content and goals of the ethics support tool, which contains four elements, is described. Part A is about providing information on the concept of confidentiality in MCD, part B is a moral compass with reflective questions, part C focuses on courses of action for careful handling of moral challenges related to confidentiality. Part D contains general lessons, best practices and tips for dealing with confidentiality in future cases. Conclusions This paper concludes with providing some lessons-learned related to developing ethics support tools and some reflections on issues of quality and normativity of ethics support tools. (shrink)

Primary care givers commonly interpret shortages of time with patients as placing them between a rock and a hard place in respect of their professional obligations to fairly distribute available healthcare resources (justice) and to offer a quality of attentive care appropriate to patients’ states of personal vulnerability (compassion). The author argues that this a false and highly misleading conceptualisation of the basic structure of the ethical dilemma raised by the rationing of time in clinical settings. Drawing on an (...) analysis of the Aristotelian virtue of nemesis, or “the sense of justice”, it is argued that, far from being a moral orientation distinct from justice, compassion is a justice response insofar as it is conceptualised as a rational, appropriate response to others’ adversity. The author then proceeds to point out that the perspective on justice and compassion as attributes of healthcare professionalism suggests a novel critical viewpoint on the ethics of managed forms of clinical rationing and the “scarcity paradigm” they engender: clinical conditions where primary care givers’ time is intentionally rendered a commodity in chronically short supply run a deficit of justice, because they fail to make adequate accommodations for the provision of the quality of care human beings deserve in situations of illness and injury, and when they are dying. (shrink)

Compassion is often described in terms of suffering. This paper investigates the nature of this suffering. It is argued that compassion involves suffering of a particular kind. To begin with a case is made for the negative claim that compassion does not involve an ordinary, or afflictive, suffering over something. Secondly, it is argued that the suffering of compassion is a suffering for someone else’s sake: If you feel compassion for another person, P, then you (...) suffer over P:s suffering for P:s sake, and if that is all you do, then you are not affected with an afflictive suffering over something. The final section identifies and addresses a problem concerning self-pity, and a suggestion is made on how to specify the proposed account so as to cover both self-directed and other-directed compassion. (shrink)

Quality is commonly applied to products and processes, but we can also define human quality in dealing with people. This requires first establishing what treatment is appropriate to the human condition. Through an inquiry into the characteristics that define the human being and what ethical requirements constitute a good treatment, we define “Human Quality Treatment” as dealing with persons in a way appropriate to the human condition, which entails acting with respect for their human dignity and rights, caring for (...) their problems and legitimate interests, and fostering their personal development. With this in mind, we can distinguish between five different levels or degrees of HQT in organizations which can be characterized by the following terms: maltreatment, indifference, justice, care, and development. (shrink)

The evaluation of labour markets and of particular jobs ought to be sensitive to a plurality of benefits and burdens of work. We use the term 'the goods of work' to refer to those benefits of work that cannot be obtained in exchange for money and that can be enjoyed mostly or exclusively in the context of work. Drawing on empirical research and various philosophical traditions of thinking about work we identify four goods of work: 1) attaining various types of (...) excellence; 2) making a social contribution; 3) experiencing community; and 4) gaining social recognition. Our account of the goods of work can be read as unpacking the ways in which work can be meaningful. The distribution of the goods of work is a concern of justice for two conjoint reasons: First, they are part of the conception of the good of a large number of individuals. Second, in societies without an unconditional income and in which most people are not independently wealthy, paid work is non-optional and workers have few, if any, occasions to realize these goods outside their job. Taking into account the plurality of the goods of work and their importance for justice challenges the theoretical and political status quo, which focuses mostly on justice with regard to the distribution of income. We defend this account against the libertarian challenge that a free labour market gives individuals sufficient options to realise the goods of work important to them, and discuss the challenge from state neutrality. In the conclusion, we hint towards possible implications for today’s labour markets. (shrink)

New York Post Best Book of 2016 We often think of our capacity to experience the suffering of others as the ultimate source of goodness. Many of our wisest policy-makers, activists, scientists, and philosophers agree that the only problem with empathy is that we don’t have enough of it. Nothing could be farther from the truth, argues Yale researcher Paul Bloom. In AGAINST EMPATHY, Bloom reveals empathy to be one of the leading motivators of inequality and immorality in society. (...) Far from helping us to improve the lives of others, empathy is a capricious and irrational emotion that appeals to our narrow prejudices. It muddles our judgment and, ironically, often leads to cruelty. We are at our best when we are smart enough not to rely on it, but to draw instead upon a more distanced compassion. Basing his argument on groundbreaking scientific findings, Bloom makes the case that some of the worst decisions made by individuals and nations—who to give money to, when to go to war, how to respond to climate change, and who to imprison—are too often motivated by honest, yet misplaced, emotions. With precision and wit, he demonstrates how empathy distorts our judgment in every aspect of our lives, from philanthropy and charity to the justice system; from medical care and education to parenting and marriage. Without empathy, Bloom insists, our decisions would be clearer, fairer, and—yes—ultimately more moral. Brilliantly argued, urgent and humane, AGAINST EMPATHY shows us that, when it comes to both major policy decisions and the choices we make in our everyday lives, limiting our impulse toward empathy is often the most compassionate choice we can make. (shrink)

