Self‐care, or self‐management, is presented in healthcare policy as a precursor to patient empowerment and improved patient outcomes. Alternatively, critiques of the self‐care agenda suggest that it represents an over‐reliance on individual autonomy and responsibility, without adequate support, whereby ‘self‐care’ is potentially unachievable and becomes ‘care left undone’. In this sense, self‐care contributes to a blame culture where ill‐health is attributed to personal behaviours or lack thereof. Furthermore, self‐care (...) may represent a covert form of rationing, as the fiscal means to enable effective self‐care and supplement, or replace, self‐care capacities, is not provided. This paper explores these arguments through a contemporary ethical analysis of the self‐care agenda. The terms self‐care and self‐management are used interchangeably throughout whereby self‐management is understood as a point in the wider self‐care continuum. (shrink)

이 글은 누스바움의 『분노와 용서』의 중심 주제인 분노에 관하여 고찰하고 분노에 관한 누스바움의 분석에서 배제된 분노의 윤리적 의미를 찾으려는 시도이다. 누스바움은 분노를 부정적 감정이라 본다. 그는 분노가 부정적인 감정인 이유를 규범 윤리의 입장에서 분석하고 분노를 제거해야 한다고 주장한다. 나는 누스바움의 분석이 설득력이 있다고 생각하지만 일면 그가 배제하고 있는 감정 그 자체로서의 분노가 주체와의 관계에서 다른 작용을 할 수 있다고 본다. 그런 이유에서 누스바움과 다른 입장의 논의들을 살펴보기 위해 아리스토텔레스의 분노에 관한 논점을 분석한다. 또 ‘자기 배려 윤리’의 논점에서 분노를 재해석하여 분노가 (...) 윤리적 질료로 가치가 있음을 보일 것이다. 이를 위해 푸코가 해석한 세네카의 분노론을 분석하고 푸코가 포착한 세네카의 분노에 대한 다른 논점들이 무엇인지 조명할 것이다. 이를 바탕으로 분노가 자기 배려 주체에게 윤리적 질료로서 의미가 있음을 보이고, 자기 배려주체에게 윤리적 힘을 키우게 하는 주된 계기로 분노의 의의를 재발견할 수 있음을 논구한다. (shrink)

In clinical practice, evidence suggests that teaching ethics using normative ethical theory has little influence on the ethical actions of providers in practice. Thus, new training methods are needed that improve clinician response to ethical problems. A sensemaking approach to ethics training has demonstrated promise as an evidence-based pedagogical method to improve ethical reasoning and response. Project ECHO is theoretically linked to improved sensemaking. This study examines the effectiveness of ECHO and training in use of sensemaking approaches to (...) ethical response by clinicians. A quasi-experimental design study using univariate linear regression was used to examine the effect of the three types of ethics training on ethical response self-efficacy scores, while controlling for participant characteristics of years in practice, discipline and sex. We found evidence that training in sensemaking through participation in ECHO promotes improved ethical response self-efficacy of clinicians. However, results also suggest that a traditional ECHO format that does not explicitly introduce sensemaking strategies into the training does not result in the same learning outcomes as measured through an ethical response self-efficacy survey. This study found important preliminary results to support use of sensemaking approaches in clinical ethics training. (shrink)

Psychologists, as well as other mental health professionals, face unique demands in the workplace that create increased risk for burnout. This article discusses burnout prevalence and detection, including issues of complexity regarding diagnosis and assessment. An ethical lens is utilized to explore problems that may arise due to burnout, and the ethical responsibility of practicing self-care. Recommendations for graduate clinical training programs as well as practicing professionals are suggested, including strategies for monitoring self and others for warning (...) signs of burnout and implementing self-care. (shrink)

Background The emerging working conditions triggered by the COVID-19 pandemic have imposed numerous ethical challenges on the nurses, which, in turn, can negatively impact the nurses’ physical and mental health, and thus their work performance through intensifying negative emotions and psychological pressures. Aim The purpose of this study was to highlight the nurses’ perceptions of the ethical challenges that they faced regarding their self-care during the COVID-19 pandemic. Research design A qualitative, descriptive study with a content analysis approach. (...) Participants and research context The data were collected through semi-structured interviews with 19 nurses working in the COVID-19 wards of two university-affiliated hospitals. These nurses were selected using a purposive sampling method and the data were analyzed using a content analysis approach. Ethical considerations The study was approved by the TUMS Research Council Ethics Committee under the code: IR.TUMS.VCR.REC.1399.594. In addition, it is based on the participants’ informed consent and confidentiality. Findings Two themes and five sub-themes were identified, including ethical conflicts (the conflict between self-care and comprehensive patient care, prioritization of life, and inadequate care) and inequalities (intra- and inter-professional inequalities). Conclusion The findings demonstrated that the nurses’ care is a prerequisite for the patients’ care. Considering that the ethical challenges faced by nurses are related to unacceptable working conditions, organizational support, and lack of access to facilities such as personal protective equipment, it seems essential to support nurses and provide adequate working conditions to provide patients with quality care. (shrink)

