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Nursing Ethics has published several pleas for care ethics and/or relationality as the most promising ethical foundation for midwifery philosophy and practice. In this article, we stand by these calls, contributing to them with the identification of the structural form of violence that a care ethical relational approach to reproductive care is up against: that of “maternal separation”. Confronted with reproductive and obstetric violence globally, we show that a hegemonic racialized, instrumentalized, and individualized conception of pregnancy is responsible for a severance of relationalities that are essential to safe reproductive care: (1) the relation between the person and their child or reproductive capabilities; and (2) the relation between the pregnant person and their community of care. We pinpoint a separation of the maternal relation in at least two discursive domains, namely, the juridical-political and the ethical-existential. Consequently, we plea for a radical re-imagination of maternal relationality, envisioning what care ethical midwifery, including abortion care, could be.

Throughout the years, care ethicists have raised concerns that prevalent definitions of empathy fail to adequately address the problem of otherness. They have proposed alternative conceptualizations of empathy that aim to acknowledge individual differences, help to extend care beyond one’s inner circle, and develop a critical awareness of biases and prejudices. We explore three such alternatives: Noddings’ concept of engrossment, Meyers’ account of broad empathy, and Baart’s concept of perspective-shifting. Based on these accounts, we explain that care ethics promotes a conceptualization of empathy that is radical in its commitment to engage otherness and that is characterized by being: (1) receptive and open, (2) broad and deep in scope, (3) relational and interactive, (4) mature and multifaceted, (5) critical and reflective, (6) disruptive and transformative. This type of empathy is both demanding and rewarding, as it may inspire health professionals to rethink empathy, its challenges, and its contribution to good care and as it may enrich empathy education and professional empathy practices in health care.

Based on autoethnographic material and feminist theory, such as care ethics and epistemic (in)justice studies, we expose four forms of epistemic injustice in reproductive care in the Netherlands: hermeneutical injustice, testimonial injustice, willful hermeneutical ignorance, and gaslighting. These forms of injustice rest on deeply rooted systems and their associated assumptions and on practices that produce and reproduce this injustice. We draw upon care ethics to suggest alternative practices that may counter these epistemic forms of obstetric violence, by explicating the (embodied) voice of the care receiver in reproductive care.

This paper investigates the functions, downsides, and limitations of empathy in chaplaincy care. Data were collected from 20humanist chaplains working in health care, prison, and military settings using semi-structured interviews. According to theparticipants, empathy is at the heart of their profession but has disadvantages as well. The analysis yields seven major functionsof empathy with corresponding downsides and limitations: (1) to connect, (2) to understand, (3) to guide, (4) to acknowledge,(5) to motivate, (6) to inspire, and (7) to humanize.We argue for a need to “talk about empathy” since despite its importanceand challenges, there is little professional and academic discussion about empathy in chaplaincy care.We hope that the findingsof this study can function as starting points for the discussion and thus contribute to the ongoing professionalization of chaplaincycare. To that end, we propose three topics for further reflection and conversation.

Empathy is considered a key component of chaplaincy care, but little is known about the daily practice of empathy and the empathy barriers that chaplains encounter. This study investigates the factors that encourage or discourage empathy and provides insight into what chaplains actually do to achieve empathy and to overcome empathy challenges. Semistructured interviews were used to collect data from twenty humanist chaplains in the Netherlands. A grounded theory approach was applied to analyze the data. The core concept of empathic flow emerged from the analysis. This refers to the stream of empathic experiences that arises within the relational, dynamic exchange between chaplain and client. Based on the analysis, three types of empathic flow were distinguished: (1) uncomplicated empathy, which flows smoothly and easily; (2) challenged empathy, which fluctuates between flow and temporal stagnation or disruption; and (3) failed empathy, in which the flow of empathy is blocked. Professional empathy emerged as a second core category from the interview data. This refers to those chaplains’ activities that aim to establish or enhance empathic flow, particularly in the face of challenges. Professional empathy relies on several underlying key components: critical self-reflection, self-care, professional standards, and the chaplain’s humanistic worldview and values. The qualitative analysis yielded 10 themes of professional empathy. Our findings suggest that empathy is a rich and complex practice to which both chaplain and client contribute. As professional caregivers, chaplains consider themselves ultimately responsible for establishing empathy and overcoming challenges.

