When our nearest and dearest experience medical crises, we may need to step into caregiving roles. But in doing so, we may find that our new caregiving relationship is actually in tension with the loving relationship that motivated us towards care. What we owe and are entitled to as friends, spouses, and family members, can be different from what we owe and are entitled to as caregivers. For this reason, caregiving carries with it the risk of a type of moral (...) distress that I call “role conflict distress.” Rather than view role conflict distress as a sign that we are falling short, I suggest that it actually speaks to the commitment that we have to the loving relationship that grounds our duty of care. (shrink)

The sacrifices of nurses in hard-hit cities during the early stages of the COVID-19 pandemic and of family caregivers for people with late-stage Alzheimer’s disease present two puzzles. First, traditional accounts of supererogation cannot allow for the possibility of making enormous sacrifices that make one’s actions supererogatory simply to do what morality requires. These caregivers, however, are doing their moral duty, yet their actions also seem to be paradigmatic cases of supererogation. I argue that Dale Dorsey’s new account of supererogation (...) can solve this puzzle. Second, these caregivers often deny that they are heroic, but standard explanations of these assertions either diminish their sacrifice, say they are confused, or attribute to them a vice. If we want to understand them without diminishing them, we should instead see their denials as a response to what Beth DeVolder calls compulsory heroism. Compulsory heroism occurs when someone is foisted into the role of hero for doing their moral duty as a distraction from the social realities that make doing their duty involve inordinate sacrifice. (shrink)

In the last decade, the cases of breast and cervical cancer have been positioned at the top rank of cancer statistics worldwide. Consequently, many husbands become family caregivers (FCGs) and get the burden of cancer caregiving. Being blind and incompetent, they need supportive care from healthcare professionals (HCPs). To support them, HCPs provide various healthcare information to meet their needs. Further, their demand for a specific type of healthcare information may reflect their need for emotional support from the HCPs to (...) reduce the burden. This study aims to examine the predictors of the need for emotional support among FCGs of female cancer patients by analyzing the demanded healthcare information. The mindsponge theory was used in conceptual development and interpretation. Bayesian Mindsponge Framework (BMF) analytics were used for statistical analysis on a dataset of 48 husbands and 12 significant others in five congested communities of Surabaya, Indonesia. Results showed that among the six types of healthcare information, the demanded cancer-specific information and information on cancer physical needs significantly predict the need for emotional support among respondents. Meanwhile, FCGs with a higher demand for information on alternative therapies are less likely to need emotional support. Other types of information have ambiguous effects on the need for emotional support. This study reveals that the demanded cancer-specific information, e.g., cancer prognosis or likely outcome, and information on cancer physical needs must be prioritized in information disclosure to meet the needs for emotional support among FCGs of female cancer patients. (shrink)

Adaptation and stress are two main concepts useful for better understanding the phases of illness and health-related human behavior. The two faces of adaptation, adaptation as a process and adaptation as a product, have raised the question of how long the adaptation process will take in cancer trajectories. The care setting transition from clinical-based into home-based cancer care has stressed the role of family caregivers (FCG) in cancer management. This study examines how types of demanded healthcare information affect the FCG’s (...) role in catalyzing the adaptation of female cancer patients. The mindsponge theory was used in conceptual development and results interpretation. Bayesian Mindsponge Framework (BMF) analytics was used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of demanded healthcare information, FCGs with a higher tendency to demand cancer-specific information are more likely to need support in catalyzing the adaptation of female cancer patients. Meanwhile, FCGs with a higher demand for information on alternative therapies are less likely to need support in catalyzing cancer adaptation. Other types of healthcare information have ambiguous effects on the need for support in cancer adaptation assistance. This study reveals that the demanded cancer-specific information, e.g., cancer’s prognosis or likely outcome, must be prioritized to assist FCG’s role in catalyzing adaptation among female cancer patients. Cancer prognosis and outcomes reflect the future of cancer care results. (shrink)

Cancer care has transitioned from clinical-based to home-based care to support longterm care in a more familiar and comfortable environment. This care transition has put family caregivers (FCGs) in a strategic position as care providers. Cancer care at home involves psychological and emotional treatment at some point, making FCGs deal with the stress of cancer patients frequently. Due to their limited care competencies, they need supportive care from healthcare professionals in cancer stress management. This study aims to examine how types (...) of demanded healthcare information affect the FCG’s role in reducing the stress of female cancer patients. The mindsponge theory was used in conceptual development and interpretation. Bayesian Mindsponge Framework (BMF) analytics were used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of healthcare information, FCGs with higher demand for cancer-specific information were more likely to need support in reducing the stress of female cancer patients. Meanwhile, FCGs with a higher demand for information about support services were less likely to need support to reduce cancer patients’ stress. Other types of healthcare information have ambiguous effects on the need for support in reducing cancer-induced stress. This study reveals that the demanded cancer-specific information, e.g., cancer prognosis or likely outcome, must be prioritized to assist FCG’s role in managing cancer stress. (shrink)

