Given the wide the range of legally available options for end-of-life care in recent decades: from aggressive, even experimental, treatment to active euthanasia, our ethical analysis struggles to keep pace with technology and law. In this essay I show that the principle of double effect (PDE) remains, and will continue to be, a useful tool for ethical analysis of end-of-life care. According to PDE, an agent may ethically perform an act that s/he foresees will have a (...) significant bad effect (e.g., death) in addition to a good effect (e.g., pain relief) only if s/he does not intend the bad effect, the act is not bad for reasons other than its causing the bad effect, and there is a proportionately serious reason to act. Following a brief explanation of PDE and preliminary considerations in favor of counting death as a bad effect, I analyze several end-of-life options in terms of the principle. I begin with those that enjoy significant consensus among proponents of PDE: active euthanasia, “passive euthanasia,” and palliative care. Then I consider the less-straightforward cases of drug provision, refusing food and water, and terminal sedation, arguing that participation in such actions is justifiable via PDE only under very limited conditions. (shrink)

With the ageing of the Portuguese population, there are more people in dependency situations and needing long-term care (LTC). In this context, it is important to ensure the quality of life (QoL) of those individuals, and that quality can be measured through their health-related quality of life (HRQoL) and overall well-being. Also, understanding how perceived service quality (PSQ) can be related to how people perceive their QoL is pertinent since service quality is an important factor to achieve (...) patient health outcomes. To develop this project, a LTC unit located in the district of Lisbon was chosen, the LTC unit of Arruda dos Vinhos. The main objective was to assess the relation between the PSQ, the HRQoL and the overall well-being of patients receiving LTC at the LTC unit of Arruda dos Vinhos. A project based on a case study was performed, through interviews based on the items of the SERVPERF, EQ-5D and ICECAP-O questionnaires, which were then analysed through content analysis. Results showed there is a relation between PSQ and HRQoL and between HRQoL and overall well-being. It was also possible to realise that to better evaluate the quality of this specific service, other subjects as the activities performed at the LTC unit, the physiotherapy service and the food provided, should be taken in consideration. Concluding, there is a relation between PSQ and the QoL of the patients receiving LTC at the LTC unit of Arruda dos Vinhos, when quality of life is measured through HRQoL. (shrink)

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)

This article examines the subtle interconnection between the sanctity of life and individual autonomy within the context of assisted dying, as seen through the lens of Orthodox Christianity. It seeks to unravel the complex theological, ethical, and pastoral considerations that inform the Orthodox stance on end-of-life issues, particularly the nuanced understanding of suffering, death, and the redemptive potential encapsulated within them. Orthodox theology, with its profound veneration for life as a divine gift, offers a counter-narrative to contemporary (...) discourses that often prioritize personal autonomy and the alleviation of suffering above all. This tradition emphasizes the transformative power of suffering when united with Christ’s own redemptive suffering, proposing a vision of end-of-life care that is rooted in compassion, dignity, and hope for resurrection. The exploration begins with a historical and theological examination of the Orthodox perspective on life’s sanctity, engaging with the teachings of Church Fathers and contemporary theological and bioethical discussions. It highlights the foundational concepts of Orthodox anthropology, which perceives human beings as an indivisible unity of body and soul, reflecting the imago Dei. This anthropological understanding challenges reductionist views of human existence and informs the Orthodox approach to medical ethics, palliative care, and the spiritual accompaniment of the dying. By critically evaluating arguments for and against assisted dying, the article presents a balanced discourse that respects the depth of individual suffering while upholding the intrinsic value of life. It argues that Orthodox Christianity, through its rich theological heritage and pastoral practice, provides a compassionate and ethically nuanced framework for navigating the moral complexities of assisted dying. This framework advocates for an end-of-life care that honors the fullness of the human person, supports the spiritual journey toward eternal life, and fosters a communal embrace of life’s sacred threshold, offering a dignified passage that aligns with the faith’s deepest convictions about human destiny and divine grace. (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)

Objectives: This study aimed to fill the gap between Vietnamese diabetic patients' needs and care through a qualitative study asking about their experiences with diabetes and quality of care. -/- Methods: Interviews with five diabetic patients were conducted at a tertiary general hospital located in southern Vietnam. The transcribed data were first subjected to quantitative text analysis using KH Coder to identify major categories of frequently used words, followed by a qualitative analysis of selected cases using the Steps (...) for Coding and Theorization (SCAT) method. -/- Results: The major categories of frequently used words were chronic health conditions, services, facilities, insurance, patient-doctor communication, and medication. SCAT analysis of three selected cases identified six themes: “Disregarding the disease at the early stage,” “Fear of complications,” “Satisfaction with hospital services and medical staff,” “Insurance-related problems,” “Long waiting times,” and “Communication barriers between patients and doctors.” Patients were satisfied with improved hospital facilities and services; however, the overloading of one hospital led to long waiting times and communication difficulties with doctors. Difficulties with health insurance were also observed, and patients were rather passive in disease management and needed to be empowered through improved communication with doctors and other care providers. -/- Conclusion: These findings from our trial of introducing a qualitative study into service evaluation suggest that listening to patients can help health providers learn their perspectives and be more responsive to their needs. (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 article, we investigate how the concept of Care Biography and related concepts are understood and operationalised and describe how it can be applied to advancing our understanding and practice of holistic and person‐centred care. Walker and Avant's eight‐step concept analysis method was conducted involving multiple database searches, with potential or actual applications of Care Biography identified based on multiple discussions among all authors. Our findings demonstrate Care Biography to be a novel overarching concept derived (...) from the conjunction of multiple other concepts and applicable across multiple care settings. Concepts related to Care Biography exist but were more narrowly defined and mainly applied in intensive care, aged care, and palliative care settings. They are associated with the themes of Meaningfulness and Existential Coping, Empathy and Understanding, Promoting Positive Relationships, Social and Cultural Contexts, and Self‐Care, which we used to inform and refine our concept analysis of Care Biography. In Conclusion, the concept of Care Biography, can provide a deeper understanding of a person and their care needs, facilitate integrated and personalised care, empower people to be in control of their care throughout their life, and help promote ethical standards of care. (shrink)

