Being a burden: Reflections on refusing medical care

Hastings Center Report

Volumn 34, Issue 5, 2004, Pages 37-43

  Gunderson, Martin ^a  

^a MACALESTER COLLEGE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALTRUISM; HEALTH CARE; HUMAN; HUMAN RELATION; MEDICAL CARE; PATIENT ATTITUDE; PATIENT CARE; PATIENT RIGHT; REVIEW; SOCIAL BEHAVIOR; TREATMENT REFUSAL; AGED; ANALYTICAL APPROACH; ARTICLE; DEPENDENT PERSONALITY DISORDER; FAMILY; FEMALE; MALE; PROFESSIONAL PATIENT RELATIONSHIP; PSYCHOLOGICAL ASPECT;

ANALYTICAL APPROACH; PROFESSIONAL PATIENT RELATIONSHIP;

AGED; ALTRUISM; DEPENDENCY (PSYCHOLOGY); FAMILY; FEMALE; HUMANS; INTERPERSONAL RELATIONS; MALE; TREATMENT REFUSAL;

EID: 14644411644     PISSN: 00930334     EISSN: None     Source Type: Journal    
DOI: 10.2307/3527591     Document Type: Review

References (65)

1. Those who argue that under some conditions the elderly should refrain from using life-saving treatments that impose heavy burdens include D. Callahan, What Kind of Life? The Limits of Medical Progress (New York: Simon and Schuster, 1990); D. Callahan, The Troubled Dream of Life: In Search of a Peaceful Death (New York: Simon and Schuster, 1993); and N.S. Jecker "Being a Burden to Others," Journal of Clinical Ethics 4 (1993): 16-20.
2. Those who argue that under some conditions the elderly should refrain from using life-saving treatments that impose heavy burdens include D. Callahan, What Kind of Life? The Limits of Medical Progress (New York: Simon and Schuster, 1990); D. Callahan, The Troubled Dream of Life: In Search of a Peaceful Death (New York: Simon and Schuster, 1993); and N.S. Jecker "Being a Burden to Others," Journal of Clinical Ethics 4 (1993): 16-20.
3. Those who argue that under some conditions the elderly should refrain from using life-saving treatments that impose heavy burdens include D. Callahan, What Kind of Life? The Limits of Medical Progress (New York: Simon and Schuster, 1990); D. Callahan, The Troubled Dream of Life: In Search of a Peaceful Death (New York: Simon and Schuster, 1993); and N.S. Jecker "Being a Burden to Others," Journal of Clinical Ethics 4 (1993): 16-20.
4. J. Hardwig, "Is There a Duty to Die?" Hastings Center Report 27, no. 2 (1997): 34-42, reprinted in Is There a Duty to Die? and Other Essays in Medical Ethics, ed. J. Hardwig (New York and London: Routledge, 2000): 119-36 (future page references are to the book) ; and J. Beloff, "Do We Have a Duty to Die?" The Euthanasia Review 3 (1988): 3-9. For a variety of perspectives, see Biomedical Ethics Reviews: Is There a Duty to Die? ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press, 2000). For a defense of altruistic suicide, see M. Gunderson and D.J. Mayo, "Altruism and Physician Assisted Death," Journal of Medicine and Philosophy 18 (1993); 281-95.
5. J. Hardwig, "Is There a Duty to Die?" Hastings Center Report 27, no. 2 (1997): 34-42, reprinted in Is There a Duty to Die? and Other Essays in Medical Ethics, ed. J. Hardwig (New York and London: Routledge, 2000): 119-36 (future page references are to the book) ; and J. Beloff, "Do We Have a Duty to Die?" The Euthanasia Review 3 (1988): 3-9. For a variety of perspectives, see Biomedical Ethics Reviews: Is There a Duty to Die? ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press, 2000). For a defense of altruistic suicide, see M. Gunderson and D.J. Mayo, "Altruism and Physician Assisted Death," Journal of Medicine and Philosophy 18 (1993); 281-95.
