An area agency on aging is a public or private nonprofit organization designated by the state to address the needs and concerns of all older persons at the regional and local levels in the United States 2019). AAAs have a successful history of developing, coordinating, and implementing comprehensive networks of services and programs that enrich communities and the lives of older adults. AAAs were established through a provision of the Older Americans Act, which was signed into law by President (...) Lyndon B. Johnson. Specifically, AAAs were created with the 1973 reauthorization of the OAA. AAAs create the infrastructure to execute comprehensive long-term support services that ensure the independence of older adults. (shrink)

An area agency on aging (AAA) is a public or private nonprofit organization designated by the state to address the needs and concerns of all older persons at the regional and local levels in the United States (Administration for Community Living (ACL) 2019). AAAs have a successful history of developing, coordinating, and implementing comprehensive networks of services and programs that enrich communities and the lives of older adults. AAAs were established through a provision of the Older Americans Act (OAA (...) 1965), which was signed into law by President Lyndon B. Johnson. Specifically, AAAs were created with the 1973 reauthorization of the OAA. AAAs create the infrastructure to execute comprehensive long-term support services that ensure the independence of older adults. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medicine-Based Values?Åge Wifstad (bio)KeywordsEthics committees, judgment, common moralityToulmin's DiagnosisIn his classical article with the unforgettable title "How medicine saved the life of ethics" (Toulmin 1982), Stephen Toulmin claims that medicine saved ethics by giving the philosophers a positive reality check through medical challenges: (1) Ethics in medicine is a serious topic, not just something to discuss at seminars. If, for example, both A and B need treatment and there (...) are only enough resources for one, the fundamental interests of these two people compete against each other. (2) In clinical medicine, the individual case might demand a different approach than that suggested by theory. Similarly, an ethicist who is confronted by a diversity of medical cases becomes aware of the fact that solutions drawn from ethical theory can be irrelevant in practice. (3) The moral philosopher has often focused on the individual and his or her universal commitments. The fact that ethical dilemmas can have deep roots in practical challenges and must be understood within a certain context has been "forgotten." (4) In clinically relevant ethics, it is important to find solutions that all involved parties find reasonable. This revitalizes central Aristotelian schools of thought on, for example, ethical judgment and situational understanding.Today, there is a common understanding that in both the education of doctors and in the implementation of medical knowledge and technology there needs to be ethical guidelines and control. Toulmin wants us to see that the background for this agreement is multifaceted. It was not just the ethicists who saved the doctors. The doctors helped the ethicists to escape their academic isolation.Ethics CommitteesThe establishment of ethics committees is perhaps the most interesting example of this. Here it is especially clear how ethical judgment establishes a basis for decision making: Each case presented to an ethics committee is special because one cannot reference decisions made in similar cases. At the same time, we are expected to handle similar cases equally. Consideration of the concrete, individual case must be balanced with the principle of similar treatment. Second, as a committee member, one must interpret and respect ethical principles that cannot be easily defined. Every principle must be interpreted and implemented within a specific and concrete context. Third, one must consider the law, but seen isolated, the implications of relevant rules can be difficult to determine. Fourth, the status of principles and rules are open for interpretation. The most important example of this is the Declaration of Helsinki, which was established through cooperation between the worlds' doctors unions. The strength and end result of such a document can be discussed. Fifth, multiple but partly conflicting juridical and ethical considerations can be [End Page 179] relevant at the same time. An example: Decisions about confidentiality can prevent data gathering that is crucial in ensuring that a research project is scientifically acceptable. Two important ethical considerations are then put up against one another. As a sixth and final point, it can be mentioned that the ethics committee is expected to make a qualitative, scientific judgment. But what kind of quality judgment and how detailed it should be is up for discussion.Two Definitions of Ethical JudgmentThe fact that the committee must base their holistic decision on ethical judgment means that the committee, in an important sense of the word, stands freely: It can be difficult to refer to specific ethical rules or laws when making an external review of the committee's decision. Unless the committee has clearly not followed known principles and rules, then the committee is able to confront criticism by replying that the decision is based on holistic considerations, where many views have been taken into account. In this way, the usage of ethical judgment makes sure that the committee has freedom to act. The catch here is that the committee's responsibility becomes even more obvious. One cannot simply say that the decision is made based on rules and principles formulated by others, such as the state. The committee must, as a unit, be able to defend their decision.The complexity of the work of the committee can, however, make it more tempting to think about ethics in... (shrink)

Public health emergencies such as pandemics can put health systems in a position where they need to ration medical equipment and interventions because the resources available are not sufficient to meet demand. In public health management, the fair allocation of resources is a permanent and cross-sector issue since resources, and especially economic resources, are not infinite. During the COVID-19 pandemic resources need to be allocated under conditions of extreme urgency and uncertainty. One very problematic aspect has concerned intensive care medicine (...) and age discrimination has been among the most hotly discussed issues, as age has been touted as a probable criterion for selection. In this paper we analyse some documents originating from scientific societies and medical associations, mainly related to EU sphere and available in English, French, Spanish and Italian, concerning the criteria for admission to the intensive care units. We highlights how, in most of these documents, it is explicitly stated that “age itself” is not a criterion for patient selection. Our conclusion is that these criteria should be defined in advance of a crisis situation and be grounded in clinical indicators. Establishing “cut-off” policies with regard to criteria such as age or chronic disability is definitely an unjustifiable form of discrimination even in the context of a public health emergency. (shrink)