How should feminists view acts of self-sacrifice performed by women? According to a long-standing critique of care ethics such acts ought to be viewed with scepticism. Care ethics, it is claimed, celebrates acts of self-sacrifice on the part of carers and in doing so encourages women to choose caring for others over their own self-development. In doing so, care ethics frustrates attempts to liberate women from the oppression of patriarchy. Care (...) ethicists have responded to this critique by noting limits on the level, form, or scope of self-sacrifice that work to restrict its role in their theories. While we do not here take issue with the initial feminist critiques of self-sacrifice, we suspect that the strategies offered by Care ethicists in response are importantly flawed. Specifically, these responses undervalue the positive roles that self-sacrifice can play in fighting patriarchal oppression. As a result, in attempting to restrict an oppressive norm, these responses risk foreclosing on valuable means of resistance. Our aim is to explore these positive roles for self-sacrifice and thereby rehabilitate its standing with feminists. (shrink)

Clinical ethics consultants are inevitably called to participate in and bear witness to emotionally challenging cases. With the move toward the professionalization of ethics consultants, the responsibility to respond to and address difficult ethical dilemmas is likely to fall to a small set of people or a single clinical ethicist. Combined with time constraints, the urgent nature of these cases, and the moral distress of clinicians and staff encountered during consultation, like other healthcare professionals such as physicians and (...) nurses, clinical ethics consultants could risk burnout. If it is true that clinical ethicists are at risk for burnout, an important strategy to avoid burnout is to develop sound self-care practices. This article reviews the goals and skills of ethics consultation and the role-specific reasons that clinical ethicists may be at risk for burnout, and argues that clinical ethicists may need to engage in self-care practices. Strategies to address burnout are reviewed and opportunities for future research are identified. (shrink)

As members of the largest and most trusted healthcare profession, nurses are role models and critical partners in the ongoing quest for the health of their patients. Findings from the American Nurses Association Health Risk Appraisal suggested that nurses give the best patient care when they are operating at the peak of their own wellness. They also revealed that 68% of the surveyed nurses place their patients’ health, safety, and wellness before their own. Globally, several nursing codes of (...) class='Hi'>ethics include the requirement of self-care. Often, these codes embed the responsibility to protect and promote one’s own health within the clearly described obligation to provide safe patient care. The American Nurses Association Code of Ethics for Nurses is unique in that it states explicitly that nurses must adopt self-care as a duty to self in addition to their duty to provide care to patients. One of the basic assumptions of Watson’s Philosophy and Science of Caring is that caring science is the essence of nursing and the foundational disciplinary core of the profession. Watson’s theory of human caring provides support for the engagement in self-care. Two important value assumptions of Watson’s Caritas are that “we have to learn how to offer caring, love, forgiveness, compassion, and mercy to ourselves before we can offer authentic caring and love to others” and we also must “treat ourselves with loving-kindness and equanimity, gentleness, and dignity before we can accept, respect, and care for others within a professional caring-healing model.” Embedded within several caritas processes is an outline for a holistic approach to caring for self and others that can guide nurses to improve their mental, physical, emotional, and spiritual health. (shrink)

This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral (...) and psychological considerations to support the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy. (shrink)

The paper studies two fundamentally different forms in which the concept of care makes its comeback in twentieth-century thought. We make use of a distinction made by Peter Sloterdijk, who argues that the ancient and medieval ‘ascetic’ ideal of self-enhancement through practice has re-emerged in the nineteenth and twentieth centuries, particularly in the form of a rehabilitation of the Hellenistic notion of self-care (epimeleia heautou) in Michel Foucault’s late ethics. Sloterdijk contrasts this return of (...) class='Hi'>self-care with Martin Heidegger’s concept of being-in-the-world as ‘total care’ (Sorge), an utterly ‘secularized’ understanding of the human being as irreducibly world-embedded that rejects the classical ascetic ideal of world-secession. We examine further the historical roots and emergence of these contrasting contemporary reappropriations of care in the Western tradition of thought and show them to be rooted in two different ontologies and ethics of the self as either world-secluded or world-immersed, autonomous or constitutively relational. The historical point of divergence of these two approaches to care, we argue, can be found in the Christian transformation of Hellenistic ethics. (shrink)

This article suggests that one means for empathetically and imaginatively engaging the intersectional differences of otherness to find commonality while still honoring, recognizing, and celebrating those differences is found in the notion of embodied care—the framing of feminist care ethics in terms of its physical elements. Because embodiment remains a common denominator among humans despite the strength of intersectional differences, the body is an important means of connectivity and thus a basis for at least partial understanding between (...) embodied beings. However, this is a humble commonality born out of responsiveness and listening because the body is also the site of inscribed differences. Authentic care is always responsive and thus respectful of the one cared for. Framing care as performed bodily actions is an effort to capture a corporal basis for morality that has the potential to help us negotiate powerful narratives of socially constructed otherness in order to engage identity-based injustice without silencing the voices and experiences of difference and dissent. Care is described as a performance of the body/self, and how such performances of the body can spark understanding across intersectional differences. The article suggests dramaturgical exercises for developing skills of caring for unfamiliar others. (shrink)

