To say health is 'special' is to say that it has a moral significance that differentiates it from other goods (cars, say or radios) and, as a matter of justice, warrants distributing it separately. In this essay, I critique a new justification for the specialness thesis about healthcare (STHC) recently put forth by Engster. I argue that, regrettably, Engster's justification of STHC ultimately fails and fails on much the same grounds as have previous justifications of STHC. However, I also (...) argue that Engster's argument still adds something valuable to the debate around STHC insofar as it reminds us that the moral significance of healthcare may be wider than simply its effect on the incidence of disability and disease: one further reason we may think healthcare is morally significant is because it concerns the treatment and care of those who are already unwell. (shrink)

On the basis of three empirical assumptions about the rhythm method and the viability of embryos, Bovens concludes that the pro-life position regarding empbryos implies that it is prima facie wrong to use the rhythm method. Pruss objects to Bovens's philosophical presuppositions and Kennedy to his empirical premises. This essay defends two revised versions of Bovens's argument. These arguments revise Bovens's empirical assumptions in response to Kennedy and, in response to Pruss, supplement Bovens's argument with what I call ‘the principle (...) of parental care’. (shrink)

The argument of this article is framed by a debate between the principle of humanity and the principle of justice. Whereas the principle of humanity requires us to care about others and to want to help them meet their vital needs, and so to be partial towards those others, the principle of justice requires us to consider their needs without the intrusion of our subjective interests or emotions so that we can act with impartiality. I argue that a deep (...) form of caring lies behind both approaches and so unites them. In the course of the argument, I reject Michael Slote’s sentimentalist form of an ethics of care, and expound Thomas Nagel’s moral theory, which seems to lie at the opposite end of a spectrum ranging from moral sentiments to impersonal objectivity. Nevertheless, Nagel’s theory of normative realism provides unexpected support for the thesis that a deep and subjective form of caring lies at the base of even our most objective moral reasons. (shrink)

We intuitively think and talk about health care as a human right. Moreover, we tend to talk about health in the language of basic rights or human rights without a clear sense of what such rights mean, let alone whose duty it is to fulfill them. Additionally, in the care ethics literature, we tend to think of a dividing line between care and justice. In this dissertation I aim to draw care and justice together in what (...) I call care justice. To attend to care justice requires the reconceptualization of the value and practice of health care, and of the moral communities in which we enact care and justice. First, I argue for a strong right to health care, though not to health. Second, I argue that health care includes much more than mere medical care. On this account health care is special for the practices of care it values and communicates. Third, I establish a theoretical framework for why, and importantly how, health care entails other forms of care: social, economic and political. My approach engages a complicity framework to rethink moral community formation and participation, and the rights and responsibilities of individuals as participants in a collective moral community. I argue that it is within communities of membership, which I define as ethical homes, that we have duties to and expectations from others. The moral community as complicit ethical home provides a way to reimagine individual shared responsibility within moral communities, and particularly regarding responsibility for practices of care. (shrink)

Care is widely thought to be a role virtue for health care professionals (HCPs). It is thought that in their professional capacity, HCPs should not only take care of their patients, but should also care for their patients. I argue against this thesis. First I show that the character trait of care causes serious problems both for caring HCPs and for cared-for patients. Then I show that benevolence plus caring action causes fewer and less (...) serious problems. My surprising conclusion is that care is a vice rather than a virtue for HCPs. In their professional capacity HCPs should not care for their patients. Instead HCPs should be benevolent and act in a caring manner toward their patients. Keywords: care, ethics, virtue CiteULike Connotea Del.icio.us What's this? (shrink)

Patient-centered care is now recognized as a clinical method and ideal model for patient – health professional relationships, and many definitions have influenced its evolution. Overall the patient-centered care literature has provided relatively little to define patient-centered care at the level of the patient-professional relationship. Additionally, patient-centered care lacks grounding in ethical theory. This thesis asserts that theoretical concepts from the ethics of care can provide a stronger conceptual basis for patient-centered care.This (...) class='Hi'>thesis begins with a critical interpretive review of the patient-centered care literature, yielding 12 articles that previously introduced new theoretical and definitional work on patient-centered care and patient-centered communication. Six common themes and ideas were discovered, and include Engaging the Patient as a Whole Person, Recognizing and Responding to Emotions, Fostering a Therapeutic Alliance, Promoting an Exchange of Information, Sharing Decision Making, and Enabling Self-Management and Patient Navigation. These elements were then compared to key elements of the ethics of care. This thesis argues that feminists have good reason to consider care as a type of moral duty, and it describes how this duty functions. This thesis also argues that a duty to care is triggered when caregivers are presented with particular substantive forms of vulnerability. Specifically, this thesis argues that vulnerable subjects whose constitutive needs are at risk require particular moral obligations. The links between the ethics of care and patient-centered care are discussed, including how an ethics of care response ought to function in the health care context. Finally, the cases of J.J. and Makayla Sault, two aboriginal girls who refused chemotherapy in favour of traditional aboriginal healing practices, are analyzed. This thesis offers a short scoping review of the bioethics discourse surrounding these cases. A review of this discourse revealed several common themes, which included the peripheral importance of culture and history, the equating of best interests with survival, the supremacy of science-based medicine, and the impartial application of ethical principles. This thesis recommends that health care professionals apply an ethics of care approach to similar ethical dilemmas in the future, which involves shifting one's ethical focus to the central relationships of the case, understanding the unique perspective of the patient's narrative, and promoting a care-based rather than a justice-based approach to problem-solving. (shrink)

Feminist care ethicshas for some time guided contemporary artists and curators in their search for sustaining and sustainable practices in the current neoliberal backwash and climate crisis. With a focus on current Australian art in the context of recent care ethics scholarship, this article considers what contemporary art – in its processes as well as aesthetic outcomes – can offer in imagining and practising care for the human and more-than-human world. The article focuses on a series of (...) exhibitions that comprised a key exploratory methodology of The Care Project: Feminism and art in neoliberal times (La Trobe University, 2019–2022). The exhibitions featured the work of regionally based artists. This accent on creative practices emerging from the experience of living in regional communities that are often on the frontline of climate change and social inequality offers unique perspectives on care ethics in practice. (shrink)