Fear of cancer is mostly related to cancer recurrence, metastasis, additional cancer, and diagnostic tests. Its legacy as a lethal disease has raised fear of approaching death. Currently, cancer’s total suffering and the worsening phenomena have raised fear, especially among female patients. Family caregivers (FCGs) who are responsible for the day-to-day cancer care at home need to help the patients deal with this fear frequently. Due to the limited care competencies, they need supportive care from healthcare professionals in cancer fear (...) management. This study aims to assess how types of demanded healthcare information affect the FCG’s role in reducing the fear of female cancer patients. The mindsponge theory was used in conceptual development and interpretation. Bayesian Mindsponge Framework (BMF) analytics were used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of healthcare information, FCGs with higher demand on cancer-specific information and information on cancer physical needs were more likely to need support in reducing the fear of female cancer patients. Meanwhile, FCGs with a higher demand for information on support services were less likely to need support to reduce cancer patients’ fear. Other types of healthcare information have ambiguous effects on the need for support in reducing cancer-induced fear. This study reveals that the demanded cancer-specific information, e.g., cancer’s prognosis or likely outcome and information on cancer physical needs, need to be met in priority to assist FCG’s role in cancer fear management. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Affect Attunement in the Caregiver-Infant Relationship and Across SpeciesExpanding the Ethical Scope of ErosCynthia WillettCompelling glimpses into the ethical capacities of our animal kin reveal new possibilities for ethical relationships encompassing humans with other animal species. Consider the remarkable report of a female bonobo in a British zoo who assists a bird found in her cage by retrieving the fallen bird, and spreading its wings so that this (...) fellow creature might fly away to its freedom. Or the report of a cat in a nursing home who curls up around dying elderly patients, and remains steadily by their side as they, unbeknownst to the medical personnel, pass away.1 Or of a sacred moment of silence by a stream for baboons in East Africa.2 Or of the ethics that spontaneously emerges among wolves at play.3 On the basis of extensive studies, biologist Frans de Waal argues that such anecdotes are far from rare, and that some core elements of moral understanding and compassion occur among a significant range of nonhuman as well as the human animal species. Apes, monkeys, and perhaps all nonhuman animals fail to display a distinctly human capacity for abstract moral reasoning. As de Waal (2006) remarks, it is difficult to tell (173–75). But our furry and feathery kin do without a doubt demonstrate rich elements of ethical response, and they often enough extend their moral concern to creatures beyond their own species. Of course, they will also bite each other’s heads off or eat their own young as well. But this is just to say that animals are neither natural [End Page 111] innocents nor savage brutes. Like us, they belong to what post-Nietzschean philosophers might frame, somewhat ironically, as a postlapsarian world of good and evil.What kind of philosophical approach could account for these postlapsarian genealogies of ethics? Biologists, primatologists, and anthropologists are drawing upon investigations of prosocial behavior to remap the boundaries of ethics, as for example in Isabelle Stengers’s call for cosmopolitical ecologies of relationships (2010, 33). Such a cosmopolitics aims to encompass our kin and kind from diverse species within the ethical boundaries of common worlds. Donna Haraway discovers an opening for Stengers’s ecology of relationships in the intimate encounters among co-evolving species, especially those she calls companion species (2008, 83). She argues, following Derrida, that the abstract reasoning processes of Stoic and Kantian cosmopolitan ethics remain closed to the participation of nonhuman animals as anything more than dependents, failing to observe the ways in which they act as companions, if not moral subjects. But then, what normative force might bind together an ethically attuned biosocial sphere that we as humans co-inhabit with other animal species?To explore this question, this essay takes its cues from well-established research on the responsive, preverbal connection of the human infant and adult caregiver (Bateson 1979; Trevarthen 1984; Stern 1985, 2010; Gibbs 2001, 2010; Hansen 2004; Anderson 2006; Papoulias and Callard 2010; Willett 1995, 2001). To this research we can add new animal studies (Smuts 1999, 2001; Fudge 2002; de Waal 2006, 2009; Bekoff 2007; Molnar 2008; Haraway 2008). These animal studies provide a basis for extending an “ethics of eros” with roots in Luce Irigaray, Michel Foucault, Enrique Dussel, Africana feminism, Freudo-Marxist critical theory, and Plato (for discussions of this tradition, see Bergoffen 1997; Huffer 2009; Willett 2001)—but reconfigured in terms of social bonds across multiple animal species. In this tradition of ethics, the lack of a cognitive-based moral subjectivity that can translate into human terms does not consign nonhuman species to a mute moral status. On the contrary, some more primordial basis for relationship and meaning may weave thin but substantial threads of a postmoral ethics across regions of the biosphere.Given the diverse modes of subjectivity among animal species, and even the lack of what we call a moral subject altogether in many species, neither ordinary modes of empathy nor of moral understanding go very far in forging multispecies social bonds. For this reason, we turn to research on “the attunement of affects” in the infant-caregiver relationship (Stern 1985). As we shall see, this... (shrink)

Among all aspects, the unmet needs of healthcare information from the healthcare and illness-related domains have the potency to predict the unmet needs of emotional support from the emotional and relational domains in this population. The current study aims to examine the predictors of the needs for emotional support among FCGs of cancer patients by analyzing the demanded healthcare information, i.e., cancer-specific information, caregiver-specific information, therapy-specific information, information on cancer physical needs, information on alternative therapies, and information on support (...) services. (shrink)

Caregiving robots are often lauded for their potential to assist with geriatric care. While seniors can be wise and mature, possessing valuable life experience, they can also present a variety of ethical challenges, from prevalence of racism and sexism, to troubled relationships, histories of abusive behavior, and aggression, mood swings and impulsive behavior associated with cognitive decline. I draw on Confucian ethics, especially the concept of filial piety, to address these issues. Confucian scholars have developed a rich set of theoretical (...) resources for dealing with beloved but imperfect elders, and navigating the challenges of supporting seniors whose ethical commitments are unreliable. These resources provide a way to reconcile two important but conflicting desiderata: to value and care for seniors, but also to clear-mindedly deal with their moral shortcomings. In particular, they articulate a duty to remonstrate with our elders when they err. Confucian filial piety can helpfully inform robot design and use in geriatric care. They can be used to strengthen and protect emotional connections in important relationships, but should not be used to reinforce patient preferences when doing so damages relationships or their ability to act morally. Rather than conceive of patient wellbeing as in tension with moral behavior, and care as a burden for caregivers, not a source of value and meaning, Confucian accounts of filial piety help identify both new areas of concern and new potential in the development of caregiving technologies, ones which see these goods as complementary. (shrink)

The current study aims to examine how types of demanded healthcare information affect the FCG’s role in catalyzing the adaptation of female cancer patients (i.e., cancer-specific information, caregiver-specific information, therapy-specific information, information on cancer physical needs, information on alternative therapies, and information on support services).

