How do we care well for a human being: ourselves or another? Non-Kantian scholars rarely identify the philosophy of Kant as a particularly useful resource with which to understand the full complexity of human care. Kant’s philosophy is often taken to presuppose that a philosophical analysis of good human life needs to attend only to how autonomous, rational agents—sprung up like mushrooms out of nowhere, without a childhood, never sick, always independent—ought to act respectfully, and how they can (...) be forced to interact rightfully. Questions involving aspects of human life captured by what Eva Kittay aptly phrased “the fact of dependency” (1999) —such as our vulnerable, fragile, and embodied social natures, asymmetrical care relations, and deep systemic injustices—are therefore commonly thought to be beyond the grasp of Kant and of Kantian philosophy. Against this historically prominent understanding of Kant’s practical philosophy, below I engage and draw upon recent Kant scholarship which shows both the inadequacy of such rationalist readings and the fruitfulness of using Kant’s practical philosophy to enhance our understanding of human care relations. After situating my approach in the existing, relevant secondary literature on Kant’s human agent, I explore key features of Kant’s accounts of human nature and the highest good. I pay special attention to his proposal that our human nature comprises reflective and unreflective aspects and patterns that we (ought to) strive to develop, transform, and integrate in wise ways through our faculty of desire. In addition, I emphasize the dangers that our ineradicable propensity to do bad things (evil) poses for our projects of self- and other- care. I proceed by outlining how Kant’s account of moral (ethical and legal) responsibility for self and others is developed through his theories of freedom, that is, through his theory of virtue (virtuous internal freedom with its account of perfect and imperfect duties) and his theory of right (rightful external freedom with its account of innate, private, and public right). On the conception I am advancing, we are pretty messy, fragile, and vulnerable beings whose projects of caring are difficult, ongoing, and complex. On the one hand, we (should) strive to care for ourselves (by striving to manage and heal badly functioning parts and by developing, transforming, and integrating immature or distinct parts of ourselves into good wholes) and for others (assisting them in their projects of management and healing and of developing, transforming, and integrating themselves into good wholes) in ways that are both respectful and attentive to the particular people we are—people with lives of our own to live—and the kinds of relationships we share. On the other hand, we should, and can, be forced to interact rightfully, meaning interaction consistent with one another’s basic (innate, private, and public) rights and, hence, contribute to reform projects that improve our inherited, imperfect legal-political systems with regard to care relations. Bringing Kant’s philosophy into dialogue with care theorists, I conclude, advances the insights of both traditions by showing one way to arrive at a multifaceted, yet unified account of human care relations where our embodied, social as well as our rational natures are given due consideration. (shrink)

Henry Richardson has recently published the first book ever devoted to ancillary care obligations, which roughly concern what medical researchers are morally required to provide to participants beyond what safety requires. In it Richardson notes that he has presented the ‘only fully elaborated view out there’ on this topic, which he calls the ‘partial-entrustment model’. In this article, I provide a new theory of ancillary care obligations, one that is grounded on ideals of communion salient in the African (...) philosophical tradition and is intended to rival and surpass Richardson’s model, which is a function of Western considerations of autonomy. I argue that the relational approach of the former has several virtues in comparison to the basic individualism of the latter. (shrink)

Are non-natural properties worth caring about? I consider two objections to metaethical non-naturalism. According to the intelligibility objection, it would be positively unintelligible to care about non-natural properties that float free from the causal fabric of the cosmos. According to the ethical idlers objection, there is no compelling motivation to posit non-natural normative properties because the natural properties suffice to provide us with reasons. In both cases, I argue, the objection stems from misunderstanding the role that non-natural properties play (...) in the non-naturalist's understanding of normativity. The role of non-natural properties is not to be responded to, but to "mark" which natural properties it is correct for us to respond to in certain ways. (shrink)

I develop the foundation for cosmopolitan care, an underexplored variety of moral cosmopolitanism. I begin by offering a characterization of contemporary cosmopolitanism from the justice tradition. Rather than discussing the political, economic or cultural aspects of cosmopolitanism, I instead address its moral dimensions. I then employ a feminist philosophical perspective to provide a critical evaluation of the moral foundations of cosmopolitan justice, with an eye toward demonstrating the need for an alternative account of moral cosmopolitanism as cosmopolitan care. (...) After providing an explanation of how care ethics in connection with Kantian ethics generates a duty to care, I consider one main feature of cosmopolitan care, namely the theory of obligation it endorses. In developing this account, I place special emphasis on the practical ramifications of the theory by using it to analyze gender violence in conflict zones. (shrink)