6. J. Hardwig, "Is There a Duty to Die?" Hastings Center Report 27, no. 2 (1997): 34-42, reprinted in Is There a Duty to Die? and Other Essays in Medical Ethics, ed. J. Hardwig (New York and London: Routledge, 2000): 119-36 (future page references are to the book) ; and J. Beloff, "Do We Have a Duty to Die?" The Euthanasia Review 3 (1988): 3-9. For a variety of perspectives, see Biomedical Ethics Reviews: Is There a Duty to Die? ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press, 2000). For a defense of altruistic suicide, see M. Gunderson and D.J. Mayo, "Altruism and Physician Assisted Death," Journal of Medicine and Philosophy 18 (1993); 281-95.
7. J. Hardwig, "Is There a Duty to Die?" Hastings Center Report 27, no. 2 (1997): 34-42, reprinted in Is There a Duty to Die? and Other Essays in Medical Ethics, ed. J. Hardwig (New York and London: Routledge, 2000): 119-36 (future page references are to the book) ; and J. Beloff, "Do We Have a Duty to Die?" The Euthanasia Review 3 (1988): 3-9. For a variety of perspectives, see Biomedical Ethics Reviews: Is There a Duty to Die? ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press, 2000). For a defense of altruistic suicide, see M. Gunderson and D.J. Mayo, "Altruism and Physician Assisted Death," Journal of Medicine and Philosophy 18 (1993); 281-95.
8. J. Hardwig, "Is There a Duty to Die?" Hastings Center Report 27, no. 2 (1997): 34-42, reprinted in Is There a Duty to Die? and Other Essays in Medical Ethics, ed. J. Hardwig (New York and London: Routledge, 2000): 119-36 (future page references are to the book) ; and J. Beloff, "Do We Have a Duty to Die?" The Euthanasia Review 3 (1988): 3-9. For a variety of perspectives, see Biomedical Ethics Reviews: Is There a Duty to Die? ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press, 2000). For a defense of altruistic suicide, see M. Gunderson and D.J. Mayo, "Altruism and Physician Assisted Death," Journal of Medicine and Philosophy 18 (1993); 281-95.
9. Oregon Department of Human Services, Fourth Annual Report on Oregon's Death with Dignity Act (Portland, Or.: Oregon Department of Human Services, February 6, 2002), table 3, p. 16, available at http://www.ohd.hr.state.or.us/ chs/pas/ar.ht m. See also A.L. Back et al., "Physician-Assisted Suicide and Euthanasia in Washington State: Patient Requests and Physician Responses," JAMA 275 (1996): 919-25, esp. 921-22.
10. Oregon Department of Human Services, Fourth Annual Report on Oregon's Death with Dignity Act (Portland, Or.: Oregon Department of Human Services, February 6, 2002), table 3, p. 16, available at http://www.ohd.hr.state.or.us/ chs/pas/ar.ht m. See also A.L. Back et al., "Physician-Assisted Suicide and Euthanasia in Washington State: Patient Requests and Physician Responses," JAMA 275 (1996): 919-25, esp. 921-22.
11. Aristotle, Nicomachean Ethics, tr. T. Irwin (Indianapolis: Hackett Publishing Company, 1985), 1171b15-20.
12. Ibid., 1124b10. For Aristotle's characterization of magnanimity, see 1122a25-30.
13. S. Lee et al., "Caregiving and Risk of Coronary Heart Disease in U.S. Women: A Prospective Study," American Journal of Preventive Medicine 24 (2003): 113-19; H.A. Shanks-McElroy and J. Strobino, "Male Caregivers of Spouses with Alzheimer's Disease: Risk Factors and Health Status," American Journal of Alzheimers Disease and other Dementias 16, no. 3 (2001): 167-75; R.J. Sisk, "Caregiver Burden and Health Promotion," International Journal of Nursing Studies 37 (2000): 37-43; N.V. Marsh et al., "Caregiver Burden at 1 Year Following Severe Traumatic Brain Injury," Brain Injury 12 (1998): 1045-1059; R. Schulz, P. Visintainer, and G.M. Silliamson, "Psychiatric and Physical Morbidity Effects of Caregiving," Journal of Gerontology 45 (1990): 181-91; and R. Schultz et al., "Psychiatric and Physical Morbidity Effects of Dementia Caregiving: Prevalence, Correlates, and Causes," Gerontologist 35 (1995): 771-91 .
