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DOMESTIC CHANGING HEORY CHANGING PRACTICE 1. Introduction Throughout our world, violence confronts us daily. We hear about it on the news. We read about it in newspapers and on the Internet. We experience it subtly and overtly in all cultures and across nations in incidents ranging from ethnic slurs to hate crimes to violence carried out in the name of ideology. Such incidents of violence tend to be easily seen as they fall within the public domain. Less visible, however, but often more devastating, is the domestic violence that occurs within the family and often against women. The International Council of Nurses (ICN) (2001) notes in a summary of research done on four continents that as many as 20 to 50 percent of all women in the studies reported experiencing partner violence. But what are the links among domestic violence, health care profession, nurses, and ethics? In moral philosophy, there is a long tradition of debate on whether true moral dilemmas can exist, some arguing that it will always be possible to decide which obligation should prevail. On this concept regardless of the abstract possibility of an ideal resolution and the pragmatic reality that decisions are made and people have to live with them. An ethical dilemma presents a choice that must be made between two mutually exclusive courses of action, each of which is perceived to rest on a moral obligation that carries significant weight for the actor confronting the dilemma. According to Draucker (2002} addresses intimate partner abuse as repeatable and increasing patterns of violence against women by men in their attempts to gain power. She notes that because this abuse occurs in a continuing relationship, or in a newly severed one, the perpetrator may have long-term access to the abused one. Furthermore, she acknowledges the many economic and sociological factors that contribute to domestic violence and then recommends, among other actions, that healthcare practioners especially nurses advocate for policies that redistribute power and wealth in the United States so that female victims of domestic violence benefit. In this sense, then, and nurses will be seen as feminisms, nurses base many of their actions, perhaps unknowingly, on the tenets of feminist ethics. In other context, domestic violence and the criminal justice system, reiterates the fact that women, not men, are the primary victims of domestic violence; that is, the man’s need to control and dominate underlies the violence, resulting in the oppression of women. She then places the violence within an historical perspective where, until the 1970s, the criminal justice system did not believe that battering of a female spouse was a crime, thus police did not view it as a serious offense but rather a private matter. However, since the 1970s, Erez notes that the women’s movement, along with other societal forces that resulted in advocacy groups for crime victims, has been responsible for changes in attitudes and approaches to domestic violence. These changes made domestic violence not only a public matter but also a crime involving both the police and the criminal justice system and leading to arrest of the batterer. However, according to feminist scholars, arrest also has its problems, for example, ignoring the autonomy of women regarding the arrest and not providing them with the necessary resources to extricate themselves from their situations. In matters of public concern and public health, practitioners play an important role. A feminist perspective on domestic violence as a serious public health problem should expand the clinicians thinking about the role of feminist ethics in health care. But why are feminist ethics so important to health care practitioners? Because some female clinicians, like other women, have been socialized to think like men regarding ethics. This means that they often do not "see" the social-political environments that oppress women, particularly if they do not view themselves as being oppressed (which may or may not be so). In addition, the word feminist causes discomfort to many health care practices, and they do not want to be labeled as one. Yet, they agree that women should not be oppressed and that clinicians play an important role in enhancing the social and political environments to obtain better health care for women. Thus, healthcare practitioners need to understand that, given the preceding beliefs, that they are in fact thinking about and practicing feminist ethics.
From September 2013 a Cultural Encounters in Intervention Against Violence(CEINAV) project has been exploring the cultural premises underlying different approaches to intervention against violence in four European countries (Germany, Portugal, Slovenia and the United Kingdom), and is seeking to illuminate ethical issues in the context of cultural encounters within and between these countries. Parallel to the empirical research (focus group discussions in multi-professional workshops in 2014, interviews with women and with young people who have experienced intervention in 2015), one theoretical task surveyed the ethical theories as they relate to intervention, and ethical dilemmas that arise in practice. Examine ethical theories as they relate to intervention against violence, and to give particular attention to the ethical issues of rights and discrimination arising from interpretations of the states duty to protect as embedded in policies and intervention of procedures. However, ethical theory has not often dealt with these issues, and conversely, the debates in intervention and protection have not generated a great deal of ethical theory. The present paper now also attempts to put together systematically the ethical issues and dilemmas that have been found in the empirical work of the project so far working papers and relate them to the aspects of ethical theory that seem most useful. Drawing on the knowledge gained from hearing the diverse voices of those who have experienced intervention, leading to a summary of theory and ethics (foreseen for October 2015). The overall goal of this paper, to which this theoretical work will contribute, to develop guidance towards respectful and responsible intervention, highlighting dilemmas and challenges to the moral sense of practices and proposing transnationally meaningful ethical foundations for intervention. Although there is a broad and many-facetted range of approaches to ethics, textbook ethics since the 1950s and reinforced by the wide recognition of John Rawls work on Theory of Justice (1971) have followed an established view that the moral assessment of social institutions should be associated with the term of justice, while the term ethics applies to the total assessment of the conduct and character of individual and collective agents. Ethics in this sense seems too narrow a scope for the aims of this paper project, as intervention against violence is located at the intersection of social institutions and individual (especially professional) agents. Furthermore, the overall context of the title of this paper and Cultural Encounters of domestic violence, reflected is the aid to understand cultural premises of intervention practice, cuts across the distinction between institutions and practices. Thus, ‘’ethics ’will be understood as comprising both levels.
An additional prefatory note is needed. Ethical theory focusses largely on clarifying what should be done, either institutionally or by individual or collective actors. The central concern around intervention is better framed by the question: How can the ‘’right thing’’ be done is such a way as to create greater safety from victimisation, more freedom and agency for those victimised, and less danger of violence? As will be seen, this question is anything but trivial, since institutional frameworks and measures taken to various actors in the hope of ‘’fighting wrongs’’ can prove ineffective or even harmful if done in the wrong way.

Relevant ethical theory
1 .A theory of justice. It should enable us to weigh the claims of individual rights against each
Other and of individual rights against the claims of social justice for the many;
2. An inclusive theory of citizenship that gives recognition to the basic needs of every person in the territorial reach of a state, and includes respect for group differences;
3. An ethic of care or contextual ethics. It should set a framework for attending to the needs of concrete persons while weighing these against the limits of the caring obligation, as well as attending to the potential of care relations to be oppressive;
4. An ethical approach to integrating perspectives of justice and care;
5. An ethic of professional or institutional intervention in the lives of others without their request or consent or without their knowledge, addressing the paternalism problem;