During the COVID-19 pandemic, focused protection strategies including selective lockdowns of the elderly were proposed as alternatives to general lockdowns. These selective restrictions would consist of isolating only those most at risk of COVID-19 hospitalization and subsequent use of healthcare resources. The proposal seems to have troubling implications, including the permissibility of selective lockdown on the basis of characteristics such as ethnicity, sex, disability, or BMI. Like age, these factors also correlated with an increased risk of hospitalization from COVID-19. (...) In this paper, we argue that age has meaningful differences as a morally relevant characteristic in the justification for selective restrictions of liberty. Thus, it might justify selective freedom restrictions in a way in which other factors might not. We offer four moral domains that separate age from other proxies: empiricism, operationality, discrimination, and disparity. (shrink)

How care can resist the stifling force of the neoliberal paradigm In a world brimming with tremendous wealth and resources, too many are suffering the oppression of precarious existences--and with no adequate relief from free market-driven institutions. Care Ethics in the Age of Precarity assembles an international group of interdisciplinary scholars to explore the question of care theory as a response to market-driven capitalism, addressing the relationship of three of the most compelling social and political subjects today: care, precarity, and (...) neoliberalism. While care theory often centers on questions of individual actions and choices, this collection instead connects theory to the contemporary political moment and public sphere. The contributors address the link between neoliberal values--such as individualism, productive exchange, and the free market--and the pervasive state of precarity and vulnerability in which so many find themselves. From disability studies and medical ethics to natural-disaster responses and the posthuman, examples from Māori, Dutch, and Japanese politics to the COVID-19 pandemic and the Black Lives Matter movement, this collection presents illuminating new ways of considering precarity in our world. Care Ethics in the Age of Precarity offers a hopeful tone in the growing valorization of care, demonstrating the need for an innovative approach to precarity within entrenched systems of oppression and a change in priorities around the basic needs of humanity. Contributors: Andries Baart, U Medical Center Utrecht, Tilburg U, and Catholic Theological U Utrecht, the Netherlands; Vrinda Dalmiya, U of Hawaii, Mānoa; Emilie Dionne, U Laval; Maggie FitzGerald, U of Saskatchewan; Sacha Ghandeharian, Carleton U; Eva Feder Kittay, Stony Brook U/SUNY; Carlo Leget, U of Humanistic Studies in Utrecht, the Netherlands; Sarah Clark Miller, Penn State U; Luigina Mortari, U of Verona; Yayo Okano, Doshisha U, Kyoto, Japan; Elena Pulcini, U of Florence. (shrink)

The last decade has seen the emergence of a feminist awareness of old age and, in particular, a growing awareness of what has come to be seen as “the problem of old women.” Old women, it has been consistently demonstrated, are disadvantaged in a variety of ways in relation to old men. They are poorer, older, and sicker; they have less adequate housing and less access to private transport; they are more likely to experience widowhood, severe disability, and institutionalization. (...) Taking “the problem of old women” as its starting point, this article argues for a less phallocentric analysis of women in old age, which is less reliant on men as a relational category to define the conditions, experiences, and resources of older women. (shrink)

Resource added for the Nursing-Associate Degree 105431, Practical Nursing 315431, and Nursing Assistant 305431 programs.

Environmental commodification, trading and offsetting are business as usual approaches to environmental policy. There is also consensus across political divides about the need for economic growth. Many environmental NGOs have become apologists for corporate self-regulation, market mechanisms, carbon pricing/trading and biodiversity offsetting/banking, while themselves commercialising species 'protection' as eco-tourism. In this issue of Environmental Values the state and direction of the environmental movement are at the fore. D'Amato et al. contrast pragmatism with the need for revolutionary change and consider which (...) will achieve social ecological transformation. Parry raises the issue of how animal activists should operate within an idealised deliberative democracy and what they could then legitimately justify doing to further their cause. Quist and Rinne are concerned with the challenges that disenfranchised groups face in building shared agendas and expressing themselves in their struggles to protect the environment and their ways of life. How natural resource extraction issues are framed by the media is the concern of Davies et al. Issues of power, inclusion and representation in the environmental movement are also raised in the paper by Fenney, which addresses the challenges specifically faced by disabled people. Societal change is an inherently value laden and political issue. Environmental policy is no more a win-win than any other policy; this journal issue shows how different polices change winners and losers. (shrink)

The two target articles in this issue draw an important connection between disability bioethics and geriatric bioethics. Dominic JC Wilkinson makes a pragmatic case for using frailty as a fa...