Background: The high level of satisfaction of users of a health service is largely due to the fact that they receive excellent care from healthcare professionals. Compassionate care is an essential component of excellent care. But what do nurses understand compassion to be? Research objectives: To analyse the concept of compassion from the perspective of nurses in the Andalusian Public Health System, Spain. Research design: This is a qualitative study following the grounded theory model. Four focus groups and (...) 25 in-depth interviews were conducted. Participants and research context: A total of 68 nursing professionals working in the Andalusian Public Health System (Spain) participated. Theoretical sampling was used, with participants being recruited using the snowball technique. Ethical considerations: This research was approved by the Research Ethics Committee of the Centro-Almería Health District (CEICA 27/9/17). Findings: From the analysis of the data, four themes emerged that helped to understand the concept of compassion according to nurses: ‘Negative perception of the term compassion’, ‘Compassion and empathy as synonyms’, ‘Beyond empathy’, and ‘Effects of having a compassionate attitude’. Discussion: Nurses perceive the concept of compassion differently to each other and even contradictorily. This concept is imbued with cultural elements, which adds confusion to understanding it, and is even perceived as something negative similar to pity. Conclusion: Nurses confuse the concepts of empathy and compassion as if they were synonymous. Before considering training in compassion for healthcare professionals, it is essential to clarify the concept of compassion through educational interventions. (shrink)

It is natural to suppose that honey tastes the way it does because it is sweet. Democritus, Plato and Aristotle all agree that this explanation is superficial and lacks causal depth; they attempt to explain gustatory phenomena by invoking explanatorily fundamental features of the world. As they work out their causal stories, do they give up on the common-sense explanation of why honey tastes the way it does? In other words, do they deny that sweetness and other sensible qualities are (...) causally efficacious features of the world around us? ;Our sources for Democritus' thinking on this issue present a problematic picture. On the one hand, Aristotle and Theophrastus suppose that Democritus wants to identify colors and flavors with causally efficacious features of the world around us. On the other hand, Theophrastus and others find Democritus defending the view that colors and flavors do not belong to the world around us. This tension, first pointed out by Theophrastus, is merely apparent, if, as certain texts suggest, Democritus distinguishes the colors and flavors which we experience from the colors and flavors which figure in his scientific explanations. ;In the Timaeus, Plato frequently says things like "What is capable of producing such and such effects on the gustatory region has the name 'bitter' thinspace". On Theophrastus' interpretation, Plato is offering definitions of the sensible qualities: flavors are identical with powers to produce certain physiological effects on the sense-organs. Theophrastus reasonably complains that sensible qualities will lack causal efficacy if they are identified with these powers of external objects, but Theophrastus' interpretation is mistaken: Plato is not defining the sensible qualities; he is fixing the reference of our sensible-quality terms. Recent historical work on the distinction between primary and secondary qualities has often emphasized the extent to which the authors of this distinction were motivated by an interest in supplanting prevalent, Peripatetic assumptions about the nature of sensible qualities, but Aristotle's theory does not differ significantly from that of Descartes: both identify colors with causally efficacious properties whose natures are revealed by scientific investigation. (shrink)

A lot of medical procedures can be justified in terms of the number of quality-adjusted life-years (QALYs) they can be expected to generate; that is, the number of extra years that the procedure will provide, with the quality of life during those extra years factored in. QALYs are a crude tool, but good enough for many decisions. Notoriously, however, they cannot justify spending any money on terminal care (and indeed on older people in general). In this paper I suggest (...) a different way of construing ‘quality’ (as meaningfulness rather than physical comfort) and ‘life’ (as both backward-looking and forward-looking), so that the terminal patient's efforts to find meaning in his life could in principle generate plenty of ‘retrospective QALYs’ to justify funding. (shrink)

OBJECTIVES: To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. DESIGN: We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed the patient, consultant physician, house (...) officer, and primary nurse and compared the ward notes with the understandings of these staff members. SETTING: The medical service of an urban university medical centre. RESULTS: The average number of documented CCCs addressed per DNR order was 1.1. The ward notes generally agreed with the perceptions of patients, house officers, and nurses (% agreement with notes = 79%, 77%, and 82%; kappa = 0.43, 0.40, 0.50). Consultant physicians' understandings were poorly reflected in the ward notes (% agreement = 59%; kappa = 0.18). They overestimated attention to CCCs compared with the notes (P < 0.0001) and with other observers (P < 0.0001). CONCLUSION: Chart review for attention to CCCs accurately reflects the understandings of patients, house officers, and nurses, but consultant physicians report more attention to CCCs than is recorded in the ward notes or understood by other observers. Better communication regarding end-of-life care plans should be encouraged. (shrink)

