Over the past thirty-odd years, the feminist contribution of the ethic of care has changed the way in which scholars and ‘lay people’ think about and approach ethical practices in our contemporary society. These changes are important in two significant ways. First, the contribution of feminist work to the body of ethics as a whole is a valuable addition. Second, by drawing attention to the concrete context of moral decision-making, particularly the notion of care, feminist scholars have opened the (...) door for meaningful discussion and understanding of the word care as it is involved in moral decision-making. The latter is where Lonergan’s theory of ethics is most beneficial.The article is written in four sections. It begins with a brief review of a feminist perspective on the ethic of care; a second section explores Lonergan’s identification of levels of consciousness as relevant to feminist notions of care; a third section explores the influence of Aquinas on Lonergan’s theory of ethics and richly applies this fuller context (linking feelings, plans, actions and decisions) to feminist contributions; a final section enlarges significantly on the meaning of the word care by introducing Lonergan’s idea of functional specialization as an ‘ethic of ethics’ that will care about the field of ethics in a radically new way. (shrink)

The perspectives of the dominant Western ethical theories, have dominated the concepts of autonomy and informed consent for many years. Recently this dominant understanding has been challenged by ethics of care which, although, also emanates from the West presents a more nuanced concept: relational autonomy, which is more faithful to our human experience. By paying particular attention to relational autonomy, particularity and Process approach to ethical deliberations in ethics of care, this paper seeks to construct a concept of (...) informed consent from the perspective of ethics of care which is here called relational autonomy-in-informed consent (RAIC). Thus, providing a broader theoretical basis for informed consent beyond the usual theoretical perspectives that are particularly Western. Care ethics provides such a broader basis because it appeals to a global perspective that encompasses lessons from other cultures, and this will help to enrich the current ideas of bioethics principles of autonomy and informed consent. This objective will be achieved by exploring the ethics of care emphasis on relationships based on a universal experience of caring; and by contrasting its concept of autonomy as relational with the understanding of autonomy in the approaches of the dominant moral theories that reflect rational, individualistic, and rights-oriented autonomy of the American liberalism. (shrink)

Philip McShane explores the implications of Bernard Lonergan’s compacted account of ‘what questions’ and ‘what-to-do questions’ for understanding deliberation. The essay provides a fascinating and instructive glimpse into McShane’s own long-continued struggle and dialogue with Lonergan’s achievement.

In psychiatry, caregivers try to get free and informed consent of patients, but often feel required to restrict freedom and to use coercion. The present article develops ethical advice given by an Ethics Committee for Mental Health Care. The advice recommends an ethical ideal of shared deliberation, consisting of information, motivation, consensus and evaluation. For the exceptional use of coercion, the advice develops three criteria, namely incapacity to deliberate, threat of serious harm and proportionality between harm and coercion.The article (...) also discusses the viewpoints of the ethical advice and of the European Convention on Human Rights and Biomedicine: is the advice in agreement with the Convention and can the advice refine the guidelines of the Convention for the particular context of psychiatry? Although the Convention emphasises the autonomy of the individual patient, whereas the advice focuses on the relationships between the partners involved, the advice enjoys a complementary and supportive function in the application of the Convention. (shrink)

Kenneth Melchin states two objectives for his book Living with Other People: 1) to present the main elements of a study of Christian ethics based on the work of Bernard Lonergan; and 2) to provide readers with tools for moral self-understanding and deliberation.

This paper explores the intersection of Bernard Lonergan’s philosophy of intentional human consciousness and the evolving discourse on artificial intelligence (AI). By understanding the distinctions between human cognition and AI capabilities, we can develop a Nouvelle théologie that addresses the ethical and theological dimensions of AI’s integration into society. This approach not only highlights the unique human capacities for self-reflection and moral reasoning but also guides the deliberate and responsible design of AI to promote human flourishing and the (...) common good. It seeks to enrich contemporary technological engagement with insights drawn from the rich reservoir of Catholic intellectual tradition, particularly through the lens of Lonergan’s cognitive theory, which emphasizes the dynamic interplay of experiencing, understanding, judging, and deciding. Highlighting the profound gap between AI’s computational abilities and the depth of human cognition, the paper argues for the uniqueness of human spiritual and moral capacities—features that AI cannot emulate. The exploration reaffirms the human person’s imago Dei and the irreplaceable capacity for transcendence, ethical discernment, and relationality, informing a responsible approach to AI development that upholds human dignity and serves the common good. The paper challenges the narrative of technological determinism, advocating for active human agency in shaping AI’s societal role. It promotes a Lonerganian ethical framework for AI that adheres to the transcendental precepts of attentiveness, intelligence, reasonableness, and responsibility—principles that guide technology development toward enhancing human well-being and fostering communal flourishing. (shrink)

