Sentimentality and the Enemies of Animal Protection

ABSTRACT

Ethical arguments promoting a higher moral status for nonhuman animals have developed a pace since the 1960s. These developments, however, have not been matched by a radical transformation in the way we treat nonhuman animals. In the 1990s, an alternative discourse emerged—the morality of care. Sympathy, empathy, compassion and pity form a family of sentiments that constitute the caring ethic. Sentimentality, the term associated with sentiment, is invariably invoked in our relationships to nonhuman animals. Although carrying positive connotations in the eighteenth century, sentimentality has since become a word of contempt and has been used to discredit our natural sympathy for nonhumans and to disparage animal protection reforms, both past and present. Here I argue for the rehabilitation of the term sentimentality and support Rorty's view that we need to create a moral sentimental education if we are to improve the world, and in particular the world as experienced by nonhuman animals. I believe that this educational enterprise should be directed at the pet-owning group, who are generally speaking already committed animal-lovers and who could be powerful agents for change in securing more justice for nonhuman animals.     

The death of dignity is greatly exaggerated: Reflections 15 years after the declaration of dignity as a useless concept

Fifteen years ago, Ruth Macklin shook the medical community with her claim in the BMJ that dignity is a useless concept. Her essay provoked a storm of reactions. What have we learned from the debate? In this article I analyse the responses to her essay and the following debate to investigate whether she was right that “[d]ignity is a useless concept in medical ethics and can be eliminated without any loss of content.” While some of the commentaries misconstrued her claim and argue against strawmen, others forcefully maintained that the concept of dignity has functions beyond “respect for persons and their autonomy.” One important point that came out of the debate is that dignity is a generic concept that covers more ground than “respect for persons or their autonomy.” In particular, dignity seems to have a wide range of protective functions as well as having reciprocal, relational, and social aspects. Dignity appears more attributional and norm-formative than respect for persons and autonomy. While the claim that dignity is unclear, vague, and can be used sloganistically seems highly relevant, it is argued that this vagueness fulfils important functions in ethics. Moreover, dismissing dignity because of its lack of clarity has implications for “respect for persons” and “autonomy,” which are also used vaguely and sloganistically. No doubt medical ethics should use as a clear concept as the context requires. Nonetheless, dignity still seems to be a widely used generic concept in ethical debates and doing as much ethical work as “respect for persons” or “respect for autonomy.” Therefore, the death of dignity seems to be greatly exaggerated.     

Exploring Wellness of Wildlife Carers in New Zealand: A Descriptive Study

The rescue and care of vulnerable wildlife is rewarding. Most people involved in animal rescue have a strong commitment to service but the work can be profoundly challenging. The ability to know and respond appropriately to an animal's needs depends on the professional skills and knowledge of wildlife carers. In the face of unrelenting suffering and countless numbers of animals in need, there are multiple stressors, vulnerabilities, and barriers that can undermine carers’ wellbeing and put them at risk of compassion fatigue. The balance between compassion satisfaction and compassion fatigue is considered professional quality of life. The aim of this study was to provide a preliminary understanding of the potential for compassion satisfaction and the risk of compassion fatigue among wildlife carers within New Zealand. Thirty wildlife carers voluntarily completed a self-report survey, which included questions on socio-demographics, self-perceived quality of life (EUROHIS-QOL), professional quality of life (ProQOL), job satisfaction, motivation for ongoing work in wildlife rehabilitation, and coping mechanisms. We found that there were significant differences in compassion satisfaction and compassion fatigue on the basis of age, gender, financial capability, and years of experience. Overall, this sample showed high levels of compassion satisfaction and low levels of compassion fatigue. Understanding the elements of professional quality of life can have a positive effect on work environment. These results may provide clues to help identify wildlife carers’ strengths for compassion satisfaction and vulnerabilities to compassion fatigue, and to help develop strategies to improve their professional quality of life.     

CLARIFYING APPEALS TO DIGNITY IN MEDICAL ETHICS FROM AN HISTORICAL PERSPECTIVE

Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in medical debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the 'special status of human beings'; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation-stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics.     