Building on the work of Mbembe (2019) and Silva (2007), we theorise how the obstetric institution can still be considered fundamentally modern, that is, entangled with colonialism, slavery, bio- and necropolitics and patriarchal subjectivity. We argue that the modern obstetric subject (doctor or midwife) representing the obstetric institution engulfs the (m)other in a typically modern way as othered, racialised, affectable and outer-determined, in order to constitute itself in terms of self-determination and universal reason.While Davis-Floyd (1987) described obstetric training as a rite of passage into a technocratic model of childbirth, we argue that students’ rite of passage is not merely an initiation into a technological model of childbirth. The many instances of obstetric violence and racism in their training make a more fundamental problem visible, namely that students come of age within obstetrics through the violent appropriation of the (m)other.We amplify students’ curricular encounters in two colonially related geopolitical spaces, South Africa and the Netherlands, and in two professions, obstetric medicine and midwifery, to highlight global systemic tendencies that push students to cross ethical, social and political boundaries towards the (m)other they are trained to care for. The embedment of obstetric violence in their rite of passage ensures the reproduction of the modern obstetric subject, the racialised (m)other, and institutionalised violence worldwide.

Care ethics emphasizes responsibility as a key element for caring practices. Responsibilities to care are taken by certain groups of people, making caring practices into moral and political practices in which responsibilities are assigned, assumed, or implicitly expected, as well as deflected. Despite this attention for social practices of distribution and its unequal result, making certain groups of people the recipient of more caring responsibilities than others, the passive aspect of a caring responsibility has been underexposed by care ethics. By drawing upon the work of the French phenomenologist Jean-Luc Marion, a care ethical conceptualization of responsibility can by enriched, by scrutinizing how responsibility is literally a response to something else. This paper starts with a vignette of an everyday situation of professional care. After that the current body of care ethical literature on responsibility is presented, followed by Marion's phenomenology of givenness, using his analysis of Caravaggio's painting The Calling of St. Matthew and resulting in his redefinition of responsibility. In the next section we present a table in which we juxtapose four distinct paradigms of responsibility, which we will describe briefly. The final section consists of an exploration of the paradigms by an analysis of the vignette and results in a conclusion concerning what Marion's view has to offer to care ethics with regard to responsibility.

Empathy is a fundamental concept in health care and nursing. In academic literature, it has been primarily defined as a personal ability, act or experience. The relational dimensions of empathy have received far less attention. In our view, individualistic conceptualizations are restricted and do not adequately reflect the practice of empathy in daily care. We argue that a relational conceptualization of empathy contributes to a more realistic, nuanced and deeper understanding of the functions and limitations of empathy in professional care practices. In this article, we explore the relational aspects of empathy, drawing on sources that offer a relational approach, such as the field of care ethics, the phenomenology of Edith Stein and qualitative research into interpersonal and interactive empathy. We analyse the relational aspects of three prevalent components of empathy definitions: the underlying ability or act (i.e. the cognitive, affective and perception abilities that enable empathy); the resulting experience (i.e. empathic understanding and affective responsivity) and the expression of this experience (i.e. empathic expression). Ultimately, we propose four inter-related understandings of empathy: (a) A co-creative practice based on the abilities and activities of both the empathizer and the empathee; (b) A fundamentally other-oriented experience; (c) A dynamic, interactive process in which empathizer and empathee influence each other's experiences; (d) A quality of relationships.

