In defense of caring

I hope to persuade Hilde L. Nelson that she is wrong about an ethics of caring....In conclusion, caring is an "ethics of attention," but it includes more than attention. 'Carers' must respond as well as attend. Much more needs to be done in describing caring responses, especially when social problems are involved. I agree with Nelson that an ethics or a moral orientation must deal with social problems. I also agree that, to date, most of us working on caring have written little on the subject. However, I do not agree that an ethics of caring is unable to address social problems. We have to work at showing that it can.     

From ‘Is’ to ‘Ought’ in Moral Epistemology

Many philosophers claim that no formally valid argument can have purely non-normative premises and a normative or moral conclusion that occurs essentially. Mark Nelson recently proposed a new counterexample to this Humean doctrine:All of Dahlia's beliefs are true.Dahlia believes that Bertie morally ought to marry Madeleine. Bertie morally ought to marry Madeleine.I argue that Nelson's universal premise has no normative content, that Nelson's argument is valid formally, and that Nelson's moral conclusion occurs essentially and not vacuously. Nonetheless, I show that Nelson's argument faces a more fundamental problem if it is used in moral epistemology. An argument that appeals to a moral authority, such as Dahlia, might justify some moral belief out of a contrast class that does not include extreme views like moral nihilism; but it begs the question against moral nihilism, since one cannot be adequately justified in believing the conjunction of its premises without depending on assumptions that moral nihilists would deny. Thus, arguments like Nelson's can accomplish something important in moral epistemology, but their use is strictly limited.     

A Caring Framework for Enhancing Couples Therapy

As couples move away from role oriented patterns of relating they enter a transitional phase where marital expectations are less clearly defined. Frequently couples seeking therapy complain of a lack of caring in their relationships. They also express confusion about the appropriateness of their desire for more caring. In this article the authors present a caring framework based on their research with couples in "vital-total" marriages. They also suggest several ways this caring framework can be used in clinical work with couples.     

Medical ethics in times of war and insurrection: Rights and duties

In this paper I shall take the Geneva Conventions and Additional Protocols as my point of departure and link these with the International Declaration of Human Rights as a statement of faith and of aspirations.... The second part of my paper will focus on medical morality with brief reference to various languages of moral discourse and to differences in conceptual logic which underpin debates on duties and rights with particular reference to the circumstances of conflict. While acknowledging the value of talking of rights as primary I shall also suggest that the shift away from discourse on duties and obligations as primary undermines the likelihood of super-erogatory moral action. I shall conclude by emphasizing the centrality of acceptance by the State and the military of their duty to the injured and to medical personnel caring for them, if man's inhumanity to man, particularly evident during times of war, is to be kept out of our concern for each other as human beings even when nations are pitted against each other in the ongoing, but hopefully not eternal, struggle for material and ideological power.     

Caregiving: The Forgotten Element in Attachment

In attachment theory, an attachment behavioral control system in the child and a complementary caregiving system in the parent act together to protect the young. The attachment account, however, fails to supply a motivation for caregiving. As a result, it cannot give a theoretical explanation for the responsive and attentive behaviors empirically observed in caregivers of secure children. In this article, we present an account of caregiving that places emotion at the center of caregiving (the connection theoretical orientation). In this account, the dyadic emotion of caring serves as an autonomous motivation to see that the needs of a specific dependent are met. Unlike the "on-off" caregiving in attachment theories, connection caring is conceptualized as enduring and variable: Caregivers experience different levels of caring over the course of a relationship. Through the emotional concepts of caring, empathy, and responsibility, the connection theoretical orientation is able to provide the coherent account of caregiving that the attachment theoretical orientation's cybernetic concepts have been unable to supply.     

Is ecology an ‘alternative’ natural science?

This article discusses whether ecology represents an alternative type of natural science, that is normatively committed. Central questions are:-how man and human action are integrated into the subject matter of ecology;-whether evaluative concepts like health are incorporated into the conceptual structure of ecology; and-whether ecology transcends the image of natural knowledge as control of nature.It is concluded that all hypotheses of ecology being inherently judgmental in character must be rejected.Like all the healing arts, ecology is through and through judgmental in character. It cannot be value-neutral.... What violates the natural harmony must be condemned; what enhances it be endorsed.... Ecology is the closest our science has yet come to an integrative wisdom. It, not physics, deserves to become the basic science of the future.     

Self‐Realization and Owing to Others: An Indirect Constraint?

