1. Is a care ethics perspective necessary to achieve proper partiality in health care? Søren Holm Manchester & Oslo & Aalborg

2. Overview Proper partiality An initial critique of proper partiality and a response A care ethics perspective on ‘proper partiality’ Other ways of reaching a justification for ‘proper partiality’ Conclusion

3. Proper partiality 1 Proper partiality ≈ the idea that: Weak account: It is not wrong (i.e. persmissible) for a health care professional to show some preference for her own patients, e.g. in relation to advocacy either for individual patients or for the group of patients Strong account: A health care professional ought to show some preference for her own patients

4. Proper partiality 2 How much partiality to allow / require is a matter of contention, and may require concrete judgement Possible relevant factors: Legal constraints The specific nature of the relationship Relationship with other ‘claimants’ for the same ressource / service The degree of partiality shown by other HCPs

5. Initial critique and response Impartiality is an important, perhaps even foundational non- negotiable norm: HCPs should be impartial The public health care system should be impartial Initial response: Yes, but formal impartiality is consistent with certain forms of partiality (e.g. we do not find it particularly strange or morally problematic that a teacher teaches the pupils in her class, and not other pupils) Yes, but all plausible ethical theories must make some room for partiality

6. Care and partiality Many strands of care ethics I take the relevant constitutive features of a care ethics to be: A rejection of an abstract formalisation of ethics (e.g. as a set of rules or principles, or as a purely formal conception of justice) A commitment to – The grounding of ethics in relations between persons – Seeing the concept / activity of ”care” in such relations as central to ethics Seems to imply partiality, since I (can (?)) only have relations with some other agents My care must, necessarily (?) be directed towards those other agents

7. Challenges for a care ethics approach to proper partiality The general challenge of accounting for justice and/or for obligations to agents outside of my circle of relationships Defining the proper scope of partiality Exploring similarities and differences between ‘personal’ and ‘professional’ care

8. Other paths to proper partiality 1.Necessary for establishing / maintaining optimal patient – HCP relationship, i.e. partiality as a role responsibility 2.Necessary for optimal ressource allocation in a semi-adversarial allocation system

9. Conclusion Care ethics provides support for (strong) ‘proper partiality’ in health care But, so does other considerations based on considerations of the role of HCPs in public health care systems Care ethics may be ‘the Royal Road’ to partiality, but it is not the only path leading to the top of the mountain

10. References / Readings Holm, Søren. "Can “Giving Preference to My Patients” be Explained as a Role Related Duty in Public Health Care Systems?." Health Care Analysis 19, no. 1 (2011): 89-97. This issue of Health Care Analysis is a thematic issue about partiality Holm, Søren. "The phenomenological ethics of KE Løgstrup–a resource for health care ethics and philosophy?." Nursing Philosophy 2, no. 1 (2001): 26-33.