The Ethics of Care: An Interview with Virginia Held

3:AM Magazine
Interview by Richard Marshall

Here are some excerpts:

3:AM: You’ve developed an ethical theory around ‘care.’ You see this as an alternative to the dominant ethical theories of the last couple of centuries. It’s important to you that it isn’t an ethics to be added on to Kantianism or utilitarianism or virtue ethics. Can you say something about why it is so important that a care ethics is not an adjunct but is a fresh start? The Kantian Christine Korsgaard has placed reciprocity and human relations at the heart of Kantianism. Onora O’Neill has argued that justice and care are not opposed. In the light of these views, would you still defend the break, or would you be happier to see it as a continuation?

VH: I don’t find it satisfactory merely to add some considerations of care to the traditional moral theories for reasons similar to why it is not enough to simply insert women into the traditional structures of society and politics built on gender domination. Feminists should understand that the structures themselves have to change. The history of ethics shows it to be a very biased enterprise. Very roughly, what men have done in public life has been deemed important and relevant to moral theory, and what women have done in the household has been considered irrelevant. I think it plausible to see Kantian ethics and utilitarianism as expansions to the whole of morality of what can be thought appropriate for law and for public policy.

I have come to see, in contrast, caring relations as the wider network, and the ethics of care as the comprehensive morality, within which we should develop legal and political institutions. Caring relations should be guided by the ethics of care, which we can best understand and which is most applicable in contexts of families and friendship. But we can and should also have weaker forms of caring relations with all persons, and within these, the more limited institutions of law should be guided, roughly, by Kantian norms, and the more limited political institutions by utilitarian ones. Yes I see the legal and political as importantly different, and both as significantly different from the contexts of family and friendship. This is a very oversimplified statement of a complex position but I try to clarify and delineate these matters in my written work.

3:AM: So ‘care’ is at the heart of this new ethic but it isn’t to replace justice. So how do you get from care to justice in your system? Do we end up losing the common use of ‘care’ for a more term of art, technical use, as is the wont with philosophers? And isn’t that a cheat?

VH: Yes, various Kantians are trying to acknowledge the concerns of care, and various philosophers interested in the ethics of care are trying to combine it with Kantian ethics. I think the ethics of care has the resources to be an alternative moral theory that can include persuasive aspects of Kantian ethics and also of utilitarianism and virtue theory. It’s nevertheless a feminist ethics that includes the goal of overcoming gender domination, in our thinking as well as our institutions. And I see it as the more comprehensive view. Korsgaard and O’Neill are still Kantians, though more persuasive ones than some traditional Kantians. I think ethics should start with a vast amount of experience (the experience of caring and being cared for) overlooked by traditional moral theories, and see how the many important and valid concerns of other moral theories can be brought into care ethics. I think it is a strength of care ethics that it is based on experience. It is experience which everyone has had: no one would have survived without enormous amounts of care, in childhood at least. Most women, and increasingly men, have also had a great deal of experience providing care, especially for children.

The entire interview is here.

Virginia Held has written: Feminist Morality: Transforming Culture, Society, and Politics, Justice and Care: Essential Reading in Feminist Ethics, and The Ethics of Care: Personal, Political and Global.

Doctors and Their Online Reputation

By Pauline Chen
The New York Times
Originally published March 21, 2013

When a doctor I know recently signed up for a Twitter account, his colleagues began teasing him. “Are you going to tweet what you eat?” one joked.

Their questions, though, soon turned serious. How often was he going to tweet? What would he do if patients asked for medical advice on Twitter? Did he make up a name or use his real one?

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Since starting his blog, KevinMD, nearly 10 years ago, Dr. Pho has become a rock star among the health care set, one of the few doctors recognizable by first name only. A primary care doctor, Dr. Pho presides over a social media empire that includes his blog, now a highly coveted publishing place for doctors and patients, a lively Facebook page and a nonstop Twitter stream that has become must-follow fodder for the medical Digirati.

The entire article is here.

Ethics Education and Psychology has highlighted a number of articles from Dr. Pho's blog.

Physicians' Top Ethical Dilemmas: Medscape 2012 Survey Results

Physicians' Top Ethical Dilemmas

Would you fight with a family that wanted to withdraw care from a viable patient? Would you follow the family's directive to continue treatment if you thought it was futile? Would you date a patient? More than 24,000 physicians told us how they feel about this and other ethical dilemmas.

The entire survey is here.

Leading pediatricians' group backs same-sex marriage

CBS/AP
Originally posted on March 21, 2013

The nation's most influential pediatrician's group has endorsed same-sex marriage, saying a stable relationship between parents regardless of sexual orientation contributes to a child's health and well-being.

The new policy of the American Academy of Pediatrics, published online Thursday, cites research showing that the parents' sexual orientation has no effect on a child's development. Kids fare just as well in same-sex or straight families when they are nurturing and financially and emotionally stable, the academy says.

Separately, a new national survey shows the nation's views on same-sex marriage are more favorable -- in large part because of a shift in attitudes among those who know someone who is gay or became more accepting as they got older of gays and lesbians.

The Pew Research Center poll also finds that a large group of younger adults who tend to be more open to gay rights is driving the numbers upward.

The entire article is here.

Patients should decide what the end of life is like, study says

By Mary VacVean
The Los Angeles Times
Originally published March 20, 2013

Finding out what dying patients want and treating them accordingly leads to happier patients who are in less pain and who use fewer healthcare dollars, UCLA researchers said Tuesday.

“You can improve care while reducing costs by making sure that everything you do is centered on what the patients want, what his or her specific goals are and tailor a treatment plan to ensure we provide the specific care he or she wants,” Dr. Jonathan Bergman, a Robert Wood Johnson clinical scholar at UCLA, said in a statement.