A dominant area of inquiry within intergenerational ethics concerns how goods ought to be justly distributed between noncontemporaries. Contractualist theories of justice that have broached these discussions have often centered on the concepts of mutual advantage and reciprocal cooperation between rational, self‐interested beings. However, another prominent reason that many in the present feel that they have obligations toward future generations is not due to self‐interested reciprocity, but simply because they care about what happens to them. (...) class='Hi'>Care ethics promises to be conceptually well‐suited for articulating this latter reason: given that future generations are in a perpetual condition of dependency on present‐day people's actions, this is precisely the kind of relational structure that care theorists should be interested in morally evaluating. Unfortunately, the care literature has been largely silent on intergenerational ethics. This article aims to advance this literature, offering the blueprints of what a care ethic concerning future generations—a “future care ethic”—should look like. The resultant ethic defends a sufficientarian theory of obligation: people in the present ought to ensure the conditions needed to encourage and sustain a world that enables good caring relations to flourish. (shrink)

These are strange and unprecedented times in the wake of the COVID-19 pandemic. Most frontline healthcare professionals have never witnessed anything like this before. As a result, staff may experience numerous and continuous traumatic events, which in many instances, will negatively affect their psychological well-being. Particularly, nurses face extraordinary challenges in response to shifting protocols, triage, shortages of resources, and the astonishing numbers of patients who require care in expedited time constraints. As most healthcare workers are passionate nursing professionals, (...) frustration and often a sense of powerlessness occur when they find themselves unable to provide needed care to their patients. The overwhelming number of deaths, patients isolated and dying alone, and the ever-present fear of being infected and then infecting colleagues, family, friends due to the lack of protective gear or known protocols takes its toll on emotional and psychological well-being. For nurses, the experience of this significant (hopefully once-in-a-lifetime) event can inflict on-going moral injury. Nurses affected by this trauma require education, coping tools, and therapy to help avoid or alleviate the adverse effects on their well-being. Institutions must provide these resources to tend to the well-being of their healthcare staff, during and beyond the pandemic. This article aims to investigate moral distress—considering it as a moral injury—and offer tools and recommendations to support healthcare nurses as they respond to this crisis and its aftermath. (shrink)

Philosophy Compass, Volume 17, Issue 4, April 2022. -/- In a moment where needs for care are acute and their provision precarious, feminist care ethics has gained new relevance as a framework for understanding and responding to necessary interdependence. This article reviews and evaluates two long-standing critiques of care ethics in light of this recent research. First, I assess what I call the pluralist feminist critique, or the dispute over the ability of care (...) class='Hi'>ethics to address the needs and histories of a range of marginalized subjects. I identify two forms of this critique: the first disputes the biased starting points shaping the development of the theory, and the second concerns the weaponization of care in support of domination. Although these critiques are well-established, I draw attention to recent responses that move care theory in generative directions. I argue that the pluralist feminist critique demands both self-critical transformation in dialog with other feminist schools of thought and a robust account of care ethics' normative authority. I then take up critiques those levied by mainstream ethicists concerned with care theory's adequacy as an ethical approach. I show that recent work on normative authority, conceptual uniqueness, and the grounding of responsibility must be engaged before care theory can be dismissed as “under-theorized.” In articulating these two sets of critiques and evaluating recent rebuttals to them, I argue for a pluralist feminist theory of care within which strands informed by varying philosophical schools and methods can coexist. (shrink)

This book advocates for the philosophical import of care in re-evaluating problems of humanitarianism in the context of the ongoing international refugee and forced migration situation. In doing so, it rethinks the human capacity to care about the suffering of distant others. At a time when emotional resources are running low, there is a need to recast what it means to care, with the aim of generating a productive movement against the rise of value fundamentalism globally—embraced in (...) mantras of ‘good and evil’ and ‘us and them’—and to confront xenophobia and oppressive politics. The author draws upon a wide array of rich traditions, including historical and contemporary writings on self-care and care of the other, to re-examine the intersection of care ethics and justice. She also rethinks the relationship between care and contestation, here analyzed in the aesthetic, ethical, political, and religious domains of human experience. From within the context of this contingent historical repetition of political oppression, the book constructs a reminder not only of what it feels like to care, but how and why we should act upon our care. Care Ethics and the Refugee Crisis is an important contribution to the growing literatures on care ethics and immigration/forced migration in philosophy. It will also appeal to scholars and advanced students working in other disciplines such as political science, refugee and migration studies, and social anthropology. (shrink)