The gendered division of labour in combination with the feminisation of international migration contribute to shortages of care, a phenomenon often called ‘care drain’. I argue that this phenomenon is an issue of global gender justice. I look at two methodological challenges and favourably analyse the suggestions that care drain studies should include the effects of fathers’ and other male caregivers’ migration and, in some cases, the effects of migration within national borders. I also explain why (...) class='Hi'>care drain is a problem of distributive justice, by looking at the background conditions that result in much of the care-givers’ migration. (shrink)

Contrary to the popular assumption that linguistically mediated social practices constitute the normativity of action (Kiverstein and Rietveld, 2015; Rietveld, 2008a,b; Rietveld and Kiverstein, 2014), I argue that it is affective care for oneself and others that primarily constitutes this kind of normativity. I argue for my claim in two steps. First, using the method of cases I demonstrate that care accounts for the normativity of action, whereas social practices do not. Second, I show that a social practice (...) account of the normativity of action has unwillingly authoritarian consequences in the sense that humans act only normatively if they follow social rules. I suggest that these authoritarian consequences are the result of an uncritical phenomenology of action and the fuzzy use of “normative”. Accounting for the normativity of action with care entails a realistic picture of the struggle between what one cares for and often repressive social rules. (shrink)

Emphasizing the importance of language is a key characteristic of philosophical reflection in general and of bioethics in particular. Rather than trying to eliminate the historicity and ambiguity of language, a continental approach to bioethics will make conscious use of it, for instance by closely studying the history of the key terms we employ in bioethical debates. Continental bioethics entails a focus on the historical vicissitudes of the key signifiers of the bioethical vocabulary, urging us to study the history of (...) terms such as “bioethics,” “autonomy,” “privacy,” and “consensus.” Instead of trying to define such terms as clearly and unequivocally as possible, a continental approach rather requires us to take a step backwards, tracing the historical backdrop of the words currently in vogue. By comparing the original meanings of terms with their current meanings, and by considering important moments of transition in their history, obfuscated dimensions of meaning can be retrieved. Thus, notwithstanding a number of methodological challenges involved in etymological exercises, they may foster moral articulacy and enhance our ability to come to terms with moral dilemmas we are facing. (shrink)

This is a critical discussion of the accuracy-first approach to epistemic norms. If you think of accuracy (gradational or categorical) as the fundamental epistemic good and think of epistemic goods as things that call for promotion, you might think that we should use broadly consequentialist reasoning to determine which norms govern partial and full belief. After presenting consequentialist arguments for probabilism and the normative Lockean view, I shall argue that the consequentialist framework isn't nearly as promising as it might first (...) appear. (shrink)

Both Martin Heidegger and Harry Frankfurt have argued that the fundamental feature of human identity is care. Both contend that caring is bound up with the fact that we are finite beings related to our own impending death, and both argue that caring has a distinctive, circular and non-instantaneous, temporal structure. In this paper, I explore the way Heidegger and Frankfurt each understand the relations among care, death, and time, and I argue for the superiority of Heideggerian version (...) of this nest of claims. Frankfurt claims that we should conceive of the most basic commitments which practically orient a person in the world and define his identity (“volitional necessities”) as naturalistic facts, foundational for and located completely without the normative space of reasons. In support of this he appeals to the supposedly foundational role played in human life by the instinct for self-preservation, what Frankfurt calls the “love of living.” The claim is that in questions of practical identity there is a definite priority of the factual over the normative. Frankfurt’s naturalistic model of volitional necessity is motivated by a misunderstanding of the temporal structure of care, a misunderstanding that helps lead him to an implausible conception of the basic structures of human identity. Heidegger advances an anti-naturalistic conception of caring, one bound up with his way of understanding how human beings relate to their own future. I argue that the existential, temporal, and normative significance that Frankfurt attributes to the naturalized “love of living” is better captured by the Heideggerian claim that human identity is defined by being “for-the-sake-of” certain projects and commitments, a way of being lived out in the way Heidegger calls “being-towards-death.”. (shrink)