Relating paternity to paternal care

Intuition suggests, to most people, that parents should be selected to care for their offspring in relation to how certain they are of being the parents of those offspring. Theoretical models of the relationship between parental investment and certainty of parentage predict the two to be related only when some other assumptions are made, few of which can be taken for granted. I briefly review the models and their assumptions, and discuss two kinds of difficulty facing an empiricist wishing to test the models. The first is the problem of unmeasured (and immeasurable) variables. The second is the problem that even the most extensive models do not capture the complexity that can be demonstrated in real systems. I illustrate some of these problems, and some qualitative tests of the models, with experimental work on a population of the collared flycatcher. My conclusion is that although there are some cases where the models have qualitative support, we are a long way from understanding whether paternal care is commonly adjusted in relation to certainty of paternity.     

Mental competence and long term care: an uncomfortable relationship

Competency is an important concept in medical ethics as well as in law. It refers to the moral principles of self-determination and autonomy, which are of central importance in the ethics of health care. These moral principles also prevail in nursing home care. Societal prejudice concerning nursing home patients suggests that the inhabitants of a nursing home are almost by definition incompetent. We assert that such prejudice rests on certain societal delusions and misinterpretations of incompetency five of which are subsequently analysed. Next we discuss the dominant conception of competency in terms of decisional capacity. This conception is predominantly oriented towards cognitive abilities and underplays affective capacities. We confront this dominant conception with an alternative proposal of competency in terms of 'the capacity to value', which--to our opinion--more properly reflects nursing home practice concerning questions of competency. Finally we address the limitations of any concept of competency or decisional capacity in relation to the moral issues of 'good care' for demented elderly. As an alternative we draw attention to the moral perspective of the 'ethics of care'.     

The Role of Compassion in Altruistic Helping and Punishment Behavior

Compassion, the emotional response of caring for another who is suffering and that results in motivation to relieve suffering, is thought to be an emotional antecedent to altruistic behavior. However, it remains unclear whether compassion enhances altruistic behavior in a uniform way or is specific to sub-types of behavior such as altruistic helping of a victim or altruistic punishment of a transgressor. We investigated the relationship between compassion and subtypes of altruistic behavior using third-party paradigms where participants 1) witnessed an unfair economic exchange between a transgressor and a victim, and 2) had the opportunity to either spend personal funds to either economically a) help the victim or b) punish the transgressor. In Study 1, we examined whether individual differences in self-reported empathic concern (the emotional component of compassion) was associated with greater altruistic helping or punishment behavior in two independent samples. For participants who witnessed an unfair transaction, trait empathic concern was associated with greater helping of a victim and had no relationship to punishment. However, in those who decided to punish the transgressor, participants who reported greater empathic concern decided to punish less. In Study 2, we directly enhanced compassion using short-term online compassion meditation training to examine whether altruistic helping and punishment were increased after two weeks of training. Compared to an active reappraisal training control group, the compassion training group gave more to help the victim and did not differ in punishment of the transgressor. Together, these two studies suggest that compassion is related to greater altruistic helping of victims and is not associated with or may mitigate altruistic punishment of transgressors.     

An Eliminativist Approach to Vulnerability

The concept of vulnerability has been subject to numerous different interpretations but accounts are still beset with significant problems as to their adequacy, such as their contentious application or the lack of genuine explanatory role for the concept. The constant failure to provide a compelling conceptual analysis and satisfactory definition leaves the concept open to an eliminativist move whereby we can question whether we need the concept at all. I highlight problems with various kinds of approach and explain why a satisfactory account of vulnerability is unlikely ever to be offered if we wish the concept to play a genuinely explanatory role in bioethical contexts. I outline why an eliminativist position should be taken with regard to this concept in light of these concerns but mitigate some of the severity of this position by arguing that we can still make sense of retaining our widespread use of the term by viewing it as nothing more than a useful pragmatic linguistic device that acts as a marker to draw attention to certain kinds of issue. These issues will be entirely governed by other, better understood ethical concepts and theories.     

International Research Ethics

This article provides a critical overview of the most important issues pertaining to the ongoing debate on international research ethics. It critically describes three problems of continuing concern: 1) the question of whether the distinction between therapeutic and non-therapeutic research should be upheld; 2) the questions of whether the currently demanded best proven diagnostic and therapeutic method of treatment for all research subjects is feasible both in developed and in developing countries, and whether it should be upheld; 3) the questions of who owns international research ethics guidelines and regulatory frameworks and, how decisions about changes to such international guidelines can possibly be achieved, given that it seems to be the case that genuine disagreement about issues of content is possible and likely.     