Modern mainstream ethical theories with its overemphasis on autonomy and non-interference have failed to adequately respond to contemporary social problems. A new ethical perspective is very much needed. Thanks to Carol Gilligan's 1982 groundbreaking work, 'In a Different Voice' , we now not only have virtue and communitarian ethicists, but also a group of feminist philosophers, charting a new direction for ethics that tempers modern ethics' obsession with autonomy, contractual rights, and abstract rules. Nel Noddings, in her 'Caring: (...) A Feminine Approach to Ethics and Moral Education', further contributed to this important discussion. In this work, Noddings proposes a new kind of moral ideal. She calls it "caring." Noddings defines "caring," as a direct, felt concern and action from the one-caring toward the well-being of the cared-for. In other words, care is a state of mental engrossment and motivational displacement that impels caring actions for the happiness of the cared-for and it transcends any rule-bound moral judgment. A caring attitude is best manifest in the spontaneous emotive bond of love between a mother and a child. This human relation of unscrutinized maternal love and care should be the model of ethics. Noddings's theory evokes a vigorous debate concerning whether or not the model can withstand rigorous philosophical scrutiny as a stand-alone ethical theory. This paper first discusses the strengths and weaknesses of a pure care ethics. Secondly, it demonstrates why both the Kantian and the Aristotelian attempts are unsatisfactory, and it offers a Confucian solution to the problems of care ethics. It argues that notwithstanding gender-oppressive practices that are at times associated with Confucianism, Confucian ethics of 'ren' (humaneness) is both more compatible with care ethics and is better equipped with conceptual resources than Kantian liberalism or Aristotelian virtue ethics to handle the moral predicament of the postmodern world. The paper demonstrates that care is an inherent element of Confucian 'ren' but that 'ren' is more than Noddings's care. It examines three essential principles that can be extracted from philosophical classical Confucianism: (1) an affectionate and particularistic approach to persons, (2) the mutual conditioning of the two prominent Confucian virtues -- humaneness (ren) and ritual propriety (li), and (3) the inseparability of the familial and the political self. The last section of the paper applies Confucian care ethics to concrete cases such as the geriatric care crisis and the problem of poverty. (shrink)

In an increasingly globalized world, the accessibility of healthcare and medication has expanded beyond local healthcare systems and national borders. This study aims to investigate the transnational health and self-care experiences of 11 Japanese women who have resided in South Korea for a minimum of six months and have utilized oral contraceptives, including those that were acquired over-the-counter (OTC). Data were gathered through semi-structured interviews and analyzed by utilizing the NVivo software. The analysis yielded three significant thematic categories, (...) namely (1) experiences and perceptions of obtaining and utilizing contraceptive pills, including OTC access; (2) individual and social perceptions of pills and their accessibility in Japan, insights from actual users; and (3) enhancing pill accessibility, transnational health and self-care experiences and perspectives. Participants acknowledged that oral contraceptives are a global product and experienced communication challenges with healthcare providers as a result of differing understandings of these medications. Additionally, this study identified transnational strategies, such as purchasing an adequate supply of pills just before departure and seeking pills from local families or acquaintances. This study not only highlights the implications of clinical care for transnational patients but also underscores their critical global perspectives on access to oral contraceptives. Furthermore, it proposes two models for improving accessibility within the Japanese healthcare system, even in prescription-only contexts, by introducing OTC options. (shrink)

Schools self-identify as caring communities and teach young children to be caring for each other. But schools also teach other contradictory and competing messages, such as individualism and self-reliance, rationalist concepts of justice and meritocracy, and other neoliberal approaches to life and community. Furthermore, while endorsements of care are commonly found in educational institutions, caring is not always (or even often) practiced or regarded as a major aim in schools, in contrast with human capital approaches to youth (...) development. This essay examines how schools do and don’t care. At its core is the rearticulation of care ethics in education, and what caring means within the contemporary field. Over time, enthusiasm for care ethics has peaked and waned. It begins with a brief explanation of what caring is within the field of care ethics, before it considers how caring is ideally involved in education. In this case, discourses of care ethics and caring in education can be coopted against the writings of care ethicists to complement positive psychology, socially conservative character education and civic education, and individualistic and neoliberal approaches to education. As a result, schools can appear to care, but do so in highly distorted ways. These distortions, I argue, do not reveal fundamental limitations or flaws within care ethics approaches to care. Instead, they demand a reconsideration and rearticulation of care ethics in the contemporary education landscape: a context which has changed considerably since debates and articulations of care ethics in the 1980s. (shrink)

As health care costs continue to escalate, cost control measures will likely become unavoidable and painful. One approach is to engage external forces to allocate resources - for example, through managed care or outright rationing. Another approach is to engage consumers to make their own allocation decisions, through "self-rationing," wherein they are given greater awareness, control, and hence responsibility for their health care spending. Steadily gaining popularity in this context is the concept of "consumer directed health (...) care" (CDHC), which is envisioned to both control cost and enhance choice, by combining financial incentives with information to help consumers make more informed health care decisions and to appreciate the economic trade-offs of those decisions. While CDHC is gaining attention in the popular press, business publications, and academic journals, it is not without controversy about its relative merits and demerits. CDHC raises questions regarding the ethical limits of consumer responsibility for their choices. While the emphasis on consumer choice implies that autonomy is the ruling ethical principle in CDHC, it must be tempered by justice and beneficence. Justice must temper autonomy to protect disadvantaged populations from further widening disparities in health care access and outcomes that could arise from health care reform efforts. Beneficence must temper autonomy to protect consumers from unintended consequences of uninformed decisions. Thoughtful paternalism suggests that CDHC plans offer choices that are comprehensible to lay consumers, limited in their range of options, and carefully structured with default rules that minimize potential error costs. (shrink)