The last three articles within this section of Cambridge Quarterly have focused on organizations or disciplines outside the mainstream of bioethics that are making inroads within the field. This issue's article may be viewed as a departure, but it is not-my thesis is that despite the active presence of the clergy in the ethics field, individuals involved in pastoral care are often thought by health professionals, as well as by a sizeable number of pastors themselves, to not be (...) within the mainstream of ethical decision-making for patients. (shrink)

In this essay I argue that sports at their best qualify as final ends, that is, as ends whose value is such that they ground not only the practices whose ends they are, but everything else we do as human agents. The argument I provide to support my thesis is derived from Harry Frankfurt's provocative work on the importance of the things we care about, more specifically, on his claim that it is by virtue of caring about things (...) and practices, really caring about them ? even loving them ? we are able to regard and treat them as final ends. Sports, I claim, are paradigmatic examples of practices cared about and loved in these deep ways, and as such deserve to be considered, rather than dismissed because of their supposed triviality, as one of those ends around which a life most worth living can be legitimately forged. (shrink)

Calling on the methodology of psychology, the authors explore the way illness alters the self-image of the sick person, and the way the experience changes the person who is ill. The reader is taken through the psychological impacts of the first clinical moment when the patient realizes he or she is in the altered state of illness, as well as the subsequent effects of pain, hospitalization, being bed-ridden, fatigued or disabled. The central thesis is that an integral picture of (...) medicine must include social-cultural aspects, the institutionalization of health care, and an attempt to provide patient-centered care. The approach taken is the empirically based psychosocial reflection of the disturbances to a person's self-image caused by various kinds of illness. Focusing on the world of the patient, the authors relate to problems concerning self-image, pain, exhaustion, isolation, handicaps, aging, dying and death. The relationships between patients and medical personnel are also examined. Concluding the work is an excellent bibliography keyed to the chapters of the text. (shrink)

There have been many attempts to define care in terms of the virtues, but meta‐analyses of these attempts are conspicuously absent from the literature. No taxonomies have been offered to situate them within the broader care ethical and virtue theoretical discourses, nor have any substantial discussions of each option's merits and shortcomings. I attempt to fill this lacuna by presenting an analysis of the claim that care is a virtue (what I call the “virtue thesis” about (...) care). I begin by distinguishing weaker and stronger versions of the virtue thesis, arguing that the weaker version is an orthodox view among care ethicists. I then go on to develop a taxonomy of approaches available to care ethicists seeking to flesh out the virtue thesis. The three I identify are analogical approaches, according to which care is analogous to some existing virtue; supplementalist approaches, according to which care is a novel virtue; and cardinalist approaches, according to which care is a cardinal virtue. Following this, I defend the virtue thesis from some foreseeable objections and argue that its most promising version is analogical. (shrink)

Recent research points to the fact that new medical technological innovations are just as relevant in the context of long‐term care or chronic care as they are in the context of acute care. In the spirit of the Nuffield Foundation recommendations, this paper explores the possibilities of using robotic aides in long‐term care and identifies the tensions that must be considered and addressed if robotics is to be introduced successfully in nursing homes. Our examination is two‐pronged. (...) First, we delve into a fundamental issue surrounding AI, namely that of consciousness. We argue that automation will always have only a limited use in caregiving since caregiving as an activity requires the use of human‐type, that is, organic, consciousness. We support the thesis that the emergence and formation of human‐type consciousness require feelings such as empathy and the sense of touch, which, in turn, create the sense of kinship with fellow human beings. And second, we examine the benefits as well as risks of using robotic aides such as ZORA and PARO in long‐term care facilities. More specifically, we look at ZORA's use in a group setting, and PARO's use in an individual setting. We emphasize that long‐term care is one‐on‐one care, including but not limited to intimate care. Crucially, we argue that touch is at the heart of this type of care. We argue that some of the tensions with the use of robotic aides are generated precisely because of the lack of human touch. (shrink)

The recent rise of injectable ‘wonder drugs’ for weight loss has been rapid and unregulated (so rapid that it has resulted in a worldwide shortage of Ozempic). We analyse the commercialisation of these drugs, and the political manoeuvres companies engage in to leverage and manufacture the gendered capitalism of ‘care’. Marketing relies heavily on situating ‘obesity’ as a chronic disease influenced by genes or other aspects of biology, working therefore to supposedly mitigate the blame and shame of the taken-for-granted (...) aetiology of ‘obesity’, overwhelmingly understood as excess food intake and insufficient activity. Armed with this evidence, women are told to ‘stand up against weight care judgement’ and to engage in ‘shame free’ care. Pharmaceutical interventions are at the ready to inject this weekly dose of care, producing freedom through neoliberal pleasure but, ironically, in doing so, sacrificing the pleasure of food and non-conditional self-acceptance as vital forms of self-care. (shrink)

Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: ‘Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by (...) the community involved.’ This thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society. (shrink)

Historically associated with military service, conscientious objection has become a significant phenomenon in health care. Mark Wicclair offers a comprehensive ethical analysis of conscientious objection in three representative health care professions: medicine, nursing and pharmacy. He critically examines two extreme positions: the 'incompatibility thesis', that it is contrary to the professional obligations of practitioners to refuse provision of any service within the scope of their professional competence; and 'conscience absolutism', that they should be exempted from performing any (...) action contrary to their conscience. He argues for a compromise approach that accommodates conscience-based refusals within the limits of specified ethical constraints. He also explores conscientious objection by students in each of the three professions, discusses conscience protection legislation and conscience-based refusals by pharmacies and hospitals, and analyzes several cases. His book is a valuable resource for scholars, professionals, trainees, students, and anyone interested in this increasingly important aspect of health care. (shrink)