Bernard Lonergan is a Jesuit philosopher-theologian whose work is having an increasing influence, particularly on those concerned with identifying the nature of theological reflection and its relation to other areas of human inquiry. The purpose of this volume is to introduce a broader philosophical and theological audience to the world of Lonergan's thought. This world is principally characterized by Lonergan's notion of horizon-analysis. Perhaps the best way to explain what this means is to link it to (...) Lonergan's view that man is a being who can ask questions. Questions that he can raise and answer constitute the known. Questions that he can raise but cannot answer as yet constitute the known unknown, the docta ignorantia. There are still other questions, meaningful in themselves. that man, because of his historical situation, cannot even raise simply because they are not meaningful for him, and these constitute the unknown unknown, the indocta ignorantia. An horizon marks the boundary between the known unknown and the unknown unknown, that is, it provides the maximum field of knowledge available within the range of questions possible within a given methodological structure. A new horizon, that is, a new field of knowledge, emerges when a new kind of consciousness with an implicit new kind of method which makes it possible for a man to ask questions that previously were meaningless for him. Lonergan's work has been a careful attempt, based on horizon-analysis, to investigate the possibilities for metaphysical and theological understanding. Tracy, in setting forth as comprehensively as possible the full range of Lonergan's work, shows how his early studies of Thomas Aquinas focused on the centrality in the Thomistic noetic of the dynamic character of the act of knowing, an act that is not one of confrontation with an object but one of identity-in-being, of a deepening interiority making it possible for new questions to become meaningful. In his major epistemological study, Insight, Lonergan sought to show how the scientific method and the critical movement in philosophy were of crucial significance in providing new horizons for the question-asking being, man, whose dynamic interiority grounds a metaphysics and whose dynamism prolonged into doing grounds an ethics. The later Lonergan, the Lonergan of the post-Insight period, is the Lonergan who is seeking to discover how a new historical consciousness, a consciousness distinct from that of "classical" man, provides a new horizon for asking questions of philosophical and theological import. Thus Lonergan's major concern today is with method, that is, with a normative pattern of recurrent operations resulting in cumulative and progressive results. Through horizon-analysis Lonergan is currently seeking "to move fully and coherently from... a notion of theology as 'reason illuminated by faith' to 'method illuminated by faith'." Because Lonergan has significant things to say about human knowledge and because his highly original approach has affinities to developments in phenomenology and linguistic analysis, this patient and painstaking introduction to his thought should be of value to many contemporary philosophers.--W. E. M. (shrink)

This paper highlights a number of ethical dilemmas encountered in a pilot study with a hard-to-reach group of research participants with harmful childhood histories. Drawing on a project exploring black teenage mothers' understandings of their own childhood experiences of abuse, it is argued that in asking young mothers to talk about such an emotionally sensitive topic as their own harmful childhood, a number of challenges are posed about how to deal with number of key ethical principles. The paper begins by (...) outlining the context of the pilot study, including the research literature on this subject. It then discusses three key ethical principles that were considered during the process of the research: issues of gaining consent; and when the principle of confidentiality ought to be breached when a duty of care prerogative emerges. The paper explores these tensions in operationalising these principles when dealing with the competing needs and rights of gatekeepers, the young women and their carers, using occasional extracts from research findings to illustrate these tensions. The paper concludes with a discussion of the ethical challenges in accessing marginal voices in social research. (shrink)

Historically, society has not had a robust, institutionalized ethic for how animals should be treated. Before the Animal Welfare Act, the only laws constraining animal use in society were the anticruelty laws forbidding sadistic, deviant, purposeless, deliberate, unnecessary infliction of pain and suffering on animals, or outrageous neglect. These laws, both by statute and by judicial interpretation, did not apply to socially accepted animal uses such as research or agriculture. Because the overwhelming use of animals in society was in agriculture, (...) aimed at providing food, fiber, locomotion, and power, and because the key to agricultural success was having healthy animals, good husbandry and good care were enforced by the most powerful sanction, self‐interest; the anticruelty laws were only there for society to manage sadists and psychopaths unmoved by self‐interest. But with the emergence of new kinds of “normal” animal use—such as intensive agriculture and animal research, both of which caused animal pain and suffering that did not fall under the anticruelty ethic—society was forced to create a new ethic for animals that went “beyond cruelty.” The Animal Welfare Act was a start, but it did not address all of the ethical concerns that society has had about the treatment of animals. As evidence of the need for a new ethic for animals, thousands of bills pertaining to animal welfare have been promulgated across the United States in the last decade. The new ethic for animals essentially applies much of our social ethic for humans, mutatis mutandis, to the treatment of animals and embodies the desired protections in the legal system. (shrink)

