The International Care Ethics (ICE) Observatory

The ICE Observatory promotes international research, development of ethics teaching, cross-cultural discussion and understanding, and ethical inter-professional and inter-agency co-operation. It runs regular conferences and seminars.

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Ethics in Care blog

  • I arrived at the Hastings Center in Garrison, New York State, with one set of questions. And left with another. This week I’ve also come across an interesting new idea in the context of bioethics: ‘binocularity’. More on this later.

    The Hastings Center

    This world-renowned bioethics center was founded in 1969 by Daniel Callahan and Willard Gaylin. The center team conducts and disseminates research, hosts the journal The Hastings Center Report and welcomes visiting scholars. The setting of the center, overlooking the Hudson river, was described as ‘grand and sublime’ by William Colyer in 1838.

    As I’ve learnt at both Tuskegee and Georgetown, location and history are important, but it is the people who make any center hospitable and a success (see )

    As I was preparing for my lunch-time seminar at the Hastings Center, I had an email from Professor Daniel Callahan, offering a phone conversation. I felt honoured to have this wonderful opportunity to talk with him. Daniel Callahan is one of the most prolific scholars and eminent leaders in bioethics. He continues to give generously of his time and wisdom to visiting scholars and others. Truly, a most magnanimous man who has influenced many of us and continues to contribute to the development of the field. ( )

    I talked also with Nancy Berlinger about ethics and care, with Josephine Johnston about current research priorities in bioethics, Erik Parens about broader issues that impact on care and with other staff members regarding their current research activities. Nancy’s work is particularly relevant to the aims and activities of the International Care Ethics Observatory at the University of Surrey and I look forward to developing research collaboration with her. I recommend to you a special issue of The Hastings Center Report, on the theme of ‘Nurses at the Table: Nursing , Ethics and Health Policy’, which was co-edited by Nancy.


    Erik Parens’ book ‘Shaping Ourselves’ introduced me to the idea of ‘binocularity’ in bioethics . By this is meant ‘a habit of thinking’ whereby we move between an ‘object’ lens (exploring third-person  explanations for experiences and considering evidence for and against different stances) and a‘subject’ lens (which focuses on first-person experience). It is argued that we need both lenses if we are to really understand people and issues such as informed consent (see Chapter 7) . He writes that ‘we can see ourselves as an object and then as a subject but we can’t do both at once’, hence ‘oscillating binocularity’. This has the potential to illuminate – more clearly and impartially – ethical issues in care.

    To return to the question of questions…

    Broader and deeper questions

    The lunch-time Hastings Center seminar discussion generated interesting questions:

    • In the course of our ethics education, are we asking too much of residential care-givers who are, generally, people without privilege?
    • Shouldn’t we focus attention on changing structures and systems rather than focusing on individual care-givers?
    • Should we aspire to ‘good enough’ care rather than to human flourishing?
    • Is ‘flourishing’ something older people themselves aspire to? (Daniel Callahan thinks not).

    My responses to these questions will be addressed in the RIPE project overview paper. Meanwhile, your thoughts on any of these questions would be most welcome.

    As it’s almost Christmas, I thought I should end on a lighter note.

    Seasons greetings…

    After the Hastings Center, I had some days of holiday in New York City. When I arrived I had lunch in an Irish bar. Prompted by a notice on the menu I asked:

    ’ When is happy hour?’

    The bartender responded:

    ‘That will be between 11am and 8pm’.

    Wishing you all many happy hours over the holiday and all good wishes for 2018.

    I thank those of you who have shared your expertise and experience with me – and shown such warm hospitality – during these 3 months in the United States. I hope I will have the pleasure of welcoming you to the UK in the years to come and perhaps to Ireland for our conference in 2018 ( .

    I look forward to seeing friends and colleagues in England soon.


  • As I entered Healy Hall, which houses the Kennedy Institute of Ethics (KIE), I overheard a campus tour guide declaring: ‘At Georgetown we pride ourselves on our religious diversity.’

    Georgetown University is the oldest Catholic and Jesuit higher learning institute in the United States (see Georgetown is close to many other unmissable Washington attractions such as the Smithsonian museums, the Kennedy Center and the new National Museum of African American History and Culture (

    The Kennedy Institute of Ethics (KIE) was set up in 1971 and was the first academic ethics centre (see ). It was originally known as ‘the Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics’. It is home to many leaders in bioethics and philosophers, for example, Robert Veatch, Daniel Salmasy, Maggie Little, John Keown, Carol Taylor, Tom Beauchamp and James Childress (the latter two well known for their ‘Principles of Biomedical Ethics’ text). The Institute also has a bioethics research library, second to none, with the most helpful librarians imaginable.

    Research areas

    The Institute is a hub for international scholars. I talked with a Belgian psychiatrist researching ethical aspects of euthanasia and mental distress; a Portuguese doctoral student analysing philosophical methodology in relation to the four principles; a German anthropologist conducting a cross-cultural study relating to end of life care; and a scholar exploring philosophical aspects of chronic fatigue syndrome and another working on a project on slavery, memory and reconciliation.