Body .1 Theorising justice for a liberal democracy With view on the moral context and conflicts and of difficult decisions, theories of justice define it in terms of universal principles, equality and reciprocity. Justice in this sense is one way of looking at human rights, placing ‘’liberty rights’’ {no-one shall be subjected to… as the fundament. Writing in the liberal tradition, John Rawls (1971) presents a picture of justice for a liberal society that he teaches us ‘’justice as fairness’’ this amounts to a theoretical framework of the legitimate use of political power. Taking the central liberal ideals of the freedom and equality of citizens, he constructs an account of the arrangements of social and political institutions which he claims is fair.
His explicit interest is in theorising principles of justice for the narrow political sphere of life, and not in formulating a general theory of right conduct. Nevertheless, ethical theory has been deeply influenced by this approach. The duty of the state to protect women against gender-based violence is based on the thesis that this violence (NOT all violence) is a form of discrimination, grounded in unequal power relations in society. In acting to fulfil this duty, the state is restoring to women (as a class) a status equal to that of men. The state cannot, at the same time, in justice treat women as less able than men to make decisions about their own lives, or violate other basic rights. When such measures are taken (e.g. information sharing without consent, taking women to a shelter against their wishes, or placing them under some kind of supervision), the ethical legitimacy must be drawn from other grounds than those of justice and non-discrimination.
According to Alya Khan in an assessment of the theories of Rawls and Habermas and of the care-justice debate between Gilligan and Kohlberg The duty of the state to protect children from harm is perhaps more complex. Justice could require that all children should equally have the right to grow up in an environment that protects them from harm, meets their developmental needs, and supports their physical and emotional flourishing. allowing some children to suffer deprivation or harm in their families could be seen as a form of discrimination. However, the UN Convention on the Rights of the Child (CRC) is not framed in terms of inequality and discrimination, and on the other hand, ethical theories of justice have given little or no attention to children at all. The most influential philosopher of a liberal theory of justice, John Rawls (1971/1999), declared that parents can be trusted to do what is best for their children and thus justice can be theorised for adult citizens. This is a consequence of defining justice as ‘’farness’’and postulating that ‘fair ‘rules are those that every reasonable person should agree to if he or she did not or could not know what his or her own situation would be when the rule is applied.
[There is also a language issue here. Rawls equates justice with fairness, and this equation seems to be intuitively meaningful among English-speakers. The latter concept has also spread into numerous other languages, often untranslated, partly as an influence of Empire and perhaps more due to its international (mis-)use in competitive sports. Most European languages also have a concept of justice, and it does not mean exactly the same as ”fairness” the the latte term has been adopted.
In German literature, the iconic figure of Michael Kohlhaas symbolises pursuit of “Gerechtigkeit” against authorities and choosing to be an outlaw, even to be executed rather than compromising his demands. There is also some question about whether legal proceedings could be considered a means of Gerechtigkeit, or whether they rather serve to restore social peace and order.]
A second major influence in theorising the just society has been the proceduralist view of democracy (Jürgen Habermas) in which truth and justice are the outcomes of free and reasoned deliberation by autonomous adults. While Rawls restricts his theory to the basic social arrangements of a just society, such that everyone would agree to them in an imaginary social contract, in the deliberative theory agreements on arrangements are conceptualized as ongoing negotiations in which citizens can bring any concerns or issues important to them into the discourse. Norms are valid if all affected persons could agree as participants in rational discourse, assuming them to be free agents, neither coerced nor dependent on others. Feminists Benhabib (2002) have added the proviso that all who would be affected by the consequences must be enabled to participate in a real discourse founded on universal respect, egalitarian reciprocity, and (with regard to culture) voluntary self-ascription, the underlying concept of the autonomous individual presenting rational arguments is maintained. Relationship ties do not enter the picture. In his classic’’ book’’ of’’ Ethics and the limits of philosophy’’, Bernard Williams notes that such theories requires a principle every decision to be based on ground discussion.
(1985/2006: 20), and in summing up, writes that much of modern ethical theory “is governed by a dream of a community of reason that is too far removed…from social and historical reality and from any concrete sense of a particular ethical life” (220). Despite these limitations, ideas such as a social contract to which all could agree or a deliberative process in which all those affected could participate is not merely dreaming, but extrapolates principles that are regularly brought to bear in political and legal discourse about justice in Western democracies. Such an ideal of justice based on equal rights may be necessary, but is probably not sufficient for our purposes, as the victims of violence are, due to that very circumstance, not free agents in the sense of these theories.

Looking at other ways of theorising justice (and injustice) In our context, without reconstructing the philosophical foundations of a just society, we may assume that a just society confers rights on individuals, and if we take human rights and children’s rights as defined in international conventions to represent (albeit imperfectly) a consensus on what those rights should be, we can connect to the first set of ethical dilemmas and regardless of critical thought on these theories of justice, issues of individual rights ae evidently significant for professionals, a dilemma between the right of the child to live in his/her family, and the child’s right to be safe from harm in a developmentally beneficial environment. In many countries, in the DV dilemmas are where the woman’s right to self-determination stood in opposition to her right to be safe from gender-based most institutions and countries, A cross-cutting dilemma for practitioners is : How far and how long should agencies accept that the woman or the child is in danger of serious harm when she/the family refuses offers of help?
A.In conflict between the parental right to raise children according to their chosen values, versus children’s rights, including protection from all forms of violence and DV the woman’s right to self-determination concerning her own relationships has to be balanced with the child’s right not to be exposed to violence. Furthermore, with DV the conflict is potential triangular: the woman’s right to end abusive relationship in safety (and to have no contact), the fathers right to child contact, and the welfare resp. best interests of the child, including the child’s right to be heard. Conflicting individual rights seem less relevant. In the UK concept of a “duty of Care” can be understood to allow or even require agencies to override the rights and wishes of an individual victim in order to secure the rights of other victims.

B.Individual rights can come into in conflict with societal or state considerations of essentials of public interest. This can be the right of the victim to decide not to cooperate with police stands in opposition to the interest of the state in prosecuting and stopping trafficking. This conflict also emerged in regard to DV, but there can be differences by country context as to whether the interest of the state primarily concerns prosecution or protection (preventing continuation). Another conflict between individual rights and public interest is exemplified when statutory agencies compile and share personal data on victims of crimes (or even minor offences) on the premise of a public interest in having the data available, or under the concept of public protection. This is not only a question of privacy rights; some professionals expressed concern that routine data-sharing (in the Uk) or bureaucratic routines (inGermany) can endanger the victim by revealing information to the perpetrator.
C. Especially with violence in close relationships or the family, the victim has a right to choose not to testify, while the criminal justice system has a duty to investigate and prosecute crimes. Victims of domestic violence have the right to decide (at least during an initial reflection period) whether to cooperate with the police; they can be obligated to testify in court, but some Criminal justice system professionals considered this ethically unacceptable as being a form of re-victimisation. Professionals in a number of workshops spoke about victims of DV not cooperating with prosecution even after making a complaint, and expressed to a greater or lesser degree reservations about criminal investigation of suspected. Professionals in Germany and Slovenia expressed strong views that prosecution is frequently not in the interest of the victim, and some even framed the decision to prosecute as a serious ethical dilemma. From a justice perspective, it is assumed that the agencies are offering the best that they can do, given the legal frameworks, resources, and professional knowledge that they have, and that a victim or family that rejects what they offer will be lost to intervention.

Social justice, theorising injustice, and the good society
Alongside the issues of individual rights in a just society, there is a body of ethical theory oriented to social justice, challenging the individualist concept of society and concerned with the relations among groups. Migration, minorities, and structural exclusion all call into question the models of a just society in which all those affected by a norm or a regulation have a voice in deliberations, or are able to make themselves heard. Over the past 20 years, one major stream of discussion on social justice and ethical theory has debated the alternative paradigms of economic redistribution (with a long tradition in justice discourse), understood to mean seeking to overcome structurally unequal access to material resources and the accompanying exclusion from social participation, versus recognition (put forth as a paradigm by Charles Taylor), understood to characterise the struggles of social groups for social relations and legal frameworks in which they can achieve self-realization in terms of their own identity. This controversy has been usefully explicated in the jointly authored
(albeit sharply controversial) book by Nancy Fraser and Axel Honneth (2003). Beginning from their shared premise of equal rights and equal autonomy for all members of society,
Fraser frames misrecognition as ‘’status status subordination’’ and sets against the principle this the of participatory parity, against which social justice can be measured, while Honneth defines the goal of justice intact possible identity formation’’ and bring the principle of mutual recogniton which may include esteem for a cultural minority constitutive practices, way of life and values) as the means of reaching that goal. Fraser understands the recognition dimension of social justice to concern status equality, not intact identity. While Honneth develops his ideas from an ethical theory of the good life, Fraser seeks to avoid appealing to ethical arguments.’’ Honneth draws on historical studies to argue broadly that perceptions of injustice are regularly associated with experiences of social humiliation and disrespect; the moral order of society must understood’ ’stood as a fragile structure of a graduated relationship of recognition’’ so that distribution conflict are always struggles for recognition. Placing recognition at the center assigns importance to the demand of social movements for cultural recognition of their collective identity, and to a greater or lesser extent, authors sharing this focus may conclude, with Kymlicka (1995), that cultural communities may legitimately claim collective rights. This is a precarious position with regard to stopping violence within the family, as cultural rights tend to be claimed especially with regard to the family sphere, often, with corollary that women and children should accept the decision making power of a male ‘’head ‘’ of the family or the clan. This may explain why cultural rights did not emerge as a significant perspective of intervention professionals.
In a challenge to both of the above paradigms, Judith Shklar (1990) has argued that moral philosophy and political theory have given too little attention to injustice, having taken for granted that injustice is simply the absence of justice, and that once we know what is just, we will know all we need to keep. looking on at justice, theories fail to address issues such as the sense of injustice, or the difficulties of identifying the victims of injustice.
Iris Marion Young argues that concepts of social justice have been too strongly oriented to the unequal distribution of social goods, such as income, resources, positions, or jobs. In her view, injustice should rather be conceptualised in terms of oppression and domination. In this way, she avoids notions of welfare rights (or individual rights to goods and services), and remains in the sphere of fundamental freedoms, or liberty rights. In her view, central elements of social justice – power, rights, opportunity and self-respect – cannot be understood as a problem of distribution, as they do not consist of things of which one can have more or less have a process nature. Moral agents, whether individual or institutions, thus have an ethical obligation to concern themselves with ensuring that no-one is subjected to domination. She proposes – and here she has links to both