ABSTRACT This paper reports on a multidisciplinary meeting held to discuss ethical issues in medical research in the developing world. Many studies, including clinical trials, are conducted in developing countries with a high burden of disease. Conditions under which this research is conducted vary because of differences in culture, public health, political, legal and social contexts specific to these countries. Research practices, including standards of care for participants, may vary as a result. It is therefore not surprising that ethical issues (...) emerge. This meeting sought to identify and discuss these issues from the perspectives of the many actors in such research, including community representatives, with a view to finding ethical and pragmatic solutions to these issues. Dialogue between these actors was also promoted, with a view to identifying the need to develop such dialogue in future. Drawing from the experiences of the speakers, the colloquium attempted to outline some answers to several key questions characterising the field today. Experiences related to epidemiologic research, vaccine trials, drug trials, diagnostic tests and to some fundamental ethical issues in health research. Speakers were from different countries, disciplines and professions. The meeting provided a forum for consultation and debate between different ethics actors. Both encouraging findings and challenges emerged. (shrink)

The problem of interdependence is crucial for understanding the climate, with its interactions between land, water and atmosphere, as well as with human activities, past and future. The concept of interdependence expresses two types of relationship, that of causality and that of responsibility. For the problems of climate governance as understood as a statistical average in the Conferences of the parties (COP), causal dependence is impossible to reconstruct precisely, notably because of the complexity of these phenomenons. However, dependence does not (...) only concern the domain of being, falling within the natural sciences and social sciences and human descriptivo-predictive. It also concerns the ought-to-be and therefore the normative sciences (ethics, political thery, law and normative economy). Here interdependence is much more problematic since it is opposed to freedom. The article discusses the various interdependencies and political solutions that are offered to take care of this needs, architectures for discussing climate change politically: systems (N. Luhmann) and deliberation (J. Habermas). He proposes then another solution, that of the moral and political consediration. (shrink)

The problem of interdependence is crucial for understanding the climate, with its interactions between land, water, and atmosphere, as well as with human activities, past and future. The concept of interdependence expresses two types of relationship, that of causality and that of responsibility. For the problems of climate governance as understood as a statistical average in the Conferences of the parties (COP), causal dependence is impossible to reconstruct precisely, notably because of the complexity of these phenomena. However, dependence does not (...) only concern the domain of being, falling within the natural sciences, the social sciences, and the human descriptive predictive. It also concerns the ought-to-be and therefore the normative sciences (ethics, political theory, law, and normative economy). Here interdependence is much more problematic since it is opposed to freedom. This article discusses the various interdependencies and political solutions that are offered to take care of this needs, architectures for discussing climate change politically: systems (N. Luhmann) and deliberation (J. Habermas). It then proposes another solution, that of moral and political consideration. (shrink)

Bernard Lonergan devoted much of his life's work to developing a generalized method of inquiry, an integrated view which would overcome the fragmentation of knowledge in our time. In Topics in Education Lonergan adapts that concern to the practical needs of educators. Traditionalist and modernist notions of education are both criticized. Lonergan attempts to work out, in the context of the human good and the 'new learning,' the rudiments of a philosophy of education based on his (...) well-known discovery of norms in the unfolding of intelligent, reasonable, and responsible consciousness. He explores how the scientific revolution has changed ways of understanding reality, and examines the implications of this revolution for education. Topics in Education, the first publication of his 1959 lectures, follows Lonergan on his early explorations of human development, studies the theories ofJean Piaget and others, and concludes with his own original ideas in the realms of ethics, art, and history. Bernard Lonergan (1904-1984), a professor of theology, taught at Regis College, Harvard University, and Boston College. An established author known for his Insight and Method in Theology, Lonergan received numerous honorary doctorates, was a Companion of the Order of Canada in 1971 and was named as an original members of the International Theological Commission by Pope Paul VI. (shrink)