14. S. Lee et al., "Caregiving and Risk of Coronary Heart Disease in U.S. Women: A Prospective Study," American Journal of Preventive Medicine 24 (2003): 113-19; H.A. Shanks-McElroy and J. Strobino, "Male Caregivers of Spouses with Alzheimer's Disease: Risk Factors and Health Status," American Journal of Alzheimers Disease and other Dementias 16, no. 3 (2001): 167-75; R.J. Sisk, "Caregiver Burden and Health Promotion," International Journal of Nursing Studies 37 (2000): 37-43; N.V. Marsh et al., "Caregiver Burden at 1 Year Following Severe Traumatic Brain Injury," Brain Injury 12 (1998): 1045-1059; R. Schulz, P. Visintainer, and G.M. Silliamson, "Psychiatric and Physical Morbidity Effects of Caregiving," Journal of Gerontology 45 (1990): 181-91; and R. Schultz et al., "Psychiatric and Physical Morbidity Effects of Dementia Caregiving: Prevalence, Correlates, and Causes," Gerontologist 35 (1995): 771-91 .
15. S. Lee et al., "Caregiving and Risk of Coronary Heart Disease in U.S. Women: A Prospective Study," American Journal of Preventive Medicine 24 (2003): 113-19; H.A. Shanks-McElroy and J. Strobino, "Male Caregivers of Spouses with Alzheimer's Disease: Risk Factors and Health Status," American Journal of Alzheimers Disease and other Dementias 16, no. 3 (2001): 167-75; R.J. Sisk, "Caregiver Burden and Health Promotion," International Journal of Nursing Studies 37 (2000): 37-43; N.V. Marsh et al., "Caregiver Burden at 1 Year Following Severe Traumatic Brain Injury," Brain Injury 12 (1998): 1045-1059; R. Schulz, P. Visintainer, and G.M. Silliamson, "Psychiatric and Physical Morbidity Effects of Caregiving," Journal of Gerontology 45 (1990): 181-91; and R. Schultz et al., "Psychiatric and Physical Morbidity Effects of Dementia Caregiving: Prevalence, Correlates, and Causes," Gerontologist 35 (1995): 771-91 .
16. S. Lee et al., "Caregiving and Risk of Coronary Heart Disease in U.S. Women: A Prospective Study," American Journal of Preventive Medicine 24 (2003): 113-19; H.A. Shanks-McElroy and J. Strobino, "Male Caregivers of Spouses with Alzheimer's Disease: Risk Factors and Health Status," American Journal of Alzheimers Disease and other Dementias 16, no. 3 (2001): 167-75; R.J. Sisk, "Caregiver Burden and Health Promotion," International Journal of Nursing Studies 37 (2000): 37-43; N.V. Marsh et al., "Caregiver Burden at 1 Year Following Severe Traumatic Brain Injury," Brain Injury 12 (1998): 1045-1059; R. Schulz, P. Visintainer, and G.M. Silliamson, "Psychiatric and Physical Morbidity Effects of Caregiving," Journal of Gerontology 45 (1990): 181-91; and R. Schultz et al., "Psychiatric and Physical Morbidity Effects of Dementia Caregiving: Prevalence, Correlates, and Causes," Gerontologist 35 (1995): 771-91 .
17. S. Lee et al., "Caregiving and Risk of Coronary Heart Disease in U.S. Women: A Prospective Study," American Journal of Preventive Medicine 24 (2003): 113-19; H.A. Shanks-McElroy and J. Strobino, "Male Caregivers of Spouses with Alzheimer's Disease: Risk Factors and Health Status," American Journal of Alzheimers Disease and other Dementias 16, no. 3 (2001): 167-75; R.J. Sisk, "Caregiver Burden and Health Promotion," International Journal of Nursing Studies 37 (2000): 37-43; N.V. Marsh et al., "Caregiver Burden at 1 Year Following Severe Traumatic Brain Injury," Brain Injury 12 (1998): 1045-1059; R. Schulz, P. Visintainer, and G.M. Silliamson, "Psychiatric and Physical Morbidity Effects of Caregiving," Journal of Gerontology 45 (1990): 181-91; and R. Schultz et al., "Psychiatric and Physical Morbidity Effects of Dementia Caregiving: Prevalence, Correlates, and Causes," Gerontologist 35 (1995): 771-91 .