The Covid-19 pandemic is a tragedy for those who have been hard hit worldwide. At the same time, it is also a test of concepts and practices of what good care is and requires, and how quality of care can be accounted for. In this paper, we present our Care-Ethical Model of Quality Enquiry (CEMQUE) and apply it to the case of residential care for older people in the Netherlands during the Covid-19 pandemic. Instead of thinking about care in (...) healthcare and social welfare as a set of separate care acts, we think about care as a complex practice of relational caring, crossed by other practices. Instead of thinking about professional caregivers as functionaries obeying external rules, we think about them as practically wise professionals. Instead of thinking about developing external quality criteria and systems, we think about cultivating (self-)reflective quality awareness. Instead of abstracting from societal forces that make care possible but also limit it, we acknowledge them and find ways to deal with them. Based on these critical insights, the CEMQUE model can be helpful to describe, interrogate, evaluate, and improve existing care practices. It has four entries: (i) the care receiver considered from their humanness, (ii) the caregiver considered from their solicitude, (iii) the care facility considered from its habitability and (iv) the societal, institutional and scholarly context considered from the perspective of the good life, justice and decency. The crux is enabling all these different entries with all their different aspects to be taken into account. In Corona times this turns out to be more crucial than ever. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Finding My Compass*Laura Inter+I was born in the 1980s, and much to my parents surprise, the doctors could not say whether I was a boy or a girl because my body had ambiguous genitalia. They then conducted a chromosome test and the result was XX chromosomes. I was assigned female and only later was diagnosed with congenital adrenal hyperplasia (CAH). Fortunately for me the endocrinologist who treated me did (...) not mention the option of surgery, so my medical treatment consisted only of taking cortisol. Apart from this, from the time I turned one, I was subjected to genital examinations twice a year, during which the endocrinologist would touch my genitals and look to see how they were developing.These unnecessary and intrusive examinations had a profound effect on me. As a young child, I did not understand why I had to lower my pants in front of a stranger—the endocrinologist—and let him touch me. The fact that my mother was present, and approved of this was something that made me feel completely helpless. All this seemed very strange to me; I found it confusing, and terribly uncomfortable, and I just felt it wasn’t right.I remember the doctor always spoke as if I wasn’t right there, and I did not always understand everything the doctor said when I was young, because of all the medical terms he used. I grew up with a feeling of being “inadequate,” of having a sense that something was wrong with me, though I didn’t know exactly what. These exams lasted until I was about 12 years old. Years later, as I began my adult, sexual life, I realized how much those displays had affected me emotionally.I discovered what was “wrong” with me during sex education classes in the first year of high school. There was a class session in which two images were shown: one displaying the external female sex organs, and the other the male sex organs. I noticed that my body was not like either of them. I was very distressed, thinking “I have deformed genitals!” I feared I could not perform sexually as either a man or a woman. I became very depressed. I was sure nobody would want me, that I would never have a relationship. I was unacceptable, “abnormal,” or at least that is what the doctors had said. And in any case my parents never spoke of it, and I didn’t know that I had CAH.Skip forward a few years: I was still looking for answers, I found my medical file and read in the documents “pseudo–hermaphrodite,” and [End Page 95] “congenital adrenal hyperplasia.” I searched the internet, but only found medical opinions that said that in the case of genital ambiguity, the best option was surgery. I wondered to myself: “Why didn’t they operate on me?”I put the question to my parents, and, at fifteen, I found myself being examined once more in the doctor’s office, this time to consider the possibility of a genital surgery which might once and for all, I believed, make me a “normal” person.I have never told anyone outside my family before, but one of those exams was the most humiliating experiences of my life. One doctor wanted to speak with me alone, so she made my mother wait outside the exam room. My mother agreed, thinking that after the doctor talked with me, my mother would be able to be present during the rest of the exam. The doctor asked me questions, some of which made me very uncomfortable: “Do you feel good about being a woman”? Did you ever feel like a man? Why don’t you dress up more, use more makeup? Are you a lesbian? Have you ever had sex? She then said she wanted to see my genitals. I felt awful and wanted my mother present, but I also wanted it to be over quickly, and said nothing. Examining my genitals, the doctor told me they “would not be adequate for sex,” and that she needed to “perform surgery.” Something else that made me uncomfortable was the presence of another doctor in... (shrink)

Many debates in biomedical ethics today involve inconsistencies in defining the key term, person. Both sides of the abortion debate, for instance, beg the question about what constitutes personhood. This book explores the arguments concerning definitions of personhood in the history of modern philosophy, and then constructs a superior model, defined in terms of distinctive features. This model is shown to have distinct advantages over the necessary and sufficient condition models of personhood launched by essentialists. Philosophers historically have been correct (...) about what some of the pivotal distinctive features of personhood are, _e.q._, rationality, communications and self-consciousness, but they have been wrong about the _methods_ of recognizing and asserting personhood, and about the relative importance of feelings. In clinical care, complaints often surface that care is not personal. This book aims to improve care through providing a method of attending to patients as people. Charts in the Appendices show that where physicians attended to personal features important to their patients, sometimes the patients rated the care even higher than the physician did. The book will be useful to health-care providers whose goals include improving quality of care, listening to patients, and preventing malpractice. (shrink)

This essay examines the structural position of Mengzi’s 孟子 heart of compassion within his theoretical goal of teaching moral self-cultivation. I first investigate Kim Myeong-seok’s account that views ceyin zhi xin as a higher cognitive emotion with a concern-based construal. I argue that Kim’s conclusion is not sufficiently supported by the text of the Mengzi, but is also tarnished by the possibility of constructing a noncognitivist counter-theory of ceyin zhi xin. Instead, I suggest that David Hume’s causation-based approach (...) to sentiment provides an alternative route to reach the theoretical core of Mengzi’s ceyin zhi xin. People’s uniform moral sentiment as the effect of mental causation implies that there is a natural cause universally engraved in the human heart. As Mengzi’s practical teaching of moral self-cultivation begins with recognizing this heart of compassion, his focus is placed not upon the characteristics of the expressed emotion, but upon the universal presence of its natural cause in the human heart which demonstrates our moral potential to care for others. (shrink)

