The Liverpool Care Pathway for the Dying has recently been the topic of substantial media interest and also been subject to the independent Neuberger Review. This review has identified clear failings in some areas of care and recommended the Liverpool Care Pathway be phased out. I argue that while the evidence gathered of poor incidences of practice by the Review is of genuine concern for end of life care, the inferences drawn from this evidence are inconsistent with the causes for (...) the concern. Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care. I conclude that improvements in training, communication, and ethical decision-making, without the added demand to end the Liverpool Care Pathway would have resulted in a genuine advance in end of life care. (shrink)

As the quality movement in health care now enters its fourth decade, the language of quality is ubiquitous. Practitioners, organizations, and government agencies alike vociferously testify their commitments to quality and accept numerous forms of governance aimed at improving quality of care. Remarkably, the powerful phrase ‘‘quality of care’’ is rarely defined in the health care literature. Instead it operates as an accepted and assumed goal worth pursuing. The status of evidence-based medicine, for instance, hinges on its ability to improve (...) quality of care, and efforts are made by both proponents and detractors to unpack the contents and outcomes of evidence-based practice while the contents of ‘‘quality of care’’ are presumed to be understood. Because the goals of medicine are far from obvious, this paper investigates the neglected term, ‘‘quality of care,’’ in an effort to understand what it is that health care practices are so uncritically assumed to be striving for. Finding lack of consensus on the terminology in the quality literature, I propose that the term operates rhetorically by way of persuasive appeal (and lack of descriptive meaning). Unsatisfied that ‘‘quality of care’’ operates as a mere buzzword in morally contentious debates over resource allocation and duties of care, I implore health care communities to go beyond mere commitments to quality and, instead, to focus attention on the difficult task of specifying what counts as quality care within an economically constrained health care system. (shrink)

Virginia Held assesses the ethics of care as a promising alternative to the familiar moral theories that serve so inadequately to guide our lives. The ethics of care is only a few decades old, yet it is by now a distinct moral theory or normative approach to the problems we face. It is relevant to global and political matters as well as to the personal relations that can most clearly exemplify care. This book clarifies just what the ethics of care (...) is: what its characteristics are, what it holds, and what it enables us to do. It discusses the feminist roots of this moral approach and why the ethics of care can be a morality with universal appeal. Held examines what we mean by "care," and what a caring person is like. Where other moral theories demand impartiality above all, the ethics of care understands the moral import of our ties to our families and groups. It evaluates such ties, focusing on caring relations rather than simply on the virtues of individuals. The book proposes how such values as justice, equality, and individual rights can "fit together" with such values as care, trust, mutual consideration, and solidarity. In the second part of the book, Held examines the potential of the ethics of care for dealing with social issues. She shows how the ethics of care is more promising than Kantian moral theory and utilitarianism for advice on how expansive, or not, markets should be, and on when other values than market ones should prevail. She connects the ethics of care with the rising interest in civil society, and considers the limits appropriate for the language of rights. Finally, she shows the promise of the ethics of care for dealing with global problems and seeing anew the outlines of international civility. (shrink)

How do we know which institutions provide good care? Some scholars argue that the best way to think about care institutions is to model them upon the family or the market. This paper argues, on the contrary, that when we make explicit some background conditions of good family care, we can apply what we know to better institutionalized caring. After considering elements of bad and good care, from an institutional perspective, the paper argues that good care in an institutional context (...) has three central foci: the purpose of care, a recognition of power relations, and the need for pluralistic, particular tailoring of care to meet individuals? needs. These elements further require political space within institutions to address such concerns. (shrink)

The ethics of care still appeals to many in spite of penetrating criticisms of it which have been presented over the past 15 years or so. This paper tries to offer an explanation for this, and then to critically engage with three versions of an ethics of care. The explanation consists firstly in the close affinities between nursing and care. The three versions identified below are by Gilligan (1982 ), a second by Tronto (1993 ), and a third by Gastmans (...) (2006 ), see also Little (1998 ). Each version is described and then subjected to criticism. It is concluded that where the ethics of care is presented in a distinctive way, it is at its least plausible; where it is stated in more plausible forms, it is not sufficiently distinct from nor superior to at least one other common approach to nursing ethics, namely the much-maligned 'four principles' approach. What is added by this paper to what is already known: as the article tries to explain, in spite of its being subjected to sustained criticism the ethics of care retains its appeal to many scholars. The paper tries to explain why, partly by distinguishing three different versions of an ethics of care. It is also shown that all three versions are beset with problems the least serious of which is distinctiveness from other approaches to moral problems in health care. (shrink)