This article examines the Belarusian protests of 2020, triggered by the rigged presidential election results and the illegal disproportionate use of force by the authorities. Given that most protesters were apolitical before 2020, the article seeks to clarify how it happened that passive vulnerable individuals were unprecedentedly mobilized for sustained collective political action. The author focuses on protest actions organized by particularly vulnerable social groups (women, pensioners, the disabled) and reveals their importance for the democratic protest against the patriarchal-authoritarian order. (...) The article traces three stages in the protest development: the moment of traumatic shaking, the caesura of the political sublime, and the rapid scale of the peaceful protest movement characteristically represented by the social groups in question. It is argued that their protest actions had a subversive effect with respect to the autocratic rule and re-actualized an alternative normative and axiological horizon in a given life-world. (shrink)

How are we to decide where our scarce medical resources are most effectively spent? The notion of a quality-adjusted-life-year has been proposed as a way of doing this. Some economists appear to think that this can be done without making ethical assumptions. We examine the application of this notion to the treatment of premature newborns, and especially to comparisons between the value of medical care for newborns, and the value of medical care for older people. We find that some highly (...) questionable ethical assumptions are inovled in such comparisons. (shrink)

본 논문의 목적은 새로운 기술 시대의 인간과 장애의 문제를 포스트휴먼적 관점에서 재해석하여 그것을 이론적, 실천적으로 극복할 수 있는 가능적 근거를 마련하는 것에 있다. 인권의 중요성과 더불어 장애와 장애인에 대한 문제는 중요하게 다루어져왔지만, 장애에 대한 근본적인 고찰의 결여로 장애는 여전히 정상과 비정상이라는 이분법적 구조 속에서 이해되었고, 장애를 가진 이들은 비정상의 범주에 분류되어 평가받는 대상에 머물렀다. 본고에서는 장애상태를 부정하지는 않되, 장애의 의미를 재해석함으로써 이 문제를 해결할 수 있는 근거를 찾고자 한다. 장애를 사회적 약자로 만드는 것은 사회적 구조의 문제이다. 그러나 사회적 시스템을 보완한다고 (...) 하더라도 장애는 늘 발생하며, 장애에 대한 인식 또한 변하지 않는다는 것은 주지의 사실이다. 장애에 관한 본질적인 문제 해결을 위해서는 장애를 가진 이들을 약자로 규정하여 보호하는 것에 머물지 않고 그들의 몸을 ‘고유한’ 몸으로 이해함으로써 보호가 아닌 권리의 주체로 이해하는 것이 필요하다. 고유한 몸인 나는 세계속에 거주하는 방식을 스스로 선택하고 요구할 수 있는 권리를 가진다. 게다가 새로운 기술시대, 디지털의 등장으로 인해 몸은 더 이상 수동성에 머물지 않고 능동적으로 변신한다. 변신하는 몸이 정상성으로 향하여 간다면, 그 몸은 여전히 평가받고 소외된 몸일 수밖에 없다. 따라서 모든 몸들의 권리를 회복하는 길을 모색하는 길이 우선적이다. (shrink)

The economic pastoral letter states that employees have rights to employment, non-discriminatory treatment, adequate wages, health care, old age and disability insurance, healthy working conditions, rest and holidays, reasonable protection from arbitrary dismissal, notice of plant closings, unionization and collective bargaining. In addition, the bishops call for better cooperation between labor and management. This paper discusses how these rights can be protected by good personnel/human resource policies and procedures.

Hastings Center Report, Volume 52, Issue 1, Page 21-28, January/February 2022.

Ideas found in the early Daoist texts can inform current debates about disability, since the latter often involve assumptions about personhood and agency that Daoist texts do not share. The two canonical texts of classical Daoism, the Daodejing and the Zhuangzi, do not explicitly discuss disability as an object of theory or offer a model of it. They do, however, provide conceptual resources that can enrich contemporary discussions of disability. Two particular ideas are discussed here. Classical Daoist (...) thinking about the body undermines normative assumptions about it that attributions of ‘disabled’ often depend upon; and Daoism vividly problematises the common inferential leap from perceived and pronounced incapacity to a more general judgment of “useless”. In conclusion, I suggest that Daoism’s skepticism and particularistic approach to experience suggest caution about the value of appealing to theoretical models of disability. (shrink)

To date, bioethics and health policy scholarship has given little consideration to questions of aging and intergenerational justice in the developing world. Demographic changes are precipitating rapid population aging in developing nations, however, and ethical issues regarding older people’s claim to scarce healthcare resources must be addressed. This paper posits that the traditional arguments about generational justice and age‐based rationing of healthcare resources, which were developed primarily in more industrialized nations, fail to adequately address the unique challenges facing (...) older persons in developing nations. Existing philosophical approaches to age‐based resource allocation underemphasize the importance of older persons for developing countries and fail to adequately consider the rights and interests of older persons in these settings. Ultimately, the paper concludes that the most appropriate framework for thinking about generational justice in developing nations is a rights‐based approach that allows for the interests of all age groups, including the oldest, to be considered in the determination of health resource allocation. (shrink)