Abstract

The relationship between self‐realization, and so what I really wholeheartedly endorse and owe to myself, and morality or what we owe to others is normally thought of as antagonism, or as a pleasant coincidence: only if I am indebted to such relations as my fundamental projects that I care wholeheartedly about does morality have a direct connection to self‐realization. The aim of this article is to argue against this picture. It will be argued that the structure of self‐realization and the caring activity involved commits the person to values that are beyond the object of his wholehearted caring, in a way that might just pave the way to morality.     

Reflections on "Nursing considered as moral practice

This response to the preceding article by Gastmans, Dierckx de Casterle, and Schotsmans challenges the notion of "good care" as the ultimate goal of nursing practice, explores further the possible goals of nursing and how they may be identified, and presents six elements of professional caring along with their related virtues and moral obligations.     

Commentary on "Quantifying the value of human life

...In his article, "Quantifying the value of human life for cost accounting of safeguards," L. Eugene Arnold proposes a cost-benefit analysis to address three allocation issues concerning the very expensive program of blood monitoring proposed by Sandoz at the time it placed Clozaril...on the American market....It is important to realize that the use of seemingly value-free procedures to arrive at answers to ethically complex questions does not eliminate the values that underlie the choice of variables to be analyzed. The analyses employed by the author to three ethical questions illustrate this point very well....     

The Will to Care: Performance,Expectation, and Imagination

This article addresses the world's contemporary crisis of care, despite the abundance of information about distant others, by exploring motivations for caring and the role of imagination. The ethical significance of caring is found in performance. Applying Victor Vroom's expectancy theory, caring performances are viewed as extensions of rational expectations regarding the efficacy of actions. The imagination creates these positive or negative expectations regarding the ability to effectively care. William James's notion of the will to believe offers a unique twist on rational expectations in that he regards humans as having the capacity to work within uncertainty to take decisive action. Applying this idea to caring performance is, this article argues that people can have the will to care, beyond strict rational calculations or limits of social norms. Historically, caring has been associated with the imagination's ability to empathize, but the will to care offers another role for the imagination in envisioning effective action. Given the significance of the imagination for ethical behavior, this article explores the implications for cultivating care in terms of what educating for care might look like. The work of feminist care ethicists, particularly Nel Noddings, is discussed, and contemporary case examples of caring performances are investigated.     

Current theoretical perspectives on adolescent pregnancy and childbearing in the United States

"The purpose of this article is to synthesize and place in perspective contemporary theories and explanations of the high rates of adolescent pregnancy and childbearing in the United States. The study examined the strengths and weaknesses of the more prominent explanations of adolescent pregnancy and childbearing in light of current research.... This article casts doubt on the hypothesis that the lack of reproductive information is in and of itself an important determinant of adolescent pregnancy in the United States. Many other factors are discussed that intervene to negate the effect of reproductive knowledge alone as a deterrent to adolescent pregnancy and childbearing. Suggestions for an integrative research agenda, as well as educational and health strategies focusing on adolescent pregnancy and childbearing are proposed."     

Rethinking Care Theory: The Practice of Caring and the Obligation to Care

Care theorists have made significant gains over the past twenty‐five years in establishing caring as a viable moral and political concept. Nonetheless, the concept of caring remains underdeveloped as a basis for a moral and political philosophy, and there is no fully developed account of our moral obligation to care. This article advances thinking about caring by developing a definition of caring and a theory of obligation to care sufficient to ground a general moral and political philosophy.     

A breakdown in the family unit

In his article, "Autonomy and beneficence in the family," David J. Doukas describes the dynamic relationship between the family and the physician. He points out: "the family covenant spells out the obligations of all parties to give and receive respect and beneficial care within the realm of medical practice"....While this model may provide a framework for ethical discussion under certain circumstances, it falls short in several major respects....     

Producing Solidarity,Inequality and Exclusion Through Insurance

Res Publica - The article presents two main arguments. First, we claim that in contemporary societies, insurance enacts peculiar kinds of solidarities as well as inequality and exclusion....     