18. S. Lee et al., "Caregiving and Risk of Coronary Heart Disease in U.S. Women: A Prospective Study," American Journal of Preventive Medicine 24 (2003): 113-19; H.A. Shanks-McElroy and J. Strobino, "Male Caregivers of Spouses with Alzheimer's Disease: Risk Factors and Health Status," American Journal of Alzheimers Disease and other Dementias 16, no. 3 (2001): 167-75; R.J. Sisk, "Caregiver Burden and Health Promotion," International Journal of Nursing Studies 37 (2000): 37-43; N.V. Marsh et al., "Caregiver Burden at 1 Year Following Severe Traumatic Brain Injury," Brain Injury 12 (1998): 1045-1059; R. Schulz, P. Visintainer, and G.M. Silliamson, "Psychiatric and Physical Morbidity Effects of Caregiving," Journal of Gerontology 45 (1990): 181-91; and R. Schultz et al., "Psychiatric and Physical Morbidity Effects of Dementia Caregiving: Prevalence, Correlates, and Causes," Gerontologist 35 (1995): 771-91 .
19. While many care ethicists assume that flourishing relationships of care have intrinsic value, I shall simply assume that the relationships are valuable without worrying about whether the value is intrinsic or extrinsic. For a recent discussion of the literature on whether relationships have value in themselves and its relationship to liberal political theory, see C.H. Wellman, "Relational Facts in Liberal Political Theory: Is There Magic in the Pronoun 'My'?" Ethics 110 (2000): 537-62.
20. N.S. Jecker, "Taking Care of One's Own: Justice and Family Caregiving," Theoretical Medicine and Bioethics 23 (2002), 121, citing K.M. Robinson, "Family Caregiving: Who Provides the Care, and at What Cost?" Nursing Economics 15 (1997): 243-47.
21. N.S. Jecker, "Taking Care of One's Own: Justice and Family Caregiving," Theoretical Medicine and Bioethics 23 (2002), 121, citing K.M. Robinson, "Family Caregiving: Who Provides the Care, and at What Cost?" Nursing Economics 15 (1997): 243-47.
22. For a feminist analysis that focuses in part on the ethics of care from the stand-point of the receiver of care, see B. Fisher and J.C. Tronto, "Toward a Feminist Theory of Caring," in Circles of Care: Work and Identity in Women's Lives, ed. E. Abel and M. Nelson (Albany: State University of New York Press, 1990): 35-62. Fisher and Tronto distinguish four phases of care, the fourth phase of which is receiving care (see pp. 40-46. See also N. Noddings, Caring: A Feminist Approach to Ethics and Moral Education (Berkeley: University of California Press, 1984), 74-78
23. For a feminist analysis that focuses in part on the ethics of care from the stand-point of the receiver of care, see B. Fisher and J.C. Tronto, "Toward a Feminist Theory of Caring," in Circles of Care: Work and Identity in Women's Lives, ed. E. Abel and M. Nelson (Albany: State University of New York Press, 1990): 35-62. Fisher and Tronto distinguish four phases of care, the fourth phase of which is receiving care (see pp. 40-46. See also N. Noddings, Caring: A Feminist Approach to Ethics and Moral Education (Berkeley: University of California Press, 1984), 74-78
24. The ethics of care is often distinguished from the ethics of principles, rights, and justice. See, for instance, Noddings, Caring, chapters 2 and 5. This distinction in moral theory was inspired by C. Gilligan's work in moral psychology. See Gilligan, In a Different Voice Psychological Theory and Women's Development (Cambridge, Mass.: Harvard University Press, 1982); and Gilligan, "Moral Orientation and Moral Development," in Women and Moral Theory, ed. E.F. Kittay and D.T. Meyers (Savage, Md.: Rowman & Littlefield, 1987): 19-33. More recent work incorporates insights from ethics that stress rights and justice as well as care. See, for instance, H. Kuhse, P. Singer, and M. Rickard, "Reconciling Impartial Morality and a Feminist Ethic of Care," Journal of Value Inquiry 32 (1998): 451-63; G. Clement, Care, Autonomy and Justice (Boulder: Westview Press, 1996); V. Held, "The Meshing of Care and Justice," Hypatia 10 (1995): 128-32; U. Narayan, "Colonialism and Its Others: Considerations on Rights and Care Discourses," Hypatia 10 (1995): 133-40; J. Kroeger-Mappes, "The Ethic of Care vis-à-vis the Ethic of Rights: A Problem for Contemporary Moral Theory," Hypatia 9 (1994): 108-31; and M. Friedman, What Are Friends For? Feminist Perspectives on Personal Relationships and Moral Theory (Ithaca and London: Cornell University Press, 1993): 126-34 and chapter 6 generally.