Nancy Fraser and Axel Honneth – a “politics of defending” group representation, and ideal of politics as deliberation in a heterogeneous public which affirms group differences and gives specific oppressed representation to oppressed groups Note, however, Young is not basing her ideal on fixed ethnic, cultural, or other (perhaps gender) groups, but on the concept of “Afinity groups” the affinity names of sharing assumption ,affected bonding networking that recognizably differentiates groups from one another, but not according to some common nature identify is constructed from a flowing process in which individuals identify themselves and others in terms of groups, and thus group identity itself flows and shifts with changes In social process Young strongly suggests With this relational understanding of difference Young strongly suggests that social movements protesting against oppression and domination are the most relevant voices.
(Honneth challenges this linkage as giving voice only to those who already have a voice). The notions of group identity, group representation, and social justice as respect for differences are central to the literature on multiculturalism, yet the open-ended and fluid concept of affinity groups seems better able to avoid reifying cultures and/or ignoring the internal power structures that may exist within religious or cultural minorities. Spivak employs the concept of synecdoche, a type of metaphor in which a part can stand for the whole. It allows a (conscious) choice enabling collective claims without an encompassing identity; when synecdoche fails, culture becomes reified

Miranda Fricker (2007) has suggested an approach to analysing injustice that does not depend on a prior identification of group identity or the ability of groups to make claims. Her concept of epistemic injustice is developed from her interest in the ‘’moral dicession of practices through which knowledge is gained, or indeed lost’’, practicese that are played out by subjects that are socially situated,that is, She looks at ethical aspects of two basic everyday epistemic practices: conveying knowledge to others by telling them, and making sense of our own social experiences.

Fricker distinguishes two kinds of epistemic injustice: testimonial injustice and hermeneutical injustice. The former relates to how far what someone tells us is taken seriously or believed, since face-to-face communication rests on the spontaneous attribution of (a greater or a lesser degree of) credibility to the speaker


Dilemmas and issues in the context of ethical theories on domestic violence
Principle of Nonmaleficence
Clearly communicate that domestic violence harms women. Some of the authors also address how domestic violence harms fetuses, children, elders, and men. Since nonmaleficence is at the ethical core of most societies and health care professions, it warrants our attention. According to Beauchamp and Childress (2001), "The principle of nonmaleficence asserts an obligation not to inflict harm on others" (p.113). It is usually translated as, "First, do no harm." This principle is supported by specific rules such as:
1. Do not kill.
2. Do not cause pain or suffering.
3. Do not incapacitate.
4. Do not cause offense.
5. Do not deprive others of the goods of life.
(Beauchamp & Childress, 2001, p. 117) However, that the principle of nonmaleficence and its supporting rules areprima facie, that is, they are always binding unless they conflict with equal or stronger duties that override them. Nevertheless, when reflecting on the principle and its supporting rules, one cannot escape their relationship to domestic violence: The principle and often all five of its supporting rules are violated.
We now examine some of the harms to health caused by domestic violence. Draucker (2002), citing the works of Campbell (1998) and Warshaw (1998), reports physical violence, including such injuries as lacerations, contusions, broken bones, and hearing/vision loss; sexual violence, including such problems as urinary tract infections, sexually-transmitted diseases, and sexual dysfunction; stress-related violence, including such problems as eating disorders, chronic irritable bowel syndrome, and persistent headaches; and psychological violence, including such problems as post-traumatic stress disorder, depression, and substance abuse. Walton-Moss and Campbell (2002) concur with Draucker (2002) on the health consequences of domestic violence.
Griffin and Koss (2002) add to the above picture. In addition to physical, sexual, and psychological violence, they add economic abuse and stalking. By economic abuse meaning such tactics as limiting access to bank accounts, transportation, and educational opportunities in order to control the victim. By stalking they mean such behaviors as repeated threats occurring at the victim’s home or office and delivered in person or by telephone or written messages. Griffin and Koss (2002) also identify five barriers that keep women from reporting partner violence: fear, cultural differences, dependence on the abuser, feelings of failure, and promise of change by the abuser.
Erez (2002) differentiates between domestic violence that is defined as criminal versus noncriminal. Stalking, for example, is considered a crime, whereas psychological and financial abuses are not. For example, where law, the minimum standard, and ethics, the highest standard, depart. The principle of nonmaleficence and its supporting rules would clearly consider psychological and financial abuses as ethically wrong even though the law is largely silent on them.
Finally, Campbell, Sharps, Gary, Campbell, and Lopez (2002) discuss health consequences of domestic violence in African American women. They point out that the African American woman’s experience is different than the Caucasian woman’s experience. First, the problem of racism may cause African American women to refrain from seeking help for domestic violence; they feel the care they receive is inferior to that of Caucasian women. Second, in a study conducted by the above authors (Campbell et al. 2002), intimate partner femicide was most likely to occur if the man was unemployed and African American

Cultural Relativism and Universalism
The issue of human rights and how it can be applied in different cultural contexts has been disputed for many years. Some existing cultural practices such as “female genital mutilation” and
“forced marriage” are considered as a violation of human rights. The conflict between culture and human rights is still unsettled in scholarly debates. At the core of these debates there are two main perspectives: “Universalism” or “Culture Blindness” (Korteweg and Yurdakul 2010) and
“Cultural Relativism” or “stigmatization” (2010). “Cultural relativism” is based on the idea that there is a variety of notions of justice that are all equally authentic in their own cultural context.
In other words, justice must be particularly defined according to social and cultural contexts.
Therefore, it is impossible to apply the values of one society when judging about justice in different social context (Anthias 2002, 276). According to Reichert (2006, 28) in cultural relativism all views are valid and truth is relative. “It refers to a view that all cultures are equal and universal values become secondary when examining cultural norms. No outside value is superior to that of the local culture” (2006, 29). Relativists believe that “each society should formulate their own human rights standards in their context” so it is socially constructed and should not be imposed to other contexts (Katiuzhinsky and Okech 2012, 4). However,
Universalists warn against “anything goes” attitude and the risks of preferring group rights to individual rights (Katiuzhinsky and Okech 2012, 5).Cultural rights can justify activities that discriminate against women and other marginalised group in a community (Healy 2008) or it can endanger the right of society as a whole. Furthermore, cultural explanation over emphasises cultural aspects over social, economic and political. Immigrants are defined by their cultures and other relevant features of their lives are overlooked (Keskinen 2011). In the case of domestic violence, cultural relativism can justify the continuing abuse and oppression of women in the name of culture and respecting cultural differences in a multicultural society. The obvious example of focusing on cultural difference is the various cases of cultural defence in court rooms in regards to domestic violence trials where culture is used to acquit the abusers and justify the abuse (Razack 1998; Gallin 1994; Maguigan 1995).