I defend five theses about caring: Thesis 1: Animals can care. Thesis 2: Care is not an emotion. Thesis 3: To care is to value. Thesis 4: Caring cannot be reduced to belief. Thesis 5: Caring cannot be reduced to desire. These five theses do not amount to a full-fledged theory of care, but they get us much closer to a workable analysis. They help sketch some of the contours of the (...) concept and close off a few false starts. This paper is principally structured as an argument from elimination. I show what care cannot be, leaving in play a restricted set of options. Caring appears to be a sui generis psychological state, common to both humans and some animals, that cannot be reduced to belief, desire, or emotion. (shrink)

Development is concerned with the transformation of people to foster their health, wholeness and growth. The link between health and development points to religion as potential social capital for development. There is an ongoing debate about the role of pastoral care as a religious resource in global healthcare contexts. This is unfortunately not the case in Africa, as pastoral care has not received sufficient attention for its role in healthcare and development in development discourses. The limited research on (...) pastoral care in healthcare contexts in Africa has implications for African healthcare systems, pastoral care and the delivery of an effective, holistic and quality healthcare service. Taking as its point of departure a thesis about the potential of religion as a social capital resource for development, the article argues for pastoral care as a viable religious resource for healthcare and development. Osmer’s theological task of good practice is employed as an interdisciplinary engagement in dialogue with selective perspectives in the disciplines of development and health and social sciences for appropriate analysis. (shrink)

The feminist debate about an ethic of care that began during the early 1980s has become so extensive that it is difficult to provide an overview of it. Since its beginnings, the debate has generated a series of independent models for an ethic of care, as well as a vast number of articles suggesting ways to expand critically, or to provide alternative readings of, traditional conceptions of morality. Carol Gilligan sparked the entire discussion with her book In a (...) Different Voice, in which she outlines her theory of the different moral developments of women and men. According to Gilligan, the “male” conception of morality may be understood as an ethic of justice, while the “female” conception can be seen primarily as an ethic of care. This thesis ignited an often very fiercely argued discussion of its empirical correctness and the validity of its generalization. (shrink)

The ethics of care has always had an opposing theoretical model in Kant’s ethics. While Kant’s ethics seems to draw an image of the moral agent as independent, autonomous, and rational, the ethics of care insists on a characterisation of the person as vulnerable, interdependent, and relational, for whom the affective dimension plays a crucial role. On the contrary, my thesis is that the two theoretical proposals are not incompatible. I will provide three arguments for this (...) class='Hi'>thesis. First, I will analyse the possibility of interpreting the Kantian agent as a vulnerable, emotional and, at the same time, autonomous subject. Second, I will show how, for Kant, relations have normatively relevant weight within the agent’s deliberation. Finally, I intend to argue that Kant does not lose the particular in favour of techniques of abstraction and generalisation, but keeps it within the agent’s maxim and preserves it in the process of moral deliberation. (shrink)

In this paper, I seek to theorise the concept of pressure in relation to families’ experiences of organ donation during COVID-19. Drawing on Australia-based fieldwork, I follow circuitries of pressure in and beyond interiorities of bodies, biographies and infrastructures of care to ask what happens when pressure builds to such an extent that there is no capacity left in bodies and in institutions. Pressure concentrates in some spaces and bodies more than others revealing uneven flows and restrictions to (...) class='Hi'>care. But how might a theorisation of pressure enable care to be imagined otherwise – to circulate differently? Extending recent care scholarship, I explore alternative versions of care enacted by families and clinicians involved in organ donation. This is an expansive and capacious care, which may offer potential to diffuse the force of pressure through radical interdependence. (shrink)

This is a critical discussion of the accuracy-first approach to epistemic norms. If you think of accuracy (gradational or categorical) as the fundamental epistemic good and think of epistemic goods as things that call for promotion, you might think that we should use broadly consequentialist reasoning to determine which norms govern partial and full belief. After presenting consequentialist arguments for probabilism and the normative Lockean view, I shall argue that the consequentialist framework isn't nearly as promising as it might first (...) appear. (shrink)

This article reads Max Weber’s Collected Essays in the Sociology of Religion (1920/1921), in particular the first two sections, The Protestant Ethic and the Spirit of Capitalism and Confucianism and Taoism, as his comparative philosophy of life. While Weber’s thesis about the determining effect of Protestantism on the emergence of industrial capitalism has been taken as a justification for the superiority of Western culture and its uniqueness in the world, this article emphasizes Weber’s critique of Protestant asceticism and his (...) pessimism toward the West in the early twentieth century. Weber’s critique is deeply connected to his concerns about life and freedom and his imagination of an aesthetic way of life in Chinese Confucianism, in which he believes to have found a well-balanced rational culture that accepts and appreciates irrationalism, as expressed in Taoism. And, as the article observes, Weber’s philosophy of life centering on aesthetic self-cultivation inspired Michel Foucault’s concept of the care of the self in the 1980s. Weber’s sociology of religion thus articulates his vision of freedom in the age of global capitalism—it is his Confucian care of the self. (shrink)

In this paper, I discuss the idea of democratic love from the perspective of gender equality. More precisely, I argue that a particular form of gender inequality, namely a gender-specific division of care labour, jeopardizes democratic love. In the first two sections of the article, I introduce Anthony Giddens’ original idea of a ‘democratization of the personal’ and show how Axel Honneth has developed it by relying on the Hegelian notion of social freedom. In the third section, I discuss (...) how the problem of care work affects democratic love relationships and depict the solution to this problem advocated by recognition theory, namely economic recognition. After having reconstructed some possible affinities between socialist-feminist arguments and Honneth’s suggestions, as well as criticisms against them, I outline another recognition-theoretic strategy for recognizing care work. I argue that the recognition paradigm conveys a view of the love relationship as inherently implying a caring recognition of human beings’ dependencies and vulnerabilities. I conclude by hinting at the idea that caring recognition may be extended beyond the social sphere of love, as constituent of social relations in general. (shrink)

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as clinical phronesis, i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of virtue ethics, yet one that is informed by the (...) exigencies of moral discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their disengaged form (reflecting the malaise of modern medicine). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the silent world of doctor and patient — provides may deny or refuse any given connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of calculative reasoning only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can save the life of medical ethics — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can prevent the death of medical ethics. (shrink)

