In Defense of the Moral Significance of Empathy

It is commonly suggested that empathy is a morally important quality to possess and that a failure to properly empathize with others is a kind of moral failure. This suggestion assumes that empathy involves caring for others’ well-being. Skeptics challenge the moral importance of empathy by arguing that empathy is neither necessary nor sufficient to care for others’ well-being. This challenge is misguided. Although some forms of empathy may not be morally important, empathy with another’s basic well-being concerns is both necessary and sufficient to care for another’s well-being, provided that one’s empathy is both cognitive and affective. I further defend the idea that empathy of this form is a moral virtue. In doing so, I address three challenges to empathy’s status as a virtue: (1) that empathy is unnecessary for being ethical, (2) that it is not useful for promoting ethical behavior, and (3) that an empathetic person can lack other traits central to being virtuous, such as being motivated by the moral good and being disposed to do virtuous things whenever appropriate opportunities arise. I argue that these challenges are mistaken.     

Feeding the Hungry Other: Levinas,Breastfeeding, and the Politics of Hunger

Breastfeeding has become a subject of moral concern as its benefits have become well known. Encouraging mothers to breastfeed has been the goal of extensive public health promotion efforts. Emmanuel Levinas makes absolute responsibility to the Other central to his ethics, with giving food to the Other the paradigmatic ethical act. However, Levinas also provides an important critique of the autonomous individual who is taken for granted by breastfeeding promotion efforts. I argue that the ethical obligation to feed the hungry child must be recognized as coextensive with meeting the needs of women, especially given the current absence of important social and economic supports for breastfeeding. Under a Levinasian framework, each of us is ethically responsible for feeding children; this responsibility is not limited to mothers. This ethical responsibility needs to be expressed through improving social and economic supports necessary for those individuals who wish to breastfeed, instead of attempting to convince women to breastfeed. This ethical responsibility must also be understood in a broader context of a politics of hunger, which provides access to quality food for all, and goes beyond mere nutrition to include the importance of culture, touch, and intimacy in the enjoyment of food—what Levinas calls “good soup.”     

Ethics and the sexual countertransference

In this paper I shall suggest that, in addition to 'conscience', the archetype of Eros plays an important part in 'benign relatedness' and that this is what constitutes an ethical attitude. I also propose that the idea of 'benign relatedness' can provide us with a workable concept for those serving on Ethics Committees especially when our Code of Ethics is unclear or limited. I attempt to show that the analytic attitude is essentially ethical and define what I see as the analytic attitude as a way of demonstrating this. By discussing the neurotic sexual countertransference and unconscious identity I hope to clarify the main reasons for unethical enactments. I use examples of ethical problems, including a personal experience, to illustrate the kinds that occur and lastly I discuss how mourning plays an important part in the resolution and avoidance of these problems.     

Genetics and the Interpersonal Elaboration of Ethics

Confidentiality in genetic testing posesimportant ethical challenges to the currentprimacy of respect for autonomy and patientchoice in health care. It also presents achallenge to approaches to decision-makingemphasising the ethical importance of theconsequences of health care decisions. In thispaper a case is described in which respect forconfidentiality calls both for disclosure andnon-disclosure, and in which respect forpatient autonomy and the demand to avoidcausing harm each appear to call both fortesting without consent, and testing only withconsent. This creates problems not only forclinicians, families and patients, but also forthose who propose clinical bioethics as a toolfor the resolution of such dilemmas.In this paper I propose some practical waysin which ethical issues in clinical geneticsand elsewhere, might be addressed. Inparticular I call for a closer relationshipbetween ethics and communication in health caredecision-making and describe an approach to theethics consultation that places particularemphasis on the value of interpersonaldeliberation in the search for moralunderstanding. I reach these conclusionsthrough an analysis of the concept of `moraldevelopment' in which I argue that theachievement of moral understanding is anecessarily intersubjective project elaboratedby moral persons.     

The Metaphysics of Ethical Love: Comparing Practical Vedanta and Feminist Ethics

In this paper I compare two very different deployments of love in ethics. Swami Vivekananda's concept of ethical love ties into the project of constructing an alternative masculinity for a colonized people; while feminist care ethics uses love to escape the perceived masculinity of traditional ethical theory. Using Kenneth Goodpaster's distinction between ‘framework questions’ and ‘application questions,’ I try to show that love in Practical Vedanta addresses the former while feminist care ethics concerns itself with the latter. Even though this difference, I suggest, could be a function of their varying historical-political contexts, the two issues need to be taken together for a more complete understanding of the ethical subject.     