To date, bioethics and health policy scholarship has given little consideration to questions of aging and intergenerational justice in the developing world. Demographic changes are precipitating rapid population aging in developing nations, however, and ethical issues regarding older people’s claim to scarce healthcare resources must be addressed. This paper posits that the traditional arguments about generational justice and age-based rationing of healthcare resources, which were developed primarily in more industrialized nations, fail to adequately address the unique challenges facing (...) older persons in developing nations. Existing philosophical approaches to age-based resource allocation underemphasize the importance of older persons for developing countries and fail to adequately consider the rights and interests of older persons in these settings. Ultimately, the paper concludes that the most appropriate framework for thinking about generational justice in developing nations is a rights-based approach that allows for the interests of all age groups, including the oldest, to be considered in the determination of health resource allocation. (shrink)

pt. 1. Background you need. -- What is brain-compatible teaching -- The old and new of it -- When brain research is applied to the classroom everything will change -- Change can be easy -- We're not in Kansas anymore -- Where's the proof -- Tools for exploring the brain -- Ten reasons to care about brain research -- The evolution of brain models -- Be a brain-smart consumer: recognizing good research -- Action or theory: who wants to read all (...) that research -- Excellent sources of research -- Fun factoids on the brain -- What's in the human brain -- Brain teaser -- The brain divided -- The brain connected -- Brain geography -- Brain "cell" ebration: far-out facts about brain cells -- Learning happens but how -- Are today's kids different -- Boy's and girl's brain differences -- Learning disabilities; different brains -- The cranial soup bowl: understanding the chemicals in our brains -- pt. 2. The foundation for teaching is principles, not strategies. What are the principles -- Principle 1: the principle of change: brain is dynamic, not fixed -- Principle 2: the principle of variety: all brains are unique -- Principle 3: the principle of developmental sensitivity -- Principle 4: the principle of interaction: we have a social brain -- Principle 5: the principle of connectivity: the brain is an integrated system of systems -- Principle 6: the principle of memory malleability -- Principle 7: the principle of resource consumption -- necessity for processing -- pt. 3. So what; now what. Asking big questions: what's in a brain-compatible curriculum -- Brain-compatible test-taking success strategies -- Systemic change: the next level -- Big picture analysis: transformation happens -- Action research makes a difference -- The learning community -- What's next. (shrink)

Around the world, the population is ageing in ways that pose new challenges for healthcare providers. To date these have mostly been formulated in terms of challenges created by increasing costs, and the focus has been squarely on life-prolonging treatments. However, this focus ignores the ways in which many older people require life-enhancing treatments to counteract the effects of physical and mental decline. This paper argues that in doing so it misses important aspects of what justice requires when it comes (...) to older people. (shrink)

Ethics, Aging and Society...is the first major work in ten years to critically address issues and methodologies in aging and ethics...This well-organized volume begins theoretically and offers new ways of thinking about ethics that can handle the complexities and realities of aging in particular social contexts."--Choice This new research-based book, by experts in the field of ethics, is excellent and much-needed...I challenge you to consider reading this book and seeing all the ways in which you might be (...) forced to rethink things that most of us take as given for ethics and aging. I know you will not be disappointed and I guarantee you will end up thinking long and hard about personal and professional decisions you may have made as well as your assumptions about aging in America."--CFLE Network Newsletter This is a book that should be required reading for all involved in the ethical provision of services to the aging on any level, as well as for policy makers and administrators in positions of influence over the lives of older patients."--PsycCRITIQUES...the authors' application of feminist ethics to frail elders rings true to both my clinical experience working with frail elders, and my research experience trying to understand their quality of life concerns...there were true gems of ideas [in this book] that illuminated the limitations of the dominant paradigm of autonomy in bioethics. [The authors] make a compelling critique of end-of-life care."--GeriPal: A Geriatrics and Palliative Care Blog This book presents second generation issues in ethics, aging, and society by presenting critical outcomes that arise when ethics is applied to the practical concerns that occur in day-to-day elder care. The first volume in over 10 years to address ethics and gerontology, it is unparalleled in its comprehensiveness and integration of well-developed philosophical arguments with empirical research, humanistic scholarship, and insights gained from practical experience. This book challenges the tried and true approaches to ethical issues in aging and opens avenues for creative problem-solving. The authors' diverse backgrounds bring the advantages of both interdisciplinary scholarship and practical experience to this comprehensive textbook. It is an essential resource for those interested in, and working with, older people, from upper-level undergraduate students and graduate-division students, to gerontology practitioners in training. Key Features: Presents the first major work in over 10 years to integrate the disciplines of ethics and aging Includes case studies derived from day-to-day practice Addresses individual/clinical ethics in health and long-term care and ethical issues raised by public policy, cultural norms and social attitudes Examines such critical issues as Alzheimer's disease, long-term care, ageism, public policy, anti-aging medicine, elder abuse, and natural disasters Explores new directions in ethical and social philosophy as they pertain to gerontology and care. (shrink)