Introduction The act of caring in nursing requires previous deliberation and decision, however this perception only arises when an ethical problem emerges. Objective: Identify ethical problems of nurses action in the area of beginning of human life Method: Exploratory and descriptive method, with a qualitative approach. Semi-structured interviews were used to collect data, who were submitted to content analysis. The sample was constituted by 26 nurses. Results 18 categories of problem areas and 56 ethical problems in early human life were (...) identified. The results obtained are very diverse, including areas such as termination of pregnancy, informed consent or maintaining privacy. However, other problem areas also emerge and numerous new subcategories/ethical problems, including: dealing with miscarriage, extreme situations, minors’ pregnancy, serious malformations detected at birth, consent regarding care during childbirth, Non- identification of a ethical problem, nurse social recognition and non-involvement of the person in labour. Conclusion Nurses face different ethical problems that impact their lives. We intend to contribute in helping to make decisions in this field, which the outset is of hope and joy, but which hides, behind this evidence, countless situations of suffering for everyone involved. The identification of ethical problems in this field, it is the first step to reflect about theme and helping decision-making for nurses that are taking care in this area of beginning of human life, when confronted whit the same type of ethical problems. (shrink)

The book relies on Bernard Lonergan’s method. It addresses today’s religious conflicts in the Middle East which have led to migrations of millions of persons. It systematically explores possible breakthroughs that might help people open their hearts to one another.

This volume is an edited version, recreated from tapes and auditors' notes, of the ten lectures that Canadian Jesuit, Bernard Lonergan, delivered on his Insight.

Background: Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. Research questions: How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Research design: Quantitative analysis of a (...) questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Participants and research context: Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Ethical considerations: Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Findings: Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. Conclusion: The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team’s cohesion as mutual understanding for one another’s views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents. (shrink)

Objective: Ethical guidelines are designed to ensure benefits, protection and respect of participants in clinical research. Clinical trials must now be registered on open-access databases and provide details on ethical considerations. This systematic survey aimed to determine the extent to which recently registered clinical trials report the use of standard of care and post-trial obligations in trial registries, and whether trial characteristics vary according to setting. Methods: We selected global randomized trials registered on http://www.clinicaltrials.gov and http://www.controlled-trials.com. We searched for intervention (...) trials of HIV/AIDS, malaria, and tuberculosis from 9 October 2004, the date of the most recent version of the Helsinki Declaration, to 10 April 2007. Results: We collected data from 312 trials. Fifty-eight percent (58%, 95% CI = 53 to 64) of trial protocols report informed consent. Fifty-eight percent (58%, 95% CI = 53 to 64) of trials report active controls. Almost no trials (1%, 95% CI = 0.5 to 3) mention post-trial provisions. Most trials measure surrogate outcomes. Twenty percent (20%, 95% CI = 16 to 25) of trials measure patient-important outcomes, such as death; and the odds that these outcomes are in a low income country are five times greater than for a developed country (odds ratio (OR) 5.03, 95% CI = 2.70 to 9.35, p = < 0.001). Pharmaceutical companies are involved in 28% (CI = 23 to 33) of trials and measure surrogate outcomes more often than nonpharmaceutical companies (OR 2.45, 95% CI = 1.18 to 5.09, p = 0.31). Conclusion: We found a large discrepancy in the quality of reporting and approaches used in trials in developing settings compared to wealthier settings. (shrink)

In The Ethics of Discernment, Patrick H. Byrne presents an approach to ethics that builds upon the cognitional theory and the philosophical method of self-appropriation that Bernard Lonergan introduced in his book Insight, as well as upon Lonergan's later writing on ethics and values. Extending Lonergan's method into the realm of ethics, Byrne argues that we can use self-appropriation to come to objective judgements of value. The Ethics of Discernment is an (...) introspective analysis of that process, in which sustained ethical inquiry and attentiveness to feelings as "intentions of value" leads to a rich conception of the good. Written both for those with an interest in Lonergan's philosophy and for those interested in theories of ethics who have only a limited knowledge of Lonergan's work, Byrne's book is the first detailed exposition of an ethical theory based on Lonergan's philosophical method. (shrink)

In this paper, we argue that ‘good care’ in residential nursing homes is enacted through different care practices that are either inspired by a ‘professional logic of care’ that aims for justice and non-maleficence in the professional treatment of residents, or by a ‘relational logic of care’, which attends to the relational quality and the meaning of interpersonal connectedness in people’s lives. Rather than favoring one care logic over the other, this paper indicates how important aspects of care are constantly (...) negotiated between different care practices. Based on the intricate everyday negotiations observed during an ethnographic field study at an elderly nursing home in Germany, the paper puts forth the argument that care is always a matter of tinkering with different, sometimes competing ‘goods’. This tinkering process, which unfolds through ‘intuitive deliberation’, ‘situated assessment’ and ‘affective juggling’ is then theorized along the conceptualization of a ‘practical ethics of care’: an ethics which makes no a priori judgments of what may be considered as good or bad care, but instead calls for momentary judgments that are pliable across changing situations. (shrink)