    I also had the privilege of meetings with KIE Academic Programme Manager, Laura Bishop, with Abigail Rian Evans (Adjunct Professor Georgetown) and Julie Trocchio from the Catholic Health Association. All shared their expertise and experience generously and directed me to many additional resources on the theme of ethics and elder care. I was excited to learn of the existence of the KIE Ethics Lab which is a design lab ‘that uses ethics and design to find innovative ways to approach complex moral problems.’ I’m looking forward to exploring areas of common interest.

    A question of identity and politics

    I talked with a philosopher interested in questions of ‘identity’ and care. She raised this question and I’d be interested in your views:

    Do you think care-givers would be more challenged by a gay/lesbian care-recipient who decides in later life that he/she is heterosexual than with a heterosexual care-recipient who decides that she/he is gay/lesbian? If so, why?

    Earlier in the week, I went along to the interfaith Chaplaincy afternoon tea gathering which began with an invitation to sign letters to support ‘the Dream Act’ ( ) which were to be delivered to Capitol Hill. It was interesting to witness this political dimension of a Chaplaincy. It was also interesting to witness the religious diversity the guide suggested: the Imam who has post-graduate qualifications in Christian theology and Judaism and the Orthodox Christian chaplain had a previous career as a physicist.

    Georgetown is a treasure trove of ethics-related riches due to the people who work and study there and the fantastic bioethics library. Conversations with people with different religious, philosophical and disciplinary perspectives left me feeling that Christmas had come early…

    This week I will be at the Hastings Center and I look forward to telling you about this in the final blog of the year.


  • ‘Do you want to know if it’s loaded?’ asked the octogenarian (Mr S) when he noticed I’d caught sight of the handgun and holster slung over my chair.

    My penultimate day in Alabama was spent with a home care team who delivered services to elders in a rural community. Before we had breakfast together, the team held hands and said prayers of thanksgiving. ‘Faith’, as I’ve found throughout my stay in the South, is unapologetically and wholeheartedly embraced.

    The occupational therapist I shadowed had an excellent rapport with those she visited – including Mr S – and was thoughtful about the everyday ethical issues we came across. We talked of those reluctant to be discharged when they were assessed as not needing home care services, of those who lived with family whose lifestyles don’t make for a healthy environment and of elders who were lonely wanting company more than the assistance with activities of daily living the OT knew they needed.

    Four lessons

    I am privileged to have been a Fulbright Scholar-in-Residence and was sad to leave Tuskegee University. I set out to explore aspects of ‘ethics and elder care’ and came to learn about much else. Four lessons stand out:

    1. ‘Black’ is complicated – I talked with Black people brought up in the US and with those who came to the US from countries such as Ghana, Nigeria, the UK and the Caribbean – all had different perspectives on Black history and what follows from it.
    2. ‘Church’ is diverse and deeply embedded in everyday life in the South – there are, for example, about 200 denominations in the Southern Baptist Convention (see I witnessed the solidarity, respect and generosity demonstrated in Church and in everyday life. I was also challenged by views and practices that were not respectful of difference.
    3. Stories illuminate intersecting identities – we need to invite and listen to stories so we understand our differences and similarities and how unique identities impact on our ability to flourish.
    4. The value of a pluralist bioethics – historical and cultural contexts impact on bioethical questions and perspectives. In the spirit of the Fulbright vision, we need to be open-minded and not assume that one perspective will suit all.

    Life, death and next steps

    Last week I promised a mention of football. Bill Shankley’s quip about soccer could apply to American college football in the South: ‘They say football’s a matter of life and death – but it’s more important than that’. I visited Montgomery the weekend local university Auburn was playing Alabama. The city was deserted as some 1000,000 people had descended on Auburn for the game. Football, I was told, is another Southern religion.

    My encounter with Mr S brought into sharp focus a very challenging aspect of Southern culture. That is, gun control. Mr S, who I met when I was being visiting with the OT, told me that his handgun was loaded and that he kept another by his armchair.

    The right to own a gun is held dear by many in Alabama so I leave you with two questions:

    • Is ‘gun control’ a topic for bioethicists to debate? and
    • What does ‘gun control’ have to do with care ethics?

    I’m currently working on a Nursing Ethics Editorial on this theme with a Tuskegee colleague, Dr David Hodge. We’ll be pleased to consider your responses as we write this.

    Next week I will tell about my time at the Kennedy Institute in Georgetown. Washington.

  • Would it be a good idea to have Historically Black Colleges and Universities (HBCU’s) in the UK? This was one of the many questions put to me in a Q and A session with final year students at Tuskegee University this week.

    HBCUs have a long history in the United States. They were set up in the 1830’s to meet the educational needs of Black Americans. The first students had little or no previous education and the focus was on the development of practical skills. Across the USA there are now 102 HBCU’s in 19 states with almost 300,000 students on a wide range of undergraduate and postgraduate programmes. It  is reported that there has been an increase in diversity in HBU’s from 15% of non-Black students in 1979 to 22% in 2015 (see ).