People with disabilities face inequalities in mental wellbeing, for which social exclusion is a contributing factor. Musical activities offer a promising but complex intervention, making impacts on a population with highly varied characteristics and needs challenging to capture. This paper reports on a mixed methods, person-centered study investigating a community music intervention for such a population. Three groups of adult service users with varied disabilities, took part in weekly music workshops in different locations. Music staff, housing and resource center (...) staff, as well as participants and members of their families, took part in semi-structured interviews. A quantitative measure administered by service staff was used to rate service users’ social development. Two lay researchers, both individuals with a disability contributed to all aspects of the study. Interviews were analyzed through thematic analysis. Improvements in individuals’ self-expression, confidence, mood, and social skills were consistent with previous findings. Differences in effect between centers included: Group 1, some of whom had previous experience of workshops, showed an improvement in musical skills; Group 2 showed a mixed response, some participated with enthusiasm but others chose art activities over music workshops; Group 3 had lasting positive impact, this group had very limited opportunities for music due to their rural location. Quantitative analysis showed significant increase over all groups in communication, interaction with others, and joint attention. The intervention was beneficial for participants in separate locations in similar ways, but also highlighted that context and prior experience mediated effects in distinct ways. The lay researchers enhanced the qualitative analysis by emphasizing the importance of recognizing participants’ self-expression in non-verbal modes of communication and the importance of having music staff with a disability to provide a positive role model. This paper proposes that mixed methods person-centered research is the most suitable approach to capture and understand the multiple and varied effects of this complex intervention for a diverse group of participants. (shrink)

Arendt’s “natality,” a promising foundation for humanness that might be expanded to include those with profound cognitive disabilities, emerges in part out of Arendt’s creative interpretation of Augustine. Returning to Augustine provides natality with resources to escape the weaknesses of Arendt’s thought when viewed from the perspective of disability theory: The traps of grounding human dignity in rationality, of downplaying expressions of creativity in non-political spheres, and of denigrating the role of the body.

Although feminist philosophers have been critical of the gendered norms contained within the history of philosophy, they have not extended this critical analysis to norms concerning disability. In the history of Western philosophy, disability has often functioned as a metaphor for something that has gone awry. This trope, according to which disability is something that has gone wrong, is amply criticized within Disability Studies, though not within the tradition of philosophy itself or even within feminist philosophy. (...) In this paper, I use one instance of this disability metaphor, contained within a passage from Georg Wilhelm Friedrich Hegel’s Philosophy of Right, in order to show that paying attention to disability and disability theory can enable identification of ableist assumptions within the tradition of philosophy and can also open up new interpretations of canonical texts. On my reading, whereas Hegel’s expressed views of disability are dismissive, his logic and its treatment of contingency offer up useful ways to situate and re-evaluate disability as part of the concept of humanity. Disability can in fact be useful to Hegel, especially in the context of his valorization of experiences of disruption and disorientation. Broadening our understanding of the possible ways that the philosophical tradition has conceived human beings allows us to better draw on its theoretical resources. (shrink)

The current coronavirus pandemic presents the greatest healthcare crisis in living memory. Hospitals across the world have faced unprecedented pressure. In the face of this tidal wave of demand for limited healthcare resources, how are clinicians to identify patients most likely to benefit? Should age or frailty be discriminators? This paper seeks to analyse the current evidence-base, seeking a nuanced approach to pandemic decision-making, such as admission to critical care.