Chapter 1 Introduction This chapter briefly explains what care ethics is, what care ethics is not, and how much work there still is to be done in establishing care ethics’ scope. The chapter elaborates on care ethics’ relationship to political philosophy, ethics, feminism, and the history of philosophy. The upshot of these discussions is the suggestion that we need a unified, precise statement of care ethics’ normative core. The chapter concludes by giving an overview of (...) the chapters to come: Chapters 2 to 5 will each develop concise statement of one of four key care ethical claims, while Chapters 6 to 8 will unify, specify, and justify those four claims under a new principle : the dependency principle. -/- Chapter 2 Scepticism about Principles Care ethicists tend to be sceptical that there is any useful role for general, abstract principles or rule in moral theory and practice. This chapter assesses this scepticism. It argues for the importance of maintaining a distinction between, on the one hand, scepticism about principles as a tool in deliberation, and, on the other hand, scepticism about principles as a ground of moral rightness. It surveys and assesses the statements made by care ethicists against principles. The conclusion is that care ethicists are correct to be somewhat sceptical about the use of principles in deliberation, but that this scepticism should not extend to principles as the source of moral rightness. -/- Chapter 3 The Value of Relationships Amongst care, a special place is often made for personal relationships. This chapter delimits and justifies this. First, it distinguishes three kinds of importance personal relationships are attributed by care ethicists –as moral paradigms, as goods to be preserved, and as sources of weighty duties. Next, it suggests such ‘relationship importance’ is not justified by the nature of personal relationships or the value of their relatives. It concludes that any personal relationship has importance in proportion to the value the relationship has to its participants. Crucially, this source of importance – a relationship’s value to participants – holds also for non-personal relationships. This allows us to understand how care ethics extends relationship importance to our relations with distant others. -/- Chapter 4 Caring Attitudes Care ethics calls upon agents to care about and for others. This chapter focus on the “about” aspect of caring: on caring attitudes. Caring attitudes are defined as pro-attitudes to the fulfilment of some entity’s interests. The moral value of these attitudes—particularly in emotions like love—is elaborated upon. However, attitudes do not seem under our voluntary control, so do not seem to be something we can be morally instructed to bear. This objection is responded to, with the explanation that we have long-term control over our attitudes and that moral theories can legitimately call upon agents to do things they cannot immediately control. Ultimately, then, care ethics’ injunction that agents hold caring attitudes is both defined and vindicated. -/- Chapter 5 Caring Actions This chapter starts by comparing and assessing the numerous definitions of care found in care ethics literature—distinguishing care, good care, bad care, and non- care. Caring actions are defined as having the intention to fulfil something’s perceived interests. The moral value of such actions is interrogated and found to be a combination off the intention’s value and the action’s consequences’ value. The chapter considers whether acknowledgment of care by the care recipient adds value to caring actions. It is suggested that such ‘ care receiving’ often, but not always, adds value to caring actions, and should not be part of the definition of care. Thus, care ethics’ imploration of agents to perform caring actions is defined. -/- Chapter 6 The Dependency Principle This chapter develops the dependency principle. This principle asserts that a moral agent, A, has a responsibility when: moral person B has an important interest that is unfulfilled; A is sufficiently capable of fulfilling that interest; and A’s most efficacious measure for fulfilling the interest will be not too costly. A incurs a weighty responsibility if ¬ to are true and A’s most efficacious measure for fulfilling the interest will be the least costly of anyone’s most efficacious measure for fulfilling B’s interest. Each of components to is elaborated on in turn. We arrive at a precise, comprehensive statement of the principle that will be used to unify, specify, and justify care ethics. -/- Chapter 7 Collective Dependency Duties It is impossible to do justice to care ethics without discussing the duties of groups—especially groups such as families and nation-states. This chapter defends the claim that the responsibilities produces by the dependency principle are, in many cases, responsibilities of groups. It develops permissive conditions that a group must meet in order to be a prospective responsibility-bearer, and explains how it is that groups’ responsibilities distribute to their individual members. This model of group responsibility is applied to states. This allows us to make sense of how the dependency principle can unify a care ethics that is greatly concerned with social and political outcomes. -/- Chapter 8 Unifying, Specifying, and Justifying Care Ethics Can the abstract, formalised ‘dependency principle ’—developed in Chapter 6 – serve as a compelling justification of the heterogeneous theory of care ethics? This chapter argues that it can. Each of the four claims of care ethics—developed in Chapters 2 to 5—is assessed in turn. Three questions are asked with regard to each. First, does the dependency principle generate some responsibilities of the relevant kind? Second, does the dependency principle generate enough responsibilities of the relevant kind? And third, does the dependency principle give the right explanation of these responsibilities? The answer each time, it is argued, is “yes”. Along the way, this answer produces some new results regarding both care ethics and the dependency principle. (shrink)

There’s the question of what there is, and then there’s the question of what ultimately exists. Many contend that, once we have this distinction clearly in mind, we can see that there is no sensible debate to be had about whether there are such things as properties or tables or numbers, and that the only ontological question worth debating is whether such things are ultimate (in one or another sense). I argue that this is a mistake. Taking debates about ordinary (...) objects as a case study, I show that the arguments that animate these debates bear directly on the question of which objects there are and cannot plausibly be recast as arguments about what’s ultimate. I also address the objection that, because they are easy answerable, questions about what there is cannot be a proper subject of ontological debate. (shrink)

