Shaun Respess

Developments in social robotics could provide warranted support to caregivers while aiding those in need. Despite their appeal, however, researchers are relatively pessimistic about whether robots can replicate the rational, emotional, and relational skills of humans who traditionally occupy these roles. In this paper, I consider the extent to which social robots can care well based on their present and projected capabilities. I follow a heuristic of good care – humble inquiry, inclusive connection, and responsive action – as conceptualized by care theorists to discern whether robots can embody the emergent normativity demonstrated in care practices. The heuristic reveals pressing challenges of developing tacit knowledge, exhibiting emotional sensitivity, and skillfully tailoring responses to diverse users. I conclude that social robots as of now can satisfy a range of needs while mirroring certain desirable emotional and social traits when facilitating care. Still, robots cannot themselves benefit from the moral resources of a care relationship and have embodied constraints that impact their ability to improvise, empathize, and mobilize to a comparable degree to humans. This could in turn reinforce a thinner and unidirectional account of care. In support of this conclusion, I offer an account of care normativity focused on embodied practice, reflexivity, and shared vulnerability while considering the broader implications of robot agency for caregiving. This paper concurrently outlines a process by which to qualitatively evaluate the current and future use of social robotics and expands the scope of included care literature with respect to them.

Escalating numbers of depressed, anxious, and suicidal persons in the United States have led to increased demands for clinical practice guidelines. These guidelines are designed by and for medical professionals to locate and promote the best evidence-based treatments. Clinicians suggest that a widespread application of substantiated treatments will curtail trends of increased despair, but there are a wider range of ethical and socio-political limitations that are not always immediately addressed in these assessments. Issues regarding social stigma, control and normalization, diverse life stressors, and disproportionate access to resources are often diluted in depictions of treatment efficacy. Consistent interpretations of the con- cepts illness, disorder, health, recovery, and need are also lacking. In this paper, I unravel the limitations of several leading evidence-based treatments and propose principles of care as preconditional commitments for future practice. This analysis specifically assesses treatment options for depression and anxiety. In response, I argue that clinical practice guidelines require a deeper engagement with the theoretical foundations of prominent therapeutic models and must consider the effects of those premises beyond controlled treatment sessions. I recommend more substantial collaborations with mental health sociology and bioethics, with a particular emphasis on care ethics.

This dissertation examines the outbreak of depression in the United States through an ethical lens of care and disconnection. Discussions in bioethics and collaborating fields largely speak of mental health as a series of phenomena attributable to individuals, subsequently using terms like ‘disease’ and ‘disorder’ to denote abnormality in those persons affected by distress. Alternatively, I respond to the ongoing “crisis of care” through a critique of neoliberalism and biomedicalization. I argue that widespread despair is the result of a collective way of life wherein persons are detached from fundamental physical and psychosocial needs by nature of fallacious cultural commitments and techniques. I implement constructivism to empirically ground a new application of care ethics to be considered by normative ethicists. In addition to merging several established traditions such as feminist philosophy and the capabilities approach, I also contribute a comprehensive model for understanding basic needs and the distribution of caring responsibilities/roles. Further, the project enhances the field of applied bioethics by featuring a practically-specific relational approach that is built from the experiences of those embedded in daily decision-making. The dissertation critiques the theoretical soundness of psychiatric and psychological classifications and the practical efficacy of prominent solutions such as antidepressant medications and various psychotherapies. I further assert that these depictions of mental health misrepresent the experiences of those affected by depression, and thus share their stories of derealization, isolation, frustration, resentment, and hopelessness through a lens of disconnection. These feelings apply to caregivers as well: the commodification of care alongside of the constraints attached to “professionalism” are used to inhibit their autonomy, exploit their labor, and detach them from relationships with charges and other carers. This leads to issues such as moral distress, burnout, and vicarious traumatization, all of which foster despair. Finally, I respond to these collective concerns with a new framework consisting of an expanded account of fundamental needs and an analysis of “care-abilities”: the capabilities one has to meet their needs and to fulfill the needs of others who depend on them. I then supplement this account with a detailed distribution of skills and responsibilities attached to the particular caring roles that one might occupy. This ethical framework is intended to be advisory and malleable to contextual practice rather than prescriptive.

The Open Paradigm Project is an initiative devoted to sharing the stories of persons who have been harmed and/or disserved while receiving psychiatric care. In these first-person accounts, participants detail their grief, disdain, anger, apprehen- sion, and frustration as they reflect on their treatment experiences. This article argues that they possess legitimate claims of ‘resentment’ that warrant acknowledgment and reparation, as evidenced by the insufficient credibility of experts and coercive regu- lation of atypical patients. Moreover, it contends that biomedicalization, which is not only an empirical process but a moral discourse, unjustifiably nullifies the testimonies of subjected patients and thus perpetuates epistemic injustices as well as physical injuries. I implement a critical ethics of care to consider the normative conditions of responsiveness while also evaluating ongoing problems like ‘ethical loneliness’ and ‘medical gaslighting.’ As illustrated in The Open Paradigm Project, certain para- digms of care can be used to sustain marginalization by blurring the boundaries of treatment, fostering abandonment, and dismissing critiques of authority. These are keen lessons that apply far beyond the scope of psychiatric settings.

The medicalization of mental health remains a point of contention for bioethicists, especially as it concerns the epistemic capabilities of those diagnosed with an illness or disorder. Gosselin (2019) argues that biomedicalization commits epistemic injustices against these persons and consequently entraps them in a “cycle of vulnerability”; in response, she proposes principles of justice to defend them from such affronts. This paper builds off of her work and responds particularly to the demand for a “sociocentric view of the self as essentially relational.” I present a theory of interdependent agency and affiliation that I contend conceptually bolsters her normative principles. I explain how an expanded use of relational epistemologies, united with a non-ideal theory of mental health, can enrich our hermeneutical resources with respect to those with mental illnesses/disorders. My account introduces normative considerations premised on interdependency, most notably from care theory. Concepts such as vulnerability, relational autonomy, attentiveness, and responsiveness ground a relationally-situated approach that (1) improves the epistemic positionalities of patients, (2) informs more suitable dynamics of care/treatment, and (3) unites groups of mutually interested actors against harm and injustice. I thus use a framework of care to promote affiliations of similarly disadvantaged persons under shared causes and initiatives. I refer to these assemblages as “caring affinity networks.”