Beginning with a focus on the ethical foundations of caregiving in health and expanding towards problems of ethics and justice implicated in a range of issues, this book develops and expands the notion of care itself and its connection to practice. Organised around the themes of culture as a restraint on caregiving in different social contexts and situations, innovative methods in healthcare, and the way in which culture works to position care as part of a rhetorical approach to dependency, (...) responsibility, and justice, The Ethics of Carepresents case studies examining institutional responses to end-of-life issues, the notion of informed consent, biomedicine, indigenous rights and postcolonialism in care and theoretical approaches to the concept of care. Offering discussions from a variety of disciplinary approaches, including sociology, communication, and social theory, as well as hermeneutics, phenomenology, and deconstruction, this book will appeal to scholars across the social sciences with interests in healthcare, medicine, justice and the question of how we think about care as a notion and social form, and how this is related to practice. (shrink)

Introduction Although there have been reports of misbehavior and disrespectful maternal care by healthcare providers worldwide, there are few intervention studies aimed at promoting respectful care, particularly among midwives. Research objectives The aim of this study was to examine the effect of Moral Case Deliberation (MCD) on the of midwives’ knowledge and practice in the field of respectful maternity care. Research design and methods This semi-experimental study involved 46 midwives working in the maternity departments of two hospitals affiliated with Bushehr (...) University of Medical Sciences in 2023. The two hospitals were randomly divided into control and intervention groups. All midwives from both hospitals were included in the study. The Dilemma Method of MCD was implemented for midwives of intervention hospital. The Midwives’ Knowledge and Practice of Respectful Maternity Care scale was used for data collection. It was administered both before and two weeks after the intervention. Data were analyzed using SPSS (version 20). Ethical considerations The study was approved by ethics committee of Bushehr University of Medical Sciences in Bushehr, Iran (ethics code: IR.BPUMS.REC.1402.017). All participants provided written informed consent. Findings The intervention group showed a significantly greater increase in knowledge scores from pre-test to post-test compared to the control group ( p <.001). The intervention group had a significantly higher mean change score in practice self-assessment and practice peer evaluation, from pre-test to post-test, than in the control group ( p <.001). Discussion MCD based on the dilemma method can improve practice in the field of respect-oriented midwifery care by increasing knowledge and potentially changing attitudes. Conclusion The Dilemma Method of MCD improved midwives’ knowledge and practice regarding respectful maternity care. This method can be included in the midwifery care quality improvement program to promote respectful maternity care. It is necessary to develop methods for wider dissemination of MCD in the cultural context of Iran. (shrink)

If ethics of care deals with the nature of relationships, attentiveness, and understanding particular others, narrativity ought to play a central part. Sometimes, caring simply amounts to working with narratives. In the article I claim that narrativity can even be said to be native to an ethics of care. Through an example, I demonstrate how a narrative ethics of care can discern and grasp some moral problems better than the standard theoretical outlooks.

In the United States, the Presidential Commission for the Study of Bioethical Issues has proposed deliberative democracy as an approach for dealing with ethical issues surrounding synthetic biology. Deliberative democracy might similarly help us as we update the regulation of human subjects research. This paper considers how the values that deliberative democratic engagement aims to realize can be realized in a human subjects research context. Deliberative democracy is characterized by an ongoing exchange of ideas between participants, and an effort to (...) justify decisions that bind participants by appeal to reasons that the participants can understand and share. Even when unanimous agreement is not reached, the active participation of everyone along with the requirement that reasons be made accessible enhances the legitimacy of the ultimate outcome. Importantly, deliberative democratic structures avoid strict hierarchies and place participants, as much as possible, in the position of equals. Human subjects research has some features that may make deliberative democratic principles seem initially unappealing. For one, there are asymmetries in knowledge between expert researchers conducting the research and participants in the research process. For another, statistical validity is made easiest by research paradigms that produce standardized, quantitative data, which can be difficult to achieve if research participants are given the power to deliberatively reshape the research design as it progresses. These and other problems have tended to produce a human subjects research process where subjects do not actively participate in shaping research, but rather consent to a predefined set of interventions designed by expert researchers and vetted by Institutional Review Boards (IRBs). In this paper, I suggest some ways in which human subjects research could do more to realize deliberative democratic values, and, in particular, how a revised Common Rule might help to realize these values. First, research participants could be treated not as passive subjects but instead involved in research design, ethical review, and the ongoing conduct and dissemination of research. Such participation might involve, for instance, including people who have served as research subjects on IRBs, or replacing IRB oversight for certain forms of research exempted from IRB oversight under a revised Common Rule with oversight by a body of community members or research subjects. It might also involve having the oversight of research that uses more participatory models be more participatory and less hierarchical in nature. I also raise questions about the exemption of research on public benefit programs from any research-level oversight and from consent requirements. While IRBs are likely not the correct overseers, there may be good reason to view such research with a critical eye, because of its potential for long-range impacts on the lives of participants. By giving research subjects a greater voice in research that aims at fine-tuning public benefit programs on which subjects rely, a deliberative oversight process has the potential to recast research participation as a form of active democratic participation and to address a “democratic deficit” in public health. Numerous proposals regarding health care have called for greater participation by laypeople and a more nonhierarchical approach to setting health priorities. Involving lay research subjects in the conduct of public benefits research and other forms of public health research may help to further these goals. (shrink)