To Stiegler’s notion of pansable (curable), one might also need to add that penser (to think) relates to the Latin penso, the frequentative of pendo, to hang, suspend. The pansable (that which can be healed) is as much the pensable (that which can be thought) and the suspensible (that which can be hung). Stiegler’s final act revealed that which was always already there: an unhealed pharmacological shadow that preceded him. While he entered philosophy with the argument of technics as the (...) impensé (unthought) of continental philosophy, he concluded in a final acting out, an impansable (uncurable) that ended his life. He, who believed that life is about cultivating rêveries and protentions capable of promise. Protention means both a capacity to invent and an ability to project oneself into the future through the practice of imagination and desire. He, who pondered about the retentions we have and the various forms of memory they take, and how to make them become the true modes of being-in-the-world. I know now that his fatal transgression is as much an accident as a departure, an emotional ceasefire and a bifurcative ending. Somehow, he found a way to remain faithful to the originary beginning of his thinking in act. (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)

For a while in this article it seems impossible to articulate a compelling reason for refraining from killing an innocent stranger with the press of a button when this would earn one a small prize and would be done with absolutely guaranteed immunity from any punishment or other harm (including even an instantaneous elimination of any chance of a guilty memory, achieved through hypnosis, and an ironclad commitment from God not to condemn the killing). After many failed attempts, a compelling (...) reason for not pushing the button is finally articulated. A distinction is demonstrated between merely apparent, mistaken desires and real desires. One might, for example, have merely an apparent, mistaken desire to be drinking the stuff in a mug of hot mud if one mistakenly believed that the stuff was hot chocolate. One would not really desire to be drinking that stuff. A desire, which must always be based on some belief about what its object is like, would always be open to correction along with the belief on which it depended. This realisation leads to the sweeping principle that one can only really desire what one would be desiring with a hypothetical perfect grasp of all that is involved. If one desires something only because of not fully grasping what that thing is, then one does not really desire it. What one really desires, then, regarding this stranger and pushing the button has to be what one would desire if fully experiencing, among other things, the entire value of the stranger's life from his own as well as every other angle along with the small value for oneself of the prize received on killing him. This equal concern for all is morality, and what is compelling in morality is that what it commands is what everyone really desires. (shrink)

This paper interprets the demonstrative retreat from public life and the promotion of self-improvement in Seneca’s later works as a political undertaking. Developing arguments by THOMAS HABINEK, MATTHEW ROLLER and HARRY HINE, it suggests that Seneca promoted the political vision of a cosmic community of progressors toward virtue constituted by a special form of progressor friendship, a theoretical innovation made in the Epistulae morales. This network of like-minded individuals spanning time and space is open to anyone who shares the (...) other members’ commitment to the improvement of one’s own self and that of others. By advertising such self-care and courting his readers as prospective friends, the author of the Epistulae morales aims to recruit new members for that community, in particular in the first nine letters. (shrink)

Dance, as a mode of physical interaction, offers opportunities to care and be cared for, but this does not mean that dancers will, in fact, care. There may be no moral motivation underlying a lift, dip or intricate sequence of coordinated action. Choreographic scores may (knowingly or not) encourage merely perfunctory movements that are a poor simulacrum to care. Moreover, the caring that is expressed through dance need not transfer to other walks of life. I am (...) not alone in knowing spectacularly talented dancers whose behaviour off the dance floor is far from ethical – from the arrogant and petty to the flagrant abuse that plagues institutions of art and culture. This article considers how dance can illuminate both the acts and sentiments of care, conveying particular ethical orientations that trouble straightforward, absolute moral reasoning. The article frames an enquiry into the relation between ethics and aesthetics of care, drawn from feminist epistemologists Joan Tronto, Maurice Hamington, and Nel Noddings, as well as my own performance research on partnering. I frame a zone between technique and competence, foregrounding care in dance as both a technical and ethical issue. I will consider the necessary conditions by which dancing together can manifest care, rather than suggest blanketly that it always does or even that it should. To make this argument, I will describe and analyse Considered Care, a duet I created in the autumn of 2021 in collaboration with Boston Ballet. This performance research project provided the material from which to consider the concept of need, a condition of care in a dancing situation. I will conclude by considering the relationship between needs and trust in conceptualizing care within partnering. (shrink)

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)

