A number of dichotomies bedevil the concept of care, among them, the question of whether healthcare is posited on care or cure. On one side the question is whether it is enough to cure without caring (to cure is to care) and on the other whether caring is sufficient without a cure. This has received attention in recent years from feminists, particularly in the nursing profession, and from renewed interest in virtue ethics. This paper describes a study that was undertaken (...) to explore what a group of experienced United Kingdom based osteopaths understand care to be. Following interviews and transcript analysis using Grounded Theory, a number of themes were identified: Care as communication; Care as understanding the patient; Care as the therapeutic relationship; Care as action; Care as most beneficial outcome. The relationships between the various themes were explored and a ‘model of osteopathic care’ was proposed. Most of the respondents put beneficial outcome of some kind at the heart of their understanding but the process of caring was not regarded as particularly important on its own. In fact the expressed intention of osteopathic care was to facilitate a beneficial outcome. However, beneficial outcome was described in very broad terms and was not confined to the resolution of patients' presenting symptoms. In placing beneficial outcome at the heart of their model of care, respondents did not appear to recognize the dichotomy between care and cure, a finding that contrasts sharply with a number of nursing studies. The paper concludes by suggesting how it may be possible to differentiate between care and good practice. (shrink)

In this paper, I discuss the role of care and competence, as well as their relationship to one another, in contemporary medical practice. I distinguish between two types of care. The first type, care1, represents a natural concern that motivates physicians to help or to act on the behalf of patients, i.e. to care about them. However, this care cannot guarantee the correct technical or right ethical action of physicians to meet the bodily and existential needs of patients, i.e. to (...) take care of them—care2. To that end, physicians must be competent in the practice of medicine both as evidence—based science (technical competence) and as patient—centered art (ethical competence). Only then, I argue, can physicians take care of (care2) patients’ bodily and existential needs in a compassionate and comprehensive manner. Importantly, although care1 precedes competence, competence—both technical and ethical—is required for genuine care2, which in turn reinforces an authentic care1. I utilize the play Wit, especially the character Jason Posner, and Francis Peabody’s exposition on caring for patients, to illustrate the role of care and competence in contemporary medical practice. (shrink)

This paper offers a critical investigation of the theological assumptions that lie within three forms of modern feminist ethics, with a view to challenging feminist ethics to enter the new theological possibilities opened up in postmodernity for the conceiving of god. The first part of the paper considers the conceiving of god in modern feminisms, in which theology becomes ethics. The consequences of this development are considered. The second part of the paper investigates the turn into postmodernity which hears the (...) saying of the death of god and the critique of onto-theology. This disturbance to the foundations of feminist ethics is understood as part of a wider critique of humanism manifest particularly in gender theory. That the end of the modern human subject might allow a conceiving of god through an understanding of the performative is the restored orthodoxy to which the paper points. (shrink)

This article discusses the challenging context that health care professionals are confronted with, and the impact of this context on their emotional experiences. Care ethics considers emotions as a valuable source of knowledge for good care. Thinking with care ethical theory and looking through a care ethical lens at a practical case example, the authors discern reflective questions that shed light on a care ethical approach toward the role of emotions in care practices, and may be used by practitioners and (...) facilitators for care ethical reflection on similar cases, in the particular and concrete context where issues around emotional experiences arise. The authors emphasize the importance of allowing emotions to exist, to acknowledge them and to not repress them, so that they can serve as a vehicle for ethical behavior in care practices. They stress the difference between acknowledging emotions and expressing them limitlessly. Formational practices and transformational research practices are being proposed to create moral space in care institutions and to support health care professionals to approach the emotionally turbulent practices they encounter in a way that contributes to good care for all those involved. (shrink)

Recent conceptualizations of sustainable global development have reflected societal concerns not only with environmental stewardship, but also with social amelioration. However, the tripartite goals of corporate profitability, environmental protection, and social responsiveness are unlikely to be achieved through conventional models of globalization. The emergent approach known as sustainable global enterprise provides a promising strategic alternate, but requires the development of “native capability” [Hart, S. L.: 2005, Capitalism at the Crossroads: The Unlimited Business Opportunities In Solving the World’s Most Difficult Problems. (...) (Pearson Education, Inc., Publishing as Wharton School Publishing, Upper Saddle River, NJ)] that comprises specific relational competencies not typically required by traditional transnational models. This article demonstrates the usefulness of an ethic of care for enhancing understanding of the competencies comprising native capability, and, provides practical insights from a care approach on the development of those skills. (shrink)