Care after research is for participants after they have finished the study. Often it is NHS-provided healthcare for the medical condition that the study addresses. Sometimes it includes the study intervention, whether funded and supplied by the study sponsor, NHS or other party. The NHS has the primary responsibility for care after research. However, researchers are responsible at least for explaining and justifying what will happen to participants once they have finished. RECs are responsible for considering the arrangements. (...) There are ethical and practical issues, in particular when participants may wish to continue on the study intervention after the study. There are also various guidelines and legislation. This document presents a framework of questions to help NHS RECs and their applicants. Information on this document’s development is here. (shrink)

Migrant women are often stereotyped. Some scholars associate the feminization of migration with domestic work and criticize the “care drain” as a new form of imperialism that the First World imposes on the Third World. However, migrant women employed as domestic workers in Northern America and Europe represent only 2% of migrant women worldwide and cannot be seen as characterizing the “feminization of migration”. Why are migrant domestic workers overestimated? This paper explores two possible sources of bias. The first (...) is sampling: conclusions about “care drain” are often generalized from small samples of domestic workers. The second stems from the affect heuristic: imagining children left behind by migrant mothers provokes strong feelings of injustice which trump other considerations. The paper argues that neither source of bias is unavoidable and finds evidence of gender stereotypes in the “care drain” construal. (shrink)

Technological developments involving robotics and artificial intelligence devices are being employed evermore in elderly care and the healthcare sector more generally, raising ethical issues and practical questions warranting closer considerations of what we mean by “care” and, subsequently, how to design such software coherently with the chosen definition. This paper starts by critically examining the existing approaches to the ethical design of care robots provided by Aimee van Wynsberghe, who relies on the work on the ethics of (...) care by Joan Tronto. In doing so, it suggests an alternative to their non-principled approach, an alternative suited to tackling some of the issues raised by Tronto and van Wynsberghe, while allowing for the inclusion of two orientative principles. Our proposal centres on the principles of autonomy and vulnerability, whose joint adoption we deem able to constitute an original revision of a bottom-up approach in care ethics. Conclusively, the ethical framework introduced here integrates more traditional approaches in care ethics in view of enhancing the debate regarding the ethical design of care robots under a new lens. (shrink)

This Open Access book provides both a broad perspective and a focused examination of cow care as a subject of widespread ethical concern in India, and increasingly in other parts of the world. In the face of what has persisted as a highly charged political issue over cow protection in India, intellectual space must be made to bring the wealth of Indian traditional ethical discourse to bear on the realities of current human-animal relationships, particularly those of humans with cows. (...) Dharma, yoga, and bhakti paradigms serve as starting points for bringing Hindu--particularly Vaishnava Hindu--animal ethics into conversation with contemporary Western animal ethics. The author argues that a culture of bhakti--the inclusive, empathetic practice of spirituality centered in Krishna as the beloved cowherd of Vraja--can complement recently developed ethics-of-care thinking to create a solid basis for sustaining all kinds of cow care communities. (shrink)

This paper argues that societal duties of health promotion are underwritten (at least in large part) by a principle of beneficence. Further, this principle generates duties of justice that correlate with rights, not merely “imperfect” duties of charity or generosity. To support this argument, I draw on a useful distinction from bioethics and on a somewhat neglected approach to social obligation from political philosophy. The distinction is that between general and specific beneficence; and the approach from political philosophy has at (...) times been called equality of concern. After clarifying the distinction and setting out the basis of the equality of concern view, I argue that the result is a justice-based principle of “specific” beneficence that should be reflected in a society’s health policy. I then draw on this account to criticize, refine, and extend some prominent health care policy proposals from the bioethics literature. (shrink)

Being aware of social injustices can cause existential and mental pain; comes with a burden; and may impede a flourishing life. However, I shall argue that this is not a reason to despair or to choose to be willfully ignorant. Rather, it’s a reason to conclude that being conscious is not enough. Rather, during times of oppression, resisters must also prioritize well-being. One way to do this is by extending what I refer to as solidarity care. I begin by (...) providing an account of solidarity care. I then offer pragmatic ways in which one can extend solidarity care to others. I conclude by responding to two possible worries. (shrink)