Recently, an article by Toshiko Tanaka, Takao Yamamoto, and Masahiko Haruno garnered a fair bit of media attention; in “Brain response patterns to economic inequity predict present and future depression indices”, they reported research that purported to show that “pro-social” individuals were more upset by unequal outcomes that didn’t directly disadvantage them than were “individualists.” Further, being pro-social was associated with a higher chance of developing depression. They linked this research with research showing that economic inequality is associated with poor (...) health outcomes, including higher rates of depression. (They cite the epidemiologists Richard Wilkinson and Kate Pickett’s 2006 work... (shrink)

Although Nietzsche scholars have paid close attention to his aphoristic and rhetorical style, few have focused on his practice of writing prefaces. In this paper, I engage in a close reading of Nietzsche’s prefaces and identify five themes present in his earlier and later prefaces: (1) he speaks directly to his readers, (2) he stresses the necessity of slow and careful reading, (3) he encourages readers to trust themselves, (4) he refers to himself as a herald, and (5) he uses (...) combative and polemical language to describe his work. Given these themes, I conclude that Nietzsche’s preface writing project constitutes a practice of self-care as described by Foucault in “Technologies of the Self” and “The Ethics of the Concern for Self as a Practice of Freedom.”. (shrink)

BackgroundPatients have the right to equal, respectful treatment. Nowadays, one third of patient complaints concern health care staff’s behavior towards patients. Ethically safe care requires ethical competence, which has been addressed as a core competence in physiotherapy. It has been defined in terms of character strength, ethical awareness, moral judgment skills in decision-making, and willingness to do good. The purpose of this study was to analyze the ethical competence of practicing physiotherapists.MethodA self-evaluation instrument (Physiotherapist’s Ethical Competence Evaluation (...) Tool) based on an analysis of a concept “ethical competence” was constructed in 2016 and physiotherapists (n = 839), working in public health services or private practice responded to the questionnaire.ResultsBased on the results, most of the physiotherapists evaluated themselves highly ethically competent in all areas of ethical competence, subscales being Strength, Awareness, Skills and Will. Willingness to do good was evaluated as highest, while character strength, including the strength to support ethical processes and speak on behalf of the patient, was evaluated the lowest. Physiotherapists most commonly consult a colleague when encountering an ethical problem. Other methods for problem solving are not very familiar, neither are the international or national ethical codes of conduct.ConclusionsThis was the first attempt to assess all aspects of ethical competence empirically in a clinical environment in physiotherapy, using a novel self-evaluation instrument. Even if physiotherapists evaluate themselves as competent in ethics, further exploration is needed for ethical awareness. Also the patients’ viewpoints about ethically competent care should be considered, to better ensure ethical safety of the patient. (shrink)

Confucian traditions have ingrained gender stratifications in Chinese culture today. Yuan proposes re-reading early Confucian texts as a vision of Ren with Dao with the unity of heaven, earth, and humanity, in order to reclaim the egalitarian aspects and develop openness for gender equity with integration of feminist critical care ethics.

Since the 1990s, numerous studies on the relationship between parents and their children have been reported on in the literature and implemented as a philosophy of care in most paediatric units. The purpose of this article is to understand the process of nurses' care for children in a paediatric setting by using Noddings's caring ethics theory. Noddings's theory is in part described from a theoretical perspective outlining the basic idea of the theory followed by a critique of (...) her work. Important conceptions in her theory are natural caring (reception, relation, engrossment, motivational displacement, reciprocity) and ethical caring (physical self, ethical self, and ethical ideal). As a nurse one holds a duty of care to patients and, in exercising this duty, the nurse must be able to develop a relationship with the patient including giving the patient total authenticity in a 'feeling with' the patient. Noddings's theory is analysed and described in three examples from the paediatrics. In the first example, the nurse cared for the patient in natural caring while in the second situation, the nurse strived for the ethical caring of the patient. In the third example, the nurse rejected the impulse to care and deliberately turned her back to ethics and abandoned her ethical caring. According to the Noddings's theory, caring for the patient enables the nurse to obtain ethical insights from the specific type of nursing care which forms an important contribution to an overall increase of an ethical consciousness in the nurse. (shrink)

In recent approaches to ethics, the personal involvement of health care providers and their empathy are perceived as important elements of an overall ethical ability. Experiential working methods are used in ethics education to foster, inter alia, empathy. In 2008, the care-ethics lab ‘sTimul’ was founded in Flanders, Belgium, to provide training that focuses on improving care providers' ethical abilities through experiential working simulations. The curriculum of sTimul focuses on empathy sessions, aimed at (...) class='Hi'>care providers' empathic skills. The present study provides better insight into how experiential learning specifically targets the empathic abilities of care providers. Providing contrasting experiences that affect the care providers' self-reflection seems a crucial element in this study. Further research is needed to provide more insight into how empathy leads to long-term changes in behaviour. (shrink)

