{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:11:25Z","timestamp":1789150285381,"version":"build-2803163510"},"reference-count":55,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"abstract":"<jats:p>Governments and international bodies have issued a great many artificial intelligence (AI) ethics guidelines over the past decade, yet evidence that they change how AI is built and deployed remains thin. This paper argues that the implementation gap in AI ethics is not only a shortfall of tools. In caring contexts, it is a consequence of moral form. Mainstream AI ethics operates, in its prevailing form, as an ethics of justice: principlist, calculative, and oriented toward what can be formalised. The claim is not that care is absent from its vocabulary. It is that the principles amenable to technical fixes, such as accountability, fairness and privacy, appear to be the ones that reach operational guidance, while dignity, relational autonomy and the prevention of suffering seem more often to be named than operationalised. Community-based care for older adults serves as a critical case. Assessed against established criteria for implementability and usability, the World Health Organization\u2019s guidance for health remains practicable in principle but not readily applicable at the point of care for this population, and the harms that matter most here, among them ageism, infantilisation, deception and social isolation, are barely registered. The paper does not call for abandoning principlism but for completing it. It sets out what a care-grounded reading changes in a single case, states what an ethics of care cannot do, and reframes implementation as ethical translation: the movement of a general commitment into the situation of a particular person. Nursing, situated where principle meets the particular patient, may hold a distinctive though not exclusive standpoint from which to contribute to that work. As a theoretical paper, this work involved no human or animal participants and required no ethical approval.<\/jats:p>","DOI":"10.1177\/09697330261483594","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:00:18Z","timestamp":1788944418000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["An ethics of justice without an ethics of care: Why artificial intelligence ethics guidelines remain unimplementable in community care for older adults"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2109-9885","authenticated-orcid":false,"given":"Claire Su-Yeon","family":"Park","sequence":"first","affiliation":[{"name":"CEO, Center for Econometric Optimization in the Nursing Workforce"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"e_1_3_7_2_2","volume-title":"Ethics guidelines for trustworthy AI","author":"European Commission","year":"2019","unstructured":"European Commission. Ethics guidelines for trustworthy AI. European Commission, 2019."},{"key":"e_1_3_7_3_2","volume-title":"Recommendation on the ethics of artificial intelligence","author":"UNESCO","year":"2021","unstructured":"UNESCO. Recommendation on the ethics of artificial intelligence. UNESCO, 2021."},{"key":"e_1_3_7_4_2","volume-title":"Ethics and governance of artificial intelligence for health: WHO guidance","author":"World Health Organization","year":"2021","unstructured":"World Health Organization. Ethics and governance of artificial intelligence for health: WHO guidance. World Health Organization, 2021."},{"key":"e_1_3_7_5_2","first-page":"729","volume-title":"Proceedings of the 2018 26th ACM joint meeting on european software engineering conference and symposium on the foundations of software engineering (ESEC\/FSE 2018)","author":"McNamara A","year":"2018","unstructured":"McNamara A, Smith J, Murphy-Hill E. Does ACM\u2019s code of ethics change ethical decision making in software development? In: Proceedings of the 2018 26th ACM joint meeting on european software engineering conference and symposium on the foundations of software engineering (ESEC\/FSE 2018). Association for Computing Machinery, 2018, pp. 729\u2013733."},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11023-020-09517-8"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11948-021-00336-3"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocaf167"},{"key":"e_1_3_7_9_2","volume-title":"In a different voice: psychological theory and women\u2019s development","author":"Gilligan C","year":"2016","unstructured":"Gilligan C. In a different voice: psychological theory and women\u2019s development. Harvard University Press, 2016."},{"key":"e_1_3_7_10_2","volume-title":"The ethics of care: personal, political, and global","author":"Held V","year":"2006","unstructured":"Held V. The ethics of care: personal, political, and global. Oxford University Press, 2006."},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/s42256-019-0088-2"},{"issue":"1","key":"e_1_3_7_12_2","first-page":"1","article-title":"A unified framework of five principles for AI in society","volume":"1","author":"Floridi L","year":"2019","unstructured":"Floridi L, Cowls J. A unified framework of five principles for AI in society. Harvard Data Sci Rev 2019; 1(1): 1.","journal-title":"Harvard Data Sci Rev"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.0000810"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1145\/3306618.3314289"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/jmp\/15.2.219"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1353\/ken.0.0111"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1038\/s42256-019-0114-4"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/s42256-020-0195-0"},{"key":"e_1_3_7_19_2","first-page":"1","volume-title":"Psychiatric and mental health nursing for Canadian practice","author":"Austin W","year":"2022","unstructured":"Austin W, Kent-Wilkinson A. Legal and ethical aspects of practice. In: Austin W, Kunyk D, Peternelj-Taylor CA, et al. (eds). Psychiatric and mental health nursing for Canadian practice. 