The U.S. Supreme Court's majority opinion in Vacco v. Quill assumes that the principle of double effect explains the permissibility of hastening death in the context of ordinary palliative care and in extraordinary cases in which painkilling drugs have failed to relieve especially intractable suffering and terminal sedation has been adopted as a last resort. The traditional doctrine of double effect, understood as providing a prohibition on instrumental harming as opposed to incidental harming or harming asa side effect, must (...) be distinguished from other ways in which the claim that a result is notintended might be offered as part of ajustification for it. Although double effectmight appropriately be invoked as a constrainton ordinary palliative care, it is not clearthat it can be coherently extended to justifysuch practices as terminal sedation. A betterapproach would reconsider double effect'straditional prohibition on hastening death as ameans to relieve suffering in the context ofacute palliative care. (shrink)

Some provisions of the UN’s Convention on the Elimination of Discrimination Against Women (CEDAW) are clearly important from the perspective of business ethics, particularly those calling for equal rights for women to employment and financial security. Some other provisions of CEDAW are equally as important for ethical business practices and Corporate Social Responsibility (CSR), but are frequently overlooked because of the presumption that they are not strictly business concerns: the rights of women to participation in public life, marriage, and (...) family rights; the rights of rural women to adequate living conditions; and general rights to equality. This chapter will discuss the conceptual commitments that underlie the assumption of a clear demarcation between work and life concerns, and examine the criticisms of this assumption made by feminism. It will, in particular, be interested in: -/- • The public/private distinction • The meaning of “work” or “labor” • The relationship between CSR and care ethics • Fostering a broader understanding of the family or familial relations • Examining the connection between fair wages and work/life integration -/- These discussions suggest that the ability for businesses worldwide to uphold the tenets of CEDAW is dependent upon a reconsideration of the character of the Ideal Worker and a nuanced understanding of the effects of workplace policies on the wider communities in which businesses operate. In particular, though work/life integration is not strictly speaking a “women’s issue,” the ethical and policy considerations addressed herein currently have disproportionately negative effects for women; thus, addressing them is crucial for achieving the aims of gender equality. (shrink)

Because an increasing number of patients have medical conditions that render them incompetent at making their own medical choices, more and more medical choices are now made by surrogates, often patient family members. However, many studies indicate that surrogates often do not discharge their responsibilities adequately, and in particular, do not choose in accordance with what those patients would have chosen for themselves, especially when it comes to end-of-life medical choices. This chapter argues that a significant part of the (...) explanation of such surrogate failure is that family surrogates are likely to undergo anticipatory grief when making end-of-life decisions. After clarifying both the emotional structure and object of grief, I propose that the pending death of a loved one induces an emotional conflict in surrogates between the care demanded by their responsibility as surrogates and the attachment surrogates feel toward their dying loved one, an attachment surrogates "resolve" in the direction of attachment rather than care. This hypothesis helps to explain both surrogates' general inability to exercise "substituted judgment" on behalf of their loved ones and a wide swath of the particular data regarding this inability (e.g., that surrogates more often err by choosing overtreatment). I conclude by considering possible clinical and philosophical responses to this hypothesis. (shrink)

Patient-centered care (PCC) is an approach to healthcare that values patients’ preference, need, and autonomy. The estimation of healthcare partly depends on how well PCC is implemented. In addition, the result of clinical research can inform the assessment of the implementation of PCC. In clinical research, health-related quality of life (HRQL) theoretical models offer a conceptual toolbox that informs clinical research and guides the hypotheses generation. Wilson and Cleary (1995) developed the most widely used HRQL theoretical model (Bakas (...) et al., 2012). Ontological assumptions about causation in Wilson and Cleary’s model will influence which kind of hypotheses will be generated. I will argue that Wilson and Cleary’s model instilled a kind of causal bias into hypothesis generation in clinical research on HRQL. Causation from biomedical factors to non-biomedical factors is frequently hypothesized while causation from non-biomedical factors to biomedical factors is rarely hypothesized. It leads to that the interdependence and interaction between constituent parts of patients are ignored, which is an obstacle to the implementation of PCC. In addition, I will propose a revised HRQL theoretical model which avoids the causal bias brought by Wilson and Cleary’s model. By doing so, I leave room for the improvement of the practice of healthcare by analyzing the ontological assumptions about causation. (shrink)

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation. We present a case in which a pediatric hospital caring for both children and adults seeks to establish guidelines for the use of extracorporeal membrane oxygenation if there are not enough resources to treat every patient. Experts in critical care, end-of-life (...) care, bioethics, and health policy discuss if age should guide rationing decisions. (shrink)

The conditions of transport and slaughter at the end of their lives are a major challenge to the welfare of agricultural animals. • End-of-life experiences should be of a greater ethical concern than others of similar intensity and duration, due to their position in the animal’s life. • End-of-life welfare can have both internal importance to the animals and external ethical importance to human decision-makers. • We should pay extra care to ensure that the conditions during (...) transport and slaughter are as positive as possible. (shrink)