Background Interventions targeting healthcare professionals’ confidence in managing ethical issues in dementia care are limited despite documented positive effects of educational programs on staff knowledge and self-efficacy. However, inconsistencies in the literature regarding the impact of educational programs underscore the need for targeted interventions. The CARE intervention, specifically designed to enhance confidence in ethical decision-making, aims to address this gap. This study evaluates the effectiveness of the CARE intervention in enhancing the ethical self-efficacy of healthcare (...) professionals caring for people with dementia, particularly those with initially low levels of self-efficacy. Methods Using a non-experimental pre-post evaluation design, the CARE intervention was administered to healthcare professionals (n = 86), measuring ethical self-efficacy pre-and post-intervention. We hypothesized significant differences in ethical self-efficacy mean scores pre- and post-intervention for all participants, particularly those with low pre-measurement scores, whom we expected to benefit most from the intervention. Statistical analysis included paired t-tests and Wilcoxon tests for the low pre-measurement subgroup analysis. Results While no significant change was observed in the entire sample, participants with low initial self-efficacy showed a statistically significant improvement post-intervention. Conclusions The CARE intervention holds promise in improving ethical self-efficacy among healthcare professionals with initial low confidence levels. Targeted interventions are essential in addressing confidence gaps in managing ethical challenges in dementia care, with implications for professional well-being and quality of care. Further research should explore long-term effects and expand sample size to enhance generalizability and sustainability of findings. (shrink)

Many teacher candidates get their first taste of life as a full-time teacher in their practicums, during which they confront a host of challenges, pedagogical and ethical. Because ethics is fundamental to the connection between teachers and students, teacher candidates are often required to negotiate dilemmas in ways that keep with the ethical ideals espoused both by the professional body and the community at large. Presenting the case of a teacher candidate who finds herself emotionally depleted in her devotion (...) to students, we look to the ethics of care and virtue for clarifying insights. Care ethics extols intersubjectivity and reciprocity, while virtue ethics enjoins commitment to a noble ideal for its own sake; both perspectives offer useful insights for our case. We argue that the perspectives and practices of contemplative traditions can facilitate the integration of care and virtue ethics, mitigating the risk of disruption in caring relations while minimizing the possibility of a personal p... (shrink)

Background:Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim they have to adapt to assistant nurses' routines. The provider–receiver incongruence revealed here warrants investigation.Aim:To describe the elements of assisted bodily care, as performed in a nursing home.Research design:Data were collected through thirty-nine (...) observations of assisted bodily care, analyzed with qualitative content analysis.Participants and research context:Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home.Ethical considerations:The research was conducted in line with the Declaration of Helsinki, further approved by the regional ethics committee.Findings:Findings show that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Assistant nurses still attempt to adapt this work to the older persons’ wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care.Discussion:Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. They nevertheless seem to know the older persons well enough to adapt the assisted bodily care according to their preferences and to support self-determination. This indicates that openness to older persons’ lifeworlds may be more important than the amount of time available.Conclusion:Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could agree on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all. (shrink)

The following paper aims to re-examine the nature of the moral self as expounded by the Care Ethicists with the prime objective of understanding its ontological potential. It will be argued that this philosophical endeavor of examining the nature of the moral self in light of the Care Ethics theory echoes ontological thoughts and ideas that orbit around themes such as relationality, emotionality, and contextuality. The paper seeks to exhaustively explore the moral significance of these (...) detected ontological standards of the Ethics of Care project. Through this engagement, an affinity between the moral and the ontological aspects of Care Ethics shall be identified. Discussing the proposed ontological significance and implication of the care theory, we shall determine if there is a possibility for developing a dialogue between the domain of ethics and ontology, and if so, then consider what the ontological roots of feminist Care Ethics are. Consequently, through this project, we shall present a revised narrative of morality altogether. (shrink)

Following a brief consideration of two contrasting purposes for teaching the medical humanities, a description is given of a film discussion elective course. In contrast to the usual teaching of medical ethics which is primarily a cognitive activity emphasizing the development of a code of principles such as justice, autonomy, and beneficence, the film discussion elective was primarily an affective activity emphasizing the development of an ethical ideal of caring, relatedness, and sensitivity to others. The pass/fail elective, offered for (...) one credit each quarter for two quarters, met once a week for one hour for twenty-four weeks. Each week a film was shown followed by a group discussion. A wide variety of social issues were covered. The objective of the course was to increase the ethical sensitivity of the medical students through promotion of introspection and reflection on social issues. A brief discussion is given of the importance and appropriateness of using film to promote the affective focus of medicine on the relief of suffering. Examples are given of how the course achieved its objective. A detailed description of the resource materials is provided. (shrink)

Teaching students to build resilience is necessary to keep imagining and fighting for a path towards social justice. To do so, clinicians can draw from the communities facing oppression and examine how they remain resilient despite oppression.