My thesis is that moral ignorance does not imply a failure to care adequately about what is in fact morally significant. I offer three cases: one in which someone is ignorant of the precise nature of what she cares about; one in which someone does not reflect on the significance of what she cares about in a particular set of circumstances, and one in which someone cares deeply about two morally significant considerations while being mistaken about their relative (...) significance. I argue that these agents all clearly care at least “adequately” about everything morally significant, including the very considerations that in fact make their acts wrong. This creates theoretical room for a way of thinking about culpable moral ignorance that respects the key concerns of those in the voluntarist tradition who have held that moral ignorance is typically blameless, within an approach to thinking about moral responsibility according to which we are blameworthy for that which manifests poor quality of will; caring adequately does not require moral omniscience, but motivated moral ignorance and moral ignorance that reflects indifference to things that matter morally are still blameworthy. My thesis also suggests a fruitful change of direction for quality-of-will theorists: we should articulate the nature and structure of the standards for adequate caring, i.e. those that specify what it is to care “adequately”. I close by offering an initial proposal as to what these standards might look like and identifying four promising avenues for further research on this topic. (shrink)

This thesis examines the practice of haemodialysis and kidney transplantation, the two medical therapies available for persons with kidney failure, from a phenomenological perspective. A basic assumption made in the thesis is that contemporary biomedicine is deeply embedded in the cultural, historical, economic, and political circumstances provided by the particular local, national, and transnational contexts in which it is practiced. The aim of the thesis is twofold. On the one hand, the aim is to examine the forms (...) of person- and patienthood enacted and negotiated in haemodialysis and kidney transplantation care and in the daily lives of persons with kidney failure. On the other hand, the aim is to investigate the ways in which the enacted and negotiated forms of person- and patienthood are culturally embedded and normatively charged. In order to examine and investigate this twofold aim, an empirical material has been gathered that comprises observations and in-depth interviews with patients and caregivers at four haemodialysis units, one in Riga, Latvia, and three in Stockholm, Sweden. The theoretical approach and methodology of the study is cultural and phenomenological in character, drawing on an ethnological and anthropological understanding of culture as processual and relational, and on a phenomenological understanding of personhood as embodied and intertwined with the surrounding world. The thesis shows that patients’ encounters and attempts to deal with the diagnoses and treatments associated with kidney failure are complex and often misalign them with the normatively charged orientations enacted and recommended by medicine. The complex situation that emerges when they undergo transplantation, for example, stands in stark contrast to the widespread official view of organ transplantation as a self-evidently health-bringing and normalising therapy. Through their repeated and extensive experiences of undergoing haemodialysis and living with the disease, patients eventually become able to create a synthesis between their lived experiences of their own body and their body as a medical object – what in the thesis is called a ‘sick body’ – a synthesis that allows them to reorient themselves in life and experience a sense of direction. This process relies, to a large extent, on the temporal structure that haemodialysis affords life; it is by repeatedly undergoing the treatment that patients become able to create a sick body. Even so, many of them find this temporal structure problematic; they experience it as disruptive of their control and future-orientedness and as causing an existentially difficult-to-handle boredom. The thesis also shows that the political developments and the norms prevalent in the two national contexts studied greatly affect the orientations of the treatment practices and the participants’ lives. In both Riga and Stockholm, ideals of freedom, activity, control, and self-actualisation influence what forms of patienthood and personhood are enacted. The study indicates that persons who fall ill with a serious and chronic disease only gradually become able to understand and actively cope with their differently embodied circumstances of life. This suggests that medical professionals should not too hastily enlist their patients as experts on their own bodies, but rather provide them with the time and support necessary for making repeated attempts at creating and maintaining a life with a sick body. (shrink)

Henry Shue’s model of basic rights and their correlative duties provides an excellent framework for analysing the requirements of global distributive justice, and for theorising about the minimum acceptable standards of human entitlement and wellbeing. Shue bases his model on the claim that certain ‘basic’ rights are of universal instrumental value, and are necessary for the enjoyment of any other rights, and of any ‘decent life’. Shue’s model provides a comprehensive argument about the importance of certain fundamental goods for all (...) human lives, though he does not consider health or health care in any significant detail. Adopting Shue’s model, I argue that access to health care is of sufficient importance to the enjoyment of any other rights that it qualifies as what Shue describes as a ‘basic’ right. I also argue that the basic right to health care is compatible with the basic rights model, and is required by it in order to for it to achieve its goal of enabling right holders to enjoy any decent life. In making this claim I also explore the requirements of the basic right to health care in terms of Shue’s triumvirate of duties and with reference to several key examples. (shrink)

Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life-sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non-equivalence, and find (...) only relatively weak reasons to restrict rationing to withholding treatment. On the contrary, resource allocation provides a strong argument in favour of equivalence: non-equivalence causes preventable death in critically ill patients. We outline two proposals for increasing equivalence in practice: (1) reduction of the mortality threshold for treatment withdrawal, (2) time-limited trials of intensive care. These strategies would help to move practice towards more rational treatment limitation decisions. (shrink)

It seems very important to us whether or not a generalization offers counter-factual support—but why? Surely what happens in other possible worlds can neither help nor hurt us? This paper explores the question whether counter-factual support does, nevertheless, have some practical value. (The question of theoretical value will be addressed but then put aside.) The following thesis is proposed: the counterfactual-supporting generalizations are those for which there exists a compact and under normal circumstances knowable basis determining the fine-grained pattern (...) of actual variation between the properties associated by the generalization (e.g., for the generalization Fs tend to be G, the exact circumstances under which any particular F is G); further, the better we understand the basis and the scope of the support offered, the greater our knowledge of fine-grained variation. We care about counterfactual support because we care about actual fine-grained variation. (shrink)