The current study aims to examine how types of demanded healthcare information affect the FCG’s role in reducing the fear of female cancer patients (i.e., cancer-specific information, caregiver-specific information, therapy-specific information, information on cancer physical needs, information on alternative therapies, and information on support services).

One of the most unpredictable things the pandemic brought to our societies was the closure of hospitals and other health services to visitors. Preventing the spread of infection was the main reason for these decisions in the early days of the pandemic when there was no clarity about the means of transmission and the origin of the virus. However, in view of the persistence of the restrictions to date and the numerous negative consequences they have had on the professional and (...) personal quality of life of doctors, nurses, patients and carers, the aim of this article is to analyse in depth the reasons why these decisions have been and, above all, are still being applied, also considering the hypothesis that the choices made so far in the training of health professionals should be questioned. The persistence of restrictions, the constant reduction of human and economic resources in the face of an increase in the demand for care have exacerbated the distance between health professionals and users, to the point of escalating into actual acts of violence and aggression. According to the Critical Pedagogy approach, educators can play a central role in activating formative and collaborative strategies, such as maieutic groups, to rebuild an alliance between those who today find themselves on opposite sides: health professionals on the one hand, and patients and families on the other. (shrink)

-/- Caring for loved ones with dementia can sometimes necessitate a loose relationship with the truth. Some might view such deception as categorically immoral, and a violation of our general truth-telling obligations. I argue that this view is mistaken. This is because truth-telling obligations may be limited by the particular relationships in which they feature. Specifically, within caregiving relationships, we are often permitted (and sometimes obligated) to deceive the people with whom we share them. Our standing to deceive follows from (...) certain features of caregiving relationships. Specifically, they are relationships that involve obligations to promote a person's interests and values (and not simply their autonomy), that often permit us to assume the hypothetical consent of the person with whom we share them, and in which we are often entitled to act out of self-interest. Once we appreciate these features, we will be able to recognize that the truth-telling norms governing our relationships with loved ones with dementia do not represent a radical departure from our general truth-telling obligations, but are instead consistent with truth-telling norms that feature in other caregiving relationships. In addition, we will be able to understand why we may feel conflicted about lying to loved ones with dementia, even when lying is permissible. (shrink)

Drawing upon the practice of caregiving and the insights of feminist care ethics, I offer a phenomenology of caregiving through the work of Eva Feder Kittay and Emmanuel Lévinas. I argue that caregiving is a material dialectic of embodied response involving moments of leveling, attention, and interruption. In this light, the Levinasian opposition between responding to another's singularity and leveling it via parity-based principles is belied in the experience of care. Contra much of response ethics’ and care ethics’ respective literatures, (...) this dialectic suggests that they are complementary in ways that productively illuminate themes of each. I conclude by suggesting that when response and care ethics are thought together through the experience of caregiving, such labors produce finite responsibility with infinite hope. (shrink)

We argue that individual and institutional caregivers have a defeasible moral duty to provide dependent children with plant-based diets and related education. Notably, our three arguments for this claim do not presuppose any general duty of veganism. Instead, they are grounded in widely shared beliefs about children’s interests and caregivers’ responsibilities, as well as recent empirical research relevant to children’s moral development, autonomy development, and physical health. Together, these arguments constitute a strong cumulative case against inculcating in children the dietary (...) practice of regularly eating meat (and other animal products) — a practice we call ‘carnism’. (shrink)

This booklet on Active Assisted Living (AAL) technologies has been created as part of the GoodBrother COST Action, which has run from 2020 to 2024. COST Actions are European research programs that promote collaboration across borders, uniting researchers, professionals, and institutions to address key societal challenges. GoodBrother focused on ethical and privacy concerns surrounding video and audio monitoring in care settings. The aim was to ensure that while AAL technologies help older adults and vulnerable individuals, their privacy and data protection (...) rights remain a top priority. This booklet is designed to guide you through the role that AAL technologies play in improving the quality of life for older adults, caregivers, and people with disabilities. AAL technologies offer tools for those facing cognitive or physical challenges. They can enhance independence, assist with daily routines, and promote a safer living environment. However, the rise of these technologies also brings important questions about data protection and user autonomy. (shrink)

Many caregivers feel that they need to lie or withhold the truth from people living with dementia, but worry that, in doing so, they are violating a duty to tell the truth. In this article, I argue that withholding the truth from and, in limited circumstances, lying to people living with dementia is not only morally permissible, but morally required by a more general requirement that we treat each other as persons worthy of respect. I do so through an analysis (...) of the groundings of the duty to tell the truth, and a critical reflection on its cognitively ableist construction. (shrink)

In “The Child’s Relations with Others,” Merleau-Ponty argues that certain early experiences are jointly owned in that they are numerically single experiences that are nevertheless given to more than one subject (e.g., the infant and caregiver). Call this the “joint ownership thesis” (JT). Drawing upon both Merleau-Ponty’s phenomenological analysis, as well as studies of exogenous attention and mutual affect regulation in developmental psychology, I motivate the plausibility of JT. I argue that the phenomenological structure of some early infant–caregiver (...) dyadic exchanges is best described as involving joint subjects. From birth, some experiences are constitutively social in that certain phenomenal states, such as the positive emotions that arise within these early exchanges, are jointly owned. Along the way, I consider a possible objection. I conclude by considering the explanatory significance of adopting JT. (shrink)