This paper begins with specific articulations of ‘care’ by three prominent care theorists - Eva Kittay (1999), Joan Tronto (2013), and Maria Puig de la Bellacasa (2017) - to analyze aspects of the Covid-19 reality in the US and in India. The central concern is to explore whether a care analysis of the pandemic can initiate radically different imaginings of ‘living with’ in a post-Covid world. After examining some roadblocks to adopting the deeply relational nature of life (...) that Covid-19 foregrounded, I explore whether our response to the crises contains an implicit self-refutation of entrenched neoliberal frameworks based on atomized selfhood, individualized responsibility, and the values of market fundamentalism. (shrink)

Patients with borderline personality disorder (BPD) are overrepresented in compulsory inpatient care for suicide-protective reasons. Still, much evidence indicates negative effects of such care, including increased suicide risk. Clinical guidelines are contradictory, leaving clinicians with difficult ethical dilemmas when deciding on compulsory care. In this study, we analyse the arguments most commonly used in favour of compulsory care of BPD patients, to find out in what situations such care is ethically justified. The aim is to (...) guide clinicians when deciding on compulsory care for BPD patients and reduce the use of potentially harmful care. The arguments analysed are (a) the patients lack decision competence, (b) the patients lack authenticity, (c) compulsory care saves the patient from suicide, (d) compulsory care safeguards against litigation, complaints, or doctor's anxiety, (e) compulsory care is a practical solution in emergencies, and (f) it is better for the caregiver to ‘err on the safe side’. We conclude that compulsory care is not ethically justified in most cases unless the clinician has probable reason to believe that the patient lacks decision capacity by suffering from a severe mental co-morbidity and stands to benefit from such care. (shrink)

‘Have you ever taken sufficient care of yourselves?’ By asking the elite Athenian youth this question, Socrates implies that the liberation of self and the capacity to govern are inseparable. Drawing on the lectures given by Michel Foucault at the Collège de France in 1984 – only recently made available to the public – we show the consequences of the return to this ancient care‐of‐self ethic in the organizational context. After reviewing the contributions made to business (...) ethics by these two philosophers, we propose four phases necessary to the emergence and constitution of a moral subject in organizations: self‐awakening, self‐evaluation, self‐transformation and self‐presentation. We then suggest various managerial practices and behaviour inspired by this philosophical parrhesia embodied by the Greek philosopher wherein the manager should have a personal relationship with his or her own activity. Finally, we discuss implications of our study in the field of business ethics and propose an agenda for future research. (shrink)

Definition of the problem The COVID-19 pandemic poses a considerable challenge to the capacity and functionality of intensive care. This concerns not only resources but, above all, the physical and psychological boundaries of nursing professionals. The question of how care for others and self-care of nurses in intensive care units are related to each other in the context of the COVID-19 pandemic has not been addressed in public and scientific discourse so far. Arguments The present (...) contribution reflects this relationship with reference to the Code of Ethics of the International Council of Nurses, particularly considering principlism and the Care Ethics according to Joan Tronto. As a result, it shows a corridor of ethically justifiable care with several borders, above all: self-care must not be given up completely for the benefit of care for others, and a categorical subordination of care for others to self-care is ethically not justifiable. Conclusion The article makes an important contribution to a differentiated ethical consideration of the rights and responsibilities of intensive care nurses as moral actors within the pandemic in Germany. It, thus, provides a first starting point for a broad social and political discourse which is urgently needed not only during but also after the pandemic in order to improve the situation of intensive care nurses and those who are cared for. (shrink)

People with dementia at times exhibit threatening and physically aggressive behavior toward care staff in residential aged care facilities (RACFs). Current clinical guidelines recommend judicious use of antipsychotic (AP) medications when there is an immediate risk of harm to care staff in RACFs and non-pharmacological interventions have failed to avert the threats. This article examines an account of how this recommendation can be ethically defensible: caregivers in RACFs may have a prima facie ethical justification, in certain cases, (...) to use APs as an act of self-defense. The author examines whether such uses of APs meet the three commonly invoked conditions of ethically permissible acts of self-defense—namely, the conditions of liability, proportionality, and necessity—and argues that such conditions obtain only in a restricted range of cases. The liability constraint can be satisfied if residents are the only ones who are causally responsible for the threats they pose. Further, the condition of proportionality obtains if there is sufficient objective ground to demonstrate that the harm of using the medications does not outweigh the good to be secured. Lastly, the necessity condition obtains when the medications are used at their lowest effective dosage and caregivers in RACFs can reasonably assume that, for the purpose of averting threats posed by residents, the use of APs is the only available course of action. Not meeting any of these fairly stringent conditions renders uses of APs as acts of self-defense in RACFs morally impermissible actions. -/- . (shrink)

This paper examines normative feminist care scholarship through the lens of a sexual bathhouse. At first glance, a space dedicated to casual sexual pleasure seems at odds with feminist care. Drawing on the Toronto Women's Bathhouse (TWB) as a case study, this paper argues that bathhouse spaces can exemplify feminist care norms. At the same time, as a casual sexual space oriented towards personal autonomy, carefree conduct, and self-care, TWB also challenges certain feminist care (...) assumptions. Drawing on these challenges, in the light of wider problems with normative care theorizing, particularly the sanitization and idealization of personal relationships, the paper seeks to revision care along non-normative lines. (shrink)

A study of clinical medical ethicists was conducted to determine the various philosophical positions they hold with respect to ethical decision making in medicine and their various positions' relationship to the subjective-objective controversy in value theory. The study consisted of analyzing and interpreting data gathered from questionnaires from 52 clinical medical ethicists at 28 major health care centers in the United States. The study revealed that most clinical medical ethicists tend to be objectivists in value theory, i.e., believe that (...) value judgments are knowledge claims capable of being true or false and therefore expressions of moral requirements and normative imperatives emanating from an external value structure or moral order in the world. In addition, the study revealed that most clinical medical ethicists are consistent in the philosophical foundations of their ethical decision making, i.e., in decision making regarding values they tend not to hold beliefs which are incompatible with other beliefs they hold about values. (shrink)