Nicole Hassoun’s sufficientarian theory is based on a particular conception of caring, which she calls ‘care, simpliciter’. However, ‘care, simpliciter’ is not described in any detail. This essay tries to offer a critical revision of Hassoun’s concept of care in a way that would put the MGL theory on its strongest footing. To that end, I will contrast her view with a taxonomy of care that supplements the accounts of care provided by Stephen Darwall and (...) Lori Gruen. I then put forward a form of empathy that is best suited to the MGL theory, which fits the description of ‘care, simpliciter’. **Unpublished manuscript: feel free to cite.**. (shrink)

The paper studies two fundamentally different forms in which the concept of care makes its comeback in twentieth-century thought. We make use of a distinction made by Peter Sloterdijk, who argues that the ancient and medieval ‘ascetic’ ideal of self-enhancement through practice has re-emerged in the nineteenth and twentieth centuries, particularly in the form of a rehabilitation of the Hellenistic notion of self-care (epimeleia heautou) in Michel Foucault’s late ethics. Sloterdijk contrasts this return of self-care with Martin (...) Heidegger’s concept of being-in-the-world as ‘total care’ (Sorge), an utterly ‘secularized’ understanding of the human being as irreducibly world-embedded that rejects the classical ascetic ideal of world-secession. We examine further the historical roots and emergence of these contrasting contemporary reappropriations of care in the Western tradition of thought and show them to be rooted in two different ontologies and ethics of the self as either world-secluded or world-immersed, autonomous or constitutively relational. The historical point of divergence of these two approaches to care, we argue, can be found in the Christian transformation of Hellenistic ethics. (shrink)

I review three existing arguments in favor of having some childcare done by nonparents and then I advance five arguments, most of them original, to the same conclusion. My arguments rely on the assumption that, no matter who provides it, childcare will inevitably go wrong at times. I discuss the importance of mitigating bad care, of teaching children how to enter caring relationships with people who are initially strangers to them, of addressing children's structural vulnerability to their caregivers, of (...) helping children and parents contain the ambivalent feelings of the child-parent relationship, and of distributing the responsibility of care and the ensuing blame for bad care more widely. I conclude that nonparental childcare should be universal. (shrink)

The growing proportion of elderly people in society, together with recent advances in robotics, makes the use of robots in elder care increasingly likely. We outline developments in the areas of robot applications for assisting the elderly and their carers, for monitoring their health and safety, and for providing them with companionship. Despite the possible benefits, we raise and discuss six main ethical concerns associated with: (1) the potential reduction in the amount of human contact; (2) an increase in (...) the feelings of objectification and loss of control; (3) a loss of privacy; (4) a loss of personal liberty; (5) deception and infantilisation; (6) the circumstances in which elderly people should be allowed to control robots. We conclude by balancing the care benefits against the ethical costs. If introduced with foresight and careful guidelines, robots and robotic technology could improve the lives of the elderly, reducing their dependence, and creating more opportunities for social interaction. (shrink)

This essay critically examines a suggestion proposed by some Confucianists that Confucianism and Care Ethics share striking similarities and that feminism in Confucian societies might take “a new form of Confucianism.” Aspects of Confucianism and Care Ethics that allegedly converge are examined, including the emphasis on human relationships, and it is argued that while these two perspectives share certain surface similarities, moral injunctions entailed by their respective ideals of ren and caring are not merely distinctive but in fact (...) incompatible. (shrink)

It is a philosophy of patient care, and is therefore open to critique and evaluation.Using the Oxford Textbook of Palliative Medicine Third Edition as their ...

A large proportion of the total global burden of disease is caused by emergency medical conditions. Emergency care research is essential to improving emergency medicine but this research can raise some distinctive ethical challenges, especially with regard to (1) standard of care and risk–benefit assessment; (2) blurring of the roles of clinician and researcher; (3) enrolment of populations with intersecting vulnerabilities; (4) fair participant selection; (5) quality of consent; and (6) community engagement. Despite the importance of research to (...) improve emergency care in low-income and middle-income countries (LMICs) and the widely acknowledged ethical challenges, very little has been written on the ethics of emergency care research in LMICs. This paper examines the ethical and regulatory challenges to conducting emergency care research with human participants in LMICs. We outline key challenges, present potential solutions or frameworks for addressing these challenges, and identify gaps. Despite the ethical and regulatory challenges, conducting high-quality, ethical emergency care research in LMICs is possible and it is essential for global health. (shrink)

True beliefs are better guides to the world than false ones. This is the common-sense assumption that undergirds theorizing in evolutionary epistemology. According to Alvin Plantinga, however, evolution by natural selection does not care about truth: it cares only about fitness. If our cognitive faculties are the products of blind evolution, we have no reason to trust them, anytime or anywhere. Evolutionary naturalism, consequently, is a self-defeating position. Following up on earlier objections, we uncover three additional flaws in Plantinga's (...) latest formulation of his argument: a failure to appreciate adaptive path dependency, an incoherent conception of content ascription, and a conflation of common-sense and scientific beliefs, which we diagnose as the ‘foundationalist fallacy’. More fundamentally, Plantinga's reductive formalism with respect to the issue of cognitive reliability is inadequate to deal with relevant empirical details. (shrink)