Bergman and colleagues wrote an article advocating for patient-centered care at the end of life in the journal JAMA Surgery.

People who are dying often receive care that is poorly coordinated and not in line with the patient’s values or goals, the journal authors said. That should change, they said.

The entire article is here.

Do We Need 'Thanaticians' for the Terminally Ill?

By Ronald W. Pies
Medscape - Ethics in Psychiatry
Originally published September 26, 2012

My 89-year-old mother had been losing ground for some years, experiencing what geriatricians sometimes call "the dwindles." Toward the end of her life, she was beset by a deteriorating heart; an inability to walk; and occasional, severe gastrointestinal pain. My family got her the best medical treatment available -- eventually including home hospice care -- and she generally maintained a positive attitude throughout her long downhill slide.

But one day, as I sat beside her bed, she seemed unusually subdued. "Honey," she said, "How do I get out of this mess?" I had a pretty good idea of what she was really asking me, but I deflected her question with another question: "Ma, what 'mess' do you mean?" I asked. "It's all right," she replied, smiling sadly, "I'll manage."

My mother was doing what she had always done: sparing her children from pain. In this case, it was the pain of dealing with the waning days of her life and the frustration of knowing there was no easy escape from the burdens of dying slowly. "Ma, I'll always make sure you are getting enough treatment for your pain," I added, taking her hand -- knowing that the prospect of unremitting pain is often an underlying fear of terminally ill persons.

Yet, unspoken in my mother's question was the issue of so-called physician-assisted dying, sometimes called "physician-assisted suicide" -- an enormously heated controversy both outside and within the medical profession. In my home state, Massachusetts, the issue has come to the fore, owing to a November ballot initiative for a measure that would allow terminally ill patients to be prescribed lethal drugs. A closely related bill (H.3884) has also come before the Massachusetts Legislature's Joint Committee on the Judiciary.

The entire ethical dilemma is here.

Kaiser Permanente cited for EHR mental health violations

By Jennifer Bresnick
EHR Intelligence
Originally published on March 20, 2013

Kaiser Permanente, the largest healthcare provider in California, has been cited by the California Department of Managed Healthcare (DMHC) for keeping two sets of patient records: an official EHR that it showed to state inspectors, and a parallel paper record that hid violations of the state’s “timely access” law that mandates shorter wait times for mental healthcare than Kaiser was able to provide.  The inaccuracies involved in the HMO’s dual record keeping system meant that mental health patients may have waited weeks longer than the law stipulates for appointments, resulting in illegal denials of access to care for schizophrenia, autism, depression and suicidal ideation, among other serious conditions.

The problem stems from Kaiser’s double appointment keeping procedures.  While there is an electronic version – the version that gets reported to government officials – Kaiser also used paper lists in some facilities, rendering its electronic appointment wait time calculators useless.

The entire story is here.

Thanks to Ed Zuckerman for this story.

Proof That Obamacare 'Rate Shock' Is An Ugly Insurance Company Deception

By Rick Unger
Forbes - Op Ed
Originally published on March 26, 2013

Over the past few months, the nation’s largest health insurance companies have been hard at work selling a narrative claiming that the Affordable Care Act is about to result in dramatically larger premium costs for a significant number of Americans. Indeed, the warnings have become so worrisome that the massive increases they are predicting have taken on a frightening descriptor all its own—rate shock.

At the heart of the health insurers’ retelling of the Chicken Little story is a regulation promulgated by the Department of Health and Human Services a few months back limiting what a health insurer can charge a 64 year old to three times what they charge a 21 year old. Currently, the average bump for older participants is typically five times that of the younger customers—although there are examples where the increase can reach ten times what is paid by the young immortals buying coverage.

As a result of the lower premium prices that will be paid by older participant, the expectation—one created by the large insurance companies—is that the youngest participants will have to pay significantly more to make up the difference.

Now, The Urban Institute—an organization so clearly bi-partisan that even the most suspicious partisan would encounter extreme difficulty making a case for bias—is out with a study that states that the ‘rate shock’ argument is “unfounded”, particularly when applied to the millions of Americans in the individual market.

The entire Op Ed is here.

The study debunking the "rate shock" rumor is here.

Bringing a Virtual Brain to Life

By Tim Requarth
The New York Times
Originally published March 18, 2013

Here are some excerpts:

In 2009, Dr. Markram conceived of the Human Brain Project, a sprawling and controversial initiative of more than 150 institutions around the world that he hopes will bring scientists together to realize his dream.
      

In January, the European Union raised the stakes by awarding the project a 10-year grant of up to $1.3 billion — an unheard-of sum in neuroscience.

      

“A meticulous virtual copy of the human brain,” Dr. Markram wrote in Scientific American, “would enable basic research on brain cells and circuits or computer-based drug trials.”

      

An equally ambitious “big brain” idea is in the works in the United States: The Obama administration is expected to propose its own project, with up to $3 billion allocated over a decade to develop technologies to track the electrical activity of every neuron in the brain.

      

But just as many obstacles stand in the way of the American project, a number of scientists have expressed serious reservations about Dr. Markram’s project.

      

Some say we don’t know enough about the brain to simulate it on a supercomputer. And even if we did, these critics ask, what would be the value of building such a complicated “virtual brain”?

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“It’s not like the Human Genome Project, where you just have to read out a few billion base pairs and you’re done,” said Peter Dayan, a neuroscientist at University College London. “For the human brain, what would you need to know to build a simulation? That’s a huge research question, and it has to do with what’s important to know about the brain.”

      

And Haim Sompolinsky, a neuroscientist at the Hebrew University of Jerusalem, said: “The rhetoric is that in a decade they will be able to reverse-engineer the human brain in computers. This is fantasy. Nothing will come close to it in a decade.”

The entire story is here.