over the issue of gender and human rights of women. In other words cultural relativism treats cultural and ethnic differences as a reason for celebration and fails to acknowledge sexist elements of cultures (Anthias 2002, 280).
On the other hand, this cultural relativism is in conflict with universalism. The concept of universalism got its reputation after World War II. The horrific consequences of the war lead to the idea that harm could result in allowing each country to define their own values regardless of human dignity. Universalism implies that “ some moral requirements are the same with everyone” (Reichert 2006, 27). Universalistic view emphasizes on universal standards of human rights for everyone regardless of their different cultural and ethnic background. It sees human rights as universal moral rights that all people everywhere and at any time should have
(Katiuzhinsky and Okech 2012). In the context of domestic violence; it condemns injustice to women, which has been imposed on them by their culture. Some liberal feminists defend universalism and reject cultural relativism. Their focus is on blaming culture as the main cause of women’s abuse. For example, both Nussbaum‘s (1995) and Okin’s (1999) arguments highlight the injustice to non-Western women caused by local cultural traditions. They criticize cultural relativism that in their view ignores the inequality and injustice of immigrant cultures. Okin
(1999 cited in Jagger, 2005:59) explains that “the rights claimed by minority groups may conflict with liberalism’s commitment to women’s equality, so that a tension exists between multiculturalism and feminism.” However, this overemphasizing on culture in relation to domestic violence and emphasising Western liberal universalism has been criticized by some scholars as they suppose it legitimizes men’s violence against women in some cultures and leads to this false belief that violence against women is only something that happens to others
(Crenshaw 1995). As Sokoloff and DuPont (2005b; cited in Pease and Rees 2008, 41) declare
“when we acknowledge that culture may be a part of the problem, there is a tendency to blame culture and to regard non-white cultures as more tolerant of men’s violence than white cultures.”
There have been some stereotypes that domestic violence in some minority groups is inherently part of their cultures. In other words, domestic violence is usually considered as cultural for non-white rather than white communities (Volpp 2011). When culture is considered as the only cause of domestic violence in immigrant families as Narayan (1997, 13; cited in
Jagger 2005, 68) argues the conclusion is that “these women suffer death by culture a fate from which western women seem curiously exempt”. It can also lead to what Razack (1998, 60) named culturalization of racism, where “black [immigrants] inferiority is attributed to ‘cultural deficiency’, social inadequacy and technological underdevelopment”. In the context of racism it sustains a tendency to blame the victims and backwardness of cultures which do not assimilate into liberal western culture. Here cultural difference does the same function as biological notion of race used to do. Racial discrimination is now expressed in the language of culture rather than biology (1998, 19).
In other words, the tension between feminism and multiculturalism or between cultural relativism and universalism is simply based on the assumption that minority cultures are more sexist than western culture. It assumes that minority women are passive victims who do not have any choice and are bound to their group-based determinism (Volpp 2005, 42). There are some problematic consequences of Okin’s term of the feminism versus multiculturalism discourse.
According to Anthias (2002, 278-279) in the responses to Okin’s (1999) argument, there are at least three critiques. First all cultures oppress women but in different ways. This is the case for western societies too. They claim that their societies have been based on Universalist ideals of equality and liberty. But as Volpp (2005, 41) argues this discourse reflects the common assumption of immigrant cultures as more sexist than western culture. “Incidents of sexual violence in the west are frequently thought to reflect the behavior of a few deviants-rather than a[n]integral part of our culture. In contrast, incidences of violence in the third world or immigrant communities are thought to characterize the cultures of entire nations”. Therefore by restricting culture to certain groups as othered, Okin is “reproducing stereotyped and potentially racist The second criticism is the danger of cultural imperialism in this argument that western universalist notion of human rights can bring justice to everyone in any social context. The last critique is that Western feminism ignores the different meanings of cultural practices for insiders and outsiders. For example, the traditional Hijab among Muslim women may be used as an act of independence against Western oppressive racism (2002, 279).
Furthermore, to simply link domestic violence to culture denies the protective role that culture plays in women’s lives (Thiara and Gill 2010, 49). It is noteworthy to remember that all cultures experience constant reshaping and transformation. Also, all cultures are contradictory and there may be prevalent acceptance of violence against women as well as old traditions of resistance and blaming violence (Warrier 2008, 541). Minority cultures like all mainstream cultures contain feminist values too. Each culture has strength as well as weakness but most of the time the tendency appears to be emphasizing the negatives. “It is essential to learn which characteristics might be protective against the effects of violence in different cultural and ethnic/racial communities” (Humphreys et al.2005 cited in Sokoloff, 2008:236).
Moreover, it is essential to mention another weakness of Universalist view which overlooks the significance of global factors and broader political and economic context which has been imposed by western globalisation and neoliberal policies around the world. For example, neoliberal globalisation and programs like structural adjustment particularly in South America and Southeast Asia destroyed small scale agricultures, business and industries which most of their employees were women. Many become seasonal, casual and temporary labourers with lower wages than their male counterparts, domestic workers or forced into prostitution or compulsory immigration (Jagger 2005). “Since gender inequality is strongly correlated with poverty, western countries bear a considerable share of the responsibility for creating the condition that make non-western women vulnerable to local violations of their rights” (2005, 69).
Moreover, supporting undemocratic and gender-conservative governments by Western states affect poor women of third world countries and add to their suffering. The best example is the
Taliban government of Afghanistan which practiced gender apartheid. The regime was established by US support and training of Mujahidin forces opposing the communist forces
(2005, 66). However, these examples do not suggest that poverty related abuse and other forms of discriminations against women are caused just by global factors. Rather these are the result of interaction of both global and local or structural and cultural factors.
Finally, it is noteworthy that both universalism and cultural relativism are based on fixed and unitary notions of individual and cultures. They overlook the dynamic character of culture and the fact that culture is a socially structured system and do not consider it as a process. Both try to homogenise cultures and ignore differences while, universalism overlooks the difference between groups, cultural relativism fails to see differences within groups. In the case of universalism there is a notion of universal principles of human rights that can be applied to all individuals in different cultural and social cultural political and economic contexts of oppression and discrimination. Whereas cultural relativism fails to notice differences of location based on gender, ethnicity, class and other sites in a particular social and cultural context (Anthias 2002,
276). In other words there are sub- cultural groups in each culture that cannot be seen as one homogenised unit.
Also one can argue that as there are different voices in each culture or community, whose voice representing the cultural needs and cultural rights of that group. Here it is essential to differentiate between two kinds of group rights. According to Kymlicka (1995) one group of minority rights which guard the interest of minority groups and those that impose restriction and limitation on their own members. The most evident example of the latter is women’s rights in a culture. In the context of gender rights it is often a traditional, patriarchal and discriminative male voice which claims to represent the cultural rights of a group. Therefore as Anthias (2002, 281)
Feminist Perspective and Development of Intersectionality
As mentioned before, the battle of gender equality and culture (or universalism and cultural relativism) creates a gap where other factors except culture or gender equality are missing. As
Volpp (2011) explains in order to understand the nature of women’s oppression in immigrant communities the analysis should be inclusive of other contextual and structural factors. Here, intersectionality is explained as a way to deal with the issue of domestic violence in a more realistic way.
First a review of the history of intersectionality and its relation to feminism seems essential.
Different approaches in the second wave feminism, from liberal to radical, have tried to find the base of women’s oppression and the plan for change. This movement was basically shaped around criticism of both notions of ‘sameness’ or an essential ‘difference’ between men and women. Liberal feminists argue that natural equality between men and women originated from their same human nature particularly their rational consciousness. So any difference will prevent women from developing their human capabilities. On the other hand, radical feminists believe in fundamental differences between men and women. In their view gender equality based on sameness is impossible as it plays down the difference. Though, equality is achieved by considering women’s separate needs according to their different biological or social conditions
(Ebert 1991, 889, 890). These views have been criticized by some early third-wave feminists such as feminists of colour and postmodern feminists.
Third wave feminism like second wave is not a uniform perspective but contains diverse approaches to feminism. However, these approaches share some commonality particularly in criticising second wave feminism. Their critiques are structured around the issue of differences, essentialism and universalism. For example, postmodern feminists reject any binary oppositions and categories such as sameness/difference, male/female, white/non-white and more. These categories are considered as false, hierarchical and patriarchal. For both postmodern and black feminists overemphasize differences between women and men in radical feminists’ view have led to insufficient attention to differences among women and among men.
Another critique is about essentialism and universalism of second wave feminism. Third wave feminism challenged essentialism and universalism of radical and liberal feminists, since “a heterosexual and socioeconomically privileged voice claims to speak for everyone” (Sokoloff,
Price, and Flavin 2004, 12). The universalism overlooked the diversity and difference of women.
It is based on the assumption that all women share the same life experience with the voice of white, middleclass, heterosexual woman as the voice of all women. Other locations of dominance such as class and race are not associated with women’s discriminatory position. In this universalism, gender was considered the main cause of women’s oppression. From these critiques of second wave feminism, black feminism or Intersectional feminism has developed.
Feminist intersectionality has evolved to explain additional factors that intersect with gender.
It is based on the assumption that each social group has unique qualities and there are interactions between different social identities such as race, gender and class. It is a system of knowledge that pursues social justice and tries to explain the process that lead to inequitable access to resources by oppressed people and groups (Kelly 2011, E43). Intersectionality focuses on interlocking system of oppression and discrimination while considering structural and cultural factors in shaping experience of abuse among immigrant women. The term ‘intersectionality’ was first coined by Kimberley Crenshaw (1994). Intersectionality is a way of understanding “the diversity and multiplicity of the experiences of women of colour in terms of identity, social location, and structural barriers that are based on multiple forms of oppression” (Mehrotra 2010,
420).This perspective acknowledges the importance of looking at the intersections between gender and other systems of oppression, such as race, class, sexual orientation, age, and disability
(McPhail et al. 2007, 819).What Collins (2000) calls the ‘matrix of domination’, Crenshaw
(1994) describes as a ‘crossroad’ and Yuval-Davis (2006) as ‘axes of difference’. In other words, the distinctive categories in a society, such as race, ethnicity, gender, religion, sexual orientation, class, and other indicators of identity and difference do not work independently but function as interlocking or intersectional phenomena (Zinn and Dill 1996; Crenshaw 1995;
Brewer 1993; Hill Collins 1993; King 1988). Furthermore, according to Dill-Thornton and
Zambrana (2009; cited in Mehrotra 2010) intersectionality recognizes different locations of inequality such as race, class, gender and sexuality as dynamic, contextual, historical and socially constructed that function at the micro-structural and macro structural levels (Burgess-
Proctor 2006, 37). Dill-Thornton and Zambrana (2009) argue that intersectionality is characterised by some theoretical features: first, placing lived experience of marginalised groups and their voices at the centre of the theory and considering the interaction of agency and social structures, second; exploring the complexities of individual and group identities which are socially constructed and changing, third; revealing how social inequality is functioning in power structure; and fourth, promoting social justice and change. Most recently, some scholars applied intersectional framework in developing theories of domestic violence.
In developing theories of domestic violence, according to an intersectional analysis
(Abraham 2000; Crenshaw 1994; Richie 1985, 2005; Sokoloff and Dupont 2005b; Sokoloff and
Pratt 2005; cited in Sokoloff 2008, 232) battered women’s oppression is often multiplied by their location at the intersections of particular race, ethnic, class, gender, sexual orientation, and immigrant systems of oppression and discrimination. It means that “the intersection of gender, race, and ethnicity, as well as the cultural differences and alienation experienced by immigrants, compound each other and become important criteria for the social construction of identity and marginalization”(Glass et al. 2011). Intersectionality does not regard traditional factors of oppression and marginalisation (such as race, class privileges, ethnicity, religion and physical ability) as independent factors. But those factors are viewed as intersecting with one another
(Crenshaw 1994; Collins 2000). As argued by Bograd (1999) domestic violence is not a monolithic phenomenon. In intersectional theory no factor alone can be the explanation of domestic violence. For example, gender inequality cannot occur in a vacuum but is modified by its intersection with other systems of power and abuse. These intersections expose immigrant women to dual marginalisation (Glass et al. 2011). In other words, to fully understand the experience of abused women, one must consider the total dimensions of their reality including their cultural orientation, socioeconomic status, age, etc. This point is one of the most significant contributions of intersectionality which is giving voice to abused women from diverse social and cultural background while still emphasising structural inequalities like racism, sexism, social class, and heterosexuality (Sokoloff and Dupont 2005a). This approach has been employed to study the experience of domestic violence not only among immigrant communities but also among native and indigenous women. As Laing (2000, 9; cited in Sokoloff 2008, 233) argues:
‘Many Aboriginal and Torres Strait Islander writers questioned the utility of a feminist analysis in addressing family violence within their communities, questioning its ability to include the important contexts of colonization, racism, and the ‘stolen generations’ in understanding the occurrence of domestic violence in Indigenous communities and to include Aboriginal men in the process of finding solutions to family violence’.
According to intersectional theory one group of factors cannot be regarded as the main cause of domestic violence or any other kinds of discrimination. Structural factors do not function independently from cultural and religious belief. On the other hand, culture cannot be blamed as the only cause of women’s abuse and oppression. Though, culture itself is shaped by other factors such as age, gender, class, race, ethnicity, immigrant status and sexual orientation argues, “the treatment of cultural differences must not erase structural power or it will undercut social change of the required political activism”.