In their strife for designing a moral system where everyone is given equal consideration, cosmopolitan theorists have merely tolerated partiality as a necessary evil (insofar it means that we give priority to our kin opposite the distant needy). As a result, the cosmopolitan ideal has long departed from our moral psychologies and our social realities. Here I put forward partial cosmopolitanism as an alternative to save that obstacle. Instead of demanding impartial universal action, it requires from us that we are (...) equally responsive in all the relationships we stand in. That goes from the local to the cosmopolitan sphere, since I defend that we are related with strangers as co-members of the global community. Thus, partiality not only is accommodated by cosmopolitanism, but actually supports it: only by having meaningful personal relationships we become able to care for distant strangers. (shrink)

Chenyang Li argues, in an article originally published in Hypatia, that the ethics of care and Confucian ethics constitute similar approaches to ethics. The present paper takes issue with this claim. It is more accurate to view Confucian ethics as a kind of virtue ethics, rather than as a kind of care ethics. In the process of criticizing Li's claim, the distinctiveness of care ethics is defended, against attempts to assimilate it to virtue ethics.

In her provocative discussion of the challenge posed to the traditional impartialist, justice-focused conception of morality by the new-wave care perspective in ethics, Annette Baier calls for ‘a “marriage” of the old male and newly articulated female... moral wisdom,’ to produce a new ‘cooperative’ moral theory that ‘harmonize[s] justice and care.’ I want in this paper to play matchmaker, proposing one possible conjugal bonding: a union of two apparently dissimilar modes of what Nel Noddings calls ‘meeting the other (...) morally,’ a wedding of respect and care. (shrink)

Dilip Ninan has raised a puzzle for centered world accounts of de re attitude reports extended to accommodate what he calls “counterfactual attitudes.” As a solution, Ninan introduces multiple centers to the standard centered world framework, resulting in a more robust semantics for de re attitude reports. However, while the so-called multi-centered world proposal solves Ninan’s counterfactual puzzle, this additional machinery is not without problems. In Section 1, I present the centered world account of attitude reports, followed by the extension (...) to counterfactual attitudes which Ninan targets with his puzzle. In Section 2, I pose the counterfactual puzzle and present Ninan’s multi-centered world solution, emphasizing similarities and differences between multi-centered and centered world accounts of attitude reports. In Section 3, I argue the counterfactual attitude wishing falls under the purview of the multi-centered proposal, but that the proposal generates false predictions for wish reports concerning unsatisfiable content. I canvass responses, ultimately concluding Ninan’s proposal requires substantial revisions. (shrink)

Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing about just (...) principles demands paying attention to the role particular goods play in our lives. This means that different approaches to the temporal subject—as well as other relevant issues—may be appropriate for different goods, including different goods within healthcare. In particular, the paper discusses two central goods targeted by healthcare: life-saving and pain relief. The view is offered as complementary to, rather than competitive with, lifetime approaches. As such, the paper finishes by considering how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives. (shrink)

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person.1 It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture.2-7 Yet medical participation (...) in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001.8-11 Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees. -/- The 2016 release of previously classified portions of guideline from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers. (shrink)

The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. (...) I examine two types of institutional contexts: (1) public research agencies – agencies or departments of states that fund or conduct clinical research in the public interest; and (2) private-for-profit corporations. I argue that investigators who are employed or have their research sponsored by the former have a distinctive institutional obligation to conduct their research in a way that is consistent with the state's duty of distributive justice to provide its citizens with access to basic health care, and its duty to aid citizens of lower income countries. By contrast, I argue that investigators who are employed or have their research sponsored by private-for-profit corporations do not possess this obligation nor any other institutional obligation that is directly relevant to the ethics of RCTs. My account of the institutional obligations of investigators aims to contribute to the development of a reasonable, distributive justice-based account of standard of care. (shrink)