25. The ethics of care is often distinguished from the ethics of principles, rights, and justice. See, for instance, Noddings, Caring, chapters 2 and 5. This distinction in moral theory was inspired by C. Gilligan's work in moral psychology. See Gilligan, In a Different Voice Psychological Theory and Women's Development (Cambridge, Mass.: Harvard University Press, 1982); and Gilligan, "Moral Orientation and Moral Development," in Women and Moral Theory, ed. E.F. Kittay and D.T. Meyers (Savage, Md.: Rowman & Littlefield, 1987): 19-33. More recent work incorporates insights from ethics that stress rights and justice as well as care. See, for instance, H. Kuhse, P. Singer, and M. Rickard, "Reconciling Impartial Morality and a Feminist Ethic of Care," Journal of Value Inquiry 32 (1998): 451-63; G. Clement, Care, Autonomy and Justice (Boulder: Westview Press, 1996); V. Held, "The Meshing of Care and Justice," Hypatia 10 (1995): 128-32; U. Narayan, "Colonialism and Its Others: Considerations on Rights and Care Discourses," Hypatia 10 (1995): 133-40; J. Kroeger-Mappes, "The Ethic of Care vis-à-vis the Ethic of Rights: A Problem for Contemporary Moral Theory," Hypatia 9 (1994): 108-31; and M. Friedman, What Are Friends For? Feminist Perspectives on Personal Relationships and Moral Theory (Ithaca and London: Cornell University Press, 1993): 126-34 and chapter 6 generally.
26. The ethics of care is often distinguished from the ethics of principles, rights, and justice. See, for instance, Noddings, Caring, chapters 2 and 5. This distinction in moral theory was inspired by C. Gilligan's work in moral psychology. See Gilligan, In a Different Voice Psychological Theory and Women's Development (Cambridge, Mass.: Harvard University Press, 1982); and Gilligan, "Moral Orientation and Moral Development," in Women and Moral Theory, ed. E.F. Kittay and D.T. Meyers (Savage, Md.: Rowman & Littlefield, 1987): 19-33. More recent work incorporates insights from ethics that stress rights and justice as well as care. See, for instance, H. Kuhse, P. Singer, and M. Rickard, "Reconciling Impartial Morality and a Feminist Ethic of Care," Journal of Value Inquiry 32 (1998): 451-63; G. Clement, Care, Autonomy and Justice (Boulder: Westview Press, 1996); V. Held, "The Meshing of Care and Justice," Hypatia 10 (1995): 128-32; U. Narayan, "Colonialism and Its Others: Considerations on Rights and Care Discourses," Hypatia 10 (1995): 133-40; J. Kroeger-Mappes, "The Ethic of Care vis-à-vis the Ethic of Rights: A Problem for Contemporary Moral Theory," Hypatia 9 (1994): 108-31; and M. Friedman, What Are Friends For? Feminist Perspectives on Personal Relationships and Moral Theory (Ithaca and London: Cornell University Press, 1993): 126-34 and chapter 6 generally.
27. The ethics of care is often distinguished from the ethics of principles, rights, and justice. See, for instance, Noddings, Caring, chapters 2 and 5. This distinction in moral theory was inspired by C. Gilligan's work in moral psychology. See Gilligan, In a Different Voice Psychological Theory and Women's Development (Cambridge, Mass.: Harvard University Press, 1982); and Gilligan, "Moral Orientation and Moral Development," in Women and Moral Theory, ed. E.F. Kittay and D.T. Meyers (Savage, Md.: Rowman & Littlefield, 1987): 19-33. More recent work incorporates insights from ethics that stress rights and justice as well as care. See, for instance, H. Kuhse, P. Singer, and M. Rickard, "Reconciling Impartial Morality and a Feminist Ethic of Care," Journal of Value Inquiry 32 (1998): 451-63; G. Clement, Care, Autonomy and Justice (Boulder: Westview Press, 1996); V. Held, "The Meshing of Care and Justice," Hypatia 10 (1995): 128-32; U. Narayan, "Colonialism and Its Others: Considerations on Rights and Care Discourses," Hypatia 10 (1995): 133-40; J. Kroeger-Mappes, "The Ethic of Care vis-à-vis the Ethic of Rights: A Problem for Contemporary Moral Theory," Hypatia 9 (1994): 108-31; and M. Friedman, What Are Friends For? Feminist Perspectives on Personal Relationships and Moral Theory (Ithaca and London: Cornell University Press, 1993): 126-34 and chapter 6 generally.
