Bern University of Applied Sciences, Switzerland; University of Zurich, Switzerland.
Nurs Ethics. 2022 Aug;29(5):1096-1106. doi: 10.1177/09697330221113061. Epub 2022 Aug 11.
Since the beginning of the pandemic spread of the Coronavirus, societies have been reminded that the impact of Covid-19 and public health measures of infection containment reflect known gradients of inequality. Measures focusing only the (acknowledged) frontstage of the pandemic and neglecting its (unacknowledged) backstage-understood as those framework conditions indispensable for societies to thrive-have worsened the impact of social determinants of health on the most vulnerable, as shown by the deleterious effects of prolonged social isolation of residents of nursing homes. To reflect this phenomenon ethically, a framework is proposed which is inspired by the feminist philosopher Margret Little. At its core stands the assumption that caring for people and moral ends allows us to identify what is morally salient. This epistemological stance allows a critical look at the alleged dilemmas invoked to enforce brute, long-lasting policies of closing nursing homes in many places-especially in the light of their dubious effectiveness in preventing viral spread and the severe physical and psychological consequences for those affected. If moral salience is only fully perceived through the closeness of the caring relationship, the human suffering resulting from these policies reveals the utter inadequacy of the dilemma rhetoric used to justify them. This insight is illustrated by the personal experience of the author: He describes his role as an essential care partner of his mother living in a nursing home and forced into the role of a "visitor" who witnessed a constant deterioration of care. Based on an epistemological understanding of caring for making reliable moral judgments, potentially exclusionary effects of distinguishing essential from non-essential groups in care will be addressed together with the need to overcome strict boundaries between front- and backstage. Such efforts will strengthen the moral community of persons needing care, professional care givers and essential care partners.
自冠状病毒大流行开始以来，社会一直被提醒，Covid-19 的影响和感染控制的公共卫生措施反映了已知的不平等梯度。仅关注（公认的）大流行前台，而忽视（未被承认的）后台——被理解为社会赖以繁荣的不可或缺的框架条件——的措施加剧了健康社会决定因素对最脆弱人群的影响，养老院居民长期社会隔离的有害影响就是明证。为了在伦理上反映这一现象，提出了一个框架，该框架的灵感来自女权主义哲学家玛格丽特·利特尔。其核心假设是，关心人和道德目的使我们能够确定什么是道德上突出的。这种认识论立场允许我们批判性地审视为在许多地方执行关闭养老院的野蛮、持久政策而援引的所谓困境——尤其是考虑到这些政策在防止病毒传播方面的可疑效果，以及对受影响者造成的严重身体和心理后果。如果道德显著性只有通过关怀关系的紧密程度才能完全感知，那么这些政策所导致的人类苦难揭示了用于证明这些政策合理的困境言论的完全不足。作者的个人经历说明了这一观点：他描述了自己作为居住在养老院的母亲的基本护理伙伴的角色，被迫扮演“访客”的角色，目睹了护理质量的不断恶化。基于对关怀的认识论理解，这种关怀可以做出可靠的道德判断，因此，在关怀中区分必要和非必要群体可能会产生排斥效应，同时也需要克服前台和后台之间的严格界限。这些努力将加强需要护理的人的道德共同体、专业护理人员和基本护理伙伴。