Justice In the context of healthcare
, justice refers to distributive rather than corrective or retributive justice. By and large, justice concerns the equitable distribution of benefits and burdens unless exceptional conditions apply (Flew 1979). It covers fairness or even-handedness in dealing with patients and freedom from discrimination, and it is generally reflected in the phrase, allocate each to their own. Justice in healthcare tends to be largely focused on access to or denial of treatment in one form or another and may be something of a movable feast. For instance, one might ask where is the justice when some patients obtain access to expensive new drugs, the cost of which significantly erodes the available budget and increases waiting times for others? Does it make a difference if those expensive new drugs are potential lifesavers? Should we penalise chronic smokers with serious chest ailments or the clinically obese? Balancing and adjudicating priorities within limited resources must necessarily compromise some elements of justice and fairness. The philosopher John Rawls (1972) suggested that a sense of justice was vulnerable to bias, being influenced by one’s personal standpoint. His theoretical concept was of justice as fairness with an imaginary veil of ignorance, such that parties should contract into basic social structures or provisions without knowing in advance the position or role they would occupy. Of course, we cannot adopt a veil of ignorance in practice, but Rawl’s concept both highlights the dangers of how personal bias colours our sense of what is fair and just and emphasises the desirability of some form of independent assessment. There is no simple answer to the question of who gets dialysis or who receives a transplant when demand exceeds supply. In reality, there is no veil of ignorance; pure chance and the perceived postcode lottery may be significant factors. Calculations based on potential quality-adjusted lifeyears (QALYs) is one solution, but can hardly be seen as just if your personal QALY score means that you are ruled out or passed over for treatment. And of course QALYs tend to favour the young and disadvantage the old.

Beauchamp and Childress (2001) attempted to accommodate these vulnerabilities by asserting that in our daily lives, we deal with competing demands by making balanced judgements all the time. A structured way of carrying this out is by using a method known as reflective equilibrium. John Rawls (1972) first used the term ‘reflective equilibrium’ in his important work A Theory of Justice, though the method itself is attributed to Nelson Goodman (1983) working with processes of inductive logic.( (2005) the role of reflective equilibrium in ethical justification.) In practice, the method of reflective equilibrium operates just as the name indicates. Whatever the problem, we can gradually adapt our beliefs as to what could and should be done to achieve a reliable, coherent and defensible solution. This means firstly, identifying the facts, the relevant moral principles and the conflicting aspects; secondly, asking challenging questions and testing the answers against the defined problem. The process can be repeated over and over again; moving forwards and backwards with each refinement until a balanced resolution is obtained.

Respect for autonomy Autonomy is literally a capacity for self-government in the personal rather than political sense. It concerns the right to make one’s own decisions and to pursue one’s own actions, commensurate with an ability to be open to reason and to consider consequences. Autonomy is often coupled with moral agency because of the Kantian idea that only those who can reason, form self-interested judgements and reflect on their actions have that ability. That no one is entirely free in any of these respects is a feature of both the natural and cultural worlds. That our rights and our abilities to decide are invariably curtailed both by law and by circumstances means that autonomous decisions are almost always limited. Children Respect for autonomy 27 below a certain age, the senile and those otherwise mentally impaired are considered to be incapable of fully autonomous decisions

Human rights Human rights are also considered in the sense of broad entitlements can be derived from a concept of human dignity. The United Nations Declaration of Human Rights indicates that it is by virtue of the property of dignity that human beings possess certain inalienable rights. These rights underpin the limitations on how people should be treated and what they are entitled to do. We say that these rights are inalienable because to deny or obstruct such rights is considered to be an infringement of something both fundamental and intrinsic to every human being. Of course a declaration from the United Nations or any other public body does not of itself protect many human beings in some countries from infringement of their rights every day of the year. The concept of ‘rights’ is itself by no means unproblematic. Grounding or basing ‘rights’ in a concept of human dignity just pushes the difficulty of arguing for the validity of ‘rights’ a stage further back. It becomes necessary then to justify both the concept of human dignity and how that concept itself supports an understanding of human rights. Eventually in arguing for any moral belief we come to a point that is, in effect, for that individual ultimate or fundamental.
Indeed Anscombe (1958) suggested that longstanding moral beliefs may persist even where adherence to religion has declined:
‘’To have a law conception of ethics is to hold that what is needed for conformity with the virtues failure in which is the mark of being bad qua4 man (and not merely, say, qua craftsman or logician) – that what is needed for this, is required by divine law. Naturally it is not possible to have such a conception unless you believe in God as a law-giver; like Jews, Stoics, and Christians. But if such a conception is dominant for many centuries, and then is given up, it is a natural result that the concept of ‘obligation’, of being bound or required as by a law, should remain though they had lost their root; and if the word ‘ought’ has become invested in certain contexts with the sense of ‘obligation’ it too will remain to be spoken with a special emphasis and a special feeling in these contexts.’’ . We can therefore look at human rights in three ways (Sen, 2004): • as an unconditional consequence of some intrinsic property such as simply being human • through limited membership, for instance citizenship of a country
• in consequence of legislation

violence in relationships. This will lead to a thematic analysis of interviews with the DVworkers who spoke at length about their understandings of women’s use of violence inrelationships, and their experiences of the responses of the police and legal system. The paperconcludes by reflecting on the implications of these findings for policy and practice responsesto women’s violence, and the need for an expanded understanding of women’s agency in thecontext of violence.