Belief in destiny is one of the principles of faith. Although the belief in fate is not explicitly mentioned in the Qur’an, there are many verses that indicate this belief. There are many hadiths about fate that have reached us from the Prophet. Although there are schools that deny destiny, Ahl al-Sunnah schools Ash‘aris and Maturidis accept the existence of belief in destiny. The definitions of destiny of these schools are expressed with words that can be used interchangeably. However, fate (...) should not be evaluated in a single category. It also has varieties. If destiny is perceived as only one kind of Forced destiny, it is inevitable to cause misunderstandings. Forced fate; it is destiny that does not give freedom to beings; It happens with the knowledge, will, power and creation of Allah. Some destinies of inanimate substances, plants, animals and humans are of this type. Jabr and responsibility are incompatible. Although some actions take place in their own bodies, people are not responsible for their forced destiny. Man is a freely created being within certain limits. The ability of intellect, will, power, and carrying out actions has been granted to them. By using them, a person performs his acts of will, and as a result, he becomes responsible for his actions. Having free will and freedom distinguishes humans from other living things. Where there is no human freedom, there is no responsibility. Human life is not uniform, it is in a state of constant change and transformation. In addition to these two types of fate, there is also a type of fate that turns into willful fate, although it was forced in the beginning. In addition to this, there are some actions that start with the will of man and later turn into forced fate. There are also types of disability that we have examined in connection with the belief in destiny and its types. Allah has sent humans to the world to be tested. Illness and disability are also part of the test. Diseases; they may be due to genetic, environmental factors, and food-related. Congenital diseases and disabilities can sometimes cause the world test to be difficult. The biological rules set by Allah are also valid for humans. Genetic hereditary diseases and disabilities occur when the genes carried by the parents are passed on to the child. While some genes are recessive, some genes are dominant. Genes that cause hereditary diseases and disabilities show an uneven distribution depending on their geographical habitats, sharing the same environment in the historical process, and the extent of intermingling of their lineages through marriages. While recessive genes can be passed on from generation to generation, dominant genes that cause death generally do not have the opportunity to pass on to the next generation. In today’s context, the diagnosis of genetic diseases and disabilities is attainable, enabling the implementation of necessary precautions accordingly; furthermore, partial or even complete treatment opportunities can be available depending on the circumstances. In this respect, all of the congenital diseases and disabilities due to genes are a forced fate that is not in the hands of man. As for those diseases and disabilities for which treatment opportunities exist, they fall under the category of fate that transitions from forced fate to willful destiny. Some genetic diseases and disabilities of people may appear in later ages. However, non-genetic diseases and disabilities are also facts of life. Every individual can become ill and experience disability during certain periods of their life. Diseases and disabilities can occur with a number of factors that do not depend on an individual's will, actions, or behaviors. Such diseases are also within the scope of forced fate. A person can also be disabled due to one’s own mistakes and negligence. However, it is a behavior befitting a Muslim to be treated in cases of all kinds of diseases and disabilities. The treatment of diseases for which there is a cure is a willed destiny. Diseases and obstacles that cannot be cured are forced fate. (shrink)

Cost-effectiveness analysis is the standard analytical tool for evaluating the aggregate health benefits of treatments, interventions, or health programs. It works by comparing the ratio of costs and benefits of different alternatives. The lower the ratio, the more effective the treatment, intervention, or program. The use of cost-effectiveness analysis can ensure that scarce health care resources are allocated in a way that maximizes the satisfaction of health needs. According to a common objection, however, the use of cost-effectiveness analysis for setting (...) priorities in the allocation of health care resources may lead to unfair discrimination against people with disabilities.The aim of the first part of this .. (shrink)

It is widely recognized that prioritizing health care resources by their relative cost-effectiveness can result in lower priority for the treatment of disabled persons than otherwise similar non-disabled persons. I distinguish six different ways in which this discrimination against the disabled can occur. I then spell out and evaluate the following moral objections to this discrimination, most of which capture an aspect of its unethical character: it implies that disabled persons' lives are of lesser value than those of non-disabled persons; (...) it constitutes “double jeopardy” or violates Frances Kamm's non-linkage principle; it conflicts with equality of opportunity; it conflicts with fairness, which requires ignoring (some/most) differential impacts of treatment; it wrongly gives lower priority to disabled persons for equally effective treatment; it conflicts with giving all persons an equal chance to reach their full potential; and, it is in conflict with giving priority to the worse off. (shrink)

Background Issues of the aging population and disability of older persons have been rapidly developing in China over the past 20 years. Since 2016, the Chinese government has been exploring remedies to alleviate social and family burdens and ensure the dignity of the disabled old persons by implementing long-term care insurance systems in a few pilot cities across the country. Purpose The purpose of this study is to present the current challenges faced by China’s long-term care insurance system (...) and put forth suggestions for the future, based on literature research and the feedback obtained from its implementation in pilot areas. Research Design This paper conducts a theoretical study based on the principles of public health ethics. Study Sample Since 2016, China has launched two batches of pilot cities for long-term care insurance. The analysis object of this study is the feedback on the policy implementation of the existing 29 pilot cities that participated. The relevant data involved in the analysis are from the authors' field research and published literature on the analysis of pilot cities. Analysis The ethical value and importance of long-term care insurance policies in China are evaluated from the perspectives of policy philosophy and social individual interests. Results The results of this evaluation show that the core ethical values were not met in the development of China’s current long-term care insurance system. Moreover, distributive justice norms were neglected, and access to the system between different social groups and within the groups covered by it was unequal. Conclusions This paper argues that long-term care insurance should not differentiate between urban and rural areas in allocating nursing resources. Additionally, it would be essential to build democratic supervision and manage public opinions by adopting open and transparent information-sharing policies. Standards of disability assessments and treatment payment should be at par to ensure a balance between the rights and obligations of policyholders. (shrink)