What is so striking about Breaking Bad is how centrally impairment and disability feature in the lives of the characters of this series. It is unusual for a television series to cast characters with visible or invisible impairments. On the rare occasions that television shows do have characters with impairments, these characters serve no purpose other than to contribute to their ‘Otherness.’ Breaking Bad not only centralizes impairment, but impairment drives and sustains the story lines. I use three interrelated themes (...) from Disability Scholarship to analyze Breaking Bad. The first theme, Bodily Control, is that good bodies are controlled bodies and that uncontrolled, messy bodies are frightening, bad bodies. Indeed, the messiness of impairment and disability is so bad, that impaired and disabled individuals are excluded or shut out or excluded from many areas of public life. The second theme, Normalcy, is that the effect of hiding away impairment, of attempting to conceal disability, is that society becomes defined by, and structured around, the concept of normalcy. Normalcy, being normal, attaining and maintaining normalcy, is the preoccupation of most in society. To fail to be normal, or to fall from what is considered to be normal, is a source of tremendous anxiety for most people. These two themes, Bodily Control and Normalcy are conceptually connected: impairment, disease and dying are so feared because they are socially invisible and, therefore unknown and unknowable. They are the undiscussable taboos. The third theme, Bodily Realism, is that having a realistic view of the body, which would at minimum require accepting the fact that human bodies are fragile things, prone to disease and accident and are ultimately destined to die, makes one more at ease in the world, and able to live better lives and live as a better person. Indeed, so the argument goes, our lives would be richer, more rewarding—emotionally and morally—if we cared less about normalcy because of a dread of abnormalcy, but instead learned to accept if not positively value the physical variability of human existence. (shrink)

Bernard Reginster, in his book The Affirmation of Life: Nietzsche on Overcoming Nihilism, takes up the challenge of figuring out what Nietzsche might mean by nihilism and the revaluation of values. He argues that there is an alternative, normative subjectivist interpretation of Nietzsche's views on nihilism and revaluation that makes as much sense as—indeed, he often clearly leans toward thinking that it makes more sense than—a fictionalist reading of Nietzsche. I argue that his arguments do not succeed. Once we (...) have looked carefully at the details of the positions and the arguments ascribed to Nietzsche, the fictionalist option is the more charitable interpretation of the texts. I focus on the metaethical issues that play a central role for Reginster in his articulation of Nietzsche's nihilism and Nietzsche's strategy for overcoming nihilism. (shrink)

Extant literature suggests a positive correlation between social trust (also called generalized trust) and life satisfaction. However, the psychological pathways underlying this relationship can be complex. Using the Bayesian Mindsponge Framework (BMF), we examined the influence of social trust in a high-violence environment. Employing Bayesian analysis on a sample of 1237 adults in Cali, Colombia, we found that in a linear relationship, generalized trust is positively associated with life satisfaction. However, in a model including the interactions between trust (...) and education level as well as between trust and socioeconomic status, generalized trust is found to be negatively associated with life satisfaction. In this non-linear relationship, both education level and socioeconomic status have moderating effects against the negative association between generalized trust and life satisfaction. In other words, less educated people living in worse socioeconomic conditions are more likely to have lower life satisfaction when they have higher levels of social trust. In contrast, highly educated people living in better socioeconomic conditions are more likely to have higher life satisfaction when they have higher levels of social trust. Due to the facilitating function of trust in information processing, lowering the rigor of the filtering system in a high-violence social environment will likely put an individual at risk. Based on our findings, we suggest that policymakers should consider the impacts of social contexts when advocating for increasing social trust. We also recommend that researchers carefully examine the psychological mechanism underlying an observed association before making suggestions for policymaking. (shrink)

Some people feel threatened by the thought that life might have arisen by chance. What is it about “chance” that some people find so threatening? If life originated by chance, this suggests that life was unintended and that it was not inevitable. It is ironic that people care about whether life in general was intended, but may not have ever wondered whether their own existence was intended by their parents. If it does not matter to (...) us whether one's own existence was intended, as will be hypothesized, then why should it matter whether there was some remote intent behind the creation of the first unicellular organism(s) billions of years ago? I will discuss three possible scenarios by which life might have originated. I will then argue that, in regard to whether one’s individual life can be meaningful, it does not matter whether life was intended or arose by chance. If complex life was unintended and is rare in this universe, this is not a reason to disparage life, but a reason to appreciate and value our existence. -/- . (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)

Many criminal offenders come from disadvantaged backgrounds, which punishment entrenches. Criminal culpability explains some disadvantageous treatment in state-offender interactions; yet offenders remain people, and ‘some mother’s child’, in Eva Kittay’s terms. Offending behaviour neither erases needs, nor fully excuses our responsibility for offenders’ needs. Caring is demanded in principle, recognising the offender’s personhood. Supporting offenders may amplify welfare resources: equipping offenders to provide self-care; to meet caring responsibilities; and enabling offenders’ contribution to shared social life, by providing support (...) and furthering the choices of others seeking to engage with them. The desistance paradigm (viewing desistance from offending as a process, following from an offender’s active choice in the context of stabilising social structures and personal circumstances), implies that a supportive environment may facilitate reduced recidivism. While decisions about criminal culpability need justice, we may use state resources most effectively by also including care ethics in our thinking about punishment. (shrink)

Breast cancer treatment is being transformed by artificial intelligence (AI). Nevertheless, most scientists, engineers, and physicians aren't ready to contribute to the healthcare AI revolution. In this paper, we discuss our experiences teaching a new American student undergraduate course that seeks to train the next generation for cross-cultural design thinking, which we believe is critical for AI to realize its full potential in breast cancer treatment. The main tasks of this course are preparing, performing and translating interviews with healthcare professionals (...) from both Portugal and the USA. Since the course is offered in Portugal as a short-term faculty-led study abroad program, students can explore the effect of culture on healthcare delivery and the design of healthcare technologies. The learning tests demonstrated student growth for breast cancer treatment in many areas important for the development of AI. In respect to understanding breast cancer care, most students had undervalued the effect of cancer and its treatment on the quality of life of women before taking this course and most were unaware of the importance of multidisciplinary care teams. Regarding AI in medical, students became more mindful of data privacy issues and the need to consider the effect of AI on healthcare professionals. (shrink)