<no abstract - brief excerpt> "...efforts at manipulating vulnerable populations into acting in particular ways that may not be in their best interest, has a history going back much longer. Arguably the internet turbocharged some of these efforts, but this has been happening for a long time.".

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 (...) 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)

Raymaker offers an interdisciplinary approach to Bernard Lonergan’s work. He presents a series of five “feedback matrices” to situate his work within a historical context. One can best empower Lonergan’s legacy through a correct understanding and implementation of how the data of human consciousness affects all human knowledge and activities.

The crisis of Covid‐19 has forced us to notice two things: our human interdependence and American society's tolerance for what Nancy Krieger has called “inequalities embodied in health inequities,” reflected in data on Covid‐19 mortality and geographies. Care is integral to our recovery from this catastrophe and to the development of sustainable public health policies and practices that promote societal resilience and reduce the vulnerabilities of our citizens. Drawing on the insights of Joan Tronto and Eva Feder Kittay, we argue (...) that the ethics of care offers a critical alternative to utilitarian and deontological approaches and provides a street‐ready framework for integration into public health deliberations to anchor public policy and investments concerning the recovery and future well‐being of America's citizens and society. (shrink)

Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out (...) consent. We then discuss challenges and opportunities for obtaining consent in labour and birth, given its unique position in medicine.We argue that consent for procedures in labour is always necessary, but this consent does not always have to be fully informed or explicit. We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to the relevant procedures. Explicit consent should always be sought at the point of intervening, unless women antenatally insist otherwise. We caution against implied consent. However, if a woman does not give a conclusive response during labour and the stakes are high, care providers can move to clearly communicated opt-out consent. Our discussion is focused on episiotomies, but also provides a useful starting point for addressing the ethics of consent for other procedures during labour, as well as general time-critical medical procedures. (shrink)

Background Hospital-dependent patients are individuals who are repeatedly readmitted to the hospital because their acute medical needs cannot be met elsewhere. Unlike the chronically critically ill, these patients do not have a continuous need for life-sustaining equipment and can experience periods of relative stability where they have a good quality of life. However, some end up spending months or even years in the hospital receiving resource-intensive care because they are unable to be safely discharged, despite an initial optimistic prognosis. It (...) is hard to reliably identify these patients on admission and more research is needed to better understand the unique medical needs of this population. But the inability to safely discharge these patients to their home or to a skilled nursing facility without rapid readmissions also creates ethical implications for the physicians who care for them. The aim of this paper is to clarify some of the ethical considerations involved in caring for hospital-dependent patients. Main body Among physicians, the care of hospital-dependent patients is likely to disproportionately affect hospitalists and intensivists, whose care is often evaluated in terms of reducing patient length of stay and readmissions. Because hospital-dependent patients’ medical needs thwart the traditional goal of safe discharge, both clinical ethics and physicians’ professional obligations are implicated by their care. The inability to reliably identify these patients early can complicate discussions about treatment goals and informed consent. Similarly, the tremendous dedication of limited resources to these patients without safe discharge back to the community may raise concerns about the just allocation of healthcare resources. Conclusion Our current acute care hospitals are not designed to provide long-term care for hospital-dependent patients. Unfortunately, safe discharge options remain elusive for these patients. Further research and support of this population is needed to more reliably identify hospital-dependent patients on admission, better inform the discussions of short- and long-term treatment goals, and more wisely allocate resources both within our acute care hospitals and larger healthcare system. (shrink)

Health Care Ethics is another addition to the growing number of texts that attempt to provide a much-needed Canadian perspective on many of the issues that arise in the delivery of health care. The readings are divided into three parts: “The Nature and Context of Health Care Ethics”; “Decision-Making in Health Care”; and “Decisions Near the Beginning and End of Life.” Collectively, they cover a variety of different issues—pluralism and multiculturalism, resource allocation and rationing, consent, research involving human (...) subjects, genetics, abortion, assisted reproductive technologies, euthanasia, and assisted suicide. The editorial introductions to these issues, while well written, readable, and clear, are general and deliberately non-committal in assessing the different and competing approaches and arguments reflected in the selected articles in which these issues are discussed. (shrink)