Debates Over Women’s Use Of Violence In Relationships
DV is a major public health and human rights issue and a leading cause of injury and death to women in Australia (VicHealth, 2004) and internationally (García-Moreno, Jansen, Ellsberg ,Heise, & Watts, 2005). Approximately one third of Australian women report being struck byan intimate partner in their lifetime (Mouzos & Makkai, 2004). The cumulative social, economic and health impacts of DV has been estimated to cost $13.1 billion per annum in Australia (NCRVAWC, 2009). In their overview of the health burden of DV, state public health agency VicHealth (2004) concluded that it is the “leading preventable contributor todeath, disability and illness in Victorian women aged 15-44” (pg. 10). The study found thatDV is responsible for more ill-health and premature death among Victorian women under the age of 45 than other well known risk factors including high blood pressure, obesity and smoking.

Is care a virtue? The word care is something of a linguistic chameleon. We tend to overlook it or take it for granted unless drawn to our attention. Care as such, is not listed in Aristotle’s table of virtues and vices. If it were, we might perhaps expect care as an altruistic characteristic, to be positioned as the mean between the excess of paternalism and the deficiency of self-centredness. van Hooft (2003) defined the virtue of caring as ‘the comportment of the self towards others, which has the inherent goal of enhancing the existence of those others, whether they are others in intiIs care a virtue? 39 mate relationships to me, or others for whom I have professional responsibility…’ And Halwani (2003) suggested that we should think of care not as a simple natural virtue but as an important one harnessed by reason and contributing to a flourishing life. Indeed, care is undoubtedly a moral concept central to the very nature of professions such as medicine, pharmacy, nursing, dentistry, veterinary practice and others that in one way or another provide healthcare. How does the moral aspect of care arise? Firstly, the healthcare practitioner by virtue of her professional status owes a duty of respect and obligation to serve the interests of the patient. She does so in the context of the vulnerability that underpins the special relationship between a patient and a healthcare provider. The relationship is to an extent voluntary, in that the patient is not required to present a prescription or seek advice at a particular pharmacy. But in doing so, patient and practitioner enter into an informal or quasi-contract (see Goodin 1985). Among the various dictionary definitions of care, we can select two that cover the important aspects most directly related to healthcare: • care as an instrumental therapeutic activity: that is, intended to achieve a particular effect, whether prevention, alleviation or elimination • care as socio-emotional behaviour.

Moral relativism
What is considered to be wrong in the moral sense undoubtedly can and does sometimes change with time, laying all contemporary opinions open to a charge of moral relativism. In other words, what we believe to be right or wrong now may be judged differently in the future. Such thoughts of relativism have a long history, and Aristotle (384–322 BC), taught that whereas natural laws are immutable, that is unchangeable, not subject to variation, and have the same validity everywhere (as fire burns both here and in Persia), notions of justice (or men’s ideas of right and wrong) are variable (see Barnes 1976, p. 190). Aristotle’s example neatly emphasises the difference between a fact (in this case aspects of combustion) and a value (justice). The ancient Greek historian Herodotus (447–449 BC) highlighted cultural preferences for religious rites and customary observances: Moral relativism 9 For if one should propose to all men a choice, bidding them to select the best customs that there are, each race of men, after examining them all, would select those of their own people; thus thin

Social justice, theorising injustice, and the good society
Alongside the issues of individual rights in a just society, there is a body of ethical theory oriented to social justice, challenging the individualist concept of society and concerned with the relations among groups. Migration, minorities, and structural exclusion all call into question the models of a just society in which all those affected by a norm or a regulation have a voice in deliberations, or are able to make themselves heard. Over the past 20 years, one major stream of discussion on social justice and ethical theory has debated the alternative paradigms of economic redistribution (with a long tradition in justice discourse), understood to mean seeking to overcome structurally unequal access to material resources and the accompanying exclusion from social participation, versus k that their own customs are by far the best’.
These key three concepts are:
• deontological ethics • consequentialist ethics • virtue ethics. Moral relativism 11 Each theory adopts a different focus, baseline or emphasis as being pivotal in addressing moral questions, and hence can lead to alternative conclusions in considering what should be done in particular circumstances. The first two, deontological ethics and consequentialist ethics, are based on identified principles in the same way that nominated principles are likely to form the basis

Confidentiality: Danger to Others
In 1983, another court ruling (Jablonski by Pahls v. United States) widened the Tarasoff duty to include protecting intended victims of violence even when no specific threat was made. In this case, a psychiatric patient with a serious history of violence towards women killed his wife, even though he did not make any specific threats to her. The court ruled that the psychiatrist should have known that, because of the patients history of violence, he was likely to commit lethal violence towards his wife, and therefore reasoned that the psychiatrist had a duty to protect her by informing her of the danger her husband posed to her.
Again in 1983, another case broadened the therapists duty to protect by including unintended victims of violence (Hedlund v. Superior Court of Orange County). In this case, a client made a specific threat to the therapists to harm his wife, which was not communicated to the wife. The client subsequently shot the victim while she and her three-year-old child were in the car. Prior to the shooting, the women threw herself over the child to protect him. The child was not physically injured. The mother had her leg shot off by the shotgun. The mother sued the therapists for not warning her of the threats to her, nor of the danger to her child. The court ruled in favor of the mother and child, stating that the therapist had a duty not only to warn the mother of the threat against herself but also to warn her of the danger to her child, since the child was likely to be in close proximity to the mother when the offender would carry out his threat. The court also noted that this did not mean that the therapist must warn unidentifiable bystanders, but that common sense should dictate that certain identifiable persons in close proximity to the victim could also suffer harm and should be warned. This could be taken to include children, roommates, and other family members whom the offender had previously threatened or actually assaulted, or those in close proximity to the potential victim. With the courts tendency to considerably broaden the duty to protect potentially identifiable victims of violence, mental health professionals in California began to feel uncomfortable with the idea of having to predict violent behavior. Research in the area of violence prediction has consistently indicated that therapists were as often wrong as they were right in predicting violent behavior. Therefore, it was argued, placing the burden of making such predictions on the therapist was unfair and unreasonable. Yet therapists indicated that under certain circumstances it would be reasonable to expect a professional to take reasonable care to protect an identifiable victim of threatened violence. For example, research does indicate that individuals who make verbal threats of violence are likely to act on those threats. In 1986, Section 43.92 of the California Civil Code was enacted through legislation. This law indicates:
..... that there would be no monetary liability on the part of the therapist, if a client makes a specific threat of violence towards an identifiable victim and the therapist make a reasonable effort to communicate the threat to the victim and notifies the local law enforcement agency.
This section of the code does not completely overrule Tarasoff; it simply provides a practitioner with a pathway for immunity. Therefore a practitioner could exercise his or her Tarasoff duty by acting in other ways to protect intended victims of violence (e.g., involuntary hospitalization of the client), yet not be immune from liability.
Since these three cases, there have been numerous other cases across the country that have challenged the notion that therapist must act to protect others from the violence perpetrated by their clients, with and without specific threats to harm. Although there are exceptions, most courts appear to have used the California standard to guide their rulings. That is, when a specific threat is made to a identifiable victim, service provides must fulfill their duty to protect by contacting the intended victim and the law enforcement authorities.