Death can be bad for an individual who has died, according to the “deprivation approach,” by depriving that individual of goods. One worry for this account of death’s badness is the Lucretian symmetry argument: since we do not regret having been born later than we could have been born, and since posthumous nonexistence is the mirror image of prenatal nonexistence, we should not regret dying earlier than we could have died. Anthony Brueckner and John Martin Fischer have developed a response (...) to the Lucretian challenge by arguing that it is rational to have asymmetric attitudes toward posthumous and prenatal nonexistence. Recently, Jens Johansson has criticized the Brueckner/Fischer position, claiming that it is irrelevant whether it is actually rational to care about future pleasures but not past pleasures. What matters, according to Johansson, is whether it would be rational for us to care about past pleasures had we come into existence earlier. In this paper, I add to the conversation between Johansson and Brueckner/Fischer by suggesting a way to defend the latter side’s position in a way that has not yet been suggested. I do this by considering a suggestion of Johansson’s for interpreting the Brueckner/Fischer position and by arguing that Johansson’s worry for the position I consider is actually incoherent. (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)

Healthcare is becoming increasingly automated with the development and deployment of care robots. There are many benefits to care robots but they also pose many challenging ethical issues. This paper takes care robots for the elderly as the subject of analysis, building on previous literature in the domain of the ethics and design of care robots. Using the value sensitive design approach to technology design, this paper extends its application to care robots by integrating the (...) values of care, values that are specific to AI, and higher-scale values such as the United Nations Sustainable Development Goals. The ethical issues specific to care robots for the elderly are discussed at length alongside examples of specific design requirements that work to ameliorate these ethical concerns. (shrink)

When, if ever, can healthcare provider's lay claim to knowing what is best for their patients? In this paper, I offer a taxonomy of clinical disagreements. The taxonomy, I argue, reveals that healthcare providers often can lay claim to knowing what is best for their patients, but that oftentimes, they cannot do so *as* healthcare providers.

It has become evident that mind–body supervenience, as merely specifying a covariance between mental and physical properties, is consistent with clearly non-physicalist views of the mental, such as emergentism. Consequently, there is a push in the physicalist camp for an ontologically more robust supervenience, a “superdupervenience,” that ensures that properties supervening on physical properties are physicalistically acceptable. Jessica Wilson claims that supervenience is made superduper by Condition on Causal Powers (CCP): each individual causal power associated with a supervenient property is (...) numerically identical with a causal power associated with its base property. Furthermore, according to Wilson, a wide variety of physicalist positions, both reductive and non-reductive, can be seen as relying on CCP to ensure that properties supervening on physical properties are physicalistically acceptable. I argue that imposing CCP on mind–body supervenience fails to ensure that mental properties are physicalistically acceptable. The problem, I contend, is that while CCP may guard against supervenient mental properties being insufficiently grounded in their physical bases it fails to guard against supervenient mental properties being too deeply grounded in their physical bases. (shrink)

By what authority does morality make its demands? In this essay I argue that we find that authority within ourselves, immanent to - not necessarily the character - but the very fact of our own self-concern.

This paper explores the relationship between dignity and robot care for older people. It highlights the disquiet that is often expressed about failures to maintain the dignity of vulnerable older people, but points out some of the contradictory uses of the word ‘dignity’. Certain authors have resolved these contradictions by identifying different senses of dignity; contrasting the inviolable dignity inherent in human life to other forms of dignity which can be present to varying degrees. The Capability Approach (CA) is (...) introduced as a different but tangible account of what it means to live a life worthy of human dignity. It is used here as a framework for the assessment of the possible effects of eldercare robots on human dignity. The CA enables the identification of circumstances in which robots could enhance dignity by expanding the set of capabilities that are accessible to frail older people. At the same time, it is also possible within its framework to identify ways in which robots could have a negative impact, by impeding the access of older people to essential capabilities. It is concluded that the CA has some advantages over other accounts of dignity, but that further work and empirical study is needed in order to adapt it to the particular circumstances and concerns of those in the latter part of their lives. (shrink)

Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcare. We argue that one prominent approach, the Rawlsian approach developed by Norman Daniels, is unable to provide such reasons and such care. This is because of (...) a central feature in Daniels' account, namely that care should be provided to restore people's opportunities. Daniels' view is both unable to provide pain relief to those who need it as a supplement to treatment and, without justice-based reasons to provide palliative care to those whose opportunities cannot be restored. We conclude that this makes Daniels' framework much less attractive. (shrink)

In this commentary, I suggest expanding the deliberative aspects of critical care policy development in two ways. First, critical-care policy development should expand the scope of deliberation by leaving fewer issues up to expertise or private choice. For instance. it should allow deliberation about the relevance of age, disability, social position, and psychological well-being to allocation decisions. Second, it should broaden both the set of costs considered and the set of stakeholders represented in the deliberative process. In particular, (...) it should consider efforts to reduce the cost of end-of-life care and to redirect resources away from the provision of costly interventions, and should expand the set of individuals included in deliberation to include stakeholders outside the health-care system. (shrink)