When Psychotherapy Is Not Working: Ethical Considerations

Evidence-based practice (EBP) models have been developed, in part, to enhance the likelihood that the outcome of health care treatment, including psychotherapy, leads to positive improvement. However, two additional outcomes can occur: no change and poor outcome (e.g., harm, worsening of symptoms). What does the clinician do when psychotherapy is not working? When faced with various treatment decisions, such as this, the EBP model posits that therapists should apply their clinical expertise in considering the “best available research” within the context of various patient characteristics. In part because of various limitations of this approach, I suggest that another important set of principles are important to consider in tandem when faced with this clinical dilemma—that is, ethical concerns. Borrowing from the American Psychological Association’s (2017a) Ethics Code, I discuss how the following issues exist when clinicians wrestle with this question: avoidance of harm, competence, conflicts of interest, and informed consent. I conclude this paper with a list of suggestions that can potentially foster the application of ethical principles when making treatment decisions.     

Health Care,Capabilities, and AI Assistive Technologies

Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in health care practices raise several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in health care practices as replacements of human care. I analyse them as demands for felt care, good care, private care, and real care. I argue that although these objections cannot stand as good reasons for a general and a priori rejection of AI assistive technologies as such or as replacements of human care, they demand us to clarify what is at stake, to develop more comprehensive criteria for good care, and to rethink existing practices of care. In response to these challenges, I propose a (modified) capabilities approach to care and emphasize the inherent social dimension of care. I also discuss the demand for real care by introducing the ‘Care Experience Machine’ thought experiment. I conclude that if we set the standards of care too high when evaluating the introduction of AI assistive technologies in health care, we have to reject many of our existing, low-tech health care practices.     

The Compatibility of Hegelian Recognition and Morality with the Ethics of Care

I draw connections between Hegel’s concepts of recognition and morality and demonstrate how they are compatible with an ethic of care. I explore Hegel’s Sittlichkeit and demonstrate the role that intersubjective recognition plays in the development and sustainment of ethical communities. I demonstrate how his emphasis on the community and interpersonal relationships play an important role in his moral theory. I then contrast Hegelian and Kantian views of morality and argue that Hegel’s account places greater emphasis on attending to the needs of others and showing genuine concern for their well-being. By highlighting the intersubjective nature of recognition between self-consciousnesses, and the interconnectedness of agents in an ethical community, I maintain Hegel’s morality is compatible with an ethic of care because it emerges out of intersubjective mutual recognition and its foundation is built upon responding to the needs of particular others and protecting the bonds of the community.     

The Diversity of Intrinsic Ethical Flaws in Fiction

This article examines what constitutes an ethical flaw in artworks and asks which ethical flaws are relevant in determining works. ethical and aesthetic values. I argue that while most of the discussion has simply taken for granted that it is intrinsic ethical flaws that should be taken into account, there are further important differences in the type of intrinsic ethical flaws that artworks display. I identify two different types of ethical defects in artworks, fictional and actual, and argue that this distinction has important consequences for debates surrounding the ethical value of works of fiction.     

Institutional identity, integrity, and conscience

Bioethics has focused on the areas of individual ethical choices -- patient care -- or public policy and law. There are however, important arenas for ethical choices that have been overlooked. Health care is populated with intermediate arenas such as hospitals, nursing homes, hospices, and health care systems. This essay argues that bioethics needs to develop a language and concepts for institutional ethics. A first step in this direction is to think about institutional conscience.     

Jewish medical ethics in the care of the cancer patient

The care of the patient with cancer requires the development not only of a medical plan, but an ethical plan as well. This plan should integrate the physician's and the patient's perceptions of medical and ethical propriety. Jewish biomedical ethical principles are based on the teaching of the Old Testament and its various interpretations. In this paper, I discuss how these principles can be used to help guide the physician caring for the patient with cancer. Other ethical systems could be applied in a similar fashion.     

Answering the Ethical Question

Many philosophers have attempted to answer the ‘ethical question’: can the ethical value of an artwork ever contribute to its aesthetic value, and if so, how? In this paper, I consider a methodological question that arises out of this discussion: should attempts to address the ethical question use analytic tools found in contemporary philosophical literature, art criticism, or some combination of the two? I concur with arguments proposed elsewhere, which suggest that art criticism has an important role to play in addressing the ethical question. However, I argue that any fruitful attempt to answer the question must defend some particular way of understanding the ethical value of artworks, which suggests that we should address what I label the ‘art question’: what is the role and importance of art? This question, I suggest, is one with which philosophers can usefully engage. This division of labour offers a way forward in addressing this important issue.     