Laplacean Determinism (his so-called demon argument) is the thesis that every event that transpires in a closed universe is a physical event caused (i.e., determined) in full by some earlier event in accord with laws that govern their behavior. On this view, it is possible, in principle, to make perfect predictions of the state of the universe at any time Tn on the basis of complete knowledge of the state of the universe at time T1. Thus, if identity theory, (...) epiphenomenalism or any other instantiation of Laplacean Determinism is correct, mental events such as free will, intention and other forms of mental agency are tricks of the mind, misleading us into believing our volitional concerns have traction in a world ruled entirely by physical circumstance. Not surprisingly, advocates of free will and related acts of human volition have engaged in spirited debate with adherents to Laplacean orthodoxy, the results of which have been far from conclusive. Rather than join these deliberations, I wholly embrace the demon argument and then ask “what are the consequences of this allegiance?” As I hope to show, acceptance of this argument commits one to a belief in the existence of human precognition. This, I suggest, is a consequence that does not fit comfortably within a contemporary scientific worldview. (shrink)

I aim to analyze in this dissertation what a desirable basic institutional structure looks like from the perspective of rationality. While the main topic is thus normative in nature, I start by clarifying in the first part what the notion of rationality exactly entails. I do so by focusing explicitly on the economic conception of rationality, according to which a rational individual is motivated to serve his self-interest on the basis of cost-benefit calculations. Such a Homo Economicus is characterized by (...) his intentional and instrumental actions, his perfectly informed beliefs and his exogenously given and egoistic preferences. In my view, however, this model is inadequate if one aims to understand what it means to be rational. The requirements that actions should be instrumental, beliefs should be based on perfect information and preferences should be exogenously given and egoistic in nature turn out to be overly demanding in this respect. That is why I propose to drop these assumptions in what I label the minimal conception of rationality. Since the latter turns out to be very formal indeed, I propose two further alternatives, which focus not so much on the choice of means to achieve certain goals, as they focus on the choice of these goals themselves. According to the first, broad conception, actions are rational if they are based on good reasons, which are further qualified as well-informed beliefs and autonomous preferences. According to the second, expressive conception, actions, beliefs and preferences are rational if they express the things the individual at hand cares about. The latter requires that individuals can reflect upon and identify with their reasons, which implies a capacity to reflect upon and distance themselves from their own bundle of preferences. In the second part of this dissertation, I try to show the value and limitations of these conceptions by applying them to the context of large-scaled elections. In this respect, it becomes immediately clear that the economic conception fails to explain why quite a lot of people go out and vote. After all, since a single vote has only an infinitesimal impact on the electoral result, it does not enable people to serve their interests or realize their goals. This leads to the so-called voting paradox, according to which no rational individual will decide to vote. The standard solution is to assume that individuals vote because they derive satisfaction from the very act itself. However, this strategy is rather ‘ad hoc’ and does not explain how people vote once they find themselves inside the voting booth. The expressive conception of rationality does better in this respect. It suggests that people vote because they care about democracy in general or about a specific political candidate or ideology. Since they conceive of themselves as being a good citizen, they express this aspect of their identity by going out to vote. In the third part of this dissertation, I analyze more fully the normative implications of the different conceptions of rationality. More specifically, I try to answer the question which basic institutional structure is desirable if one assumes that people are by and large rational. This immediately shows that both the normative issue and the explanatory issue are closely connected. In my view, proposals regarding institutional design and reform should be based on empirically adequate models of individual actions and motivations. This search for a realistic utopia goes against the conventional strategy of most economists. They rely on the Homo Economicus model, even if this fails to explain individual behavior. To explain more fully what the normative implications are of the counterfactual assumption that all people are economically rational, I focus on the work of James Buchanan. In his theory of constitutional choice, he argues in favor of a minimal state whose only task is to make sure that the market functions properly. Buchanan thus favors strict constitutional limitations for governments, which tend to expand beyond legitimate borders as soon as politicians and public servants are allowed to serve their own interests. In my view, however, the abovementioned criticisms of the Homo Economicus model have theoretical as well as normative implications. After all, the empirically supported fact that a majority of individuals does not act in economically rational ways creates more room for legitimate government intervention. Expressively rational citizens will, for example, more easily agree on the necessity and desirability of a collective provision of certain public goods. In addition, expressively rational politicians and public servants can be more easily trusted to serve the public interest rather than their narrowly defined self-interest. As an alternative to Buchanan’s one-sided focus on economic rationality and the market, I focus on the work of Samuel Bowles en Herbert Gintis. More specifically, I explore their work on the phenomenon of strong reciprocity, which refers to the widespread tendency of people to reward prosocial behavior and punish antisocial behavior, even if this is costly for themselves. Since this is clearly economically irrational, Bowles and Gintis propose to complement the Homo Economicus model with the Homo Reciprocans model. This model, which comes close to the expressive conception of rationality, is able to incorporate the insight that social norms surrounding reciprocity, cooperation and fairness are crucial in regulating interactions. At the normative level, Bowles and Gintis stress that such norms often lead to socially desirable outcomes, since they enable people to live in harmony without relying on coercive and costly government interventions. This suggests that the debate between proponents of the market on the one hand and the state on the other hand neglects the importance of communities where people spontaneously interact on the basis of generally prosocial norms. As such, the insights of Bowles and Gintis lead to a defense of a basic institutional structure in which markets, states and communities mutually complement and reinforce each other. They also justify a general optimism as regards to the capacity and motivation of people to try and improve the rules and institutions that govern their everyday lives. (shrink)

We aim at providing a philosophical analysis of the notion of “proof by Church’s Thesis”, which is – in a nutshell – the conceptual device that permits to rely on informal methods when working in Computability Theory. This notion allows, in most cases, to not specify the background model of computation in which a given algorithm – or a construction – is framed. In pursuing such analysis, we carefully reconstruct the development of this notion (from Post to Rogers, to (...) the present days), and we focus on some classical constructions of the field, such as the construction of a simple set. Then, we make use of this focus in order to support the following encompassing claim (which opposes to a somehow commonly received view): the informal side of Computability, consisting of the large class of methods typically employed in the proofs of the field, is not fully reducible to its formal counterpart. (shrink)