Amaç: Kanserle yaşayan bireylerin (KYB) bakımında, resmiyette görünür olmayan ve çoğunlukla herhangi bir profesyonel donanıma sahip olmayan, ama sürecin başından sonuna, hasta bireye eşlik eden bakım verenler kritik öneme sahiptir. Baş etmesi zor bir hastalık olan kanserle mücadele eden bireylerin bakımında, bakım verenler fiziksel, zihinsel ve sosyal birtakım zorluklarla karşılaşmaktadır. Bu araştırma, KYB’lere bakım veren, yakınlarının karşılaştıkları zorlukları gündeme getirmeyi ve ihtimam etiği perspektifinden, bakım verenlerin bakımına yönelik öneriler sunmayı amaçlamaktadır. Gereç ve Yöntem: Bu araştırma tanımlayıcı ve kesitsel olup araştırmanın (...) evreni Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi (MÜPEAH) Onkoloji kliniğinde takip edilen, 15 Mart-5 Nisan tarihleri arasında kemoterapi ünitesine ve servis hizmetlerine başvuran KYB’lerin bakım veren yakınlarıdır. KYB’lere bakım verenlerin umutsuzluk derecelerini tespit etmek ve bunu etkileyen faktörleri ölçmek için, veri toplama aracı olarak; sosyodemografik sorular, bakım alan bireyin hastalık derecesine yönelik sorular ve Beck Umutsuzluk Ölçeği sorularından oluşan bir anket elden dağıtılmıştır. Anket bakım verene yönelik sosyodemografik sorular 8, KYB’nin hastalığının durumu ile ilgili sorular 7, Beck Umutsuzluk Ölçeği 20 olmak üzere 35 sorudan oluşmaktadır ve yaklaşık 10 dakikada tamamlanmaktadır. Elde edilen veriler önce Microsoft Excel aracılığıyla dijitalleştirilmiş, ardından IBM SPSS 27.0.1 sürümüyle analiz edilmiştir. Verilerin analizinde Ki-kare, Fisher’s Exact testi ve Pearson Korelasyon analizi kullanılmış, istatistiksel anlamlılık değeri için p<0.05 kabul edilmiştir. Bulgular: Ankete katılan 151 bakım verenin 83’ü (%55,3) kadın, 67’si (%44,7) erkektir. Katılımcıların yaş ortalaması 40,09’dur. Bakım verenlerin %41,1’i umutsuzluk düzeyi ölçeğinde “minimal ya da yok”, %39,7'si "hafif düzeyde", %13.2'si orta düzeyde ve %6’sı “aşırı düzeyde” skorunu almıştır. KYB’lere bakım verenlerin demografik özellikleri ile umutsuzluk düzeyi arasında anlamlı bir ilişki bulunmamıştır. Bakım verenlerin yaşı, cinsiyeti, medeni durumu, gelir durumu ve bakım verme süresi ile umutsuzluk skorları arasında anlamlı bir ilişki bulunmazken, eğitim seviyesi ile umutsuzluk skorları arasında anlamlı bir ilişki bulunmuştur. (p=0,019). Sonuç: Bakım verenlerin, umutsuzluk düzeyleri göz önüne alındığında, önemli psikolojik yükler taşıdığına ve bu yükün, özellikle bakım verenin eğitim seviyesi ile hastanın sağlık durumu arasında belirgin ilişkiler gösterdiğine ulaşılmıştır. Bu bilgiler ışığında, sosyodemografik özelliklerin bakım verenleri önemli ölçüde etkilediği görülmüştür. Bakım verenlerin duygusal yükleri, bakım alıcılarla olan ilişkileri ve bu sürecin hem bireysel hem toplumsal düzeyde getirdiği zorluklar ve sorumluluklar, ihtimam etiği kapsamında ele alınmıştır. Araştırma neticesinde bakım verenlerin karşılaştığı zorluklar ve ihtiyaçlarının daha geniş bir toplumsal ve etik perspektiften ele alınmasının gerekliliği ortaya konmuştur. Bakım verenlerin bakımına yönelik öneriler, duygusal destek; teorik eğitim ve bilgilendirme desteği; pratik ve uygulamalı destek; kaynak erişimi ve tahsisi; tanıma ve doğrulama başlıkları altında sunulmuştur. (shrink)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...) both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (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)

Children's vulnerability gives rise to duties of justice towards children and determines when authority over them is legitimately exercised. I argue for two claims. First, children's general vulnerability to objectionable dependency on their caregivers entails that they have a right not to be subject to monopolies of care, and therefore determines the structure of legitimate authority over them. Second, children's vulnerability to the loss of some special goods of childhood determines the content of legitimate authority over them. My interest is (...) in the so-far little-discussed goods of engaging in world discovery, artistic creation, philosophical pursuits and experimentation with one's self. I call these ‘special goods of childhood’ because individuals, in general, only have full access to them during childhood and they make a distinctive and weighty contribution to wellbeing. Therefore, they are part of the metric of justice towards children. The overall conclusion is that we ought to make good institutional care part of every child's upbringing. (shrink)

I consider the developmental origins of the socially extended mind. First, I argue that, from birth, the physical interventions caregivers use to regulate infant attention and emotion (gestures, facial expressions, direction of gaze, body orientation, patterns of touch and vocalization, etc.) are part of the infant’s socially extended mind; they are external mechanisms that enable the infant to do things she could not otherwise do, cognitively speaking. Second, I argue that these physical interventions encode the norms, values, and patterned practices (...) distinctive of their specific sociocultural milieu. Accordingly, not only do they enhance and extend the infant’s cognitive competence. They also entrain the infant to think and act in culturally appropriate ways. These physical interventions are thus arguably the earliest examples of social practices that scaffold the infant’s cognitive development and shape the development of their cultural education. (shrink)