Background: Empathy is a contested concept in the field of care ethics. According to its proponents, empathy is a unique way to connect with others, to understand what is at stake for them, and to help guide moral deliberation. According to its critics, empathy is biased, inaccurate or a form of projection that does not truly grasp and respect the otherness of the other, and that may be distorted by prejudices. Objectives: We aim to contribute to a better understanding of the significance of empathy in care ethics by reviewing both the functions and limitations of empathy in this field. Research design: Drawing on literature from care ethics and closely related fields, we identify the relevant functions and limitations of empathy from the relational, epistemic, normative, and political perspectives. These perspectives are drawn from four main characteristics of care ethics, which serve as a concise framework for understanding the significance of empathy. Participants and research context: This article is written as part of an empirical and theoretical research project that aims to better understand the functions and limitations of empathy in care practices, from the perspective of care ethics. Ethical considerations: We try to do justice to both the appraisal and critique of empathy in the care ethics literature. Findings: Our findings stress that the relationship between care ethics and empathy is complicated and rife with opposing views. Therefore, we conclude that care ethics is not an ethics of empathy. Discussion and conclusion: Based on our findings, we formulate pathways that may guide the further analysis of empathy in care practices and care ethics.

Background: Nursing Ethics has featured several discussions on what good care comprises and how to achieve good care practices. We should “nurse” ethics by continuously reflecting on the way we “do” ethics, which is what care ethicists have been doing over the past few decades and continue to do so. Ethics is not limited to nursing but extends to all caring professions. In 2011, Elin Martinsen argued in this journal that care should be included as a core concept in medical ethical terminology because of “the harm to which patients may be exposed owing to a lack of care in the clinical encounter,” specifically between doctors and patients. However, Martinsen leaves the didactical challenges arising from such a venture open for further enquiry. Objectives: In this article, we explore the challenges arising from implementing care-ethical insights into medical education. Research design: Medical education in the Netherlands is investigated through a “care-ethical lens”. This means exploring the possibility of enriching medical education with care-ethical insights, while at the same time discovering possible challenges emerging from such an undertaking. Participants and research context: This paper has been written from the academic context of a master in care ethics and policy. Ethical considerations We have tried to be fair and respectful to the authors discussed and take a neutral stance towards the findings portrayed. Findings: Several challenges are identified, which we narrow down to two types: didactical and non-didactical. Discussion and conclusion: In order to overcome these challenges, we must not underestimate the possible resistance to a paradigm shift. Our efforts should mainly target the learning that takes place in the clinical phases of medical training and should be accompanied by the creation of awareness in healthcare practice.

The aim of Shared Decision Making (SDM) is to provide information to patients in order to enable them to decide autonomously and freely about treatment together with the doctor, without interference, force, or coercion by others. Relatives may be considered as hindering or impeding a patient’s own decision. Qualitative-empirical research into lived experience of SDM of patients with cancer, however, problematizes the patient’s autonomy when facing terminal illness and the need to make decisions regarding treatment. Confronted with this difficulty, this contribution tries to think through patients’ dependency of others, and make their autonomy more relational, drawing upon care-ethical critics of a one-sided view of autonomy and upon Ricoeur’s view of the fundamentally intersubjective, relational self. We aim to conceptualize relatives not as a third party next to the doctor and the patient, but as co-constituents of the patient’s identity and as such present in the decision-making process from the outset. What is more, partners and the family may be of inestimable help in retrieving the patient’s identity in line with the past, present and possible future.

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.

This introduction to the special issue on ‘Ricœur and the ethics of care’ is not a standard editorial. It provides not only an explanation of the central questions and a first impression of the articles, but also a critical discussion of them by an expert in the field of care ethics, Joan Tronto. After explaining the reasons to bring Ricœur into dialogue with the ethics of care (I), and analyzing how the four articles of this special issue shape this dialogue (II), the authors give the floor to Tronto (III). She focuses on the central issue at stake: what may be the value of a more abstract, conceptual approach for the ethics of care as a radically practice-oriented way of thinking? She argues that the four contributions too easily frame this value in terms of Ricœur’s relational anthropology. Instead she points out that if the ethics of care is a kind of practice, it makes sense to think of such practices as necessarily building upon one another, expanding constantly the context and relationships upon which practices are built. In the final section (IV) the authors respond to Tronto’s framing of ‘practices all the way up’ by arguing that this approach need not be at odds with one inspired by Ricœur’s conceptual thinking. Rather the two can be seen as different movements – upwards and downwards – that both contribute constructively to the shaping of the important intermediary zone between the practices and the abstract ideals.