The aim of the paper is to study socio-ethical aspects of Slovak higher education policy in the context of contemporary discussions on university assessment criteria. I conduct an ethical analysis and assess the criteria introduced in Slovakia that consider employment opportunities and the graduate unemployment rate, publishing in high impact journals, participation in European research programmes, etc., which often discriminates against the humanities and social sciences. On the other hand, I also point to the absence of a social contract regarding (...) the common good provided by Slovak universities, drawbacks of a legislative nature which often provide a basis for unethical behaviour within the Slovak academic community and, most often, problems concerning academic ethics in contemporary Slovakia. (shrink)

On one side of his sign board, a nineteenth century surgeon depicted a physician operating on a patient's leg; the other side showed the Good Samaritan taking care of the victim's wounds. Christ's parable has often been quoted and depicted as a primary example of human compassion, to be followed by all persons and, a fortiori, by so-called professionals such as physicians and nurses. If we grant that the parable has not lost its narrative power for 20th century (...) “postmodern” readers living in a “pluralistic” society, it merits a closer analysis. (shrink)

This paper investigates legal and moral justificationsof coerced treatment for psychiatric patients who aredetained on the grounds that they may harm others.While the general issues concerning compulsorytreatment and detention have been widely canvassed, ithas seldom, if ever, been noticed that the moralreasons that we may have to detain a person whoappears to be dangerous to others are different fromthe moral reasons we may have to treat him or her. For example, it has not been noticed that compulsorydetention and (...) compulsory treatment are supported bytwo different moral principles, namely the Principleof Harm and the Principle of Beneficence, and,therefore, that the arguments which support compulsorydetention do not also support compulsorytreatment. The conceptual confusion between legitimacyof compulsory detention and legitimacy of compulsorytreatment is exacerbated by the ambiguous wordingutilised in S 3 of the UK Mental Health Act, whichimplies that treatment may be necessary for theprotection of others. Failure to pay attention to these distinctions has led to tragic consequences, in terms of violations of individual autonomy and in terms of public safety. (shrink)

The abstract notion of “the feminine”, —in French, le f minin, and in German, das Weibliche —as substantivum neutrum, remains together with its opposite, the masculine, connotative of an inherent disparity. It is meant neither as the biological affiliation of sex, nor as gender, the social response, or echo, of this biological affiliation. Rather, it is the spiritual attitude which is the norm for psychic manifestations in general, and is its subtle psychosomatic background. It is not necessarily connected with (...) the rude biological differentiation of sex, but rather appears as a quality in one or the other form; either as the individual, the social group or forms of activities, etc., without respect to the biological manifestations of the participants. What this paper attempts to demonstrate, is the way in which the above described notion of the feminine, functions in classical Asian cultures and philosophies. In the famous Yijing, for instance, this is seen as the hexagram correlated to the male Qian; in the philosophy of Yin and Yang, as Yin the Earth, in correlation with Yang, the Heaven; which are united in the famous Taiji diagram, a sophisticated development of Chinese Neo-Confucianism. The paper focuses on the Dao de jing, in which Lao Zi gives, as a counterbalance to the existing praxis, priority to the female principle. He remains, however, faithful to the Asian tradition, maintaining that the masculine and the feminine should remain equal, correlative, neither one nor the other vying for dominance. The correlative embrace, “When you know the male yet hold on to. the female” subsists in the mythical past where both principles are joined in androgynous unity. (shrink)

Vaccine research, as well as the development, testing, clinical trials, and commercial uses of vaccines involve complex processes with various biological data that include gene and protein expression, analysis of molecular and cellular interactions, study of tissue and whole body responses, and extensive epidemiological modeling. Although many data resources are available to meet different aspects of vaccine needs, it remains a challenge how we are to standardize vaccine annotation, integrate data about varied vaccine types and resources, and support advanced vaccine (...) data analysis and inference. To address these problems, the community-based Vaccine Ontology (VO) has been developed through collaboration with vaccine researchers and many national and international centers and programs, including the National Center for Biomedical Ontology (NCBO), the Infectious Disease Ontology (IDO) Initiative, and the Ontology for Biomedical Investigations (OBI). VO utilizes the Basic Formal Ontology (BFO) as the top ontology and the Relation Ontology (RO) for definition of term relationships. VO is represented in the Web Ontology Language (OWL) and edited using the Protégé-OWL. Currently VO contains more than 2000 terms and relationships. VO emphasizes on classification of vaccines and vaccine components, vaccine quality and phenotypes, and host immune response to vaccines. These reflect different aspects of vaccine composition and biology and can thus be used to model individual vaccines. More than 200 licensed vaccines and many vaccine candidates in research or clinical trials have been modeled in VO. VO is being used for vaccine literature mining through collaboration with the National Center for Integrative Biomedical Informatics (NCIBI). Multiple VO applications will be presented. (shrink)

A few years ago I set out to canvass the literature on Charles Darwin. I thought it would be a manageable task, but I soon realized what a naïve idea this was. I do not know how many books have been written about him, but there seem to be thousands, and each year more appear.1 Why are there so many? Part of the answer is, of course, that he was a tremendously important figure in the history of human thought. But (...) as I read the books- or, at least, as many of them as I could- it gradually dawned on me that all this attention is also due to Darwin’s personal qualities. He was an immensely likeable man, modest and humane, with a personality that continues to draw people to him even today. Reflecting on his father’s character, Darwin’s son Francis wrote that ‘The two subjects which moved my father perhaps more strongly than any others were cruelty to animals and slavery. His detestation of both was intense, and his indignation was overpowering in case of any levity or want of feeling on these matters.’2 Darwin’s strong feelings about slavery are expressed in many of his writings, most notably in the Journal of Researches, in which he recorded his adventures on the Beagle voyage. His comments there are among the most moving in abolitionist literature. But it was his feelings about animals that impressed his contemporaries most vividly. Numerous anecdotes show him remonstrating with cab-drivers who whipped their horses too smartly, solicitously caring for his own animals and forbidding the discussion of vivisection in his home.3 At the height of his fame he wrote an article for a popular magazine condemning the infamous leg-hold trap in terms that would not seem out of place in an animal-rights magazine today. (shrink)

