The general expectation that patients should be willing to trust nurses is rarely explored or challenged despite claims of diminishing public trust in social and professional institutions. Everyday meanings of trust take account of circumstance and suggest that our understanding of what it means to trust is contextually bound. However, in the context of health care, to trust implies a particular understanding which becomes apparent when abuses of this trust are reported and acknowledged as scandals. The predominant assumption in the (...) literature that trust is something that occurs between equally competent adults cannot explain trust in nursing precisely because of the unequal power relationships between patients on the one hand and healthcare professionals on the other. Moreover, the tendency to conflate terms such as trust, reliance, confidence and so on suggests that confusion permeates discussions of trust in nursing. In this paper, I argue in support of Annette Baier’s requirement of good will (or lack of ill will) as the essential feature of trust, and outline how this account (i) enables us to make the necessary distinctions between trust on the one hand and ‘trust pretenders’ on the other; and (ii) lays the foundations for understanding trust in relationships, such as those between patients and nurses, where power differentials exist. (shrink)

The goal of this paper is to propose a relational turn in healthcare professionalism, to improve the responsiveness of both healthcare professionals and organizations towards care of patients, but also professionals. To this end, it is important to stress the way in which difficult situations and vulnerability faced by professionals can have an impact on their performance of work. This article pursue two objectives. First, I focus on understanding and making visible shared vulnerability that arises in clinical settings from a (...) triple perspective: patient and family, health professionals, and institutions. Second, to address this challenge for professionalism, in this paper I articulate the term "relational centered-patient professionalism", which has two main axes. The relational approach means taking into account how the relationships among professionals, patients and institutions determine the constitution and evolution of those professional values. The focus on patient centered care is indispensable, because it is the ultimate goal pursued by the development of these professional values, and must always be at the center. (shrink)

This paper raises several concerns about vulnerability as an alternative language to conceptualize injustice and politicize its attendant injuries. First, the project of resignifying “vulnerability” by emphasizing its universality and amplifying its generative capacity, I suggest, might dilute perceptions of inequality and muddle important distinctions among specific vulnerabilities, as well as differences between those who are injurable and those who are already injured. Vulnerability scholars, moreover, have yet to elaborate the path from acknowledging constitutive vulnerability to addressing concrete injustices. Second, (...) vulnerability studies respond to, and have been shaped by, debates in the 1980s and 1990s over oppression, identity and agency. This genealogy needs to be acknowledged and evaluated. As I demonstrate, prominent theorists define vulnerability in contradistinction to victimization, adopting neo-liberal formulations of victims and victimhood. Finally, I turn to address the politics of vulnerability. At issue are not simply matters of utility or programmes for implementation, but the fraught relationship among ontology, ethics and politics, which I address through an engagement with Rancière's conception of the political and the case of the Black Lives Matter movement. (shrink)

:Although recent literature on professionalism in healthcare abounds in recommended character traits, attitudes, or behaviors, with a few exceptions, the recommendations are untethered to any serious consideration of the contours and ethical demands of the healing relationship. This article offers an approach based on the professional’s commitment to trustworthiness in response to the vulnerability of those seeking professional help. Because our willingness and ability to trust health professionals or healthcare institutions are affected by our personality, culture, race, age, prior experiences (...) with illness and healthcare, and socioeconomic and political circumstances—“the social determinants of trust”—the attitudes and behaviors that actually do gain trust are patient and context specific. Therefore, in addition to the commitment to cultivating attitudes and behaviors that embody trustworthiness, professionalism also includes the commitment to actually gaining a patient’s or family’s trust by learning, through individualized dialogue, which conditions would win their justified trust, given their particular history and social situation. (shrink)

The idea that nurses should be trustworthy seems to be accepted as generally unproblematic. However, being trustworthy as a nurse is complicated because of the diverse range of expectations from patients, relatives, colleagues, managers, peers, professional bodies and the institutions within which nursing takes place. Nurses are often faced with competing demands and an action perceived by some as trustworthy can be seen by others as untrustworthy. In this article some of the reasons for the importance of being trustworthy are (...) offered together with a preliminary discussion about how being a trustworthy nurse is far from straightforward. (shrink)