This dissertation integrates the work of feminist care theorists such as Carol Gilligan with the phenomenological work on embodiment of Maurice Merleau-Ponty as well as the social philosophy of Jane Addams to create an approach to morality that I call, "Embodied Care." I define embodied care as an approach to morality that shifts ethical considerations to context, relationships, and affective knowledge in a manner that can only be fully understood if its embodied dimension is recognized. Care (...) is exhibited through habits that are an expression of embodied knowledge and contribute to a caring imagination. Care is committed to the flourishing and growth of individuals yet acknowledges our interconnectedness and interdependence. This dissertation aims to contribute two ideas to existing care discourse: Care cannot be fully understood without attending to its embodied dimension and that care can be a viable component of a social ethic but only if its corporeal aspect is addressed. ;The introduction contains my definition of care that will be explicated throughout the dissertation. The opening chapter reviews the current literature on care ethics and organizes various positions held to help clarify the assertion I will make throughout the dissertation: care is more foundational than an ethical theory because it is rooted in the body. Largely drawing upon the work of Maurice Merleau-Ponty, chapter two establishes how the body is "built for caring" by exploring caring knowledge and caring habits. Chapter three bridges individual and social considerations through the notion of a caring imagination which employs corporeal resources to transcend distance and time to understand and empathize with others. In chapter four the work of Jane Addams is used to understand how attending to embodiment can contribute to social habits of care that build a caring society. The final chapter explores how embodied care transforms the moral landscape on a personal and a social level. ;Rather than providing the definitive answers desired by traditional ethical systems, embodied care points to the kinds of questions and issues that should be attended to. Embodied care is not about "getting it right," but about "making it better" for those involved. (shrink)

This article is a literature review on the development of elderly care courses for undergraduate students in Sichuan Province's music teacher profession. Through a review of relevant literature, the study finds that music education positively impacts the mental health and social participation of elderly individuals. However, there are shortcomings in curriculum design, personalized teaching, and interdisciplinary integration. This paper aims to explore how to effectively integrate music education with elderly care knowledge, optimize curriculum design, and establish scientific assessment (...) mechanisms to enhance the practical effectiveness of the courses. This study provides theoretical support and practical guidance for developing elderly care courses for music teacher undergraduates in Sichuan Province. This paper draws its content from the doctoral thesis, "The Development of Subject Curriculum for Caring for the Elderly Among Music Teacher Profession Students at the Undergraduate Level in Sichuan Province, China.". (shrink)

El objetivo del texto radica en resaltar algunos elementos de pensamiento en salud de los notables médicos cubanos Tomás Romay y Carlos J. Finlay. Se analizan sus posturas y connotación acerca del nexo entre la ciencia y la sociedad. El método investigativo utilizado ha sido la revisión documental en publicaciones periódicas, libros y repositorio de tesis. Destaca en este acercamiento la conmemoración en agosto del centenario de la muerte de Finlay. Por lo cual este sucinto trabajo constituye un homenaje a (...) su obra y, a su vez, al ideario de vanguardia manifiesto en la labor médica de ambos hombres de ciencia. The objective of this text is to highlight some elements concerning health care stated by the outstanding Cuban doctors Tomas Romay and Carlos J. Finlay. It is analysed their attitude about the link between science and society. The investigative method used has been bibliographic review of newspapers, books and thesis repository. Though it is stressed the commemoration of Carlos J. Finlay centenary of death this work pays tribute to the work and advanced ideas in the field of medicine of these men of science. (shrink)

The Belmont Report’s distinction between research and the practice of accepted therapy has led various authors to suggest that these purportedly distinct activities should be governed by different ethical principles. We consider some of the ethical consequences of attempts to separate the two and conclude that separation fails along ontological, ethical, and epistemological dimensions. Clinical practice and clinical research, as with yin and yang, can be thought of as complementary forces interacting to form a dynamic system in which the whole (...) exceeds the sum of its parts. Just as effective clinical practice cannot exist without clinical research, meaningful clinical research requires the context of clinical practice. We defend this thesis by triangulation, that is, by outlining how multiple investigators have reached this conclusion on the basis of varied theoretical and applied approaches. More confidence can be placed in a result if different methods/viewpoints have led to that result. (shrink)

Reasoning and judgement in health care entail complex responses to problems whose demands typically derive from several areas of specialism at once. We argue that current evidence- or value-based models of health care reasoning, despite their virtues, are insufficient to account for responses to such problems exhaustively. At the same time, we offer reasons for contending that health professionals in fact engage in forms of reasoning of a kind described for millennia under the concept of wisdom. Wisdom traditions (...) refer to forms of deliberation which combine knowledge, reflection and life experience with social, emotional and ethical capacities. Wisdom is key in dealing with problems which are vital to human affairs but lack prescribed solutions. Uncertainty and fluidity must be tolerated in seeking to resolve them. We illustrate the application of wisdom using cases in psychiatry, where non-technical aspects of problems are often prominent and require more systematic analysis than conventional approaches offer, but we argue that our thesis applies throughout the health care field. We argue for the relevance of a threefold model of reasoning to modern health care situations in which multifaceted teamwork and complex settings demand wise judgement. A model based on practical wisdom highlights a triadic process with features activating capacities of the self, other and aspects of the problem itself. Such a framework could be used to develop current approaches to health care based on case review and experiential learning. (shrink)

Any study of radical care needs to pay attention to the institution as a place of care. Yet, institutions have been more readily associated with failures of care than successes. We undertake close reading of the Ockenden Review of maternity services in a National Health Service hospital trust in England, concerning a large number of families that received inadequate care during pregnancy and birth, including investigations of adverse outcomes such as deaths of babies and mothers. We (...) argue that to enable better care in the institution requires a close attention to its institutional nature, particularly its scale, bureaucratic mode and functions, and the professional identities that work within it, and the ways they shape the practice of emotion. (shrink)