28. The ethics of care is often distinguished from the ethics of principles, rights, and justice. See, for instance, Noddings, Caring, chapters 2 and 5. This distinction in moral theory was inspired by C. Gilligan's work in moral psychology. See Gilligan, In a Different Voice Psychological Theory and Women's Development (Cambridge, Mass.: Harvard University Press, 1982); and Gilligan, "Moral Orientation and Moral Development," in Women and Moral Theory, ed. E.F. Kittay and D.T. Meyers (Savage, Md.: Rowman & Littlefield, 1987): 19-33. More recent work incorporates insights from ethics that stress rights and justice as well as care. See, for instance, H. Kuhse, P. Singer, and M. Rickard, "Reconciling Impartial Morality and a Feminist Ethic of Care," Journal of Value Inquiry 32 (1998): 451-63; G. Clement, Care, Autonomy and Justice (Boulder: Westview Press, 1996); V. Held, "The Meshing of Care and Justice," Hypatia 10 (1995): 128-32; U. Narayan, "Colonialism and Its Others: Considerations on Rights and Care Discourses," Hypatia 10 (1995): 133-40; J. Kroeger-Mappes, "The Ethic of Care vis-à-vis the Ethic of Rights: A Problem for Contemporary Moral Theory," Hypatia 9 (1994): 108-31; and M. Friedman, What Are Friends For? Feminist Perspectives on Personal Relationships and Moral Theory (Ithaca and London: Cornell University Press, 1993): 126-34 and chapter 6 generally.
29. The ethics of care is often distinguished from the ethics of principles, rights, and justice. See, for instance, Noddings, Caring, chapters 2 and 5. This distinction in moral theory was inspired by C. Gilligan's work in moral psychology. See Gilligan, In a Different Voice Psychological Theory and Women's Development (Cambridge, Mass.: Harvard University Press, 1982); and Gilligan, "Moral Orientation and Moral Development," in Women and Moral Theory, ed. E.F. Kittay and D.T. Meyers (Savage, Md.: Rowman & Littlefield, 1987): 19-33. More recent work incorporates insights from ethics that stress rights and justice as well as care. See, for instance, H. Kuhse, P. Singer, and M. Rickard, "Reconciling Impartial Morality and a Feminist Ethic of Care," Journal of Value Inquiry 32 (1998): 451-63; G. Clement, Care, Autonomy and Justice (Boulder: Westview Press, 1996); V. Held, "The Meshing of Care and Justice," Hypatia 10 (1995): 128-32; U. Narayan, "Colonialism and Its Others: Considerations on Rights and Care Discourses," Hypatia 10 (1995): 133-40; J. Kroeger-Mappes, "The Ethic of Care vis-à-vis the Ethic of Rights: A Problem for Contemporary Moral Theory," Hypatia 9 (1994): 108-31; and M. Friedman, What Are Friends For? Feminist Perspectives on Personal Relationships and Moral Theory (Ithaca and London: Cornell University Press, 1993): 126-34 and chapter 6 generally.
30. The ethics of care is often distinguished from the ethics of principles, rights, and justice. See, for instance, Noddings, Caring, chapters 2 and 5. This distinction in moral theory was inspired by C. Gilligan's work in moral psychology. See Gilligan, In a Different Voice Psychological Theory and Women's Development (Cambridge, Mass.: Harvard University Press, 1982); and Gilligan, "Moral Orientation and Moral Development," in Women and Moral Theory, ed. E.F. Kittay and D.T. Meyers (Savage, Md.: Rowman & Littlefield, 1987): 19-33. More recent work incorporates insights from ethics that stress rights and justice as well as care. See, for instance, H. Kuhse, P. Singer, and M. Rickard, "Reconciling Impartial Morality and a Feminist Ethic of Care," Journal of Value Inquiry 32 (1998): 451-63; G. Clement, Care, Autonomy and Justice (Boulder: Westview Press, 1996); V. Held, "The Meshing of Care and Justice," Hypatia 10 (1995): 128-32; U. Narayan, "Colonialism and Its Others: Considerations on Rights and Care Discourses," Hypatia 10 (1995): 133-40; J. Kroeger-Mappes, "The Ethic of Care vis-à-vis the Ethic of Rights: A Problem for Contemporary Moral Theory," Hypatia 9 (1994): 108-31; and M. Friedman, What Are Friends For? Feminist Perspectives on Personal Relationships and Moral Theory (Ithaca and London: Cornell University Press, 1993): 126-34 and chapter 6 generally.