Background The worldwide increase in older persons demands technological solutions to combat the shortage of caregiving and to enable aging in place. Smart home health technologies (SHHTs) are promoted and implemented as a possible solution from an economic and practical perspective. However, ethical considerations are equally important and need to be investigated. Methods We conducted a systematic review according to the PRISMA guidelines to investigate if and how ethical questions are discussed in the field of SHHTs in caregiving for older (...) persons. Results 156 peer-reviewed articles published in English, German and French were retrieved and analyzed across 10 electronic databases. Using narrative analysis, 7 ethical categories were mapped: privacy, autonomy, responsibility, human vs. artificial interactions, trust, ageism and stigma, and other concerns. Conclusion The findings of our systematic review show the (lack of) ethical consideration when it comes to the development and implementation of SHHTs for older persons. Our analysis is useful to promote careful ethical consideration when carrying out technology development, research and deployment to care for older persons. Registration We registered our systematic review in the PROSPERO network under CRD42021248543. (shrink)

Women continue to be in charge of most childrearing; men continue to be responsible for most breadwinning. There is no consensus on whether this state of affairs, and the informal norms that encourage it, are matters of justice to be tackled by state action. Feminists have criticized political liberalism for its alleged inability to embrace a full feminist agenda, inability explained by political liberals’ commitment to the ideal of state neutrality. The debate continues on whether neutral states can accommodate two (...) feminist demands: to enact policies aimed at dismantling the feminization of caregiving, especially childrearing, and to compensate women for some of the disadvantages they incur by being primary care-givers. I contribute to this debate with three arguments in support of policies meant to de-gender care-giving and compensate care-givers. The first appeals to equality of opportunity to positions of advantage and justifies policies that prevent or mitigate statistical discrimination and implicit biases. The second draws attention to a possible causal relationship between the specialization of women in early childcare and misogyny; since the latter is incompatible with political liberal justice, it yields the conclusion that political liberals ought to further investigate the causal hypothesis with the aim of establishing or refuting it. The third argument concludes that legitimate childrearing prohibits adults from socializing children or, at least girls, into gender norms; it justifies duties of justice on the side of parents, educators, and economic agents, and state policies meant to offset foreseeable breaches of some of these duties. (shrink)

A safe and secure environment is an essential part of the early childhood development of any child. This study aims to investigate the safety and protection practices of early childhood centers in the Anambra state, Nigeria, and to determine if any improvements can be made to them. This study analyzed data collected from 60 Early Childhood Care Centers (ECCE Centers) and 60 Pre-Primary Schools (Preprimary School) in Anambra State using the Evaluation of ECCE Implementation Kit (KEIEP), direct observation, and unstructured (...) interviews, all of which were conducted using the evaluation tool. Using descriptive statistics, chi-squares, and student t-statistics, the data were analyzed. According to the results of this study, 28.0% of the private ECCE centers were in compliance with the requirements for enough space for children to play, fenced facilities, a standard first aid box, a splint bandage and an antiseptic. It is important to note that the majority of public early childhood education centers (62.0%) comply with the requirements for fencing, a first aid box, splint bandages, cotton wool, antiseptic, scissors, methylated spirit, liniment, analgesics, and thermometers, whereas 31% of those centers do not have the remaining seven practices. A conclusion of the study was that both private and public ECCE centers in Anambra State comply with the safety and protection provisions and practices in place. (shrink)

This chapter examines the hypothesis that episodic memory is a mindshaped capacity. Presenting evidence from cognitive, developmental, and cross-cultural psychology, we argue that episodic memory is mindshaped for the purposes of interpersonal and social coordination. We examine how cultural influences, parental reminiscing styles, and the constructive nature of memory contribute to such mindshaping, promoting cognitive and behavioral homogeneity. We propose that epistemic norms of remembering are gradually acquired and internalized in practices of joint reminiscing between children and adult caregivers, a (...) crucial component in an extended process of normative enculturation. We also explore the close relationship between episodic memory and imagination, highlighting the ways in which simulated vicarious experiences function as socio-cognitive tools, transforming us into more easily interpretable cognitive objects. The chapter concludes by emphasizing the need for further research to elucidate the varieties and extent of memory mindshaping, shedding light on the nature of episodic memory and its role in the normative enculturation of human rememberers. (shrink)

Paternalism means, roughly, benevolent interference: benevolent because it aims at promoting or protecting a person’s good; interference because it restricts his liberty without his consent. The paternalist believes herself superior in that she can secure some benefit for the person that he himself will not secure. Paternalism is opposed by the liberal tradition, at least when it targets sufficiently voluntary behavior. In legal contexts, policies may be paternalistic for some and not for others, forcing trade-offs. In medical contexts, paternalism can (...) be an open or hidden aspect of the relationship between caregiver and patient. (shrink)

The profound changes in personality, mood, and other features of the self that neural interventions can induce can be disconcerting to patients, their families, and caregivers. In the neuroethical debate, these concerns are often addressed in the context of possible threats to the narrative self. In this paper, I argue that it is necessary to consider a dimension of impacts on the narrative self which has so far been neglected: neural interventions can lead to a loss of meaning of actions, (...) feelings, beliefs, and other intentional elements of our self-narratives. To uphold the coherence of the self-narrative, the changes induced by neural interventions need to be accounted for through explanations in intentional or biochemical terms. However, only an explanation including intentional states delivers the content to directly ascribe personal meaning, i.e., subjective value to events. Neural interventions can deprive events of meaning because they may favor a predominantly biochemical account. A loss of meaning is not inherently negative but it can be problematic, particularly if events are affected one was not prepared or willing to have stripped of meaning. The paper further examines what it is about neural interventions that impacts meaning by analyzing different methods. To which degree the pull towards a biochemical view occurs depends on the characteristics of the neural intervention. By comparing Deep Brain Stimulation, Prozac, Ritalin, psychedelics, and psychotherapy, the paper identifies some main factors: the rate of change, the transparency of the causal chain, the involvement of the patient, and the presence of an acute phenomenological experience. (shrink)