The Aristotelian‐Thomist philosopher holds that human intellectual knowledge is possible because of the order in the world and natural human capacities. It is the position of this paper that there is a shared human form or nature that unites all humanity as members of the same kind. Moral treatment is due to every human being because they are human, and is not based upon expression of abilities. Humans have substantial dynamic existence in the world, an existence which overflows in expressive (...) relationships. As both patient and health professional are human, human nature forms the natural foundation of health care. This paper looks towards human nature for moral guidance. The therapeutic relationship is seen as a part of the interpersonal moral space formed by human relationality, which tends towards community – in this case, the healthcare system. The therapeutic relationship is also a source of moral responsibility, as illness makes the patient vulnerable, while knowledge and nursing capacities generate in the nurse a duty to care. Nursing theory serves to connect philosophical reflection and nursing practice. Imogene King's conceptual system and theory of Goal Attainment is the theory that follows from the perspective of human person being presented. This synthesis of philosophy and theory is developed with the goal of shedding light on healthcare decisions in palliative care. The article concludes with the acknowledgement that the complexity of contextualized individual decisions requires the insight and discipline of the moral practitioner, and provides some thoughts on how education, development, and refinement transform an individual into a nurse. (shrink)

The introduction of and the commitment to evidence-based nursing in all care settings have led to a rapid increase of intervention and outcome-based research programs. Yet, the topics of nursing research are not only affected by interventions and outcomes but also affected by the concept of caring derived from humanistic philosophy. Considering this twofold orientation of nursing science, nuanced ethical regulations for nursing research programs are called for. In addition to the different research approaches, further arguments for ethical regulations are (...) as follows: first, the different degrees of contextualization and the variety of participation models regarding the target groups; second, the capacities and opportunities of participants; and third, the caring relationship between nurses and research subjects. To capture these special features of nursing science, four approaches to fill the gaps in existing ethical regulations for nursing research are proposed: (a) process orientation, (b) community orientation, (c) context orientation, and (d) relation orientation. (shrink)

Concern for human vulnerability seems to be at the heart of bioethical inquiry, but the concept of vulnerability is under-theorized in the bioethical literature. The aim of this article is to show why bioethics needs an adequately theorized and nuanced conception of vulnerability. We first review approaches to vulnerability in research ethics and public health ethics, and show that the bioethical literature associates vulnerability with risk of harm and exploitation, and limited capacity for autonomy. We identify some of the challenges (...) emerging from this literature: in particular, how to reconcile universal human vulnerability with a context-sensitive analysis of specific kinds and sources of vulnerability; and how to reconcile obligations to protect vulnerable persons with obligations to respect autonomy. We then briefly survey some of the theoretical resources available within the philosophical literature to address these challenges, and to assist in understanding the conceptual connections between vulnerability and related concepts such as harm, exploitation, needs, and autonomy. We also sketch out a taxonomy of sources and kinds of vulnerability. Finally, we consider the implications for policy evaluation of making vulnerability an explicit and central focus of bioethics. Our investigation is in the form of a broad survey motivating a research agenda rather than a detailed analysis. (shrink)

This paper focuses on how experiences of trauma can lead to generalized fear of people, objects and places that are similar or contextually or conceptually related to those that produced the initial fear, causing epistemic, affective, and practical harms to those who are unduly feared and those who are intimates of the victim of trauma. We argue that cases of fear generalization that bring harm to other people constitute examples of injustice closely akin to testimonial injustice, specifically, mnemonic injustice. Mnemonic (...) injustice is a label that has been introduced to capture how injustice can occur via the operation of human memory systems when stereotypes shape what is remembered. Here we argue that injustices can also occur via memory systems when trauma leads to a generalized fear. We also argue that this calls for a reformulation of the notion of mnemonic injustice. (shrink)

While some trust theorists have adverted to the vulnerabilities involved in trust, especially vulnerability to betrayal, the literature on trust has not engaged with recent work on the ethics of vulnerability. This paper initiates a dialogue between these literatures, and in doing so begins to explore the complex interrelations between vulnerability and trust. More specifically, it aims to show how trust can both mitigate and compound vulnerability. Through a discussion of two examples drawn from literary sources, the paper also investigates (...) the effects of pathogenic vulnerability on the psychic economies of trust and distrust. (shrink)

Background:Background: In general, qualitative research design often involves merging together various data collection strategies, and researcher’s may need to be prepared to spend longer periods i...

The concept of suffering is discussed among those who are cognitively aware and verbally capable to express their suffering. Due to immaturity, preterm infants’ abilities to express suffering are limited. Relieving suffering is an ethical and juridical demand of good nursing care. The purpose of this study is to describe nurses’ perceptions of the suffering of preterm infants. A descriptive qualitative approach was selected. Data were collected from essays written by nurses (n = 19) working in the neonatal intensive care (...) unit. Inductive content analysis guided by the research question was performed. The nurses described individually determined suffering of the preterm infants according to four categories: suffering ruled by maturation, existence of suffering, individual threshold of suffering and interpreting the cues of suffering. Suffering of preterm infants is manifested by population-specific features, emphasising the need to develop sensitive interventions for relieving their suffering. (shrink)

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes (...) and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare. (shrink)