In this provocative new book, renowned educator and philosopher Nel Noddings extends her influential work on the ethics of care toward a compelling objective—global peace and justice. She asks: If we celebrate the success of women becoming more like men in professional life, should we not simultaneously hope that men become more like women—in caring for others, rejecting violence, and valuing the work of caring both publicly and personally? Drawing on current work on evolution, and bringing concrete examples from (...) women’s lived experience to make a strong case for her position, Noddings answers this question by locating one source of morality in maternal instinct. She traces the development of the maternal instinct to natural caring and ethical caring, offering a preliminary sketch of what a care-driven concept of justice might look like. Finally, to advance the cause of caring, peace, and women’s advancement, Noddings urges women to abandon institutional, patriarchal religion and to seek their own paths to spirituality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 23 (2003) 161-164 [Access article in PDF] Dakini's Warm Breath: The Feminine Principle in Tibetan Buddhism. By Judith Simmer-Brown. Boston: Shambhala, 2001. xxv + 404 pp. For more than a century, the dakini of Hindu and Buddhist tantric literature and practice lore has intrigued, fascinated, beguiled, and confounded Western scholars. First described by Austine Waddell in 1895 as "demonical furies" and "she-devils," S.C.Das's ATibetan-English Dictionary, published (...) just shortly afterward, defined mkha' 'gro ma (the Tibetan equivalent of the Sanskrit term dakini ) as "a class, mainly of female sprites, akin to our witches, but not necessarily ugly or deformed." More recently the dakini has been investigated by scholars as diverse as David Snellgrove, Rene Nebesky-Wojkowitz, Nathan Katz, Janet Gyatso, Miranda Shaw, and myself. Snellgrove suggested in his Buddhist Himalaya (1957) that "their [i.e., the dakinis' ] activities are generally so gruesome and obscene as to earn them quite properly the name witch," but he conceded that they entered Tibetan mythology "in a rather more gentle aspect." Even so, this ubiquitous, powerful, and yet ever-elusive figure —or symbol, image, motif, or principle—has remained, it seems, just beyond our reach. In a certain respect, this is exactly as it should be; for the dakini— at least within the systems of the Buddhist tantras—is the symbol of transcendent wisdom itself, direct and unmediated, hovering just outside the reach of all discursive language and reasoning.Today one scholar, Judith Simmer-Brown, has given us a thoughtful, well-informed, and well-researched treatment of the history and functioning of the dakini (which she prefers to refer to as a "symbol" or "principle") that seeks to present a balanced discussion and overview of this feminine principle and steers clear of the essentializing and reductionist pitfalls of either Jungian interpretations or contemporary feminist ones. It is timely that we take a careful look at Simmer-Brown's work, not only because it represents the most complete exploration to date of the dakini in a single volume, but also because this valuable study has just been reprinted in paperback.Though in the preface of her work Simmer-Brown characterizes her methodology as being "perhaps wildly messy," there is clearly both system and method in her [End Page 161] presentation. Her study begins with a careful delineation of what may be called the two extremes or poles of contemporary interpretations of the dakini: the one, influenced by Jungian psychology in which the dakini is seen as Jung's famed "shadow," and the other, influenced by feminist goddess theology, which has served either to see the dakini as a feminine savior or as the source of a critique of Tibetan Buddhism in which this feminine ideal reflects an objectified product of patriarchal fantasy. For Simmer-Brown, both poles of interpretation are inadequate; and in her first chapter, "Gender, Subjectivity, and the Feminine Principle," she argues powerfully and convincingly about why this is the case. Indeed, in many respects, this carefully argued opening chapter is the true centerpiece of the work.With respect to Jungian analysis, while Simmer-Brown sees "some real benefits in employing Jungian ideas in interpreting the dakini, " she notes the skewing and distorting complications introduced by Jung's emphasis on contrasexuality. Ultimately, Simmer-Brown declares, "the pervasiveness of the Jungian paradigm in examination of the dakini emphasizes contrasexuality, the ultimacy of gender imagery, and psychological interpretation. These emphases have precipitated a blizzard of feminist objections, and no wonder. However, that critique may be directed more toward Jungian tenets than toward Tibetan Buddhism, which has not been properly represented in Western interpretation" (17).Simmer-Brown's case is especially well made with regard to the second pole of interpretation. Here she notes that recent studies of the dakini that employ feminist considerations have generally taken two directions. Namely, "one identifies the dakini as a construct of patriarchy drawn by a primarily monastic Buddhism in Tibet into the service of the religious goals of male practitioners only. The second perspective identifies the dakini as a goddess figure in... (shrink)