This piece lays out the framework for a special issue on the topic of "Fits and Misfits," published as volume 7, issue 1 of Puncta: A Journal of Critical Phenomenology. We discuss the relationship between the concept of misfitting, coined by Rosemarie Garland-Thomson, and debility, coined by Jasbir Puar, in relationship to scholarship on Merleau-Ponty. We then introduce each of the eight articles in the special issue: Rosemarie Garland-Thomson's "What Misfitting Makes," Susan Bredlau's "Conversational Accessibility: Healthcare, Community, and the Ethics (...) of Everyday Encounters," Helen A. Fielding's "Being Touched by Wellness: Merleau-Ponty, Nancy, and the Intensive Care Unit," Ann Murphy's "The Spirited Interworld: Caregiving and the Liminal Phenomenology of Dementia," Rachel Elliott's "Sharing Time with Misfits: We-Experience across Bodily Difference," David Morris's "An-Archic Time: Melting the Clock as Hypernorm of the I Can -- and Philosophy," Rebecca Longtin's "Merleau-Ponty's Cézanne as Misfit Artist," and, finally, Laura McMahon's "The Politics of Vulnerability and the School for Peace: Insights from Butler, Merleau-Ponty, and Family Systems Theory.". (shrink)

Children are routinely treated paternalistically. There are good reasons for this. Children are quite vulnerable. They are ill-equipped to meet their most basic needs, due, in part, to deficiencies in practical and theoretical reasoning and in executing their wishes. Children’s motivations and perceptions are often not congruent with their best interests. Consequently, raising children involves facilitating their best interests synchronically and diachronically. In practice, this requires caregivers to (in some sense) manage a child’s daily life. If apposite, this management will (...) focus partly on a child’s well-being. To be ably executed, an account of children’s well-being will need to be articulated. This chapter focuses on the nature of children’s well-being. It has five sections. The first section clarifies the focus. The second section examines some hurdles to articulating a view of children’s well-being. The third section evaluates some accounts of children’s well-being. The fourth section addresses the view that children possess features essential to them that make their lives on balance prudentially bad for them. The fifth section sums things up. (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 care drain is a (...) problem of distributive justice, by looking at the background conditions that result in much of the care-givers’ migration. (shrink)

Abstract:This paper considers novel ethical issues pertaining to near-future artificial intelligence (AI) systems that seek to support, maintain, or enhance the capabilities of older adults as they age and experience cognitive decline. In particular, we focus on smart assistants (SAs) that would seek to provide proactive assistance and mediate social interactions between users and other members of their social or support networks. Such systems would potentially have significant utility for users and their caregivers if they could reduce the cognitive load (...) for tasks that help older adults maintain their autonomy and independence. However, proactively supporting even simple tasks, such as providing the user with a summary of a meeting or a conversation, would require a future SA to engage with ethical aspects of human interactions which computational systems currently have difficulty identifying, tracking, and navigating. If SAs fail to perceive ethically relevant aspects of social interactions, the resulting deficit in moral discernment would threaten important aspects of user autonomy and well-being. After describing the dynamic that generates these ethical challenges, we note how simple strategies for prompting user oversight of such systems might also undermine their utility. We conclude by considering how near-future SAs could exacerbate current worries about privacy, commodification of users, trust calibration and injustice. (shrink)

I argue that, in the currently gender-unjust societies a basic income would not advance feminist goals. To assess the impact of a social policy on gender justice I propose the following criterion: a society is gender-just when the costs of engaging in a lifestyle characterized by gender-symmetry (in both the domestic and public spheres) are, for both men and women, smaller or equal to the costs of engaging in a gender-asymmetrical lifestyle. For a significant number of women, a basic income (...) would increase the costs of leading gender-symmetrical lifestyles because it would make it easier for both women and men to pursue gender-unjust preferences. I argue that preference satisfaction is distinct from justice. I conclude by showing why a basic income would lead to further privatisation of caregiving, and I outline the negative effects this would have on women. (shrink)

I present empirical evidence suggesting that an infant first becomes aware of herself as the focal center of a caregiver's attending. Yet that does not account for her awareness of herself as agent. To address this question, I bring in research on neonatal imitation, as well as studies demonstrating the existence of a neural system in which parts of the same brain areas are activated when observing another's action and when executing a similar one. Applying these findings, I consider (...) gestural exchanges between infant and caregiver, such as reciprocal smiles and imitative vocalizations. Lacking self-awareness at first, the infant is unaware of her own agency. By returning her unwitting gesture, the caregiver singles out for her—thanks to neural matching—the gesture's kinesthesis. Moreover, the caregiver's smile, imitative vocalization, or other gesture is the form that focusing takes. The kinesthesis of the infant's gesture, in being singled out, is experienced by the infant as what the caregiver is focusing on. It is experienced as being within the focal center. In this way, the infant becomes aware of herself as a bodily entity acting toward the caregiver. Exchanges that involve matching are at first essential, I argue, in making the infant present to herself in action. Matching will cease to be necessary, but self-awareness continues to depend fundamentally on others until the acquisition of language, when the child becomes capable of talking to herself as if she were the caregiver. (shrink)

With robots being introduced into caregiving, particularly for older persons, various ethical concerns are raised. Among them is the fear of replacing human caregiving. While ethical concepts like well-being, autonomy, and capabilities are often used to discuss these concerns, this paper brings forth the concept of social dignity to further develop guidelines concerning the use of robots in caregiving. By social dignity, we mean that a person’s perceived dignity changes in response to certain interactions and experiences with other persons. In (...) this paper, we will first present the concept of social dignity, and then identify a niche where robots can be used in caregiving in an ethical manner. Specifically, we will argue that, because some activities of daily living are performed in solitude to maintain dignity, a care recipient will usually prefer robotic assistance instead of human assistance for these activities. Secondly, we will describe how other philosophical concepts, which have been commonly used to judge robotic assistance in caregiving for the elderly so far, such as well-being, autonomy, and capabilities, are less useful in determining whether robotic assistance in caregiving is ethically problematic or not. To conclude, we will argue that social dignity offers an advantage to the other concepts, as it allows to ask the most pressing questions in caregiving. (shrink)