In this paper, I distinguish two conceptions of solidarity, which I call solidarity as beneficence and solidarity as mutual advantage. I argue that only the latter is capable of providing a complete foundation for national universal health care programs. On the mutual advantage account, the rationale for universal insurance is parallel to the rationale for a labor union’s “closed shop” policy. In both cases, mandatory participation is necessary in order to stop individuals free-riding on an ongoing system of mutually (...) advantageous cooperation. (shrink)

Starting from two observations regarding nursing ethics research in the past two decades, namely, the dominant influence of both the empirical methods and the principles approach, we present the cornerstones of a foundational argument-based nursing ethics framework. First, we briefly outline the general philosophical–ethical background from which we develop our framework. This is based on three aspects: lived experience, interpretative dialogue, and normative standard. Against this background, we identify and explore three key concepts—vulnerability, care, and dignity—that must be observed (...) in an ethical approach to nursing. Based on these concepts, we argue that the ethical essence of nursing is the provision of care in response to the vulnerability of a human being in order to maintain, protect, and promote his or her dignity as much as possible. (shrink)

The aim of this paper is to show that a business ethic based on the ethics of care is superior to traditional business ethics. It shall be argued that neo-liberalism is inconsistent with the ethics of care since it either excludes caring institutions or treats them as preferences to be satisfied as the ‘free’ market sees fit. Unlike traditional business ethics, a business ethic based on the ethics of care can play an important role in challenging the (...) neo-liberal paradigm. Many business issues that are treated as peripheral by traditional business ethics can thus take central stage in a business ethic based on the ethics of care. (shrink)

Health care systems can positively influence our personal decision-making and health-related behavior only if we trust them. I propose a conceptual analysis of the trust relation between the public and a healthcare system, drawing from healthcare studies and philosophical proposals. In my account, the trust relation is based on an epistemic component, epistemic authority, and on a value component, the benevolence of the healthcare system. I argue that it is also modified by the vulnerability of the public on healthcare (...) matters, and by the system’s credibility. I apply my proposed analysis of public trust in health care systems to the phenomenon of vaccine hesitancy, a tendency to question vaccine policies, and to seek alternative vaccine schedules or to refuse vaccination. Understanding the role of trust and its components can be key to understanding the phenomenon. (shrink)

Theorists attending to the epistemic condition on responsibility are divided over whether moral ignorance is ever exculpatory. While those who argue that reasonable expectation is required for blameworthiness often maintain that moral ignorance can excuse, theorists who embrace a quality of will approach to blameworthiness are not sanguine about the prospect of excuses among morally ignorant wrongdoers. Indeed, it is sometimes argued that moral ignorance always reflects insufficient care for what matters morally, and therefore that moral ignorance never excuses. (...) Furthermore, quality of will theorists treat their skepticism about excuses for the morally ignorant as a natural implication of their approach. It is therefore unsurprising that, while many have argued for the blamelessness of certain morally ignorant agents on grounds concerning reasonable expectation, the possibility that morally ignorant agents might be blameless even according to quality of will views has not been adequately addressed. I illustrate and explain how it is possible for morally ignorant agents to display sufficient care for the morally relevant features of their wrong behavior. Thus, even if quality of will views are correct, moral ignorance sometimes excuses. (shrink)

This summary of Freedom to Care begins with the core claims and conceptualizations upon which the theory of liberal dependency care rests. It then summarizes the book’s chapters. The first five chapters (Part I) delineate its theoretical foundations, which include the two-level contract theory approach to distributive justice for caregiving arrangements. In Part II of the book, chapters six through nine, I formulate liberal proposals for justice-enhancing social change before identifying cross-cultural metrics of justice for the internal evaluation (...) of caregiving arrangements. (shrink)

We propose to understand the global financial crisis of 2008 as an historical event marked by public decisions, economic evaluations and ratings, and business practices driven by a sense of subjugation to powerful others, uncritical conformity to serendipitous rules, and a levelling down of all meaningful differences. The crisis has also revealed two important things: that the free-market economy has inherent problems highlighting the limits of business, and, consequently, that the business organisation is not as strong as is usually assumed. (...) We reconstruct some of the most dramatic events of that time by using the narratives of two former Lehman Brothers insiders. We then provide an interpretation of that world by using Heidegger’s notions of being and care. Our investigation uncovers persistent inauthentic relationships nourished by the public structure of the financial market, which, drawing on Heidegger, we call the they. In the financial market the what of the world becomes more important than authentic being and self. But a hitch-free switch to authenticity becomes possible through anxiety and the call of conscience. (shrink)