Background: Compassion-based practices in midwifery are the most important expression of the depth of care quality. This concept is insufficiently represented in literature, therefore, studies on this subject are of utmost importance. Objectives: This study aims to determine the levels of compassion of midwives working in the delivery room and the factors affecting these levels. The study was carried out in Kocaeli, Turkey. Methods: This descriptive study was carried out from 1 February to 15 April 2019 in delivery (...) rooms of six different hospitals located in the provincial centre of Kocaeli, Turkey, with 78 actively working midwives. Data were collected using a ‘Compassion Scale’ and analysed using the Mann–Whitney U test, the Kruskal–Wallis H test and the Spearman correlation test. Ethical considerations: This study was conducted according to ethical scientific guidelines. Results: The compassion score of the midwives were found to be 4.19 ± 0.39. The total compassion score was affected by professional factors such as number of patients, alternating shift work, number of traumatic births and work satisfaction. While the kindness subscores decreased depending on shift work and number of traumatic births, it was determined that the midwives who were satisfied with their work had higher kindness scores than those who were not. Also, as the age and professional experience of the midwives and the number of traumatic births increased, their indifference score also increased. Midwives who reported that they were not satisfied with their job had higher scores regarding separation and disengagement scores than those who were satisfied with their job. Conclusion: It was determined that the compassion levels of midwives were found to be negatively affected by factors such as age, professional experience, job satisfaction and number of monthly traumatic births in a month. They should be reminded that compassionate midwifery care for women is a basic human right. (shrink)

As the quality movement in health care now enters its fourth decade, the language of quality is ubiquitous. Practitioners, organizations, and government agencies alike vociferously testify their commitments to quality and accept numerous forms of governance aimed at improving quality of care. Remarkably, the powerful phrase ‘‘quality of care’’ is rarely defined in the health care literature. Instead it operates as an accepted and assumed goal worth pursuing. The status of evidence-based medicine, for instance, hinges on its ability to improve (...) quality of care, and efforts are made by both proponents and detractors to unpack the contents and outcomes of evidence-based practice while the contents of ‘‘quality of care’’ are presumed to be understood. Because the goals of medicine are far from obvious, this paper investigates the neglected term, ‘‘quality of care,’’ in an effort to understand what it is that health care practices are so uncritically assumed to be striving for. Finding lack of consensus on the terminology in the quality literature, I propose that the term operates rhetorically by way of persuasive appeal (and lack of descriptive meaning). Unsatisfied that ‘‘quality of care’’ operates as a mere buzzword in morally contentious debates over resource allocation and duties of care, I implore health care communities to go beyond mere commitments to quality and, instead, to focus attention on the difficult task of specifying what counts as quality care within an economically constrained health care system. (shrink)

This essay aims to delineate Mengzi’s view of emotion by analyzing his first ethical sprout, often referred to by the Chinese term cèyǐn zhī xīn 惻隱之心.Previous scholars usually translate this term as “compassion,” “sympathy,” or “commiseration,” in the sense of the painful feeling one feels at the misfortune of others. My goal in this article is to clarify the nature of this painful feeling, and specifically I argue that (1) cèyǐn zhī xīn is primarily construing another being’s misfortune (...) with sympathetic concern, and that (2) the painfulness of cèyǐn zhī xīn comes from this concern-based construal of the object of one’s compassion. My interpretation of cèyǐn zhī xīn as a concern-based construal is an attempt to construct an important alternative to the inclinational view of Mengzian emotions, and it could be also considered as making a crucial step toward a new interpretation of the Mengzian theory of emotional cultivation. (shrink)

This study presents a reconsideration of Levinas's concept of the feminine. This reconsideration is facilitated by a philosophically informed analysis of Levinas's Talmudic readings on that subject.The innovation of this research is in its methodology, which combines the two corpora of Levinas' writings as important components of an integrated system of thought. Two main phenomena are derived here from Levinas' Talmudic readings and raise main principles of his ethics. In the heart of the discussion on Eros we find a (...) statement of the differentiation between feminine and masculine in Levinas's thought, and its implication for gender and for the ethics of otherness. In the center of Levinas's terminology of maternity we uncover his phenomenology of pregnancy, and its ethical implication regarding responsibility to the other. The extreme responsibility committed to the other since there is a immanent conflict between parents and their child. (shrink)

Compassion is generally thought to be a morally valuable emotion both because it is concerned with the suffering of others and because it prompts us to take action to their behalf. But skeptics are unconvinced. Not only does a viable account of compassion’s evaluative content—its characteristic concern—appear elusive, but the emotional response itself seems deeply parochial: a concern we tend to feel toward the suffering of friends and loved ones, rather than for individuals who are (...) outside of our circle of intimates. In response, I defend a sophisticated, non-cognitivist account of compassion and explain how it avoids the difficulties that undermine other proposals. (shrink)