Palliative care seeks to provide holistic care to improve the quality of life for the sick, especially as they approach the end of their lives. Addressing the spiritual dimension of the human person is useful because it provides answers to the meaning of life. Spiritual care has been shown to be of great benefit to patients. Therefore, this paper explores the importance of the spiritual dimension in palliative care; highlight the act of listening as (...) a key part of spiritual care, showing that physician burnout is the main obstacle to improving listening as an appropriate service that is both comforting and healing. -/- Los cuidados paliativos buscan ofrecer una atención holística para brindar una mejor calidad de vida a los enfermos, especialmente cuando se aproximan al fin de su existencia. Profundizar en la dimensión espiritual de la persona humana resulta útil puesto que ofrece respuestas al sentido de la vida. Se ha constatado que la atención espiritual aporta grandes beneficios para el paciente. Es por eso que en este trabajo hemos querido profundizar en la importancia de la dimensión espiritual en los cuidados paliativos; se destaca la actitud de la escucha como pieza clave de dicha atención espiritual, lo que evidencia que el burnout de los médicos es el principal obstáculo para potenciar la escucha como una adecuada disposición que resulte consoladora y sanadora. (shrink)

Narrated in the first person, Peter Carey’s novel about the life of Australian bushranger Ned Kelly incorporates other aspects of speech derived both from Carey’s personal experience and from the editorial process. Kelly's voice is toned down to some extent by virtue of the latter, introducing expressions Kelly himself would not have used. Identifying these elements, along with the specific attributes of Kelly’s own speech, enjoins a diversity of cultural and social groupings that intersect and, in some instances, compete (...) with or contradict one another. Shifts in speakers might be signalled by textual markers or by adopting different expressive qualities and speech patterns, which may or may not include a change in grammatical person. In this novel, at one instance, a shift in person is apparent, but I want to argue, not necessarily a shift in the identity of the speaker because, although the grammatical voice shifts, its qualitative features are largely unaltered. The shift nonetheless introduces a significant change. Paradoxically, as far as literary theory is concerned, the subjective qualities produced through voice mean that stylisations of speech may be indicative of character point of view, rather than what is understood to be narrative voice, because they might function in narrative as inflections of speech that do not correspond to the established voice of the grammatically instanced speaker—offering a focalised perspective instead. The shift in True History presents problems in these terms, however: the point of view instanced here is clearly that belonging to the speaker, though the voice is Kelly’s, for the narrator’s point of view determines the generality of the descriptive terms where once these were specific and personal. Had the novel been narrated wholly in third person, an unproblematic reading of Kelly’s point of view, suggested by the use of his voice, would be possible. But the shift undermines this—Kelly’s point of view gives way to another, instanced in the shift that takes place in narrative voice. Carey, in other words, inverts the convention. This is not an instance of free indirect style or discourse, where grammatical mood is at odds with the speaker’s position and tenses align with the implicated subject position of another. The same features of voice that might identify character point of view must, in absence of any disparity of mood or tone, function in respect to narrative voice to convey something of its speaker’s subjectivity, and this seems apparent here: the speaker shares Kelly’s subjective emotional and intellectual perspective, but no longer occupies the subject position. Carey’s voicing of the bushranger therefore complicates distinctions between voice and point of view by revealing qualitative features of voice to be important to the question of who is speaking the narrative. (shrink)

This chapter investigates older people’s needs in contemporary Ghana using the analyses of quantitative and qualitative data sets. The findings identified eight distinct patterns of needs, namely basic needs, care, and domestic help; sociability, emotional and affective support; information; counseling; spiritual needs, free bus rides, and rights. These needs highlight older adults’ social and personal requirements regarding daily living and healthcare in their desire to age with dignity. Their provision may avert problems related to population ageing, including old-age dependency. (...) These needs can be addressed through the following measures. First, the facilitation of the informational needs of older people is attainable through the introduction of initiation for adults and/or older people into the social structure and/or life course. Second, the provision of houses through the mediation of government on behalf of pension contributors, payable in installments. These may ensure appropriate adjustment to life in old age, albeit longevity. The life-sustaining needs of older people have existed since time immemorial. However, these needs are now taking a new dimension in the era of population ageing and increased life expectancy, economic hardships, and weakening extended family support system. We, therefore, argue that these require interventions at both the family and institutional or state levels or formal and informal levels, particularly needs satisfying programs and policies should be instituted by the government in addition to the existing ones. (shrink)

End-of-life care has a number of characteristics that make economic evaluation particularly challenging. These include proximity to death, the improbability of survival gain, individuals’ changing priorities, declining cognition and effects on close persons. In view of these particularities of end-of-life care, some researchers have determined that current ‘extra-welfarist’ approaches to defining do not adequately reflect well-being. As a result, suggestions are being made that would see the QALY approach either replaced or subject to significant redefinition. The (...) purported goal of adopting alternative evaluation approaches is to extend the evaluative space ‘beyond’. The purpose of this chapter is to guide the definition of what should be included in the evaluative space in end-of-life care. (shrink)