The main aim of this paper is to shed light on two somewhat underappreciated theories, which, by drawing attention to the embodied and relational nature of the self, both went beyond the disembodied and individualist paradigm long before most current leading approaches in the field. The paper first considers the routes out of the crisis of this paradigm proposed by care ethics. The first part focuses mainly on Carol Gilligan’s relational account of subjectivity, which served as an inspiration for the (...) development of care ethics as a moral theory, and discusses the strengths and weaknesses of her account. In the next step, the paper sets out to compare the view of the self deployed by care ethics with Donald Winnicott’s account of the transitional area of play. The paper argues that both care ethics and Winnicott’s theory make it possible to understand human subjectivity as at the same time dependent and mature, ambivalent and integrated, vulnerable and responsible, relational and non-arbitrary. Winnicott and care ethicists jointly demonstrate that it is neither an absolute symbiosis with others, nor a total separation from them, that is decisive for the well-being of an individual and a social field. Rather, it is beneficial and morally desirable to cultivate concrete interpersonal relationships in the area of complex relationality. The paper concludes that the crisis of the disembodied and individualistic paradigm of the self cannot be overcome by an uncritical emphasis on the positive function of relational, embodied and supra-individual aspects of human existence. Though essential, these aspects are at the same time complex and developmentally conditioned. (shrink)

This article takes up the educational challenge of the framers of the Universal Declaration of Human Rights. Specifically, the author explores the question of: how can we talk about a universal conception of human rights in a way that both respects the need for cultural pluralism and the necessity to protect those rights and freedoms that all people—regardless of differences such as race, class, culture, or religion—are entitled to? What metaphor or metaphors can be useful for us to speak clearly (...) and coherently about the issue of universal human rights in a diverse world? The author examines a prevailing yet problematic metaphor, which Makau Mutua critiques in his well-known essay ‘Savages, Victims and Saviors: The Metaphor of Human Rights.’ He then attempts to articulate some common values that can serve as a foundation for an alternative conception of human rights. Next, he proposes an alternative metaphor—the Buddhist notion of equalizing and exchanging self and other—that more aptly captures the complexity and contradictions of talking about universal human rights. Finally, he turns to the role of education in helping people become familiar with and respect this alternative metaphor. (shrink)

Philosophy and schools, children and dynamite, elephants and postage stamps: each has a place, but not necessarily in any natural combination with the other. Whether schools and philosophy belong together depends largely on what we mean by both. To the extent that schools are instruments of government regulation and a mechanism for production of economic subjectivity, philosophy might be welcome as an ancillary technique for enhancing problem-solving skills or helping students to think more logically. If, on the other hand, teachers (...) are concerned to promote education as the development of independent thought beyond the realm of instrumental utility, then philosophy is a vital, and potentially critical, engagement with power, with the way schools function, and more generally with society and its government. With reference to some recent policy moves in education, this article argues that the focus on the economic productivity of education is intensifying, and that as educational institutions become more heavily regulated and monitored, there is little provision for, or toleration of, any form of structural criticism, philosophical or otherwise. The conclusion is that philosophy may have an explicit place within the existing school programmes, but that any philosophy which provides a basis for fundamental change in our patterns and expectations of schooling is likely to be undermined. Commitment to critical philosophy becomes, then, a surreptitious activity on the part of individual teachers, operating outside the official curriculum and frustrated by increasing surveillance and demands for accountability. (shrink)

In this paper, I argue that care ethics should be understood as a form of value pluralism. Writers on the ethics of care tend not explicitly to address issues in the theory of value, although much of what has been written about care ethics may be taken to suggest that it endorses some form of value monism. I argue against this conception of care ethics by showing that the practical reality of caregiving is more accurately represented by a pluralist account (...) of value. Practices of care are plausibly guided by a number of distinct and potentially conflicting values. These include quality of life, autonomy, dignity, personal development, and the value of nurturant relationships. Whilst caring takes each of these values to be important in its own right, they are not always jointly realisable, and carers are sometimes forced to promote one such value at the expense of another. The possibility of conflict between values is, of course, precisely what a pluralist conception of value tells us to expect. In this respect, then, value pluralism more faithfully reflects the reality of caregiving than does value monism, and care ethicists ought for this reason to endorse it. (shrink)

The dominance of technological paradigms within psychiatry creates moral and ethical tensions over how to engage with the interpersonal narratives of those experiencing mental distress. This paper argues that such paradigms are poorly suited for fostering principled responses to human suffering, and proposes an alternative approach that considers a view of relationships based in feminist theories about the nature of caring. Four primary characteristics are presented which distinguish caring from technological paradigms: a concern with the particular nature of contexts, embodied (...) practice, the dialogical basis of caring and the existential basis of caring. From this we explore the role of the moral imagination and our ability, through narrative, to acknowledge, engage with and bear witness to the injustices that shape the lives of those who suffer. This, we argue, is at the heart of caring. Clinical implications are discussed, including an exposition of the importance of narrative in recovery from trauma and distress. Narrative Psychiatry, The Sanctuary Model of care, and Soteria, are outlined as examples of this type of practice. (shrink)