Might constraint be compatible with care? Home care as a situational ethics

Staging Paro: The care of making robot(s) care

Paro, a baby seal robot, is arguably the best-known care robot worldwide. Its clinical effects on people with special needs have been studied for more than twenty years by multidisciplinary teams. However, there are very few studies of Paro 'in the wild', inserted in the routines and pressures of a care home, which is supposed to be Paro's natural environment. Based on fieldwork in a French public nursing home, this article relocates Paro's psychosocial effects - asserted by its corporate and academic advocates to stem from the robot's software and user-friendly design - in the situated practice of care deployed by the nursing staff. Although it is commonly assumed that the robot can interact autonomously, thanks to its AI, it took considerable efforts to enable 'patient-robot' interactions, and interactions were always mediated by care staff. The supervision of the interaction between Paro and its user(s) by at least one care worker, prescribed by its sales representative to prevent the seal robot from being harmed or monopolized by a resident, thus framed the very course and meaning of the interaction, through an entanglement of verbal and tactile guidance. Staging Paro often meant awakening and maintaining interest from confused or passive users, and playing with its ontological flexibility to meet the preferences of its elderly interlocutors.

The making of a professional digital caregiver: personalisation and friendliness as practices of humanisation

The aim of this paper is to explore how a digital caregiver, developed within a Swedish interdisciplinary research project, is humanised through health-enhancing practices of personalisation and friendliness. The digital caregiver is developed for being used in older patients' homes to enhance their health. The paper explores how the participants (researchers and user study participants) of the research project navigate through the humanisation of technology in relation to practices of personalisation and friendliness. The participants were involved in a balancing act between making the digital caregiver person-like and friend-like enough to ensure the health of the patient. Simultaneously, trying to make the patients feel like as if they were interacting with someone rather than something-while at the same time not making the digital caregiver seem like a real person or a real friend. This illustrates the participants' discursive negotiations of the degree of humanisation the digital caregiver needs in order to promote the health of the patient. A discursive conflict was identified between a patient discourse of self-determination versus a healthcare professional discourse of authority and medical responsibility: whether the digital caregiver should follow the patient's health-related preferences or follow the healthcare professionals' health rules. Hence, a possible conflict between the patient and the digital caregiver might arise due to different understandings of friendliness and health; between friendliness (humanisation) as a health-enhancing practice governed by the patient or by the healthcare professionals (healthcare professionalism).

Doing good: autonomy in the margins of welfare

The welfare systems in the global North has seen changes in professional care delivery systems in the margins of welfare, from care in large treatment institutions, to community care and, more recently, to care taking place in home spaces. Care and support are increasingly provided in the home of the service user through floating support and home visits. Drawing on empirical ethics, we aim to inquire into modes of doing good care during professional workers' home visits by building on observations of service interactions taking place during these home visits in two different settings: that is, a mental healthcare unit performing home visits in the context of psychiatric care and a special-housing unit performing home visits in the context of homelessness services. We also build on interviews as retrospective reflections on service interactions. Drawing on these empirical materials, we ask what is considered as doing good in the margins of welfare and identify three ideal patterns: the relationality of care, the situatedness of care and the subject of care. Furthermore, these ideal patterns are connected to two different ideals of good care and conceptions of autonomy in care relations.

Estranged relations: coercion and care in narratives of supported decision-making in mental healthcare

Supported decision-making has become popular among policymakers and mental health advocates as a means of reducing coercion in mental healthcare. Nevertheless, users of psychiatric services often seem equivocal about the value of supported decision-making initiatives. In this paper we explore why such initiatives might be rejected or ignored by the would-be beneficiaries, and we reflect on broader implications for care and coercion. We take a critical medical humanities approach, particularly through the lens of entanglement. We analyse the narratives of 29 people diagnosed with mental illness, and 29 self-identified carers speaking of their experiences of an Australian mental healthcare system and of their views of supported decision-making. As a scaffolding for our critique we consider two supported decision-making instruments in the 2014 Victorian Mental Health Act: the advance statement and the nominated person. These instruments presuppose that patients and carers endorse a particular set of relationships between the agentic self and illness, as well as between patient, carer and the healthcare system. Our participant narratives instead conveyed 'entangled' relations, which we explore in three sections. In the first we show how ideas about fault and illness often coexisted, which corresponded with shifting views on the need for more versus less agency for patients. In the second section, we illustrate how family carers struggled to embody the supported decision-making ideal of the independent yet altruistic nominated person, and in the final section we suggest that both care and coercion were narrated as existing across informal/formal care divisions. We conclude by reflecting on how these dynamic relations complicate supported decision-making projects, and prompt a rethink of how care and coercion unfold in contemporary mental healthcare.

Patients' autonomy as a negotiated order: an ethnographic perspective on the clinical management of childhood obesity

The principle of patients' autonomy has assumed a central place in healthcare. Patients are encouraged to play an active role in the management of their health, especially when they are affected by chronic illnesses that require long-term follow-up. In this article, we analyse patients' and professionals' conceptions of patients' autonomy in the context of childhood obesity management. Based on the results of an ethnographic study that we conducted within a paediatric hospital in French-speaking Switzerland, we put into perspective the discourses that professionals, parents and children construct around their experiences of the therapy. Our study reveals that the conceptions that these three different actors have of patients' autonomy converge on several points, but they also diverge on many others. While the rise of autonomy in healthcare has mostly been analysed as a form of empowerment of patients, our results show that this principle also introduces new forms of social control over patients' lives, and it creates new tensions for patients who are unable to match with the normative expectations of professionals in terms of self-management and self-care.

From Valuation to Instauration: On the Double Pluralism of Values

At the request of Valuation Studies, Antoine Hennion reflects on his own investigative trajectory as a way to explore the ways in which the sociology of attachment, which lies at the heart of his pragmatist approach, can refine our understanding of a number of recurring problems with which the sociology of valuation is confronted.