Recognizing the importance of health‐promoting relationships in engaging people who are experiencing homelessness in care, most research on health clinics for homeless persons has involved some recognition of client–provider relationships. However, what has been lacking is the inclusion of a critical analysis of the policy context in which relationships are enacted. In this paper, we question how client–provider relationships are enacted within the culture of community care with people who are experiencing homelessness and how clinic‐level and broader social and health (...) policies shape relationships in this context. We explore these questions within a critical theoretical perspective utilizing a critical ethnographic methodology. Data were collected using multiple methods of document review, participant observation, in‐depth interviews and focus groups. The participants include both clients at a community health clinic, and all clinic service providers. We explore how clients and providers characterized each other as ‘good’ or ‘bad’. For providers, this served as a means by which they policed behaviours and enforced social norms. The means by which both providers’ and clients’ negotiated relationships are explored, but this is couched within both local and system‐level policies. This study highlights the importance of healthcare providers and clients being involved in broader policy and systemic change. (shrink)

Patient-centered care is now recognized as a clinical method and ideal model for patient – health professional relationships, and many definitions have influenced its evolution. Overall the patient-centered care literature has provided relatively little to define patient-centered care at the level of the patient-professional relationship. Additionally, patient-centered care lacks grounding in ethical theory. This thesis asserts that theoretical concepts from the ethics of care can provide a stronger conceptual basis for patient-centered care.This thesis begins with a critical interpretive review of (...) the patient-centered care literature, yielding 12 articles that previously introduced new theoretical and definitional work on patient-centered care and patient-centered communication. Six common themes and ideas were discovered, and include Engaging the Patient as a Whole Person, Recognizing and Responding to Emotions, Fostering a Therapeutic Alliance, Promoting an Exchange of Information, Sharing Decision Making, and Enabling Self-Management and Patient Navigation. These elements were then compared to key elements of the ethics of care. This thesis argues that feminists have good reason to consider care as a type of moral duty, and it describes how this duty functions. This thesis also argues that a duty to care is triggered when caregivers are presented with particular substantive forms of vulnerability. Specifically, this thesis argues that vulnerable subjects whose constitutive needs are at risk require particular moral obligations. The links between the ethics of care and patient-centered care are discussed, including how an ethics of care response ought to function in the health care context. Finally, the cases of J.J. and Makayla Sault, two aboriginal girls who refused chemotherapy in favour of traditional aboriginal healing practices, are analyzed. This thesis offers a short scoping review of the bioethics discourse surrounding these cases. A review of this discourse revealed several common themes, which included the peripheral importance of culture and history, the equating of best interests with survival, the supremacy of science-based medicine, and the impartial application of ethical principles. This thesis recommends that health care professionals apply an ethics of care approach to similar ethical dilemmas in the future, which involves shifting one's ethical focus to the central relationships of the case, understanding the unique perspective of the patient's narrative, and promoting a care-based rather than a justice-based approach to problem-solving. (shrink)

With the point of departure in the ongoing discussion of the professional and moral responsibility for those who are not equally included in the established health services, the question of how to include individuals and groups facing marginalisation is one of the major challenges within the ethics of care. This makes marginalisation a core concept in our time, which is challenged by, among other things, differentness with respect to ethnicity and social status as well as breach with norms and laws. (...) The representation of individuals and groups facing marginalisation is not merely an intellectual question, however, but an epistemological one with political, practical and ethical implications. This article discusses a pilot project exploring what we can do within nursing education to sensitise students to professional and moral responsibility for individuals and groups facing marginalisation. A dialogical approach to knowledge, including cooperation with voluntary organisations and low-threshold facilities with a long tradition of trying to prevent people from falling through the net', was chosen to highlight the professional challenges and the ethical dilemmas that arise in the interface between closeness and distance, caring and marginalisation. Evaluation of data indicated that such an approach to knowledge seems to benefit the students' learning. (shrink)

The Ethics of Care (EoC) theory has been widely applied in the field of management, and there is a growing consensus that it is important to recognise the value and practice of care in the workplace. In this paper, we consider the implications of the EoC at work, and in particular the risks unboundaried care demands may pose to employees who encounter unmanageable ‘calls to care’. We present findings from interviews with 27 nurses in Malaysia, which suggest that the demand (...) to care at work, in addition to demands made in the non-work sphere, may be unmanageable. We argue for a more boundaried approach to the EoC at work with a view to ensuring that in valuing care we do not over-burden the carer. (shrink)