Ethical issues in managed care: a Catholic Christian perspective.

A Christian analysis of the moral conflicts that exist among physicians and health care institutions requires a detailed treatment of the ethical issues in managed care. To be viable, managed care, as with any system of health care, must be economically sound and morally defensible. While managed care is per se a morally neutral concept, as it is currently practiced in the United States, it is morally dubious at best, and in many instances is antithetical to a Catholic Christian ethics of health care. The moral status of any system of managed care ought to be judged with respect to its congruence with Gospel teachings about the care of the sick, Papal Encyclicals, and the documents of the Second Vatican Council. In this essay, I look at the important conceptual or definitional issues of managed care, assess these concerns over against the source and content of a Catholic ethic of health care, and outline the necessary moral requirements of any licit system of health care.     

Foucault and ethical universality

Foucault's resistance to a universalist ethics, especially in his later writings, is well-known. Foucault thinks that ethical universalism presupposes a shared human essence, and that this presupposition makes it a straitjacket, an attempt to force people to conform to an externally imposed 'pattern'. Foucault's hostility may be warranted for one - perhaps the usual - conception of ethical universality. But there are other conceptions of ethical universality that are not vulnerable to Foucault's criticism, and that are ethically and culturally important. I set out one such conception, and show why it matters. Paul Patton has argued that Foucault is best read as grounding his analyses of power in a 'conception of human being' traceable to Nietzsche. I explain why this does not amount to the ethical universalism that I sketch below.     

Designing Robots for Care: Care Centered Value-Sensitive Design

The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What’s more, given the stage of their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future.     

Codes of medical ethics and the exportation of less-than-standard care

Recently a number of AIDS/AZT research studies, carried out by U.S. universities, have come under intense ethical scrutiny. In these studies, control groups of HIV-positive pregnant women were being given a placebo rather than AZT. Such research protocols would be illegal if practiced in the U.S. I examine a number of lamentable ethical lapses in the studies, and conclude that at least some of these ethical problems are traceable to a troubling contradiction between differing international codes of ethics. In a word, some international codes mandate that all research subjects (including control groups) receive the best standard of care available in the country sponsoring the research, while others suggest that providing only a "local" standard of care is ethically appropriate. I argue that these two ethical mandates cannot both be satisfied, and that host country populations will remain subject to exploitation unless this contradiction is resolved.     

How careproviders can acquire and apply greater wisdom

In this issue of JCE, Baum-Baicker and Sisti present senior psychoanalysts' views of wisdom. Although views on wisdom differ widely, there is agreement that when ethical conflicts arise, wisdom may be critical in bringing about an optimal result. Here I will present recent empirical findings on wisdom and the ways careproviders may acquire and apply it, especially in ethical conflicts.The findings are not well-known and may seem counterintuitive; I selected them, in large part, for those reasons. A core challenge may be to decide when to give patients standard care and when to make exceptions. In this issue of JCE, Baum-Baicker and Sisti discuss exceptions and Bursztajn and colleagues consider how these exceptions may be further validated as evidence-based treatments.     

Infinite Responsibility in the Bedpan: Response Ethics,Care Ethics,and the Phenomenology of Dependency Work

Because Levinas understands ethical response as a response to the radical alterity of the other, he contrasts it with justice, for which alterity becomes a question of equality. Drawing upon the practice of dependency work and the insights of feminist care ethics, I argue that the opposition between responding to another's singularity and leveling it via parity‐based principles is belied in the experience of care. Through a hermeneutic phenomenology of caring for my post‐stroke grandfather, I develop an account of dependency work as a material dialectic of embodied response involving moments of leveling, attention, and interruption. Contra much of response ethics’ and care ethics’ respective literatures, this dialectic suggests that they complement each other 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 dependency work, such labors produce finite responsibility with infinite hope.     

Bioethics and the marginalization of mental illness

This paper explores why ethical issues associated with mental illness have been generally neglected in the literature and texts of the discipline of bioethics. I argue that the reasons for this are both philosophical and structural, involving the philosophical framework of principlism in bioethics, in particular the privileging of the principle of autonomy, and the institutional location and disciplinary boundaries of bioethics as a profession. Other contributing factors include developments outside of bioethics, in medicine and law and in the delivery patterns and funding sources of mental health services, and above all the pervasive stigma that attaches to mental illness. My goal is to show both how the attention bioethics could bring would benefit this neglected area of health care, and why attending to the issues surrounding mental illness would benefit bioethics in meeting its professional obligations as the public voice on matters of ethical significance in health care.