An Islamic approach from its theological sources to address the spiritual pain related to palliative care of terminally ill patients can be established on attaining a spiritual stage of soul or spirit termed as reassured soul. The attainment of such stage is based on hope of the patient to receive mercy and forgiveness of God. And the way of attainment of hope is possible by doing the repentance, praying, and patience. In combating the pain and suffering, the patient is (...) supposed to understand that the life in its reality is a test and facing such a test is possible by two ways, one is patient centric by building patience within to endure the suffering and second is seeking help from God by praying. For the spiritual wellbeing, the patient should understand that his suffering is in fact expiation for his sins. On the other hand, the visitors and caregivers of patients have certain responsibilities that contribute to enhancing of the spiritual well-being of the patient, including comforting them by giving hope to the patients and at the same time praying for their recovery. These all elements enhance the spiritual well-being of patients and help in prevention of suffering by spiritual means. (shrink)

This paper will address Foucault’s analysis of the Hebrew and Christian pastor and argue that Foucault’s analysis of pastoral power in Security, Territory, Population neglects an important characteristic of the shepherd/pastor figure: violence. Despite Foucault’s close analysis of the early development of the Hebrew pastor, he overlooks the role of violence and instead focuses on sacrifice. However the sacrificial pastor does not figure in the Hebrew Scriptures. The Hebrew pastor is called to lead, feed and protect the flock, not sacrifice (...) for them. This is not to suggest that the theme of sacrifice is absent in the Hebrew Scriptures but that sacrifice is not a role attributed to the pastor until Jesus’ reinterpretation of the “good shepherd” in Chapter 10 of The Gospel of John.4 In distinguishing the Hebrew and Christian formulations of the pastor, the roles of violence and sacrifice in each can be understood more clearly. Beginning with the Hebrew Scriptures I will demonstrate the importance of violence in the figure of David as the first “shepherd of men”. I will argue that violence and the ability to protect the flock was a significant and determining characteristic of the Hebrew pastor. Contrary to Foucault’s assertion I will demonstrate that sacrifice was not a role attributed to the Hebrew pastor. While the words and life of Jesus provide a new sacrificial paradigm for understanding the “shepherd of men,” it is Paul who provides the foundation on which the practice of the Christian pastor is established in the Church. Therefore I will examine the writing of Paul to demonstrate the way violence operates in the Christian pastorate. I will argue that sacrifice does not replace violence but violence is subsumed in the sacrificial pastor and continues to operate. Finally I will suggest that the introduction of violence into Foucault’s analysis establishes a deeper connection between pastoral power and biopower. Thus, this connection engenders a richer understanding of the tension in Foucault’s work between care and violence in the poles of biopower: to make live and let die. (shrink)

This chapter examines Wittgenstein’s battles with the profound anxiety that can arise in response to a sense of the radical contingency of everything one is and everything one cares about. By giving particular attention to entries in Wittgenstein’s ‘Koder Diaries’ from the 1930s, the chapter analyses the nature of ‘the problem of life’ both as it manifested in Wittgenstein’s own life and as a universally relevant problem. It then defends the seriousness of the problem by reconstructing ways in (...) which Wittgenstein might have responded to questions about whether life really is as problematically precarious as his most angst-ridden diary entries seem to presume. (Abstract adapted from Mikel Burley’s ‘Introduction: Wittgenstein, Religion and Ethics: Seeing the Connections’, p. 7). (shrink)

Erik Wielenberg recently invoked the parent-child analogy in an argument against Christian theism. The argument relies on the claim that a loving parent would never allow her child to feel abandoned in the midst of what feels like gratuitous suffering. In this paper, I offer three clear counterexamples to Wielenberg’s central premise. At the same time, a successful counterexample does not a robust theology of suffering make. To that end, and with a careful eye towards anti-theodical concerns, I defend the (...) need for a more proactive Christian philosophical examination of the role of suffering in a meaningful life. (shrink)

How can work be a genuine good in life? I argue that this requires overcoming a problem akin to that studied by Marx scholars as the problem of work, freedom and necessity: how can work be something we genuinely want to do, given that its content is not up to us, but is determined by necessity? I argue that the answer involves valuing contributing to the good of others, typically as valuing active pro-sociality – that is, valuing actively doing (...) something good for others. This makes work better in one way, and may even make work something we are genuinely glad to have in our lives. Contemporary philosophical thinking about good work tends to focus on how work can be good for the person doing it, by providing, for example, self-realization or social relationships, while underappreciating the special importance of valuing social contribution. People will typically only really want work if they want a part of their lives to be about the good of others. This also means that work may be a part of the best life, something we should take into account when discussing work-related policies and the desirability of a ‘post-work’ future. (shrink)

There has been much debate regarding the 'double-effect' of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing 'slow euthanasia.' On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten death. In (...) this paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary 'slow euthanasia'). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a 'grey' area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that 'slow euthanasia' may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of 'time' for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed. (shrink)