In recent years a growing body of literature on the ethics of care has made significant contributions to understanding the multiple dimensions of care. Feminist theories provide the resource for this interdisciplinary research in which there has been scant attention given to black women's approaches to moral deliberations and understandings of care. Although there are differing interests and diversity among black women, this article seeks to disrupt current frameworks surrounding the ethics of care and discusses a more relevant (...) conceptual framework to bring diverse perspectives to bear in the current wave of interest in caring. By applying black feminist thought to the complexities of black womanhood in the broader society, this paper considers cultural antecedents and lived experiences as a starting point for ethical concerns in reclaiming the everyday world as self-defined by black women themselves to open up new insights into care and its multiple dimensions. (shrink)

Clinical trials for acute conditions such as myocardial infarction and stroke pose challenges related to informed consent due to time limitations, stress, and severe illness. Consent processes shou...

Background: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what (...) Moral Case Deliberation should contain. Objective: To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces. Methods: A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority. Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation. Findings: Other than ‘moral reasoning’ (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of ‘reflections on the psychosocial work environment’ to a varying extent (md: 29%). Additional content comprised ‘assumptions about the patient’s psychosocial situation’ (md: 6%), ‘facts about the patient’s situation’ (md: 5%), ‘concrete problem-solving’ (md: 6%) and ‘process’ (md: 3%). Conclusion: The findings suggest that a restorative function of staff’s wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants’ own emotional needs and to develop the use of their emotional knowing to focus on the ethically difficult patient situation. (shrink)

Background: Rationing of various needed services, for example, nursing care, is inevitable due to unlimited needs and limited resources. Rationing of nursing care is considered an ethical issue since it requires judgment about potential conflicts between personal and professional values. Objectives: The present research sought to explore aspects of rationing nursing care in Iran. Research design: This study applied qualitative content analysis, a method to explore people’s perceptions of everyday life phenomena and interpret the subjective content of text data. Data (...) collection was performed through in-depth, unstructured, face-to-face interviews with open-ended questions. Participants and research context: The study population included Iranian nurses of all nursing positions, from clinical nurses to nurse managers. Purposive sampling was employed to select 15 female and 3 male nurses (11 clinical nurses, 3 supervisors, 1 matron, 1 nurse, and 2 members of the Nursing Council) working in hospitals of three cities in Iran. Ethical considerations: The study protocol was approved by Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all participants. Findings: According to the participants, rationing of nursing care consisted of two categories, that is, causes of rationing and consequences of rationing. The first category comprised three subcategories, namely, patient needs and demands, routinism, and VIP patients. The three subcategories forming the second category were missed nursing care, patient dissatisfaction, and nurses’ feeling of guilt. Conclusion: Levels at which healthcare practices are rationed and clarity of the rationing are important structural considerations in the development of an equal, appropriate, and ethical healthcare system. Moreover, the procedure of rationing is critical as it not only influences people’s lives but also reflects the values that dominate in the society. Therefore, in order to minimize the negative consequences of rationing of nursing care, further studies on the ethical dimensions of this phenomenon are warranted. (shrink)

In this article we argue that ubuntu (human interdependence) is not some form of essentialist notion that unfolds in exactly the same way as some critics of ubuntu might want to suggest. Rather, we offer a philosophical position that (re)considers the situation of the self in relation to others. The article starts from the general issues at stake in the debate concerning particularity and universalist ethics. We then reconsider the general position of the ethics of care, and particularly (...) how it has recently been revisited by Michael Slote. Following this, ubuntu is characterised as a particular kind of ethic of care. With this in mind, what we shall put forward is an extension of Seyla Benhabib's (2006) view that the self and others should iteratively and hospitably engage in deliberation. Although we agree with Benhabib that iterations (as arguing over and over again and talking back) are worthwhile in themselves, considering ubuntu (‘a person becoming a person in relation with other persons’), we find Stanley Cavell's (1979) idea of ‘living with skepticism’—particularly, acknowledging humanity in the Other and oneself—as more apposite to extend the theoretical premises of ubuntu. Although the practice of ubuntu is lived out differently amongst Africa's people, we want to add to the diverse ways in which ubuntu can both disrupt and offer ways as to how challenges of human conflict and violence can possibly be resolved. The article finally addresses a couple of educational examples and argues that this approach, by being well-grounded in the life experience of learners, can critically assist the central role of education. (shrink)