PALLIATIVE CARE, PUBLIC HEALTH AND JUSTICE: SETTING PRIORITIES IN RESOURCE POOR COUNTRIES

Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care , we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non-abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries.     

Assessing formal teaching of ethics in physiology: an empirical survey, patterns, and recommendations

Ethics should be an important component of physiological education. In this report, we examined to what extent teaching of ethics is formally being incorporated into the physiology curriculum. We carried out an e-mail survey in which we asked the e-mail recipients whether their institution offered a course or lecture on ethics as part of the physiology teaching process at their institution, using the following query: "We are now doing an online survey in which we would like to know whether you offer a course or a lecture on ethics as part of your physiology teaching curriculum." The response rate was 53.3%: we received 104 responses of a total of 195 sent out. Our responses came from 45 countries. While all of our responders confirmed that there was a need for ethics during medical education and scientific training, the degree of inclusion of formal ethics in the physiology curriculum varied widely. Our survey showed that, in most cases (69%), including at our Medical University of Graz, ethics in physiology is not incorporated into the physiology curriculum. Given this result, we suggest specific topics related to ethics and ethical considerations that could be integrated into the physiology curriculum. We present here a template example of a lecture "Teaching Ethics in Physiology" (structure, content, examples, and references), which was based on guidelines and case reports provided by experts in this area (e.g., Benos DJ. Ethics revisited. Adv Physiol Educ 25: 189-190, 2001). This lecture, which we are presently using in Graz, could be used as a base that could lead to greater awareness of important ethical issues in students at an early point in the educational process.     

Evaluating interventions in health: a reconciliatory approach

Health-related Quality of Life measures have recently been attacked from two directions, both of which criticize the preference-based method of evaluating health states they typically incorporate. One attack, based on work by Daniel Kahneman and others, argues that 'experience' is a better basis for evaluation. The other, inspired by Amartya Sen, argues that 'capability' should be the guiding concept. In addition, opinion differs as to whether health evaluation measures are best derived from consultations with the general public, with patients, or with health professionals. And there is disagreement about whether these opinions should be solicited individually and aggregated, or derived instead from a process of collective deliberation. These distinctions yield a wide variety of possible approaches, with potentially differing policy implications. We consider some areas of disagreement between some of these approaches. We show that many of the perspectives seem to capture something important, such that it may be a mistake to reject any of them. Instead we suggest that some of the existing 'instruments' designed to measure HR QoLs may in fact successfully already combine these attributes, and with further refinement such instruments may be able to provide a reasonable reconciliation between the perspectives.     

中国临终关怀服务现状与伦理探讨

随着社会经济的发展、人口老龄化和疾病谱的改变,临终关怀已成为我国社会所关注的重要民生问题,也成为医学伦理的热点。该文结合中国生命关怀协会对我国城市临终关怀服务利用与需要状况的调研,反映当前我国城市临终关怀服务的基本特征,对临终关怀中涉及医学伦理的部分概念,以及临终关怀服务中的相关权益进行阐述,并建议应当在逐步完善全民医疗保健制度的基础上,健全服务体系,包括临终关怀伦理道德法规体系,才能更好地为临终患者服务,提高患者的生命质量。     

Plasticity in the timing of physiological development: Physiological heterokairy — What is it, how frequent is it, and does it matter?

The study of developmental sequences of physiological traits could be an important way of placing comparative developmental physiology (CDP) within the research agenda being forged by work on developmental plasticity. Here we focus on the concept of heterokairy defined by Spicer & Burggren in 2003 as changes in the timing of physiological development in an individual. The role of this concept in the future of the CDP is discussed. First we provide an historical perspective of the ideas that have led to the investigation of sequences in CDP. This is followed by a re-examination and clarification of the definition of physiological heterokairy before empirical case studies that (explicitly or implicitly) demonstrate physiological heterokairy are reviewed. We suggest that physiological heterokairy can be demonstrated through a wide range of invertebrate and vertebrate examples. However, care must be taken when inferring that heterokairy as a pattern is always the result of heterokairic processes as there is evidence that physiological heterokairy could result from the altered timing of both homologous or analogous physiological mechanisms. We conclude by discussing the potential link between heterokairy and heterochrony and suggest that the investigation of this link should be a major goal for workers in both CDP and developmental plasticity.     

Plasticity in the timing of physiological development: physiological heterokairy--what is it, how frequent is it, and does it matter?