Going beyond the scope of psychiatric diagnoses, this study introduces the concept of human vulnerability as a means of linking the phenomenological approach—focusing on the patient’s experience—with psychotherapeutic treatment. To this end, it applies Karl Jaspers’ concept of “limit situation” to the existential vulnerability in the manifestation of mental illness and the ontological vulnerability in schizophrenia. From a psychological or empathic standpoint, vulnerability, as experienced in different cases of mental illness, refers to the condition of being confronted with disturbing meaningful (...) social encounters with others. In these social encounters, existential meanings acquire disturbing qualities for a person’s integrity, giving rise to various psychopathological phenomena. This study incorporates the practice of psychotherapy and empirical research to suggest that the experience of vulnerability is crucial not only in understanding the manifestation of mental illness but also a key element of phenomenological psychotherapeutic treatment, and it uses schizophrenia as an example. (shrink)

In this article, I examine the legal position of those who perform caregiving work within the context of a cohabiting relationship through a novel relational vulnerability lens. I argue that the state, through privatising and devaluing caregiving labour, situates carers within an unequal and imbalanced relational framework, exposing them economic, emotional, and spatial harms. Unlike universal vulnerability, which is inherent and unavoidable, relational vulnerability can be avoided and reduced if the state were to acknowledge that humans are embodied and relational (...) rather than self-sufficient and rational. Law’s treatment of cohabiting carers reflects the state’s broader tendency to value economic self-sufficiency, while confining caregiving to the private family. I argue that the state has a duty to respond directly to relational vulnerability and should aim to make cohabiting carers resilient. Resilience must involve the provision of material resources but should also have a normative commitment to achieving autonomy and equality for those marginalised by law and state policies. (shrink)

In gegenwärtigem sozialen Protest lässt sich, mit Eva von Redecker, eine „Revolution für das Leben“ ausmachen: eine neue Protestform, die sich durch einen Bezug auf bedrohtes Leben auszeichnet und die Vulnerabilität politisiert. Im vorliegenden Beitrag möchte ich mit John Dewey ein Verständnis von Politisierung durch sozialen Protest entwickeln und dieses in Bezug auf die „Revolution für das Leben“ erläutern. Dazu schlage ich vor, Politisierung als Problematisierung auf drei Ebenen zu begreifen. Sozialer Protest artikuliert, erstens, ausgehend von Erfahrungen, Sachverhalte als Probleme (...) von öffentlicher Bedeutung, die einer Lösung bzw. Bearbeitung bedürfen. Zweitens thematisiert er diese zugleich als Probleme zweiter Ordnung, d.i. als Probleme sozialer Institutionen und gesellschaftlicher (Selbst-) Gestaltung. Und schließlich stellt sozialer Protest die Grenzen politischer Gemeinschaft zur Disposition, indem er zugleich Probleme dritter Ordnung, d.i. politischer Teilhabe adressiert. In diesem Sinne ist auch die „Revolution für das Leben“ zu verstehen: sie artikuliert Vulnerabilität nicht nur als sachliches Problem des Schutzes von akut bedrohten Leben, sondern auch als soziales Problem gestaltbarer Praktiken der Sorge um verletzliche Leben sowie als politisches Problem des Ausschlusses aus der Gemeinschaft derjenigen, deren Leben als der Sorge und des Schutzes wert und würdig anerkannt werden. (shrink)

In this paper, following the taxonomy developed by Mackenzie, Rogers and Dodds of different sources and states of vulnerability, I claim that wild animals are inherently and situationally vulnerable. This is because they can experience suffering as a response to certain internal and external states and have a high exposure to, and a low capacity to cope with, harmful natural processes. From this it follows that we have a moral obligation to support and assist individuals who are occurrently vulnerable and (...) to reduce the risk of dispositional vulnerabilities becoming occurrent in the future, by endorsing some form of what I call ‘environmental enhancement’. Finally, I pay critical attention to how to prevent interventions aimed at ameliorating vulnerability from paradoxically generating pathogenic vulnerabilities. (shrink)

DINÇ L and GASTMANS C. Nursing Inquiry 2012; 19: 223–237 Trust and trustworthiness in nursing: an argument‐based literature reviewCaring requires nurses to establish trusting relationships with patients and to be trustworthy professionals. This article provides insight into the conceptual understanding of trust and trustworthiness in nursing through an argument‐based literature review of 17 articles published between 1980 and 2010. Trust is characterized as an attitude relying with confidence on someone. The importance of trust relationships is considered by addressing the imbalances (...) of power in nurse–patient relationships as they increase the vulnerability and dependency of the truster. Trust is considered as a process, and time, reliance on others, risk and fragility are identified as basic attributes of trust. However, trustworthiness is inadequately explored in the nursing ethics literature. Nurse educators have a responsibility to ensure that nurses are equipped with the attitudes and knowledge that are needed to establish trusting nurse–patient relationships. (shrink)