Lisa A. Eckenwiler

Forthcoming, Johns Hopkins University Press 2012

Long-term care can be vexing on a personal as well as social level, and it will only grow more so as individuals continue to live longer and the population of aged persons increases in the United States and around the world. This volume explores the ethical issues surrounding elder care from an ecological perspective to propose a new theory of global justice for long-term care.

Care work is organized not just nationally, as much current debate suggests, but also transnationally, through economic, labor, immigration, and health policies established by governments, international lending bodies, and for-profit entities, in a manner that raises pressing questions of local as well as global responsibility,. Taking an epistemological approach termed “ecological knowing,” Lisa A. Eckenwiler examines this organizational structure to show how it creates and sustains injustice against the dependent elderly and those who care for them, including a growing number of migrant care workers, and weakens the capacities of so-called “source” countries and their health care systems. She identifies those who are harmed by the existing long-term care system—the elderly, family caregivers, and paid care workers, especially migrants and populations in source countries—and from there, offers a corrective philosophical framework. By focusing on the fact that a range of policies, people, and places are interrelated and mutually dependent, Eckenwiler is able to not only provide a holistic understanding of the way long-term care works to generate injustice, she also finds ethical and practicable policy solutions for caring for aging populations in the U.S. and in less well-off parts of the world.

Deeply considered and empirically informed, this examination of the troubles in transnational long-term care is the first not only to probe the issue from a perspective that reckons with the interdependence of policies, people, and places, but also to recommend how policymakers, planners, and families can together develop cohesive, coherent long-term care policies around the ideal of justice.

Transnational Women Workers: Ethical and Political Issues

Edited by Zahra Mehani and Lisa Eckenwiler

Forthcoming, Routledge 2013

Compelled by global economic policies, every year, millions of women from poorer countries reluctantly leave their families and communities to cross borders in search of work in richer countries. While some of them have work authorization permitting them to seek employment in the nations they have traveled to, many do not. However, whether they are documented or undocumented, a significant number (especially those who do not have employment authorization) confront injustice in many forms. Often, they are systematically exploited, dominated, or marginalized in the nations where they labor. This, unfortunately, is true whether they seek work in wealthy tyrannical undemocratic regimes or rich liberal democracies. Their life prospects are likely to be constrained by sexist norms, racist, ethnic, and cultural stereotypes, and in some cases by, forms of nationalist rhetoric that encourage them to work abroad for the benefit of their home country’s economy. Those factors act in conjunction to determine what kind of work they have access to and under what conditions. They may be paid less and receive fewer benefits and protections than citizens of the destination countries doing the same work. In some cases, they may have no access to benefits or protections by virtue of their status as foreigners in those countries. In addition, they may be subjected to sexual and physical violence; undocumented women workers in low skill jobs are particularly vulnerable in that respect. Those injustices are compounded by the fact that the wealthy foreign nations where they are employed have policies that make it very difficult, if not impossible, for these women to seek permanent residency or citizenship in those countries. Such policies allow those countries to use this population of workers on their terms, whilst denying them substantive legal status or political agency. Thus, these women find themselves in a bind, supporting the social and economic activities of the more privileged in destination countries, while they themselves have few legal rights or protections and no political status.

The countries from which these women workers migrate in search of work feel their absence socially, politically, and economically. Consider that when these labor migrants are health care workers from poorer countries, significant health inequities in those nations may be exacerbated. By working abroad, moreover, female migrant workers tend to pay a high price in their personal relationships. All too often, they leave behind dependent family members. However, their ability to visit them is usually constrained by restrictive travel and immigration laws.  As a result, they and their kin suffer from strained filial ties. That is an especially severely painful reality for undocumented workers, for whom crossing borders is a particularly dangerous prospect. Women who migrate may be blamed for social ills such as their children’s poor school performance or stress in their marriages. They also may not have a say in how their remitted earnings are spent by their families. All in all, the population of female international migrant workers, especially the sub-population that is undocumented, suffers a variety of serious ethical and political harms.