5th ed. Wolters Kluwer, 2022, pp. 1\u201328.","edition":"5"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1080\/13501763.2022.2144419"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-30371-6"},{"key":"e_1_3_7_22_2","volume-title":"Moral philosophy and moral life","author":"Christensen A-MS","year":"2021","unstructured":"Christensen A-MS. Moral philosophy and moral life. Oxford University Press, 2021."},{"key":"e_1_3_7_23_2","volume-title":"Moral boundaries: a political argument for an ethic of care","author":"Tronto JC","year":"1993","unstructured":"Tronto JC. Moral boundaries: a political argument for an ethic of care. Routledge, 1993."},{"key":"e_1_3_7_24_2","volume-title":"Caring democracy: markets, equality, and justice","author":"Tronto JC","year":"2013","unstructured":"Tronto JC. Caring democracy: markets, equality, and justice. New York University Press, 2013."},{"key":"e_1_3_7_25_2","unstructured":"Crawford K Joler V. Anatomy of an AI system. https:\/\/anatomyof.ai\/ (2018). Accessed 3 February 2023."},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-022-00819-3"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnab167"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnac144"},{"key":"e_1_3_7_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/josi.12157"},{"key":"e_1_3_7_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11031-022-09989-4"},{"issue":"1","key":"e_1_3_7_31_2","first-page":"59","article-title":"Artificial intelligence as a means of infantilization","volume":"2","author":"Pembecio\u011flu N","year":"2022","unstructured":"Pembecio\u011flu N. Artificial intelligence as a means of infantilization. Artif Intell Theory Appl 2022; 2(1): 59\u201373.","journal-title":"Artif Intell Theory Appl"},{"key":"e_1_3_7_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10676-010-9234-6"},{"key":"e_1_3_7_33_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1021386708994"},{"key":"e_1_3_7_34_2","doi-asserted-by":"publisher","DOI":"10.1109\/MTS.2020.2967493"},{"key":"e_1_3_7_35_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-019-0437-z"},{"key":"e_1_3_7_36_2","first-page":"1","article-title":"Virtual carers for the elderly: a case study review of ethical responsibilities","volume":"2","author":"Garner TA","year":"2016","unstructured":"Garner TA, Powell WA, Carr V. Virtual carers for the elderly: a case study review of ethical responsibilities. Digit Health 2016; 2: 1\u201314. https:\/\/doi.org\/10.1177\/2055207616681173","journal-title":"Digit Health"},{"key":"e_1_3_7_37_2","doi-asserted-by":"publisher","DOI":"10.1177\/09697330241312383"},{"key":"e_1_3_7_38_2","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2025.1643238"},{"key":"e_1_3_7_39_2","volume-title":"Ethics and governance of artificial intelligence for health: guidance on large multi-modal models","author":"World Health Organization","year":"2024","unstructured":"World Health Organization. Ethics and governance of artificial intelligence for health: guidance on large multi-modal models. World Health Organization, 2024."},{"key":"e_1_3_7_40_2","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-26"},{"key":"e_1_3_7_41_2","doi-asserted-by":"publisher","DOI":"10.1002\/chp.47"},{"key":"e_1_3_7_42_2","doi-asserted-by":"publisher","DOI":"10.3928\/19404921-20150522-02"},{"issue":"2","key":"e_1_3_7_43_2","first-page":"65","article-title":"Usability: a concept analysis","volume":"19","author":"Shultz S","year":"2015","unstructured":"Shultz S, Hand MW. Usability: a concept analysis. J Theor Construct Test 2015; 19(2): 65\u201370.","journal-title":"J Theor Construct Test"},{"key":"e_1_3_7_44_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11948-011-9343-6"},{"key":"e_1_3_7_45_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10676-016-9409-x"},{"key":"e_1_3_7_46_2","doi-asserted-by":"publisher","DOI":"10.1525\/9780520352797"},{"key":"e_1_3_7_47_2","doi-asserted-by":"publisher","DOI":"10.1177\/1463499607077295"},{"key":"e_1_3_7_48_2","doi-asserted-by":"publisher","DOI":"10.1111\/scs.13036"},{"key":"e_1_3_7_49_2","doi-asserted-by":"publisher","DOI":"10.1111\/nup.12306"},{"key":"e_1_3_7_50_2","doi-asserted-by":"publisher","DOI":"10.1177\/09697330251366619"},{"key":"e_1_3_7_51_2","doi-asserted-by":"publisher","DOI":"10.1177\/09697330251366599"},{"key":"e_1_3_7_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2026.102808"},{"key":"e_1_3_7_53_2","doi-asserted-by":"publisher","DOI":"10.1002\/9781444315516"},{"key":"e_1_3_7_54_2","doi-asserted-by":"publisher","DOI":"10.1353\/sor.2019.0046"},{"key":"e_1_3_7_55_2","volume-title":"How is it between us? Relational ethics and care for the world","author":"Zigon J","year":"2024","unstructured":"Zigon J. How is it between us? Relational ethics and care for the world. HAU Books, 2024."},{"key":"e_1_3_7_56_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-018-0637-6"}],"container-title":["Nursing Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261483594","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09697330261483594","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261483594","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:50:57Z","timestamp":1789149057000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09697330261483594"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":55,"alternative-id":["10.1177\/09697330261483594"],"URL":"https:\/\/doi.org\/10.1177\/09697330261483594","relation":{},"ISSN":["0969-7330","1477-0989"],"issn-type":[{"value":"0969-7330","type":"print"},{"value":"1477-0989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"article-number":"09697330261483594"}}