This essay considers the dependency of trans youth by bridging transgender studies with feminist care ethics to emphasize a trans wisdom about solidarity through dependency. The first major section of the essay argues for reworking Sara Ruddick's philosophy of mothering in the context of trans and gender‐creative youth. This requires, first, stressing a more robust interaction among her divisions of preservative love, nurturance for growth, and training for acceptability, and second, creating a more nuanced account of “nature” in relation to (...) nurturance for growth to avoid casting transition as contrary to a trans youth's healthy development. In the second major section of the essay, I depart from Ruddick's framework to emphasize the difference of care for trans youth by trans and/or queer communities and through mutual caregiving, stressing a trans wisdom about dependency and solidarity found in the work of Sylvia Rivera and Marsha P. Johnson. Turning to Eva Feder Kittay's links between dependency work and equality, I argue that Rivera and Johnson's work contains a distinct knowledge derived from practice necessitating the connection between solidarity and dependency in particular communities. I then call for more work on trans care ethics, trans ethics, and trans wisdom more broadly. (shrink)

Psychologists often characterize the infant’s attachment to her primary caregiver as love. Philosophical accounts of love, however, tend to speak against this possibility. Love is typically thought to require sophisticated cognitive capacities that infants do not possess. Nevertheless, there are important similarities between the infant-primary caregiver bond and mature love, and the former is commonly thought to play an important role in one’s capacity for the latter. In this work, I examine the relationship between the infant-primary caregiver (...) bond and love. I argue that while these very early attachments do not represent genuine love, a fuller understanding of them can inform extant philosophical views of love. (shrink)

Different sort of people are interested in personal identity. Philosophers frequently ask what it takes to remain oneself. Caregivers imagine their patients’ experience. But both philosophers and caregivers think from the armchair: they can only make assumptions about what it would be like to wake up with massive bodily changes. Patients with a locked-in syndrome (LIS) suffer a full body paralysis without cognitive impairment. They can tell us what it is like. Forty-four chronic LIS patients and 20 age-matched healthy medical (...) professionals answered a 15-items questionnaire targeting: (A) global evaluation of identity, (B) body representation and (C) experienced meaning in life. In patients, selfreported identity was correlated with B and C. Patients differed with controls in C. These results suggest that the paralyzed body remains a strong component of patients’ experienced identity, that patients can adjust to objectives changes perceived as meaningful and that caregivers fail in predicting patients’ experience. (shrink)

We explain metacognition as a management of cognitive resources that does not necessitate algorithmic strategies or metarepresentation. When pragmatic, world-directed actions cannot reduce the distance to the goal, agents engage in epistemic action directed at cognition. Such actions often are physical and involve other people, and so are open to observation. Taking a dynamic systems approach to development, we suggest that implicit and perceptual metacognition emerges from dyadic reciprocal interaction. Early intersubjectivity allows infants to internalize and construct rudimentary strategies for (...) monitoring and control of their own and others’ cognitions by emotion and attention. The functions of initiating, maintaining, and achieving turns make proto-conversation a productive platform for developing metacognition. It enables caregiver and infant to create shared routines for epistemic actions that permit training of metacognitive skills. The adult is of double epistemic use to the infant – as a teacher that comments on and corrects the infant’s efforts, and as the infant’s cognitive resource in its own right. (shrink)

This paper examines rights and the protection of rights from both the minarchist and the anarchist perspectives. The former relies on Objectivist perspectives and the latter relies primarily on Murray Rothbard’s views. My view is that government protection as put forth by Objectivists is coercive, as are all methods of financing. However, under anarcho-capitalism, children who have been killed or abused by their caregivers do not have equal protection under the law. The principle of equal protection is one with which (...) both Objectivists and Rothbard agree. A case is made for government protection of rights under those circumstances. In addition, a case is made for positive rights to parental care for children, and also for government protection of those rights if they have been violated by their caregivers. I also argue for government oversight in instances when the rights of children have been violated and as a consequence the children have no alternative means of care. (shrink)

When I see a mountain to be far away, there is non-reflective awareness of myself as that from which distance is measured. Likewise, there is self-awareness when I see a tree as offering shade or a hiding place. In such cases, how can the self I am aware of be the same as I who am aware of it? Can the perceived be its perceiver? Mobilizing infancy research, I offer the following thesis as to how one can be aware of (...) oneself, at a single stroke, as perceiver and as embodied entity. During face-to-face interaction at 2 or 3 months, the infant has a sensuous perception of the caregiver as well as a non-sensuous impression of something she is eyeing and vocalizing toward. This implicit target is the self as it first becomes present to the child. It is shown how the target of her attending is experienced by him as embodied, active, affective, and continuous. After acquiring language, however, the child becomes capable of playing the caregiver toward himself: He can speak in her manner while listening as the one addressed. Thus the relation is internalized. The outcome is the independent and secure self-awareness that typifies post-infancy life. Independence bears a price, which is assessed. (shrink)