Drawing from a wide array of disciplinary perspectives and geographical contexts, this volume offers new insights for critically engaging with the problem of vulnerability. The essays here contained take the move from the COVID-19 pandemic, in order to explore the inherent vulnerability of individuals, but also of social, economic and political systems, and probe the descriptive and prescriptive import of the concept.Each chapter provides a self-contained perspective on vulnerability, as well as a specific methodological framework for questioning its meaning. Taken (...) together, the chapters combine into a multi-disciplinary toolkit for approaching the various forms and structures of vulnerability, with a special attention to the intersectional factors shaping the individual experience of it: from gender to age, from disability to mental illness, from hospitalisation to incarceration. The book explores the theoretical richness and complexity of the concept and proposes new analytical approaches to it, before illustrating its multifariousness through empirically grounded case studies. The closing section engages with “the future of vulnerability”, as a hermeneutic, epistemological, and critical-normative perspective to be deployed beyond the domain of global crises and emergencies.The volume is primarily intended as a reference for scholars in the human, social and health sciences. The accessible structure and plain language of the chapters make it also a valuable didactic resource for graduate courses in philosophy, the social sciences and public health. (shrink)

Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...) first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (shrink)

Theories of distributive justice are most severely tested in the area of disability. In this book, Mark Stein argues that utilitarianism performs better than egalitarian theories in this area: whereas egalitarian theories help the disabled either too little or too much, utilitarianism achieves the proper balance by placing resources where they will do the most good. Stein offers what may be the broadest critique of egalitarian theory from a utilitarian perspective. He addresses the work of egalitarian theorists John Rawls, (...) Ronald Dworkin, Amartya Sen, Bruce Ackerman, Martha Nussbaum, Norman Daniels, Philippe Van Parijs, and others. Stein claims that egalitarians are often driven to borrow elements of utilitarianism in order to make their theories at all plausible. The book concludes with an acknowledgment that both utilitarians and egalitarians face problems in the distribution of life-saving medical resources. Stein advocates a version of utilitarianism that would distribute life-saving resources based on life expectancy, not quality of life. Egalitarian theories, he argues, ignore life expectancy and so are again found wanting. _Distributive Justice and Disability _is a powerful and engaging book that helps to reframe the debate between egalitarian and utilitarian thinkers. (shrink)

The Aging Self and the Aging Society Ethical issues involving the elderly have recently come to the fore. This should come as no surprise: Since the turn of the century, there has been an eightfold in crease in the number of Americans over the age of sixty five, and almost a tripling of their proportion to the general population. Those over the age of eighty-five- the fastest growing group in the country-are twenty one more times as numerous as (...) in 1900. Demographers expect this trend to accelerate into the twenty-first century. The aging of society casts into vivid relief a num ber of deep and troubling questions. On the one hand, as individuals, we grapple with the immediate experience of aging and mortality and seek to find in it philosophical or ethical significance. We also wonder what responsi bilities we bear toward aging family members and what expectations of others our plans for old age can reasona bly include. On the other hand, as a community, we must decide: What special role, if any, do older persons occupy in our society? What constitutes a just distribution of medical resources between generations? And, How can institutions that serve the old foster imperiled values, such as autonomy, self-respect, and dignity? Only recently have we begun to explore these themes, yet already a rich and fruitful literature has grown up around them. (shrink)

Coronavirus vaccines have made their debut. Now, allocation practices have stepped into the spotlight. Following Centers for Disease Control and Prevention guidelines, states and healthcare institutions initially prioritised healthcare personnel and elderly residents of congregant facilities; other groups at elevated risk for severe complications are now becoming eligible through locally administered programmes. The question remains, however: whoelseshould be prioritised for immunisation? Here, we call attention to individuals institutionalised with severe mental illnesses and/or developmental or intellectual disabilities—a group highly susceptible (...) to the damages of COVID-19, recent research shows, and critical to consider for priority vaccination. The language describing both federal-level and state-level intentions for this population remains largely vague, despite the population’s diversity across age, diagnosis, functional status and living arrangement. Such absence of specificity, in turn, leaves room for confusion and even neglect of various subgroups. We review data stressing this group’s vulnerability, as well as select state plans for priority vaccination, highlighting the importance of clarity when describing intentions to vaccinate, or even generally care for, diverse populations composed of distinct subgroups in need. (shrink)

A plateau has been reached in how to analyze people's use of their common property resources. We require fresh ways of thinking about the issue. Four new and very different approaches are sketched in the article.

Much can be learned about (old) age-identity and age-related oppression by noting their similarities to, respectively, impairment and ableism. Drawing upon the work of Shelley Tremain, I show that old age, like impairment, is not a biological given but is socially constructed, both conceptually and materially. I also describe the striking similarities and connections between ableism and ageism as systems of oppression. That disability and aging both rest upon a biological given is a fiction that functions to excuse (...) and perpetuate the very social mechanisms that perpetuate ableist and ageist oppression. (shrink)

Cost-effectiveness analysis (CEA) is an analytical tool in health economics. One of the most important objections to it is that its use can lead to unjust discrimination against people with disabilities. This chapter evaluates this objection. It begins by clarifying its nature, then it examines some alleged forms of discrimination. It argues that they are either not cases of unjust discrimination, or they are based on misunderstandings of CEA. However, the chapter does point out that there is one case in (...) which the use of CEA may disadvantage people with disabilities. It goes on to consider several proposals for explaining the wrongness of discrimination but argues that none of them accommodates this case. It concludes that the case should not be thought as a matter of unjust discrimination; rather, it should be thought of as raising an issue for justice in the allocation of health-care resources. (shrink)