The study of developmental sequences of physiological traits could be an important way of placing comparative developmental physiology (CDP) within the research agenda being forged by work on developmental plasticity. Here we focus on the concept of heterokairy defined by Spicer & Burggren in 2003 as changes in the timing of physiological development in an individual. The role of this concept in the future of the CDP is discussed. First we provide an historical perspective of the ideas that have led to the investigation of sequences in CDP. This is followed by a re-examination and clarification of the definition of physiological heterokairy before empirical case studies that (explicitly or implicitly) demonstrate physiological heterokairy are reviewed. We suggest that physiological heterokairy can be demonstrated through a wide range of invertebrate and vertebrate examples. However, care must be taken when inferring that heterokairy as a pattern is always the result of heterokairic processes as there is evidence that physiological heterokairy could result from the altered timing of both homologous or analogous physiological mechanisms. We conclude by discussing the potential link between heterokairy and heterochrony and suggest that the investigation of this link should be a major goal for workers in both CDP and developmental plasticity.     

论＂医德＂的基本范畴

医德是医疗卫生领域精神文明建设的重要部分,也是调整医务人员与病人、医务人员之间以及与社会之间关系的行为准则。医德范畴是指人们对现代医务人员职业道德和医患关系的总结,它不仅概括了医生所应履行的职责义务,而且反映着一段时间内医患关系的本质。本文通过对医德范畴内,医生的权利和义务、责任和良心、功力和荣誉、审慎和保密四类问题的阐述,探讨当下医生在工作中应该保持何种心态,如何与患者进行沟通,以期更好地提供医疗服务。     

Health care ethics and health law in the Dutch discussion on end-of-life decisions: a historical analysis of the dynamics and development of both disciplines

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction (Abbott) and the assignment of responsibilities (Gusfield). This theoretical framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as 'intentionally taking the life of another person by a physician, upon that person's request' can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction.     

Research versus practice: The dilemmas of research ethics in the era of learning health‐care systems

In this article we attempt to answer the question of how the ethical and conceptual framework (ECF) for a learning health‐care system (LHS) affects some of the main controversies in research ethics by addressing five key problems of research ethics: (a) What is the difference between practice and research? (b) What is the relationship between research ethics and clinical ethics? (c) What is the ethical relevance of the principle of clinical equipoise? (d) Does participation in research require a higher standard of informed consent than the practice of medicine? and (e) What ethical principle should take precedence in medicine? These questions allow us to construct two opposite idealized positions on the distinction between research and practice: the integration model and the segregation model of research and practice. We then compare the ECF for an LHS with these two idealized positions. We argue that the ECF for a LHS does not, in fact, solve these problems, but that it is a third, separate position in the relationship between research ethics and clinical ethics. Moreover, we suggest that the ECF for a LHS raises new ethical problems that require additional ethical analysis and justification. Our article contributes to the discussion on the relationship between research ethics and clinical ethics, revealing that although a learning health‐care system may significantly change the landscape of health care, some ethical dilemmas still require resolving on both theoretical and policy‐making levels.     

Pollution and Intimacy in a Transcendent Ethics of Care: A Case of Aged-care in India

In India, where children’s care of ageing parents is seen as practical and sacred, animated by notions of seva (selfless service), the outsourcing of elder care causes considerable concern. Meanwhile, carers’ work in old-age homes is treated as transactional, and their moral claims about this work are either overlooked or criticised. While gendered, socio-economic circumstances compel the women we discuss in this paper to care-work at an old-age home in Pune, they also understood this work as a register for the spiritual striving normally reserved for higher classes and castes. Accordingly, notions of polluting and non-polluting bodily waste inform the sense of kin-like intimacy through which they frame their labour. Attending to the institutional, spiritual, emotional and bodily registers of these carers’ work, we argue for a transcendent ethics of care, a conceptualisation that contributes to broader understandings of marginalisation and moral imagination in an ordinary ethics of care.     

The challenges of cross-cultural healthcare--diversity,ethics, and the medical encounter

Difficulties in the provider-patient relationship arise from many sources, and pose various challenges to the integrity of the medical encounter. When these issues are especially sensitive or important to the patient's health and well-being, a complete breakdown in the therapeutic relationship may result. The goal of the emerging field of cross-cultural healthcare is to improve providers' ability to understand, communicate with, and care for patients from diverse backgrounds. We should weave the concepts of cross-cultural care into the ethics of caring if we truly hope to have a positive impact on the health status of diverse patient populations.