Our book, Migrant Women Workers: Ethical and Political Issues, offers nuanced ethical and political philosophical analyses of this feminized global flow of labor. The essays in our collection draw on the data collected by sociologists, geographers, economists, and political scientists about the unjust treatment in wealthy liberal Western democracies of female migrant workers from the global South. Thus, the articles advance the work done by social scientists by developing detailed analyses of the moral and political significance of the asymmetrical global flow of female labor from the South to the North, from poorer to richer nations.

Global Solidarity, Migration, and Health Equity

Lisa Eckenwiler, Ryoa Chung, and Christine Straehle

The grounds for global solidarity have been theorized and conceptualized in recent years, and many have argued that we need a global concept of solidarity.  But the question remains: what can motivate efforts of the international community and nation-states? Our focus is the grounding of solidarity with respect to global inequities in health. We explore what considerations could motivate acts of global solidarity in the specific context of health migration, and sketch briefly what form this kind of solidarity could take.  First, we argue that the only plausible conceptualization of persons highlights their interdependence.  We draw upon a conception of persons as “ecological subjects” and from there illustrate what such a conception implies with the example of nurses migrating from low and middle-income countries to more affluent ones. Next, we address potential critics who might counter any such understanding of current international politics with a reference to real-politik and the insights of realist international political theory.  We argue that national governments – while not always or even often motivated by moral reasons alone – may nevertheless be motivated to acts of global solidarity by prudential arguments.  Solidarity then need not be, as many argue, a function of charitable inclination, or emergent from an acknowledgment of injustice suffered, but may in fact serve national and transnational interests. We conclude on a positive note: global solidarity may be conceptualized to helpfully address global health inequity to the extent that personal and transnational interdependence are enough to motivate national governments into action.

Simulating the Effects of Age-Based Premiums and Voucher-Based ESI Portability in the Patient Protection and Affordable Care Act: An Economic and Ethical Analysis

Jack Hadley, Lisa Eckenwiler and Tim Waidman

Passage of the Patient Protection and Affordable Care Act (PPACA) in 2010 started the process of developing the detailed regulations that will govern the structure of the new health insurance exchanges scheduled for implementation in 2014.  Two important issues the exchanges must address are the extent to which age should be taken into account in setting premiums and the portability of employer-sponsored insurance (ESI).  The former indirectly addresses the question of how health risks should affect premiums, while the latter potentially influences ESI’s role as the foundation of private health insurance.  This study simulates the effects of alternative age-rating bands coupled with complete ESI portability on the distributions of insurance coverage and costs across age, income, and health status groups.  We then apply ethical criteria to evaluate the distributional consequences of the alternatives relative to PPACA’s current structure.  Our objective is not to answer the ethical questions raised here, but instead, to help frame them so that policy makers can better understand the ethical implications of the choices before them.  We focus on the principles of equality, autonomy, solidarity, and human flourishing.

Other projects and forthcoming publications

Associate Editor, Encyclopedia of Bioethics, 4th edition, forthcoming 2014

Long-term Care and Feminist Ethics, International Journal of Feminist Approaches to Bioethics (special issue), forthcoming 2013

UNESCO Working Group on Bioethics and Gender

UNESCO’s Statement on “Vulnerability”: Nice but Not Quite, International journal of Feminist Approaches to Bioethics (forthcoming 2012)

Care Work in a Global Context, Stanford Online Encyclopedia of Philosophy (forthcoming 2012)

Long-term Care Workers in the US and Global Health Inequities Abroad, in The Routledge Companion to Bioethics, ed. John Arras, Rebecca Kukla, and Elizabeth Fenton. New York: Routledge (forthcoming 2013)

“Ecological Selves and Relational Democracy,” in Ecological Political Economy: Conceptual Foundations and Governance, ed. Peter Brown, Bruce Jennings, and David Smith. Edward Elgar Press (forthcoming 2012)