Reduction of caregiver burden in Alzheimer's disease by treatment with galantamine

Alzheimer's disease is a progressive condition characterized by a loss of cognition, altered behavior, and a loss of functional ability, such as bathing, dressing, toileting, and organizing finances. Family and friends provide nearly three quarters of all care for patients with Alzheimer's disease. This informal care results in significant burden to caregivers. Caregiver burden is the set of physical, psychological or emotional, social, and financial problems that family members may experience when caring for impaired older adults. Caregivers of Alzheimer's disease patients report higher rates of physical symptoms, mortality, depression, and fatigue, as well as adverse effects on employment compared with those who are not caregivers for Alzheimer's disease patients. In many cases, the same family members are responsible for both out-of-pocket expenditures and caregiving duties. For this article, a MEDLINE search using the key words "caregiver and Alzheimer's disease" and "cost and Alzheimer's disease" was performed. The purpose of this article is to review the literature on caregiver burden, the components of caregiver burden, effects of caregiving on the health of caregivers, the cost of Alzheimer's disease on the caregiver and society, and the benefits attainable with treatment.     

Moral responsibility and manipulation: on a novel argument against historicism

Philosophical Studies - Taylor Cyr offers a novel argument against, as he puts it, “all versions of historicism” about direct moral responsibility (Philos Stud....     

Partiality and Its Dual

This paper explores allowing truth value assignments to be undetermined or "partial" (no truth values) and overdetermined or "inconsistent" (both truth values), thus returning to an investigation of the four-valued semantics that I initiated in the sixties. I examine some natural consequence relations and show how they are related to existing logics, including ukasiewicz's three-valued logic, Kleene's three-valued logic, Anderson and Belnap's (first-degree) relevant entailments, Priest's "Logic of Paradox", and the first-degree fragment of the Dunn-McCall system "R-mingle". None of these systems have nested implications, and I investigate twelve natural extensions containing nested implications, all of which can be viewed as coming from natural variations on Kripke's semantics for intuitionistic logic. Many of these logics exist antecedently in the literature, in particular Nelson's "constructible falsity".     

Optimizing assurance: the risk regulation system in relationships

A model of risk regulation is proposed to explain how people balance the goal of seeking closeness to a romantic partner against the opposing goal of minimizing the likelihood and pain of rejection. The central premise is that confidence in a partner's positive regard and caring allows people to risk seeking dependence and connectedness. The risk regulation system consists of 3 interconnected "if--then" contingency rules, 1 cognitive, 1 affective, and 1 behavioral. The authors describe how general perceptions of a partner's regard structure the sensitivity of these 3 "if--then" rules in risky relationship situations. The authors then describe the consequences of such situated "if--then" rules for relationship well-being and conclude by integrating other theoretical perspectives and outlining future research directions.     

The social individual in clinical ethics

Except for several provocative final sentences, Sigrid Fry-Revere's "A Libertarian Critique of H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics" is not a libertarian so much as it is a philosophical critique. Engelhardt's work has been widely reviewed, and its arguments have been discussed in Fry-Revere's article and elsewhere. Although it would be impractical in this context to undertake the development of a full-scale, philosophical alternative to libertarianism in bioethics, some recent work in philosophy and clinical ethics bears strongly on the challenge that Engelhardt's work represents. In this commentary I will focus on the implications of a certain alternative philosophy -- and by comparison the limitations of Engelhardt's libertarianism -- for one important aspect of clinical ethics: our understanding of the nature of individuality, with special reference to the situation of the patient. I write as an admiring critic of Engelhardt's work, from which I have learned and drawn inspiration....     

Why we need a theory of suffering, and lots of other theories as well: commentary

In the first section of his article, "The Role of Suffering and Community in Clinical Ethics," Erich Loewy sketches a theory of suffering. His conviction is that clinical medical ethics is not clearly rooted in theory and is inadequately grounded because of this. While acknowledging the merits of virtue ethics and casuistry, Loewy quickly dispenses with them, as contenders for this theoretical basis. Kantianism and utilitarianism are likewise rejected as "a universally acceptable grounding for ethics." In their place, Loewy proposes that "a deeper and more universal grounding can be found in the capacity of sentient beings to suffer." It is on this capacity to suffer that he builds his hierarchies of moral value, including primary, secondary, and symbolic worth. This theory of suffering should be welcomed. It promises to expand our awareness of clinical experience, and moral life generally, away from autonomy, utility, or virtue orientations toward attention to suffering and our response to it. Such a theory can give us a revitalized language to probe the issues of medical ethics. This should lead us to a careful reading of Loewy's larger work on which this article is based. Yet my enthusiasm is tempered by Loewy's noncritical acceptance of a peculiar, yet pervasive, understanding of the role and use of theory in ethics....