Abstract The values of the healthcare sector are fairly ubiquitous across the globe, focusing on caring and respect, patient health, excellence in care delivery, and multi-stakeholder collaboration. Many individual pharmacists embrace these core values. But their ability to honor these values is significantly determined by the nature of the system they work in. -/- The paper starts with a model of the prevailing pharmacist workforce model in Scotland, in which core roles are predominantly separated into hierarchically disaggregated jobs focused (...) on one professional ‘pillar’: Clinician /Practice Provider; Educator; Leader/Manager; and Researcher. This is the ‘Atomistic’ Model. This skills-segregation yields a workforce of individuals working in isolation rather than collaborating together, and lacking a shared information flow, purpose and identity. Key strategic flaws include suboptimal responsiveness to population and subpopulation needs, inconsistency and inequity of care, an erosion of professional agency, and lower job satisfaction. It is conjectured that this results from a lack of congruence between values, professional ethos, and organizational structure. ‘Atomism’ culminates in a syndrome of widespread professional-level cognitive dissonance. -/- The paper contrasts this with a new emerging workforce vision, The Collaborative Care Model. This new model defines a systems-first-approach, built on the principle that all jobs must include all four professional ‘pillars’. Vertical skills integration, involving education and task sharing, will support sustainability and succession planning. Horizontal skills integration (across practice, leadership and research) is included to improve responsiveness to population need and individual professional agency. The working conditions, supportive ethos, and career structure needed to make the model work are described. Moral theory and workforce theory are used to justify why the model may be more effective for population health, delivering greater job satisfaction for individuals and ultimately helping systematically realize and honor healthcare values. Finally, the paper sketches the first steps needed to implement the model at the national level, starting with the operationalization of new multi-pillar professional curricula across the career spectrum. Potential pitfalls and challenges are also discussed. -/- Co-Authors: 1. Paul Forsyth (PF) Lead Pharmacist Clinical Cardiology, Pharmacy, NHS Greater Glasgow & Clyde. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Writing - original draft (lead author), Writing - review & editing (lead author) 2. Andrew Radley (AR), Consultant in Public Health Pharmacy, NHS Tayside. Contribution: Conceptualization; Model curation; Model Theory; Writing - review & editing 3. Gordon Rushworth (GR), MPharm MSc FFRPS FRPharmS (Consultant). Programme Director, Highland Pharmacy Education & Research Centre, NHS Highland, Inverness. Contribution: Model curation; Writing - review & editing 4. Fiona Marra (FM) National Lead Clinician Scottish Infection and Immunology Network (SPAIIN) / Advanced Pharmacist HCV / HIV, NHS Greater Glasgow & Clyde. Contribution: Model curation; Writing - review & editing 5. Susan Roberts (SR) Associate Postgraduate Pharmacy Dean, NHS Education for Scotland. Contribution: Model curation; Writing - review & editing 6. Roisin O’Hare (RO) Lead Teacher Practitioner Pharmacist, Northern Ireland University Network, Southern Health and Social Care Trust. Contribution: Model curation; Writing - review & editing 7. Catherine Duggan (CD) Chief Executive Officer, International Pharmaceutical Federation (FIP). Contribution: Model curation; Writing - review & editing 8. Barry Maguire (BM) Senior Lecturer, School of Philosophy, Psychology and Life Sciences, The University of Edinburgh. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Supervision; Writing - original draft (senior academic supervisor), Writing - review & editing (senior academic supervisor) -/- . (shrink)

The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA’s provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is (...) neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the health care system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry. (shrink)

Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision making are the harm principle, the principle of best interest, and the threshold view. This paper consider how these principles apply to a case of a premature neonate with multiple significant comorbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles help (...) to understand what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case, but that the case reveals common bioethical principles for medical decision making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism. (shrink)

This article presents the topic of crisis in the context of prevention in pastoral workers. It points to the possibility of coping with crisis and thus offers a theological view of overcoming it. It is based on the theoretical points of view and practical experience of pastoral workers. Selected aspects, types, preventions and therapies of crisis at the psychotherapeutic or spiritual-theological level are presented in this paper. -/- .

The absence of meaningfulness in life is meaninglessness. But what is the polar opposite of meaningfulness? In recent and ongoing work together with Stephen Campbell and Marcello di Paola respectively, I have explored what we dub ‘anti-meaning’: the negative counterpart of positive meaning in life. Here, I relate this idea of ‘anti-meaningful’ actions, activities, and projects to the topic of death, and in particular the deaths or suffering of those who will live after our own deaths. Connecting this (...) idea of anti-meaning and what happens after our own deaths to recent work by Samuel Scheffler on what he calls ‘the collective afterlife’ and his four reasons to care about future generations, I argue that if we today make choices or have lifestyles that later lead to unnecessarily early deaths and otherwise avoidable suffering of people who will live after we have died, this robs our current choices and lifestyles of some of their meaning, perhaps even making them the opposite of meaningful in the long run. (shrink)

Though the duties of care owed toward innocents in war and in civil life are at the bottom univocally determined by the same ethical principles, Bazargan-Forward argues that those very principles will yield in these two contexts different “in-practice” duties. Furthermore, the duty of care we owe toward our own innocents is less stringent than the duty of care we owe toward foreign innocents in war. This is because risks associated with civil life but not (...) war (a) often increase the expected welfare of the individuals upon whom the risk is imposed, (b) are often imposed with consent, and (c) are often imposed reciprocally. The conclusion—that we have a pro tanto reason for adopting a more stringent standard of risk imposition toward foreign innocents in war—has implications for not only what standards of risk we should adopt in war, but also how we should weigh domestic versus foreign civilian lives. (shrink)