The present volume consists of diverse individual texts, produced between 1980 and 1986, which take two forms: interviews in which Bourdieu confronts a series of probing and intelligent interviewers, and conference papers that clarify and extend specific areas of his research. Now that Bourdieu's work has achieved wide diffusion and celebrity, this is an appropriate time for this volume, a pause for retrospection and resynthesis, for corrections of misreadings and extension of previous insights, and for projection of the next stages (...) of his work. For this English edition, Bourdieu's celebrated inaugural lecture at the Collège de France, Leçon sur la Leçon, has been added. The texts fall into two fundamental areas. The first area provides an overview of Bourdieu's central concepts, never before clearly explained. The second area clarifies the philosophical presuppositions of Bourdieu's studies and gives an account of his relations with the series of thinkers who formulated the problems in social and cultural theory that still preoccupy us: Kant, Hegel, Marx, Durkheim, Wittgenstein, Weber, Parsons, and Lévi-Strauss. Bourdieu's visions of these figures is personal and penetrating, and in his vivacious, spontaneous responses one sees at work a mode of thought that can in itself be a liberating tool of social analysis. Bourdieu applies to himself the method of analyzing cultural works that he expounds, evoking the space of theoretical possibilities presented to him at different moments of his intellectual itinerary. (shrink)

Over the last four decades, the French sociologist Pierre Bourdieu produced one of the most imaginative and subtle bodies of social theory of the postwar era. When he died two years ago, he was considered to be a thinker on a par with Foucault, Barthes, and Lacan--a public intellectual as influential to his generation as Sartre was to his. Science of Science and Reflexivity will be welcomed as a companion volume to Bourdieu's now seminal An Invitation to Reflexive Sociology . (...) In this posthumous work, Bourdieu declares that science is in danger of becoming a handmaiden to biotechnology, medicine, genetic engineering, and military research--that it risks falling under the control of industrial corporations that seek to exploit it for monopolies and profit. Science thus endangered can become detrimental to mankind. The line between pure and applied science, therefore, must be subjected to intense theoretical scrutiny. Bourdieu's goals in Science of Science and Reflexivity are to identify the social conditions in which science develops in order to reclaim its objectivity and to rescue it from relativism and the forces that might exploit it. In the grand tradition of scientific reflections on science, Bourdieu provides a sociological analysis of the discipline as something capable of producing transhistorical truths he presents an incisive critique of the main currents in the study of science throughout the past half century and he offers a spirited defense of science against encroaching political and economic forces. A masterful summation of the principles underlying Bourdieu's oeuvre and a memoir of his own scientific journey, Science of Science and Reflexivity is a capstone to one of the most important and prodigious careers in the field of sociology. (shrink)

This work by Pierre Bourdieu develops the anthropological theory which has formed the basis of his scientific research. It discusses the problems posed by "structuralist" philosophers in order to solve or dissolve them.

Introduction Few areas of social inquiry are more exciting and important, and yet at the same time more marked by controversy and dispute, than the area ...

Starting from the controversies surrounding Bourdieu's political involvement, this article investigates the form of ethico-political involvement consistent with Bourdieu's notion of reflexivity. The argument begins by drawing the ethico-political dimensions of Bourdieu's methodology, especially his notions of socio-analysis and reflexivity. These latter emerge as the counterparts of Bourdieu's politics of the field, grounding the `conversion of the gaze' required for political action and presenting possibilities for social agents to comprehend, accept and even re-create their selves. Applying a `dispositional reading' to (...) some of Bourdieu's texts, the article proposes a new interpretation of the tense relation between Bourdieu's biography and writings, consistent with the ethico-political reading of socio-analysis and reflexivity. Bourdieu's texts can be read as an example of a socio-analysis, a rhetorical strategy devised to enlist individuals into the painful exercise of rewriting their social biographies. (shrink)