Confidentiality: Child Abuse
In an ideal world the child abuse reporting statutes would be clear, unfortunately the opposite appears to be the case. Not only are there inconsistencies between states, but there are also inconsistencies within jurisdictions within each state. For example, child abuse reporting is a statutory requirement in every state. In Massachusetts, the standard for reporting is "...reasonable cause to believe...", whereas in Mississippi the standard is "...that a child brought to him or coming before him..." Thus the standard can vary from reasonable suspicion to actually seeing the abused child. Similarly, it has been the authors experience that a child protective service worker in one county in California, when given a specific set of circumstances, will suggest making a formal report whereas another worker either in the same or different county may not recommend making a formal report.
When surveyed, mental health professionals indicated that the child abuse reporting mandate was the most common of a number of confidentiality issues confronted in the course of their work. The findings of numerous studies have indicated that a significant number of clinicians have complied inconsistently with the legal mandate to report abuse. While there has been speculation that under-reporting results from professional responsibility and clinical judgment being subordinated to clinicians serving a policing function and concern for the patients welfare others believe that under-reporting, in part, stems from differences in the interpretation of the child abuse laws as well as situational and therapist characteristics. The problem of reporting is critical in cases of domestic violence as treatment decisions will be made based on the types of abuse occurring within the family and reports of child abuse may ultimately affect the clients status within the criminal justice system. Moreover, additional acts of abuse are frequently detected and/or perpetrated after the commencement of treatment and therefore the clinician working with this population must be prepared to deal with the need to report child abuse in addition to family violence.

The decision to report or not report is complex where the interests of the individual, the family, the profession and the community potentially come into conflict. Although most would agree that child abuse is appalling, there are many disagreements as to what actions should be taken to protect children who have been victimized and are at risk for further abuse. The fact that many therapists do not report abuse, in spite of the potential legal and ethical consequences, is evidence that legislation is not a panacea to address this complex social phenomenon. In exploring clinicians decision making, researchers have determined that a variety of factors appear to influence this process. These factors include responsibility for the abuse, history of abuse, severity of abuse, recantation, perception of the therapists role, type of abuse, socioeconomic status of patient and license of professional, years of practice, clinicians expectation of what potential expectations reporting may have on the individual or family, the perpetrators admission or denial of abuse, sex of therapist and alleged perpetrator, age of child, behavior of alleged victim, therapists history of reporting, perpetrators relationship to child, therapists knowledge of law and clarity of legal requirements. Given the significant number of variables identified, it is clear that in any given potential reporting circumstance how any unique combination of variables may operate synergistically to impact the decision to report or not. Therefore, at the least, clinicians must be intimately familiar with their states reporting statute.
The basic information that clinician need in order make informed clinical decisions is to be clear what constitutes child maltreatment according to scholars in the field and what is the reporting threshold within any particular community. This information, in conjunction with clinical consultation, will provide clearest direction necessary to enhance optimal decision making and thus, outcome.
While each type of maltreatment (physical abuse, sexual abuse, neglect and psychological abuse) is distinct in principle, in practice there is a great deal of overlap so that clinicians will rarely see only one type of abuse. However, for the sake of reporting, it is important to identify each type of abuse, describe it clearly based on the information received from the patient or family member.

Confidentiality: Reporting of Domestic Violence by Health Professionals
California Penal Code Section 11160-11163.5 provides mandatory reporting for any health practitioner provides medical services for a physical condition caused by domestic violence. This includes individuals employed in a physicians office, health facility, clinic, local or state public health department or a clinic or other type of facility operated by a local or state public health department. The injury must meet at least one of the following criteria. 1. Any wound or other physical injury, either self-inflicted or other inflicted, by means of a firearm. 2. Any wound or other physical injury inflicted upon the person where the injury is the result of assaultive or abusive conduct.
The health practitioner must make report immediately or as soon as practically possible by telephone to the local law enforcement agency. A written report shall be prepared and sent to the local law enforcement agency within two working days of receiving the information regarding the person.
Originally this law was written to include mental health professions. But there was concern that such a mandate would discourage victims from seeking mental health services. Although this law is primarily directed to physicians and other medical personnel, mental health professionals who working within these mandated settings may be required to report abuse disclosed by victims seeking medical services.
Confidentiality With Regard to Fellow Group Member
When treating perpetrators in a group setting, the program can not guarantee that confidentiality will not be violated by group members. In order to address this issue, programs should require that all group members sign a mutual agreement to confidentiality. In this agreement programs should require that patients promise to hold confidential all communications made by participants and all information obtained from or about any participant while in a group therapy session. Programs should ask participants to make these mutual promises of confidentiality to help to ensure that each member of the group will feel more comfortable revealing personal details about their lives enabling the therapist to obtain as much information as possible. This, of course, is necessary to receiving the maximum benefit from the treatment process. Although this measure does not guarantee that all members will abide by the rule, it does set the expectation that can then be addressed clinically or administratively when a client does violate his/her agreement.

On the basics of pharmauetical
Ethics has been described as the systematic study of moral choices; it concerns the values that lie behind them and the language used to describe them. Ethical decision making is the process whereby one recognises that a problem needs to be overcome or a difficult choice made, identifies the possible courses of actions, chooses one, takes it and then accepts responsibility. (When)...faced with ethical dilemmas pharmacists are expected to use their professional judgment in deciding on the most appropriate course of action (and) must be able to justify their decisions to their peers, and to any person or organisation which may be affected by their actions, including individual patients, the public, the National Health Service, their employers, and other health care professionals. Before accepting employment pharmacists must disclose any factors which may affect their ability to provide services. Where pharmacists’ religious beliefs or personal convictions prevent them from providing a service they must not condemn or criticise the patient and they or a member of staff must advise the patient of alternative sources for the service requested. reflect seven proposed key principles: • make the care of patients your first concern
• exercise your professional judgement in the interests of patients and the public
• show respect for people
• encourage patients to participate in decisions about their care • develop your professional knowledge and competence
• be honest and trustworthy
• take responsibility for your working practices. What is meant by a principle? Principles are considered to be fundamental truths or laws that we employ as a basis for deliberation or reasoning, or in deciding what action to take. Sometimes the term ‘principle ethics’ or ‘principlism’ is used when a set of so-called prima facie (‘on the face of things’ or ‘at first sight’) obligations form the basis of a particular approach.

Dilemmas and Perspectives The complexities of a gendered conflict transformation strategy are great, as are its challenges. it is by no means obvious how to deal politically with the inequalities and injustices produced by intersecting differences along the lines of gender, “race”, class or age. Changing gender relations, after all, might create new tensions. In war-torn societies, which have experienced violence and social upheaval, this might in turn lead to new forms of private and public violence. Feminism has developed three major strategies, which today are implicitly or explicitly adapted in most policy fields, from labour policies to development aid. They include equality and quota policies, affirmative action and identity politics. German sociologist and feminist Gudrun-Axeli Knapp (2001, 44) points to at least three problematic dimensions of these strategies. The “dilemma of equality” implies that ignoring difference by employing “equality policies” actually leads to inequality being maintained. Most “one size fits all” approaches lead to such problems, because they ignore the very different resources and capabilities that different people have. The “dilemma of difference” means that the disparate treatment of differences leads to the maintenance of discrimination. For example, affirmative action policies tend to re-create the categories of discrimination they actually set out to fight and dissolve. The “dilemma of identity” points to the fact that substantial group-identities always produce exclusions of the non-identical. For example, peace politics based on an assumption of the general peacefulness of women exclude all those men who might share such a habitus and severely underestimates the importance of women’s agency for war systems. Another complicating factor is a perceived “clash of cultures”: those women and men who struggle for social change, peace and gender justice in their societies often feel neglected and threatened by “western” activism at the same time. Cultural relativism on the part of “western” actors gives oppressive regimes leeway to hide human rights violations behind “traditions”. On the other hand, universalist projections of rights, gender roles and modernity have constantly and rightly provoked criticism because of the paternalism and neglect of local experiences related to such unilateral projects of emancipation. While there are no easy solutions to these dilemmas, there is some good advice. Cynthia Cockburn (2004, 29) argues: “An assumption of equality and similarity should prevail except when those liable to suffer from differentiation (women in this case) say that difference should be taken into account. […] When should women be treated as ‘mothers’, as ‘dependents’, as ‘vulnerable’? When on the contrary, should they be disinterred from ‘the family’, from ‘womenandchildren’ […], and seen as themselves, women – people, even? Ask the women in question. They will know.” Thus, successful conflict transformation should be geared towards supporting and initiating those social processes that are necessary for producing context-specific answers to these dilemmas. This implies a participatory approach and a willingness to learn on the part of those Section I: Challenges and Concepts Gender Relations, Violence and Conflict Transformation 151 who might come from the outside in order to support local conflict transformation. Knowledge transfer should always be a voluntary, two-way process. International concepts need to be adapted to the local context in a dialogue with those women and men who dare to challenge the gendered rules and restrictions of their societies. Very often, the local activists can suggest sustainable answers to the dilemmas of cultural context sensitivity and cultural relativism.

