Against dichotomies: on mature care and self-sacrifice in care ethics

Introduction: In previous issues of this journal Carol Gilligan’s original concept of mature care has been conceptualized by several (especially Norwegian) contributors. This has resulted in a dichotomous view of self and other, and of self-care and altruism, in which any form of self-sacrifice is rejected. Although this interpretation of Gilligan seems to be quite persistent in care ethical theory, it does not seem to do justice to either Gilligan’s original work or the tensions experienced in contemporary nursing practice. Discussion: A close reading of Gilligan’s concept of mature care leads to a view that differs radically from any dichotomy of self-care and altruism. Instead of a dichotomous view, a dialectical view on self and other is proposed that builds upon connectedness and might support a care ethical view of nursing that is more consistent with Gilligan’s own critical insights such as relationality and a practice-based ethics. A concrete case taken from nursing practice shows the interconnectedness of professional and personal responsibility. This underpins a multilayered, complex view of self-realization that encompasses sacrifices as well. Conclusion: When mature care is characterized as a practice of a multilayered connectedness, caregivers can be acknowledged for their relational identity and nursing practices can be recognized as multilayered and interconnected. This view is better able to capture the tensions that are related to today’s nursing as a practice, which inevitably includes sacrifices of self. In conclusion, a further discussion on normative conceptualizations of care is proposed that starts with a non-normative scrutiny of caring practices

Why Good Quality Care Needs Philosophy More Than Compassion Comment on “Why and How Is Compassion Necessary to Provide Good Quality Healthcare?”

Although Marianna Fotaki’s Editorial is helpful and challenging by looking at both the professional and institutional requirements for reinstalling compassion in order to aim for good quality healthcare, the causes that hinder this development remain unexamined. In this commentary, 3 causes are discussed; the boundary between the moral and the political; Neoliberalism; and the underdevelopment of reflection on the nature of care. A plea is made for more philosophical reflection on the nature of care and its implications in healthcare educatio

Training Spiritual Care in Palliative Care in Teaching Hospitals in the Netherlands (SPIRIT-NL):A Multicentre Trial

Background: In the Netherlands, the spiritual dimension in healthcare became marginal in the second part of the twentieth century. In the Dutch healthcare sys- tem, palliative care is not a medical specialization and teaching hospitals do not have specialist palliative care units with specialized palliative care teams. Palliative care in these hospitals is delivered by healthcare professionals in general depart- ments (mainly curative focused ones), and is based on multidisciplinary guide- lines supported by palliative care consultation teams. A national multidisciplinary guideline on spiritual care is included, but standardized training based on this guideline still lacks. Implementation of this guideline is expected to have a posi- tive effect on quality of care but is in an early state, the role of the specialists in this field—the healthcare chaplains—is developing. The objective of this article is to present the protocol of this study and stimulate discussion about methods of research on spirituality and spiritual care.Methods and Findings: This action research study is planned as an explorative mul- ticentre trial. Healthcare chaplains of ten teaching hospitals will offer training on spiritual care in palliative care for healthcare professionals. What is the effect of this intervention on the competences of clinical teams? What is the effect on the perceived care and treatment as experienced by patients?The effects of the intervention on the competences of the clinicians will be meas- ured once pre-study and twice post-study. Effects on patients’ physical symptoms and spiritual distress, and the perceived focus of caregivers on their spiritual needs or existential questions will also be measured pre- and post-study