31. The ethics of care is often distinguished from the ethics of principles, rights, and justice. See, for instance, Noddings, Caring, chapters 2 and 5. This distinction in moral theory was inspired by C. Gilligan's work in moral psychology. See Gilligan, In a Different Voice Psychological Theory and Women's Development (Cambridge, Mass.: Harvard University Press, 1982); and Gilligan, "Moral Orientation and Moral Development," in Women and Moral Theory, ed. E.F. Kittay and D.T. Meyers (Savage, Md.: Rowman & Littlefield, 1987): 19-33. More recent work incorporates insights from ethics that stress rights and justice as well as care. See, for instance, H. Kuhse, P. Singer, and M. Rickard, "Reconciling Impartial Morality and a Feminist Ethic of Care," Journal of Value Inquiry 32 (1998): 451-63; G. Clement, Care, Autonomy and Justice (Boulder: Westview Press, 1996); V. Held, "The Meshing of Care and Justice," Hypatia 10 (1995): 128-32; U. Narayan, "Colonialism and Its Others: Considerations on Rights and Care Discourses," Hypatia 10 (1995): 133-40; J. Kroeger-Mappes, "The Ethic of Care vis-à-vis the Ethic of Rights: A Problem for Contemporary Moral Theory," Hypatia 9 (1994): 108-31; and M. Friedman, What Are Friends For? Feminist Perspectives on Personal Relationships and Moral Theory (Ithaca and London: Cornell University Press, 1993): 126-34 and chapter 6 generally.
32. M. Mayeroff, On Caring (New York: Harper Collins, 1971), 1.
33. For discussion of the relationship between non-distorted altruistic care and autonomy, see Clement, Care, Autonomy and Justice, chapter 2 and L. Blum et al, "Altruism and Women's Oppression," The Philosophical Forum 5 (1975): 222-47.
34. For discussion of the relationship between non-distorted altruistic care and autonomy, see Clement, Care, Autonomy and Justice, chapter 2 and L. Blum et al, "Altruism and Women's Oppression," The Philosophical Forum 5 (1975): 222-47.
35. R Bowden, Caring: Gender-Sensitive Ethics (London; New York: Routledge, 1997), 79-80.
36. M. Sandel, Liberalism and the Limits of Justice (Cambridge: Cambridge University Press, 1982).
37. A. MacIntyre, After Virtue (Notre Dame, Ind.: Notre Dame University Press, 1984), 220.
38. The importance of mutuality or reciprocity is noted by many who have written on care. See Bowden, Caring: Gender-Sensitive Ethics, 90-92; Friedman, What Are Friends For? 158-61; Noddings, Caring: A Feminist Approach to Ethics and Moral Education, 69-74; and Mayeroff, On Caring, 46-48.
39. The importance of mutuality or reciprocity is noted by many who have written on care. See Bowden, Caring: Gender-Sensitive Ethics, 90-92; Friedman, What Are Friends For? 158-61; Noddings, Caring: A Feminist Approach to Ethics and Moral Education, 69-74; and Mayeroff, On Caring, 46-48.
40. The importance of mutuality or reciprocity is noted by many who have written on care. See Bowden, Caring: Gender-Sensitive Ethics, 90-92; Friedman, What Are Friends For? 158-61; Noddings, Caring: A Feminist Approach to Ethics and Moral Education, 69-74; and Mayeroff, On Caring, 46-48.
41. The importance of mutuality or reciprocity is noted by many who have written on care. See Bowden, Caring: Gender-Sensitive Ethics, 90-92; Friedman, What Are Friends For? 158-61; Noddings, Caring: A Feminist Approach to Ethics and Moral Education, 69-74; and Mayeroff, On Caring, 46-48.