    The benefits of HBCUs

    So what are the benefits of HBCUs?

    I checked this out with a small group of students here at Tuskegee University. They self-defined as Catholic, Christian and Muslim. All agreed that the experience of being in a HBCU had developed their ‘Black identity’ and heightened their sense of pride. One said it had been ‘an eye opener’ to learn about Black history. They acknowledged the diversity of ‘Black’ and some of the challenges of racism which, they felt, came from ignorance and fear. If you want to get to understand people, they said, you need to take time to get to know them.

    Some questions…

    Is it not more beneficial to promote educational integration? Surely having a diverse student body, studying together, inevitably leads to enhanced respect and mutual understanding?

    There is evidence that even within institutions with a lot of diversity, prejudice exists. This was described by a Fulbright scholar just this week on an excellent Radio 4 progamme entitled ‘Being Muslim in America’ (listen at

    If we are to go down the voluntary segregation road, which groups should be entitled to a college of their own? Women? Catholics? Muslims? Humanists? There are already many schools that are segregated on the basis of sex and faith. Which should we be supportive of?  and Why?Please do share your views.


    [Photo of the Adams Chapel School (1898) at Old Alabama Town Museum, Montgomery]

    Impartial education?

    The students I talked with here at Tuskegee said they aspired to love, peace and harmony across the globe. To that end, a high quality education is crucial with mutual respect between teacher and student and impartial disciplinary expertise that develops critical thinking.

    Towards that end, our first year students at the University of Surrey have just completed an innovative 6 week online course (pre-MOOC) on the theme of ‘Applying Ethics to Health and Social Care’. Their discussion feedback highlights the value of video extracts that help them understand a wide range of patient and professional perspectives on good care. They referred to the usefulness of ethical principles, virtues and human rights. The students had also engaged with a range of future oriented ethical challenges, including robots in care.

    One student’s question amused and reminded of the importance of real people engaging in authentic educational activities together. She requested more face-to face interaction and asked: ‘How do we know that she (online teacher) is not a highly developed professorbot?’

    In the next blog post I will be reflecting on my final week in Alabama and focusing on ‘football, Church and Bioethics’. I will also be visiting an elder care service and will be able to tell you about that.


  • ‘One of the cool things about Savannah’, said the speaker by the Marshall House hotel fireplace, ‘is that we all love our history.’ In recent weeks, I’ve been made to think about about the value of history. Why should we care about history? What is history for? Can it be used unhelpfully contributing, for example, to moral blindness?

    I’m here in Savannah for the weekend and am left in no doubt that this part of the state of Georgia is steeped – nay glories – in history. There seems to be something here for everyone. If the colonisation period is of interest, you can learn about the arrival of Englishman James Edward Oglethorpe to set up a new colony in Savannah in 1732. You may be surprised by his friendship with Tomochichi, leader of the Yamacraw Indians, who were the local indigenous people. Or you may be interested in the original Charter for the city that prohibited slavery, lawyers, ‘hard liquor’ and Catholics?

    If you are interested in matters more recent, you might like to know that the book ‘Midnight in the Garden of Good and Evil’ is about Savannah (the fireplace speaker said it was 90% true). And that ‘Forrrest Gump’ was filmed here….

    So an abundance of history, much of it to most of you of little interest perhaps.

    In preparing my Fulbright talk for Friday, I felt compelled to make connections between the civil rights history of the South and the history of the Northern Irish ‘Troubles.’ Recently, a scholarly historian told me of his discovery that a stack of historical documents of interest to him were being left to rot. His research involves meticulous analysis of these types of documents and his publications have detailed footnotes to defend the claims he makes.

    So why should we care about history? Like the historian, we can care about uncovering truth for its own sake. We can come to understand and make connections amongst different epochs and world regions. For many people, history is personal and it can help people make sense of their lives in relation to the lives of their ancestors. A positive consequence is that our history enables us to celebrate, and build on, the achievements of those who have gone before us. In terms of what history is for, if we take it seriously, we can learn from and work to prevent the repetition of mistakes. In the case of Northern Ireland, this can involve breaking down myths about the ‘other’ side and working towards more integration of different religions and of different political perspectives.

    So can history be used unethically contributing, for example, to moral blindness? What if history is used to perpetuate prejudice against another group, for example, descendants of a group who engaged in discrimination in the past?  What if it works to keep people apart rather than bringing them together? Or if it is it is used to reinforce victimhood rather than recovery? Steve Marboli said ‘Letting means to come to the realisation that some people are part of our history, not a part of your destiny.’

    Two questions for readers:

    • In your experience, have you come across situations where history has illuminated and enhanced a life?
    • Have you come across situations where history appears to demoralise or thwart human flourishing?

    I look forward to hearing from you.