Professional medical ethics demands of health care professionals in addition to specific duties and rules of conduct that they embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired implied attitude of physicians. In a sequel of three articles, a set of three of these concepts is presented in an interpretation that is meant to characterise the morally emotional part of this attitude: “empathy”, “compassion” and “care”. In the first article of (...) the series, “empathy” has been developed as a mainly cognitive and morally neutral capacity of understanding. In this article, the emotional and virtuous core of the desired professional attitude—compassion—is elaborated. Compassion is distinguished from sympathy, empathy and pity. Several problems of compassion as a spontaneous, warm emotion for being a professional virtue are discussed: especially questions of over-demand, of justice and of concerns because of a possible threat to the patient’s dignity and autonomy. An interpretation of compassion as processed and learned professional attitude, that founds dignity on the general idea of man as a sentient being and on solidarity, not on his independence and capacities, is developed. It is meant to rule out the possible side effects and to make compassion as a professional attitude and as professional virtue attractive, teachable and acquirable. In order to reach the adequate warmth and closeness for the particular physician-patient-relation, professional compassion has to be combined with the capacity of empathy. If appropriate, the combination of both empathy and compassion as “empathic compassion” can demand a much warmer attitude towards the patient than each of the elements alone, or the simple addition of them can provide. The concept of “care” that will be discussed in a forthcoming article of this sequel is a missing necessary part to describe the active potential of the desired moral attitude of the physician more completely. The reconstruction of the desired professional attitude in terms of “empathic compassionate care” is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) by Sarah RichardsonQuill KuklaQuill Kukla, review of Sarah Richardson's The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021)I had been eagerly anticipating the release of Sarah Richardson's meticulously researched The Maternal Imprint: The Contested Science of Maternal-Fetal Effects (2021) for several years, and I was not disappointed. A leading feminist scholar of the history and philosophy of (...) science, Richardson traces the scientific history of the idea that pregnant people's bodies control the future health, character, and well-being of their offspring. She also explores how this science is translated into social messaging and shaped by social ideology. Richardson delves into the details of the methodology, motivations, results, and communication of the science of maternal influences. She reveals a history of shaky results, contested methods, and socially loaded messaging, unified by a sustained interest in framing maternal bodies as sites of risk and responsibility for birth outcomes.A central narrative of the book is that the perceived location and mechanism through which pregnant bodies control fetal development keeps shifting around; over time, scientists have located this maternal influence in the uterine environment, the cytoplasm, the methylation of DNA, maternal nutrition, and even in the emotions, thoughts, and imagination of the mother, among other locations.1 Each time a version of the maternal influence hypothesis re-emerges, targeting a different bodily location and mechanism, it comes along with similar social messaging: pregnant people are distinctively responsible for the 'quality' of their children; their bodies are distinctive sites of risk, in need of social management; and their influence can be understood and controlled independent of the context in which they live. Given how many times this scientific hypothesis and its accompanying social messaging has died and been reborn, it is hard not to conclude, with Richardson, that background ideology compels us to keep searching for new stories that take this same form. The idea that pregnant people's bodies are understood as decontextualized and heightened sites of risk and responsibility for birth outcomes, in need of systematic discipline (both self-discipline and social discipline) in order to ensure their production of proper offspring, is one that has been explored [End Page e-1] in quite a bit of depth within feminist theory and reproductive ethics over the last thirty years. To name just a few, Barbara Duden's Disembodying Women: Perspectives on Pregnancy and the Unborn (1993), Deborah Lupton's "Risk and the Ontology of Pregnant Embodiment" (1999), Lisa Mitchell's Baby's First Picture: Ultrasound and the Politics of Fetal Subjects (2001), and my own Mass Hysteria: Medicine, Culture, and Mothers' Bodies (2005) are all works firmly within this tradition. What is new about Richardson's book is not the development and exploration of this cultural narrative and imaginary, but rather her rigorous and skillful analysis of the science that has grown out of and undergirded it. Richardson is a masterful writer, who makes scientific details comprehensible and fascinating. Her historical and epistemological analyses of exactly what shaped the science at each stage, what each scientific iteration did and didn't manage to show, and how these different scientific movements were translated into public messaging, is sharp and compelling. Richardson shows us the inner workings of how scientific programs build momentum; how scientists make methodological decisions; and how results feed into ongoing research programs. From this book, we also develop a rich sense of just how much uncertainty is baked into the science of human development, and how both scientific and public excitement about a given research program are mostly independent of the success and security of the science that comes out of it. The book traces 150 years of the history of the science of maternal influences, culminating in the current focus on epigenetics—which, like various past maternal influence theories, has ignited our broader social imagination. Epigenetics, roughly, is the study of molecular changes outside our DNA that control how genes express themselves. Environmental stimuli (such as stress) can cause changes in methylation, and thereby influence the expression of the genome: "Epigenetic markers that help determine whether a... (shrink)

The paper explores how several commissions of inquiry established in Quebec, Canada, have, over time, contributed in redefining the meaning of quality in health-care and its management. Adopting an interpretive analysis of commissions’ reports, the paper examines the particular ‘conceptual boxes’ used by their members to tackle quality and the embedded nature of their work. It is shown that although quality was always considered, this was generally done by bringing into focus specific quality domains and issues, some new, others (...) not so new. In addition, the various management approaches to quality featured in the reports were informed by evolving templates; although this evolution was not as straight and unwavering as some retrospective studies of quality in health-care seem to indicate. A common thread to all commissions is the fact that, beyond the definition of general principles, responsibility for quality oversight was not clearly assigned and criteria on whether quality initiatives should be voluntary or compulsory were often left unspecified. Further, quality was never regarded by the commissions as a strategic aspect of health-care. It is speculated that these failings on the part of commissions may partly explain the unassertive course of action taken by the provincial government in the area. (shrink)

In presenting the case for according rights and dignity to other creatures, Mark Gold argues that compassion for our fellow humans is a prerequisite for sympathy for animals. He shows how, down the years, animal campaigners have played a crucial role in the struggles against slavery, racism and the oppression of women and children. For those new to the subject, Animal Rights offers a whole new philosophy of life, based on care and compassion for all of creation. For (...) those already converted, here is a heart-warming endorsement of their concerns that demonstrates how a combination of peaceful, determined campaigning and caring consumerism can and does produce results. After answering all the common arguments and misrepresentations levelled against those who campaign for animal rights, Mark Gold moves from theory to practice, offering advice in the second half of the book on the best available alternatives to the many things we do and buy that depend upon animal exploitation. Extensive listings of addresses and sources in both Britain and the USA will prove invaluable to old hands and the newly converted alike. (shrink)