My thoughtrs Key moral concepts in healthcare beneficence • non-maleficence • respect for autonomy • justice. The overall intrest is that ethical judgements can be justified by reference to certain principles. The rubric of beneficence, nonmaleficence, respect for autonomy and justice, is used to form a bridge between so-called common morality (the norms that all morally serious people share) and the higher-level theories of morality that philosophers explore. Importantly, Beauchamp and Childress stressed that reliable, balanced judgements can be made even where there are competing claims from two or more of the principles.
In some respects, one principle good, two or more principles potentially problematic. Which of the principles takes precedence or are they considered to be of equal importance? It is not too difficult to imagine circumstances where the claims of beneficence and non-maleficence, or respect for autonomy and justice appear to be pulling in opposite directions. This conflict may be particularly intractable when attempting to accommodate the views and beliefs of two or more people. The principles themselves have the merit of being easy to remember and, at very least, serve as mental ‘post-its’, or to mix the metaphor, forget-menots of key factors in making healthcare decisions. Beneficence and non-maleficence Beneficence relates to acting in ways that benefit a patient, essentially doing good or being actively kind. Neither the RPSGB’s guide Medicines, Ethics and Practice (MEP; July 2006) nor the consultation document (RPSGB November 2006) expressly refers to a patient’s good or benefit. But these characteristics are implicit in the terms (patients’) interests or care, and in requirements to provide the best possible healthcare for the community. Non-maleficence is not the direct opposite of beneficence but concerns avoiding harming a patient. The phrase ‘above all do no harm’ is often used – do good if you possibly can, but above all do no harm. Both principles have a very long history in medicine and are clearly stated in the Hippocratic oath written in ancient Greece about 430 BC (Lloyd 1978): • I will use my power to help the sick to the best of my ability and judgement • I will abstain from harming any man by it. At first sight, the implications of the principles of beneficence and nonmaleficence are apparently clear and straightforward, but in practice may be rather less so. Perhaps what needs to be added is a requirement to take account of intention or purpose, and context. Prescribing medication with the intention of relieving a symptom, but which induces an unanticipated adverse response, is hardly beneficent from a patient’s point of view. Indeed, the result is distinctly maleficent, that is harmful. But such circumstances, though not uncommon, do not undermine the two principles – because the intention was to be both beneficent and non-maleficent. The doctor did not intend to harm the patient. We may say that the harmful effect was contingent, that is dependent on an uncertain event or circumstance. But what if the harmful consequence was not (entirely) unexpected?
It remains to re-emphasise that there is no single or preferred approach in ethical analysis and that individuals must develop their own systems with which they feel most comfortable. Almost inevitably, circumstances will vary from one ethical issue to another. At very least, we must always remember that, although we have much in common, all human beings are uniquely individual. Also, in a culturally diverse situation, awareness of and sensitivity to the religious and cultural backgrounds of patients and colleagues may be extremely important. Yes, there will always be similarities, but there will also be significant differences. In philosophy, the process of analogy has sometimes been put to good use in drawing out underlying aspects that can relate an issue to Moral relativism 21 previous experience, and an analogical process known as casuistry was once much favoured in the Catholic Church and used to explore special circumstances within a context of general rules. A term favoured by philosophers is ceteris paribus, meaning ‘all things being equal’. To an extent it is the universal get out clause, for in reality things are seldom if ever equal! A comment such as: ‘parents’ rights and responsibilities for their underage children, ceteris paribus, take precedence over consideration of a child’s autonomy’ should always flag up the possibility of a moral conflict and the need for caution. Finally, a practitioner may be faced with a moral dilemma in which a choice must be made between two or more seemingly mutually incompatible and possibly equally desirable or undesirable alternatives. Somehow a balance has to be struck or a hard decision taken

The ‘four-stage approach’
‘Our’ four steps are:
1. Gather relevant facts
2. Prioritise and ascribe values
3. Generate options
4. Choose an option.
To isolate legal and ethical issues from any clinical considerations, we use the following true scenario to illustrate application of our four-step process. Two pharmacists were reprimanded by the Statutory Committee in
1991 following convictions for the supply to a 17-year-old youth of sodium cyanide in one case and strychnine hydrochloride, potassium permanganate and glycerol in another (Anon. 1991a,b).

This suggests seeking answers to these questions in the following order. 1. Indications for medical intervention: establish a diagnosis, what are the options for treatment, what are the prognoses for each of the option?
2. Preferences of patient: is the patient competent? If so what does he/she want? If not competent, then what is in the patient’s best interest?
3. Quality of life: will the proposed treatment improve the patient’s quality of life?
4. Contextual features: do religious, cultural, legal factors have an impact on the decision?
Trevino and Nelson (1995, pp. 85–90) describe a different stepwise approach, this time in the context of business ethics.
1. Gather the facts
2. Define the ethical issues
3. Identify the affected parties
4. Identify the consequences
5. Identify the obligations
6. Consider your character and integrity
7. Think creatively about pot
Masculinities and Violence Empirically, men run a high risk of experiencing (physical) violence ranging from “private” domestic violence, e.g. by parents against their children, to public criminal violence, e.g. in youth gangs, or sexualised violence, e.g. in prisons or as means of torture. Most violent crimes accounted for are perpetrated among men. Many acts of violent crime during times of peace are committed exclusively within male groups (Farr/Gebre-Wold 2002). As a consequence, the overwhelming majority of prison inmates today are male. Most soldiers are men, as are most military victims of war. And in ethnopolitical conflicts, young civilian men frequently become victims of massacres because they are anticipated to be the “future soldiers of the enemy” (for Rwanda, see Zdunnek 2002; for Bosnia, see Cockburn/Zarkov 2002).

Femininities and Violence The “feminine face” of war (Wasmuht 2002, 88) is as diverse as the male one. In terms of intersectionality, for example, female members of the dominant ethnopolitical or social class may have as much interest in the escalation and the maintenance of violence as men. Like men, they may be driven by greed and grievance, by the belief in ideologies or the struggle for personal gains in power and money. Women may be active or passive supporters of militarised masculinities and, therefore, involved in maintaining a violent conflict culture. As soldiers, nurses, suppliers, weapon producers and smugglers, women also actively sustain armed conflict. Even marginalised women may profit economically from a violent conflict by supplying the troops as merchants. Women have not only been fighters in armies or guerrilla groups (Hagemann/SchülerSpringorum 2002). They have also played a major role in the execution of collective violence in totalitarian and genocidal systems, as evident in Rwanda where women were heavily involved in violence (Zdunnek 2002; McKelvey 2007)

Conclusion Race, class, gender, sexuality, age, ability, nation, ethnicity, and similar categories of analysis are best understood in relational terms rather than in isolation from one another. These mutually constructing categories underlie and shape intersecting systems of power; the power relations of racism and sexism, for example, are interrelated. Intersecting systems of power catalyze social formations of complex social inequalities that are organized via unequal material realities and distinctive social experiences for people who live within them. Because social formations of complex social inequalities are historically contingent and crossculturally specific, unequal material realities and social experiences vary across time and space. Individuals and groups differentially placed within intersecting systems of power have

To sum up, the discussion about the dilemma of gender equality and culture or universalism and cultural relativism leaves a vacuum that overlooks other factors. Reviewing the literature reveals the deficiency of one dimensional analysis of domestic violence. On one hand, cultural relativism is reluctant to sexism and hereby may overlook discrimination against abused women. On the other hand, over- emphasising structural factors can result in universalism which ignores women’s particular experiences and values. Intersectionality as an alternative approach goes beyond single- factor analysis of women’s oppression and abuse. It criticises the application of universal rights to all women as well as theories which consider cultural difference as the major difference between women. According to this approach, cultural practices are multiple and experienced differently in different contexts. However across different cultures, common structural factors can be found that shape cross-cultural discourses and analysis of domestic violence. Finally, intersectionality views women’s lives as multilayered identities which stem from race, class, ethnicity, sexual orientation, culture, age, immigration status and yet is seen as a whole. Focusing on different cultural and structural factors in intersectional theory does not obscure the importance of women’s agency. It helps women to voice their experiences and compare them in a dialogical and reflexive manner.

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