The global increase in patients with chronic conditions has led to increased interest in ethical issues regarding such conditions. A basic biomedical principle—respect for autonomy—is being reexamined more critically in its clinical implications. New accounts of this basic principle are being proposed. While new accounts of respect for autonomy do underpin the design of many public programs and policies worldwide, addressing both chronic disease management and health promotion, the risk of applying such new accounts to clinical setting remain understudied. However, (...) the application of new accounts of respect for autonomy to clinical settings could support disrespectful attitudes toward or undue interference with patients with chronic conditions. Reconsidering autonomy and respect using Kantian accounts, this paper proposes respect for persons as an alternative basic bioethical principle to respect for autonomy. Unlike the principle of respect for persons in the Belmont Report, our principle involves respecting any patient’s decisions, behaviors, emotions, or life-style regardless of his or her “autonomous” capabilities. Thus, attitudes toward patients should be no different irrespective of the assessment of their decisional or executive capabilities. (shrink)

This paper articulates dignity as relational engagement in concrete care situations. Dignity is often understood as an abstract principle that represents inherent worth of all human beings. In actual care practices, this principle has to be substantiated in order to gain meaning and inform care activities. We describe three exemplary substantiations of the principle of dignity in care: as a state or characteristic of a situation; as a way to differentiate between socio-cultural positions; or as personal meaning. We continue our (...) analysis by presenting cases on dignity in care related to us in focus groups with medical professionals. Our empirical ethical lens is in this paper is to analyse, not the meaning of dignity, but the way in which it emerges in practices where it is pursued, within relationships between people, technologies, places, regulations, and the values cherished by or embedded in them. We show that professional caregivers recognize in the dignity of the person they care for their own dignity; giving up on the one implies no less than giving up on the other. This ‘mirrored experience’ of dignity expresses itself in professional’s engagement with the situation. The value of this engagement, we argue, lies not primarily in realizing the particular content of the values at stake. We point to the importance of engagement itself, even if the values engaged with cannot be realized to the full, and even if competing versions of dignity are at stake simultaneously. In this way the caregivers provide us with interesting examples of moral actorship in situations of conflicting values. (shrink)

Research has suggested a fundamental connection between fairness and well-being at the individual, relational, and societal levels. Mattering is a multidimensional construct consisting of feeling valued by, and adding value to, self and others. Prior studies have attempted to connect mattering to both fairness and a variety of well-being outcomes. Based on these findings, we hypothesize that mattering acts as a mediator between fairness and well-being. This hypothesis was tested through Covariance-Based Structural Equation Modeling using multidimensional measures of fairness, mattering, (...) and well-being. Results from a Latent Path Analysis conducted on a representative sample of 1,051U.S. adults provide support to our hypothesis by revealing a strong direct predictive effect of mattering onto well-being and a strong indirect effect of fairness onto well-being through mattering. Results also show that mattering is likely to fully mediate the relationship between fairness and multiple domains of well-being, except in one case, namely, economic well-being. These findings illustrate the value of a focus on mattering to understand the relationship between fairness and well-being and to provide future directions for theory, research, and practice. Theoretical implications for the experience of citizenship and participation, along with cross-cultural considerations, are also discussed. (shrink)