This article deals with the biotechnology revolution in agriculture and analyzes it in terms of Bernard Stiegler’s theory of techno-evolution and his thesis that technologies have an intrinsically pharmacological nature, meaning that they can be both supportive and destructive for sociotechnical practices based on them. Technological innovations always first disrupt existing sociotechnical practices, but are subsequently always appropriated by the social system to be turned into a new technical system upon which new sociotechnical practices are based. As constituted and (...) conditioned by a technical system, human cultures are necessarily systems of care. Humans take care of themselves and the world through technologies. Agriculture is a very old system of care, stable for more than 10,000 years, but at the moment it is experiencing a profound rupture thanks to the invention of genetic engineering technologies, that promise to revolutionize it. However, their current deployment under capitalist conditions everywhere leads to processes of proletarianization, due to the fact that they enable the expropriation of farmers of the means of production, depriving them of the possibility of appropriating these new technologies and frustrating the invention of a new agricultural system of care. This has lead to a widespread rejection of the new technologies, which is a grave error though, as these technologies can become the basis of a new system of care. But only under the condition that they are wrought from corporate control and redeployed instead to initiate a process of deproletarianization. It is argued that current initiatives in open source and commons-based biotech are probably the most promising harbingers of such a process of deproletarianization. (shrink)

In his posthumously published Living Up to Death Paul Ricoeur left an impressive testimony on what it means to live at a high old age with death approaching. In this article I present him as a teacher who reminds us of valuable lessons taught by patients in palliative care and their caretakers who accompany them on their way to death, and also as a guide in our search for a modern ars moriendi, after—what many at least experience as—the breakdown (...) of traditional religious belief in a personal afterlife. These lessons can be summarized in the following theses. ‘Living up to death, one cannot experience one’s own death. Therefore, never consider someone dying as moribund’. ‘Though everybody is alone in dying, nobody should die alone.’ ‘The preparation for death is an affirmation of life’. ‘Life experienced as a gift can be given up’. The plausibility of the last thesis, however, may go beyond the confines of austere philosophical thinking. (shrink)

Hi‘ilei Julia Kawehipuaakahaopulani Hobart and Tamara Kneese (2020) define radical care as ‘as a set of vital but underappreciated strategies for enduring precarious worlds’ (16). Yet they sound a note of caution when they argue that ‘because radical care is inseparable from systemic inequality and power structures, it can be used to coerce subjects into new forms of surveillance and unpaid labor’ (16). This article explores scaffolded peer-to-peer programmes as a form of radical care. In these programmes (...) and approaches people are connected in non-hierarchical structures of mutual support and care that locate lived experience, rather than solely professional accreditation, as powerful, inclusive and collaborative expertise. The often implicit and traditional hierarchies of care are challenged in this structuring; we argue that the dynamic and horizontal structure of peer care practices can subvert and ultimately enrich circulating discourses of self-care, commodified care and the neoliberal devolution of responsibility for health and well-being to individuals. (shrink)

Some argue that it is ethically justifiable to unilaterally withdraw life‐sustaining treatment during crisis standards of care without the patient's consent in order to reallocate it to another patient with a better chance of survival. This justification has been supported by two lines of argument: the equivalence thesis and the rule of the double effect. We argue that there are theoretical issues with the first and practical ones with the second, as supported by an experiment aimed at exploring (...) whether the Knobe effect, which affects the folk concept of intention, applies to situations of unilateral withdrawal. Fifty‐two critical care physicians from one university were asked to ascribe intention in two hypothetical scenarios A and B in which outcomes differ—the patient from whom life‐sustaining treatment is withdrawn dies in scenario A but survives in scenario B—but the intention, to save the other patient regardless of the outcome of the other, is the same. The survey was administered via a web‐based survey and all answers were anonymous. A paired proportion test was used to compare responses to both questions. All 52 surveyed individuals responded in scenario A and 30 (57.7%) ascribed intention when outcomes were unfavorable, whereas 50 responded in scenario B and 8 (16%) ascribed intention when outcomes were favorable, a difference that was statistically significant (p < 0.001). There are theoretical and practical issues with the arguments proposed to justify the unilateral withdrawal of life‐sustaining treatment based on the equivalence thesis and the rule of double effect. (shrink)

Imagine you are the CEO of a hospital [. . .]. Decisions are constantly being made in your organization about how to spend the organization's money. The amount of money available to spend is never adequate to pay for everything you wish you could spend it on, therefore you must set spending priorities. There are two questions you need to be able to answer . . . How should we set priorities in this organization? How do we know when we (...) are doing it well? When people seek to achieve good public policy, the result will tend to be good public policy. In a collective choice process, public‐spirited individual participants produce good public policy by deliberating—talking with each other, listening to each other's arguments, and being willing to learn and change their minds based on such dialogue. –Steven Kelman (1992: 181) Public policy scholars agree that those persons (or agencies) vested with the authority to establish health care priorities should elicit public input before making rationing decisions. The two most common approaches are (i) consultation and (ii) deliberation. Though deliberation has obvious advantages over consultation, it falters in the face of the objection that ordinary citizens lack the cognitive resources for the extended, rigorous inquiry required of them in undertaking the priority‐setting task. To overcome this objection, I propose that deliberative forums for health care rationing should be designed so that they imitate the natural pattern of human experience. The experience of deliberation should encompass both prolonged periods of less‐demanding cognitive activity, in which citizens passively receive information, and briefer periods of more‐demanding cognitive activity, in which they engage in active problem‐solving. In arguing for this thesis, I rely on two theoretical sources and one practical case study, in the following order: (i) John Dewey's metaphysics of experience, (ii) cognitive science research on schemas and frames, and (iii) the Health Care Council in São Paulo, Brazil. (shrink)