Looking to Scripture through the eyes of contemporary medical experience, I analyze the meaning of the criteria used for determining death, specifically in the light of Jesus’ final moments and the resurrection of the Shunammite’s son in 2 Kings, chapter 4. I argue that four theses are consistent with, and informed by, these passages that can help guide Christian belief and decision-making about how death is determined in the clinical context: (1) death is neither permanent nor irreversible; (2) something like (...) the “brain dead” state is, at best, a confounding state that requires one to “pace and pray” or let go; (3) that the case for determining death by neurologic criteria depends on the “working togetherness” of the body's parts for the sake of impacting its environment; and (4) that the practice of neurologically-based death determination is a response to the problem of disaggregation of the human form into its organ systems that modern critical care medicine makes possible. I end with advice about how Christians might approach the debates over the law and practice even if they cannot come to a consensus. (shrink)

Spiritual formation currently lacks a robust epistemology. Christian theology and philosophy often spend more time devoted to an epistemology of propositions rather than an epistemology of knowing persons. This paper is an attempt to move toward a more robust account of knowing persons in general and God in particular. After working through various aspects of the nature of this type of knowledge this theory is applied to specific issues germane to spiritual formation, such as the justification of understanding spiritual growth (...) on an integrative and holistic (heart and mind) model, the reality of hearing God’s voice, and knowing his activity, as well as how such a theory should change the shape of sermons, evangelism, and apologetics. (shrink)

Desire comes in two kinds: attraction and aversion. But contemporary theories of desire have paid little attention to the distinction, and some philosophers doubt that it is psychologically real. I argue that one reason to think there is a difference between the attitudes, and to care about it, is that attractions and aversions contribute in radically different ways to our well-being. Attraction-motivated activity adds to the good life in a way that aversion-driven activity does not. I argue further (...) that the value of attraction-motivated activity is irreducible to the prudential value of pleasure or desire-satisfaction. Rather, it contributes in a distinctive way to the felt meaningfulness of life. In the end, I offer a hypothesis: when we are attracted to something, we see it as (noncomparatively) good; and it is only when we pursue the apparent good that we see ourselves as engaged with the type of value that makes our lives and the universe worth maintaining. (shrink)

When pessimists claim that human life is meaningless, they often also assert that the universe is “blind to good and evil” and “indifferent to us”. How, if it all, is the indifference of the universe relevant to whether life is meaningful? To answer this question, and to know whether we should be concerned that the universe is indifferent, we need a clearer and deeper understanding of the concept of “cosmic indifference”, which I will seek to provide. I will (...) argue that the lives of many individuals are meaningful and that human life, in general, is somewhat meaningful, despite the indifference of the universe. Furthermore, I will seek to demonstrate that even if the universe cared about us, or had preferences for how we live our lives, that this likely would not enhance the quality of our lives. (shrink)

Background Bronchial asthma is one of the most common chronic conditions among children. Despite the improvement in asthma treatment regimens, its prevalence and related morbidity are increasing, especially among underserved, minority children. There are barriers in the management of asthma, which may impact the quality of outcomes. The goal of this study is to explore these barriers. Methods A cross-sectional study was conducted on interview data collected through 2019 from mothers of children (aged 6 - 12 years) with asthma visiting, (...) for convenience, a public shopping mall. The interviewees were randomly selected, because they met the inclusion criteria. Participants were considered if the mother answered “yes” to the following questions: Has your child had physician-diagnosed asthma? Is your child currently taking asthma medications of asthma? Two community nurses conducted the interviews. Data was obtained using administrative questionnaires. Data were analyzed using SPSS version 21.0 (IBM Inc., Chicago, IL, USA). Descriptive statistics of percentage, mean, frequency and standard deviation were applied for categorical and continuous variables. Results Three hundred mothers participated in this study. Their average age was 36.8 years, 55% were housekeepers by profession, and 34% had obtained less than high school education. The majority of children (61%) were males, 45% had moderate asthma, and 42% had mild asthma. The most frequent types of barriers identified by parents were environmental factors (67.7%), followed by health care providers (63%), the health care system (48%), and patient or family characteristics (43%). Mothers were specifically concerned about the use, safety, and long-term complications of medications, the impact of exercise limitation on their child’s quality of life, and their own quality of life. Conclusion This study showed several barriers against asthma care in Saudi Arabia, which mainly related to environmental or personal characteristics. This highlights the need to enhance current policies within the health care system in Saudi Arabia to overcome these barriers. (shrink)

Purpose – Contemporary technology has been implicated in the rise of perfectionism, a personality trait that is associated with depression, suicide and other ills. is paper explores how technology can be developed to promote an alternative to perfectionism, which is a self- constructionist ethic. Design/methodology/approach – is paper takes the form of a philosophical discussion. A conceptual framework is developed by connecting the literature on perfectionism and personal meaning with discussions in information ethics on the self, the ontic trust and (...) technologies of the self. To illustrate these themes, the example of selfies and self-portraits is discussed. Findings – e self today must be understood as both individualistic and relational, i.e., hybrid; the trouble is balance. To realize balance, the self should be recognized as part of the ontic trust to which all information organisms and objects belong. us technologically-mediated self-care takes on a deeper urgency. e selfie is one example of a technology for self-care that has gone astray (i.e., lost some of its care-conducive aspects), but this can be remedied if selfie-making technology incorporates relevant aspects of self-portraiture. is example provides a path for developing self- constructionist and meaningful technologies more generally. Practical implications – Technology development should proceed with self-care and meaning in mind. e comparison of selfies and self-portraits, situated historically and theoretically, provides some guidance in this regard. Some specific avenues for development are presented. Originality/value – e question of the self has not been much discussed in information ethics. is paper links the self to the ontic trust: the self can be fruitfully understood as an agent within the ontic trust to which we all belong. (shrink)