A deity is a superhuman person. Since deities are persons, they are axiologically comparable with each other. They are comparable in terms of their moral, political, and other axiological qualities. I regard all deities as contingent concrete worldbound particulars. To compare deities is to compare possible objects across worlds. I aim to compare the axiological qualities of deities taken from the entire Western ecosystem of deities. I will compare deities in terms of their moral and political qualities (this deity is (...) a morally better person than that deity). I will compare them in terms of their relations with non-divine persons (this deity is better for humans than that deity). I will compare the worlds in which the deities occur (a world with this type of deity is a better world than a world with that type of deity). I will compare types of deities and use specific deities to illustrate those types. The deities of some popular theologies are very bad; but the deities of some less popular theologies are very good. (shrink)

There is an increasing need for quality in ethics consultations, though there have been significant achievements in the United States and Europe. However, fundamental concerns that place the profession in jeopardy are discussed from the perspective of the U.S. in a manner that will be helpful for other countries. The descriptive component of the essay (the first two points) explains the achievements in ethics quality (illustrated by the IntegratedEthics program of the Veterans Health Administration) and the progress on standards and (...) competencies for ethics consultations (represented by the Core Competencies of the American Society for Bioethics and Humanities). Based on these achievements, the analytical component of the essay (the final three points) identifies and seeks to resolve three fundamental concerns (with increasing levels of importance) that compromise quality in ethics consultations: standards of quality; professionalism; and credentialing. The analysis argues for clearer standards of quality in ethics consultation and urges further professionalism by explaining the need for the following: interpreting the ASBH core competencies in a normative manner, developing a Code of Ethics, and clarifying the meaning of best practices. However, the most serious concern that threatens quality in ethics consultations is the lack of a credentialing process. This concern can be resolved effectively by developing an independent Ethics Consultation Accreditation Council to accredit and standardize graduate degree programs, fellowship experiences, and qualifying examinations. This credentialing process is indispensable if we are to strategically enhance quality in ethics consultations. (shrink)

The degree of success in creating quality care for people suffering from dementia is limited despite extensive research. This article describes healthcare providers’ experience with the ethical challenges and possibilities in the relationship with patients suffering from dementia and its impact on quality care. The material is based on qualitative, in-depth individual narrative interviews with 12 professional healthcare providers from two different nursing homes. The transcribed interview texts were subjected to a phenomenological–hermeneutical interpretation. To provide quality care to patients with (...) dementia, the healthcare providers emphasized the importance of sensing and understanding the patients’ emotional and bodily expressions through sentient attentiveness and recognition of the patient as a person. They also described reciprocity of expressions in the relationship where the patient recognized them both as persons and healthcare providers. The analyses of the findings are, inter alia, discussed in light of Løgstrup’s relational philosophy of ethics. (shrink)

Health care organizations are constantly seeking ways to improve quality of care and one of the often-posed solutions to deliver ‘good care’ is reflexivity. Several authors stress that enhancing the organizations’ and caregivers’ reflexivity allows for more situated, and therefore better care. Within quality improvement initiatives, devices that guarantee quality are also seen as key to the delivery of good care. These devices do not solely aim at standardizing work practices, but are also of importance in facilitating reflexivity. (...) In this article, we study how quality improvement devices position the relationship between situated reflection and standardization of work processes. By exploring the work of Michel Callon, Michael Lynch, and Lucy Suchman on reflexivity in work practices, we study the development and introduction of the Care Living Plan. This device aimed to transform care organizations of older people from their orientation towards the system of care into organizations that take a client-centred approach. Our analysis of the construction of specific forms of reflexivity in quality devices indicates that the question of reflexivity does not need to be opposed to standardization and needs to be addressed not only at the level of where reflexivity is organizationally situated and who gets to do the reflecting, but also on the content of reflexivity, such as what are the issues that care workers can and cannot reflect upon. In this paper we point out the theoretical importance of a more detailed empirical study of the framing of reflexivity in care practices. (shrink)

There is an ongoing discussion concerning personal vs. impersonal considerations in professional care. In this article, three different positions within the ethics of closeness will be discussed. These are: (a) reserving the ethics of closeness for close experienced others, ‘including the experienced Other’, which is Nortvedt's position; (b) trying to bring the distant, non‐experienced others closer, ‘including the Third’; and (c) finally, an examination of whether a perspective of closeness may lead to the exclusion of various groups in (...) need of help, ‘including the Other at the expense of the Third’. These positions are discussed with a view to clarifying some of the challenges that the ethics of closeness faces when it maintains that greater ethical obligation is associated with personal than with impersonal relations, without discussing the terms on which the obligation is based. Key questions that arise for a nurse or other health professional are: If our primary moral responsibility is for those that are close to us, the experienced others, who is to be responsible for those that are outside the established health services, the non‐experienced others? Is it evident that favouring the experienced others is based on legitimate needs? Can a discussion on the legitimate basis of nursing be avoided in questions relating to closeness and priorities? This discussion touches the heart of our discipline. Is a one‐sided perspective of closeness, rejecting moral responsibility for those with whom we have no relationship, a defensible ethical position? (shrink)