42. Clement, Care, Autonomy and Justice, chapter 2.
43. Ibid., 27. See also E.K. Abel and M.K. Nelson, "Circles of Care: an Introductory Essay," in Circles of Care, 5.
44. Ibid., 27. See also E.K. Abel and M.K. Nelson, "Circles of Care: an Introductory Essay," in Circles of Care, 5.
45. Clement, Care, Autonomy and Justice, 25-26 and 28-29. See also Blum et al., "Altruism and Women's Oppression," 231.
46. Clement, Care, Autonomy and Justice, 25-26 and 28-29. See also Blum et al., "Altruism and Women's Oppression," 231.
47. D. Callahan, "Our Burden upon Others: A Response to John Hardwig," in Is There a Duty to Die? ed. J. Hardwig (New York and London: Routledge, 2000), 143.
48. I assume here that the care is authentic in the sense that it reflects the caregiver's genuine values and is not merely the result of oppressive conditioning or neurosis.
49. T.E. Hill, Jr., "Servility and Self-Respect," in Autonomy and Self-Respect, ed. T.E. Hill, Jr. (Cambridge: Cambridge University Press, 1991), 14-15.
50. Ibid., 5.
51. Hardwig, Is There a Duty to Die? 126. Note that the wise use of medical assistance planning could, in all probability, avoid such a scenario. Nonetheless, Hardwig's example is helpful for philosophical purposes.
52. Callahan, "Our Burden Upon Others"; and D. Callahan, letter to the editor, Hastings Center Report 27, no. 6 (1997), 4. See also R. Spellecy, "Dying for Others: Family, Altruism, and a Duty to Die," in Biomedical Ethics Reviews, ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press, 2000): 208-10.
53. Callahan, "Our Burden Upon Others"; and D. Callahan, letter to the editor, Hastings Center Report 27, no. 6 (1997), 4. See also R. Spellecy, "Dying for Others: Family, Altruism, and a Duty to Die," in Biomedical Ethics Reviews, ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press, 2000): 208-10.
54. Callahan, "Our Burden Upon Others"; and D. Callahan, letter to the editor, Hastings Center Report 27, no. 6 (1997), 4. See also R. Spellecy, "Dying for Others: Family, Altruism, and a Duty to Die," in Biomedical Ethics Reviews, ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press, 2000): 208-10.
55. D. Drebushenko, "How Could There Be a Duty to Die?" in Biomedical Ethics Reviews, ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press, 2000): 159-76.
56. Jecker, "Taking Care of One's Own," 127, following B. Williams, "Persons, Character and Morality," in Moral Luck, ed. B. Williams (New York: Cambridge University Press, 1981), 14-15. One need not accept Jecker's position that the self is characterized in terms of personal projects or her Rawlsian analysis in order to acknowledge the importance of projects that are central to a person's life.
57. Jecker, "Taking Care of One's Own," 127, following B. Williams, "Persons, Character and Morality," in Moral Luck, ed. B. Williams (New York: Cambridge University Press, 1981), 14-15. One need not accept Jecker's position that the self is characterized in terms of personal projects or her Rawlsian analysis in order to acknowledge the importance of projects that are central to a person's life.
58. Drebushenko, "How Could There Be a Duty to Die?" 172-73.
59. Hardwig, Is There a Duty to Die? 129-30.
60. Ibid., 121-22 and 127-28.
61. M.P. Battin, "Global Life Expectancies and the Duty to Die," in Biomedical Ethics Reviews, ed. J.M. Humber and R.F. Almeder (Totowa, N.J.: Humana Press, 2000), 6-7.
62. Jecker, "Taking Care of One's Own;" and MJ. Meyer, "Rights between Friends," Journal of Philosophy 89 (1992): 467-83.
63. Jecker, "Taking Care of One's Own;" and MJ. Meyer, "Rights between Friends," Journal of Philosophy 89 (1992): 467-83.
64. Jecker, "Taking Care of One's Own," 122, citing N.S. Jecker, "What Do Husbands and Wives Owe Each Other in Old Age?" in Long-term Care Decisions, ed. L.B. McCullough and N.L. Wilson (Baltimore, Md.: Johns Hopkins University Press, 1955): 155-80.
65. Jecker, "Taking Care of One's Own," 122, citing N.S. Jecker, "What Do Husbands and Wives Owe Each Other in Old Age?" in Long-term Care Decisions, ed. L.B. McCullough and N.L. Wilson (Baltimore, Md.: Johns Hopkins University Press, 1955): 155-80.