Humans interact with animals in numerous ways and on numerous levels. We are indeed living in an “animal”s world,’ in the sense that our lives are very much intertwined with the lives of animals. This also means that animals, like those dogs we commonly refer to as our pets, are living in a “human’s world” in the sense that it is us, not them, who, to a large degree, define and manage the interactions we have with them. In this sense, (...) the human-animal relationship is nothing we should romanticize: it comes with clear power relations and thus with a set of responsibilities on the side of those who exercise this power. This holds, despite the fact that we like to think about our dogs as human’s best friend. Dogs have been part of human societies for longer than any other domestic species. Like no other species they exemplify the role of companion animals. Relationships with pet dogs are both very widespread and very intense, often leading to strong attachments between owners or caregivers and animals and to a treatment of these dogs as family members or even children. But how does this relationship look from the dogs’ perspective? How do they perceive the humans they engage with? What responsibilities and duties arise from the kind of mutual understanding, attachment, and the supposedly “special” bonds we form with them? Are there ethical implications, maybe even ethical implications beyond animal welfare? The past decades have seen an upsurge of research from comparative cognition on pet dogs’ cognitive and social skills, especially in comparison with and reference to humans. We will therefore set our discussion about the nature and ethical dimensions of the human–dog relationship against the background of the current empirical knowledge on dog (social) cognition. This allows us to analyze the human–dog relationship by applying an interdisciplinary approach that starts from the perspective of the dog to ultimately inform the perspective of humans. It is our aim to thereby identify ethical dimensions of the human–dog relationship that have been overlooked so far. (shrink)

In this paper we argue that the eudaimonist virtue of hope holds pride of place in development of psychological traits that promote human flourishing. The argument is part theoretical and part empirical. On the theoretical side, hope, the virtue, is the disposition to envision future good possibilities for oneself and one’s community and to move towards those possibilities. This renders hope necessary for any agent’s self-conscious pursuit of the goods that constitute flourishing, and also for the development of other virtues. (...) On the empirical side, we draw on evidence from psychology to argue that early in development, humans need relationships of trust with caregivers to develop the future orientation and features of agency constitutive of the virtue of hope. Thus the virtue of hope generally needs to be fostered, in part, through trusting relationships for humans to flourish. (shrink)

Previous research has shown that women are disproportionately negatively affected by a variety of socio-economic hardships, many of which COVID-19 is making worse. In particular, because of gender roles, and because women’s jobs tend to be given lower priority than men’s (since they are more likely to be part-time, lower-income, and less secure), women assume the obligations of increased caregiving needs at a much higher rate. This unfairly renders women especially susceptible to short- and long-term economic insecurity and decreases in (...) wellbeing. Single-parent households, the majority of which are headed by single mothers, face even greater risks. These vulnerabilities are further compounded along the dimensions of race, ethnicity, class, and geography. Drawing upon the philosophical literature on political responsibility and structural injustice (specifically, the work of Iris Marion Young), I argue that while the state may not have had either foresight into, or control over, the disproportionate effect the pandemic would have on women, it can nonetheless be held responsible for mitigating these effects. In order to do so, it must first recognize the ways in which women have been affected by the outbreak. Specifically, policies must take into account the unpaid labor of care that falls on women. Moreover, given that this labor is particularly vital during a global health pandemic, the state ought to immediately prioritize the value of this work by providing financial stimuli directly to families, requiring employers to provide both sick leave and parental leave for at least as long as schools and daycares are inoperational, and providing subsidized emergency childcare. (shrink)

On 26 July 2016, Satoshi Uematsu murdered 19 and injured 26 at a caregiving facility in Sagamihara, Japan, making it the country’s worst mass killing since WWII. In this article, I offer an analysis of the Sagamihara 19 massacre. I draw on the work of Julia Kristeva and Emmanuel Levinas to argue that claims about disability experience are insufficient to justify normative projects. In short, disability is normatively ambiguous.

Advocates of the Person-Centered Healthcare (PCH) approach say that PCH is a response to a failure of caring for patients as persons. Nevertheless, there are many human subjects falling to fulfill the requirements of a traditional philosophical definition of personhood. Hence, if we take, PCH seriously, a greater clarification of the key terminology of PCH is urgently needed. It seems necessary, for instance, that the concept of the person should be extended in order to include those individuals with insipient or (...) immature levels of consciousness, as well as those who are severely and permanently mentally handicapped. In this article, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. We suggest that persons are human beings with a socially recognized biography, which implies to recognize as persons individuals with necessities, but also with narratives about their interests and claims, expressed sometimes by other people related to them. This is particularly the case of individuals that suffer from severe disorders of consciousness. For those, is not only care that matters; respect matters too. Caregivers should therefore not only sympathetically care for the well-being of these people; they should also be concerned to respect their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons and we think that our revised concept of personhood fits with this requirement. (shrink)

Social robots are marketed as human tools promising us a better life. This marketing strategy commodifies not only the labor of care but the caregiver as well, conjuring a fantasy of technoliberal futurism that echoes a colonial past. Against techno-utopian fantasies of a good life as one involving engineered domestic help, I draw here on the techno-dystopian television show Humans (stylized HUMⱯNS) to suggest that we should find our desires for such help unsettling. At the core of my argument (...) is a return of the “uncanny valley” problem, from its reformulation as an engineering/design problem to its origins as a psychosocial symptom of an unresolved, traumatic past. I conclude that our sense of the uncanny may be best understood as a moral capacity that should be honed rather than evaded. (shrink)

Care is more than dispensing pills or cleaning beds. It is about responding to the entire patient. What is called “bedside manner” in medical personnel is a quality of treating the patient not as a mechanism but as a being—much like the caregiver—with desires, ideas, dreams, aspirations, and the gamut of mental and emotional character. As automata, answering an increasing functional need in care, are designed to enact care, the pressure is on their becoming more humanlike to carry out (...) the function more effectively. The question becomes not merely whether the care automaton can effect good bedside manner but whether the patient’s response is not feeling deceived by the humanlikeness. It seems the device must be designed either to effect explicit mere human-“likeness,” thus likely undermining its bedside-manner potential, or to fool the patient completely. Neither option is attractive. This article examines the social problems of designing maximally humanlike care automata and how problems may start to erode the human rights of users/patients. The article then investigates the alternatives for dealing with this problem, whether by industrial and professional self-regulation or public-policy initiatives. It then frames the problem in the broader historical perspective in terms of previous bans, moratoria, and other means of control of hazardous and potentially rights-violating techniques and materials. (shrink)