The concept of ‘geneticization’ has been introduced in the scholarly literature to describe the various interlocking and imperceptible mechanisms of interaction between medicine, genetics, society and culture. It is argued that Western culture currently is deeply involved in a process of geneticization. This process implies a redefinition of individuals in terms of DNA codes, a new language to describe and interpret human life and behavior in a genomic vocabulary of codes, blueprints, traits, dispositions, genetic mapping, and a gentechnological approach to (...) disease, health and the body. This article analyses the thesis of ‘geneticization’. Explaining the implications of the thesis, and discussing the critical refutations, it is argued that ‘geneticization’ primarily is a heuristic tool that can help to re-focus the moral debate on the implications of new genetic knowledge towards interpersonal relations, the power of medicine, the cultural context and social constraints, rather than emphasizing issues as personal autonomy and individual rights. (shrink)

The work of thinking about, with, and through care is not the prerogative of any single discipline or positionality, as this Special Issue vividly illustrates. Rather, its wide-ranging and enduring force as empirical reality, conceptual approach and political disposition are best grappled with through a multidisciplinary lens, bringing into meaningful conversation and careful comparison different subjects, sites and scales of care. In the process, care emerges as a contested terrain, an object of debate and difference, as well (...) as an ongoing central dimension to life as lived across the realms of the individual to the collective and the institutional. It is thus our hope that the offerings in this Special Issue invite further attention to care's role in shaping social and political life, in Australia and beyond, and for humans and non-humans. We intend for this Issue to stimulate the kinds of coalitional thinking and acting that care demands of scholars across fields and also across differently situated communities of ‘we’. (shrink)

Some moral philosophers in the West hold that adult children have no more moral obligation to support their elderly parents than does any other person in the society, no matter how much sacrifice their parents made for them or what misery their parents are presently suffering. This is because children do not ask to be brought into the world or to be adopted. Therefore, there is a "basic asymmetry between parental and the filial obligations." I argue against the Daniels/English (...) class='Hi'>thesis by employing the traditional Confucian view of the nature of filial obligation. On the basis of a distinction between 'moral duty' and 'moral responsibility' and the Confucian concept of justice, I argue that the filial obligation of adult children to care respectfully for their aged parents is not necessarily self-imposed. I conclude that due to the naturalistic character of the family, the nature of our familial obligations cannot be consensual, contractarian and voluntarist, but instead existential, communal and historical. (shrink)

Most punishment theories acknowledge neither the full extent of the harms which punishment risks, nor the caring practices which punishment entails. Consequently, I shall argue, punishment in most of its current conceptualizations is inconsistent with treating offenders as equals qua persons. The nature of criminal punishment, and of our interactions with offenders in punishment decision-making and delivery, risks causing harm to offenders. Harm is normalized when central to definitions of punishment, desensitizing us to unintended harms and obscuring caring practices. Offenders (...) may be partially silenced and excluded by mainstream criminal justice practices which limit interaction between offenders and practitioners. When we ignore significant harms, or silence and exclude, we treat others as passive non-subjects. This partially objectifies offenders, and is inconsistent with treatment as equals. Penal theories employing harm-centred and harm-normalizing definitions of punishment can provide few resources to help practitioners either avoid, or recognize and respond to, harms. Care ethics, by contrast, motivates the avoidance of harm, ongoing inclusive engagement, and respectful interaction with others. I argue that defining punishment without presupposing harm facilitates the identification of morally problematic harms, and recognition of caring practices. I offer a principled argument, and political and pragmatic supplementary arguments, for responding to offenders without intentional harm and with care. Principles drawn from care ethics can help to strengthen mainstream criminal practices by structuring decision-making and action. Bottom-up alternative criminal justice practices share some values with these proposed guiding principles, allowing a partial test of the principles. I consider examples of restorative justice practices, therapeutic jurisprudence, community justice and other problem-solving court practices, in addition to considering how well mainstream punishment practices measure up to these principles. My analysis illuminates the strengths and weaknesses of the principles, and how they might contribute to securing treatment as equals for offenders in mainstream practices. (shrink)

The relation between the concepts of the subject of apperception, the phenomenal self, and the noumenal self has long puzzled commentators on Kant’s theoretical account of the self. This paper argues that many of the puzzles surrounding Kant’s account can be resolved by treating the subject of apperception and other transcendental predicates of thinking as a dimension of the noumenal self. Yet this interpretation requires a clarification of how the transcendental predicates of thinking can be attributed to the noumenal self (...) without violating the thesis of noumenal ignorance. The clarification is achieved through a careful analysis of the meaning of the latter thesis. The paper’s interpretation is then shown to be consistent with Kant’s rejection of traditional ontology and with the dual-aspect view. The paper’s final section argues that transcendental predicates are properly construed as logical predicates but must be distinguished from ordinary examples of the latter. (shrink)

In "Monkeys, Men, and Moral Responsibility: A Neo-Aristotelian Case for a Qualitative Distinction," Paul Carron (2017) uses the tragic case of Travis the chimpanzee to test Frans de Waal's gradualism. If Travis is not to blame for anything simply because he's a chimp, then gradualism cannot be total: There must be a qualitative difference between chimps and humans that makes humans morally responsible and chimps not. As I understand it, Carron's neo-Aristotelian thesis is that chimps cannot emotionally regulate: The (...) emotional states from which primates act are given to them and "lack rational content," whereas the emotional states from which humans act can be self-consciously developed in the cultivation of character. Carron takes this thesis to be a friendly amendment because it arises "from within the sentimentalist tradition itself broadly construed." In this comment I question just how friendly Carron's amendment turns out to be. (shrink)

The relation between the concepts of the subject of apperception, the phenomenal self, and the noumenal self has long puzzled commentators on Kant’s theoretical account of the self. This paper argues that many of the puzzles surrounding Kant’s account can be resolved by treating the subject of apperception and other transcendental predicates of thinking as a dimension of the noumenal self. Yet this interpretation requires a clarification of how the transcendental predicates of thinking can be attributed to the noumenal self (...) without violating the thesis of noumenal ignorance. The clarification is achieved through a careful analysis of the meaning of the latter thesis. The paper’s interpretation is then shown to be consistent with Kant’s rejection of traditional ontology and with the dual-aspect view. The paper’s final section argues that transcendental predicates are properly construed as logical predicates but must be distinguished from ordinary examples of the latter. (shrink)