Genetic testing reveals information about a patient's health status and predictions about the patient's future wellness, while also potentially disclosing health information relevant to other family members. With the increasing availability and affordability of genetic testing and the integration of genetics into mainstream medicine, the importance of clarifying the scope of confidentiality and the rules regarding disclosure of genetic findings to genetic relatives is prime. The United Nations International Declaration on Human Genetic Data urges an appreciation for principles of equality, (...) justice, solidarity and responsibility in the context of genetic testing, including a commitment to honoring the privacy and security of the person tested. Considering this global mandate and recent professional statements in the context of a legal amendment to patient privacy policies in Australia, a fresh scrutiny of the legal history of a physician's duty to warn is warranted. This article inquiries whether there may be anything ethically or socially amiss with a potential future recommendation for health professionals or patients to universally disclose particular cancer predisposition genetic diagnosis to genetic family members. While much of the discussion remains applicable to all genetic diagnosis, the article focuses on the practice of disclosure within the context of BRCA1/2 diagnosis. An ‘ethic of care’ interpretation of legal tradition and current practice will serve to reconcile law and medical policy on the issue of physician disclosure of genetic results to family members without patient consent. (shrink)

Background: Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. Aim: To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. Research design and context: A case study was conducted (...) in a professional development course (‘learning circle’) for home care nurses, including participant observations and focus groups. The theoretical notion of ‘relational agency’ and the moral concept of ‘practices of responsibility’ were used to conduct a narrative analysis on the nurses’ stories about autonomy. Participants: Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Findings: Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients’ strengths and collaboration with patients and informal caregivers. Discussion: On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. Conclusion: The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together. (shrink)

This article explores the potential of Bernard Lonergan’s philosophy of subjectivity as objectivity as a grounding for value sensitive design (VSD) and the design turn in applied ethics. The rapid pace of scientific and technological advancement has created a gap between technical abilities and our moral assessments of those abilities, calling for a reflection on the philosophical tools we have for applying ethics. In particular, applied ethics often presents interconnected problems that require a more general (...) framework for ethical reflection. Lonergan’s philosophy, which emphasizes the importance of selfunderstanding and self‐transcendence in achieving objectivity, can provide a valuable perspective on VSD and the design turn in applied ethics. The article examines how Lonergan’s philosophy can be applied to VSD and the design turn, and how scientific knowledge can be integrated into an ethics of science without reducing it to an external reflection. By adopting Lonergan’s perspective, we can address the ethical challenges arising from scientific and technological advancements while promoting a more holistic approach to applied ethics. (shrink)

Background: Palliative carers constantly face ethical problems. There is lack of organised support for the carers to handle these ethical problems in a consistent way. Within organisational ethics, we find models for moral deliberation and for developing organisational culture; however, they are not combined in a structured way to support carers’ everyday work. Research objective: The aim of this study was to describe ethical problems faced by palliative carers and develop an adapted organisational set of values to support the (...) handling of these problems. Research design: Ethical problems were mapped out using focus groups and content analysis. The organisational culture were developed using normative analysis and focus group methodology within a participatory action research approach. Main participants and research context: A total of 15 registered nurses and 10 assistant nurses at a palliative unit (with 19 patient beds) at a major University Hospital in Sweden. Ethical considerations: The study followed standard ethics guidelines concerning informed consent and confidentiality. Findings: We found six categories of ethical problems (with the main focus on problems relating to the patient’s loved ones) and five categories of organisational obstacles. Based on these findings, we developed a set of values in three levels: a general level, an explanatory level and a level of action strategies. Discussion: The ethical problems found corresponded to problems in other studies with a notable exception, the large focus on patient loved ones. The three-level set of values is a way to handle risks of formulating abstract values not providing guidance in concrete care voiced in other studies. Conclusion: Developing a three-level set of values adapted to the specific ethical problems in a concrete care setting is a first step towards a better handling of ethical problems. (shrink)

This article draws on ethnographic field data collected during an investigation of the informed consent process and AIDS clinical trials. It describes the involvement of care providers (physicians, nurse practitioners, physician assistants) during the enlistment, or recruitment, phase of the informed consent process. It shows that sometimes care providers are involved in the receipt, evaluation and distribution of information on clinical trials through their interactions with research professionals and patients. It suggests that the involvement of care providers has the potential (...) to influence the informed consent process. Some of the ethical and practice considerations of this are discussed. (shrink)

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and (...) methodologies have emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry. (shrink)