Monique Lanoix | : Over three decades ago, Carol Gilligan’s seminal book In a Different Voice provided feminist theorists with a powerful new approach to address the shortcomings of traditional moral theories. With a focus on concrete situations, an ethics of care can attend to the specifics of moral dilemmas that might otherwise be glossed over. As feminist reflection on moral and political philosophizing has progressed, another challenge has emerged. Recent feminist scholarship proposes non-ideal theories as preferable action-guiding (...) theories. In this paper, I examine Kittay’s call for a version of care ethics as a naturalized ethics that comes from lived experience, in order to draw out the salient characteristics of the caring agent. This allows me to show how Kittay’s key assertion that “we are all some mother’s child” resonates with Ricoeur’s framing of self-esteem, which is, in turn, anchored on a notion of solicitude. Secondly, I make the case that care ethics can benefit from Ricoeur’s little ethics as it helps buttress the goal of good caring practices. Finally, care ethics, with its emphasis on the universality of care needs, helps to strengthen the central role of solicitude for the political sphere. | : Il y a plus de trente ans, le livre fondateur de Carol Gilligan, In a Different Voice, fournissait aux théoriciennes féministes une nouvelle approche permettant d’affiner la critique des théories morales traditionnelles, particulièrement en ce qui concerne leur universalisme. Focalisant sur les situations concrètes, l’éthique du care chez Gilligan permet de recentrer l’attention sur les spécificités d’un dilemme moral qui, autrement, risquent de rester dans l’ombre. La réflexion féministe en philosophie morale et politique a progressé depuis, s’attelant à de nouveaux défis. La recherche récente suggère qu’une théorie morale non idéale est préférable aux théories dites idéalistes. Dans cet article, j’examine l’éthique du care selon Eva Feder Kittay, soit à titre d’éthique naturalisée, afin de mettre en relief les caractéristiques saillantes de l’agent.e caring. Cela me permettra ensuite de montrer comment l’affirmation clé de Kittay selon laquelle « nous sommes tou.te.s l’enfant d’une mère » fait écho à la pensée ricoeurienne de l’estime de soi qui est, en retour, ancrée dans la notion de sollicitude. Deuxièmement, je soutiens que la « petite éthique » ricoeurienne peut enrichir les éthiques du care, précisément en ce qui a trait au telos du care. Ce faisant, les éthiques du care, qui placent l’accent sur l’universalité des besoins en cette matière, pourront mieux ancrer la sollicitude dans la sphère politique. (shrink)

High moral standards and adherence to a moral code have long been strong tenets of the profession of medicine, even though there have been occasional lapses that have led to renewed calls for a revitalization of moral integrity in medicine. Certainly, a moral component has generally been held to be an important aspect of the concept of a physician.

Background The fourth section of the 1967 Abortion Act states that individuals (including health care practitioners) do not have to participate in an abortion if they have a conscientious objection. A conscientious objection is a refusal to participate in abortion on the grounds of conscience. This may be informed by religious, moral, philosophical, ethical, or personal beliefs. Currently, there is very little investigation into the impact of conscientious objection on service users in Britain. The perspectives of service users are (...) imperative in understanding the real-world consequences and potential impact of conscientious objection and should be considered when creating and reviewing policies and guidelines. This research provided a platform for women and those who can become pregnant to share their experiences and opinions at a time when these voices are largely excluded in the great tradition of Western political philosophy and law-making processes. Method Five service users were interviewed using a narrative interview approach to uncover their abortion journeys and experiences of conscientious objection. Findings The findings were presented as found poems and uncovered that doctors are not always: informing service users that they have a conscientious objection to abortion, giving service users enough information to access abortion (indirect referral), treating them non-judgmentally, and providing medically correct information. Service users did not experience burdens such as long waiting times and were still able to access legal abortion. However, service users did experience negative emotional effects, as they were often left feeling scared, angry, and hopeless when they were not referred and/or were mistreated. Conclusions Findings indicate that conscientious objection could work in practice. However, it is currently failing some individuals on an emotional level, as not all doctors are adhering to guidelines. Conscientious objection in Britain needs to be addressed, to ensure service users receive fair, impartial, non-judgmental care. (shrink)

Patients in nursing homes sometimes give accounts of episodes in which they feel their autonomy and/or self-respect are violated as a result of the care they receive from nursing staff. In these ethically difficult care situations nurses use strategies such as negotiation, explanation and, in some cases, restraint. This study investigates how nurses apply these strategies to resolve ethical dilemmas in such a way that patients experience respect rather than violation. Critical issues that will be discussed include (...) the definition of ethically difficult care situations in nursing homes and the identification of strategies for resolving such situations. Examples of the use of three strategies are presented. The use of negotiation, restraint and explanation are discussed in order to ensure respect for patients’ autonomy and thus to optimize health care outcomes. (shrink)