The inconsistent findings of past board diversity research demand a test of competing linear and curvilinear diversity–performance predictions. This research focuses on board age and gender diversity, and presents a positive linear prediction based on resource dependence theory, a negative linear prediction based on social identity theory, and an inverted U-shaped curvilinear prediction based on the integration of resource dependence theory with social identity theory. The predictions were tested using archival data on 288 large organizations listed on the (...) Australian Securities Exchange, with a 1-year time lag between diversity (age and gender) and performance (employee productivity and return on assets). The results indicate a positive linear relationship between gender diversity and employee productivity, a negative linear relationship between age diversity and return on assets, and an inverted U-shaped curvilinear relationship between age diversity and return on assets. The findings provide additional evidence on the business case for board gender diversity and refine the business case for board age diversity. (shrink)

[This piece is written for those working in social gerontology and aging studies, with the aim of bringing insights from disability studies and philosophy of disability to bear on enduring debates in those fields.] The guiding question of humanistic age-studies—What does it mean to grow old?—cannot be answered without reflecting on disability. This is not simply because growing old invariably means becoming impaired in various ways, but also because the discriminations and stigmas involved in ageism are (...) often rooted in ableism. We here draw on research in the philosophy of disability as well as the interdisciplinary field of disability studies to explore the relationship between ageism and ableism. (shrink)

It often appears that the most appropriate form of addressing disadvantage related to disability is through policies that can be called “status enhancements”: changes to the social, cultural and material environment so that the difficulties experienced by those with impairments are reduced, even eradicated. However, status enhancements can also have their limitations. This paper compares the relative merits of policies of status enhancement and “personal enhancement”: changes to the disabled person. It then takes up the question of how to (...) assess the priority of the claims of disabled people in the face of scarcity of resources for which there can be many competing social claims, arguing for the theory of “declustering disadvantage”. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by policymakers (...) and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.One expert's framing of the mission of public health may help improve understanding of the range of hazards for which to be legally prepared. These hazards include urgent realities — such as chronic disease, injury, disabilities, conventional communicable diseases, and an aging and obese population — and urgent threats, such as pandemic influenza, natural disasters, and terrorism. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by policymakers (...) and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.One expert's framing of the mission of public health may help improve understanding of the range of hazards for which to be legally prepared. These hazards include urgent realities — such as chronic disease, injury, disabilities, conventional communicable diseases, and an aging and obese population — and urgent threats, such as pandemic influenza, natural disasters, and terrorism. (shrink)

Many ethical theorists believe that a given distribution of healthcare is morally justified only if (1) it is cost-effective and (2) it does not discriminate against older adults and disabled people. However, if (3) cost-effectiveness involves maximizing the number of quality-adjusted life-years (QALYs) added by a given unit of healthcare resource, or cost, it seems the pursuit of cost-effectiveness will inevitably discriminate against older adults and disabled patients. I show why this trilemma is harder to escape than some theorists (...) think. We cannot avoid it by using age- or disability-weighted QALY scores, for example. I then explain why there is no sense of “discrimination” on which discrimination isbothunjust, and thus something healthcare rationing must avoid,andsomething cost-effective healthcare rationing inevitably involves. I go on to argue that many of the reasons we have for not favoring rationing that maximizes QALYs outside the healthcare context apply in healthcare as well. Thus, claim (1) above is dubious. (shrink)

As societies industrialize, the age profile of consumption tilts strongly toward the elderly, while elder labor supply drops. Low fertility and long life lead to population aging. For millennia, material resources have, on net, flowed downward from older to younger within populations, but now in many rich societies net flows have reversed and go upwards from young to old.

Insofar as many older adults fit some definition of disability, disability studies and gerontology would seem to have common interests and goals. However, there has been little discussion between these fields. The aim of this paper is to open up the insights of disability studies as well as philosophy of disability to discussions in gerontology. In doing so, I hope to contribute to thinking about the good life in late life by more critically reflecting upon the (...) meaning of the body, ability, and the variability of each. My central argument is that we should conceptualize age‐associated bodily variations and abilities not in terms of individual capacity, but in terms of what I call “the extended body.” It is in light of the meaning of embodiment and ability in general that we must think differently and more capaciously about the meaning of late life in particular. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Health Care Ethics: A Comprehensive Christian Resource by James R. ThobabenPaul D. SimmonsHealth Care Ethics: A Comprehensive Christian Resource by James R. Thobaben Downers Grove, IL: Intervarsity Press, 2009. 429pp. $28.00In recent years, a stir has been created by the vocal and aggressive involvement of evangelicals in such issues as abortion, homosexuality, and end-of-life decisions. James Thobaben, the dean of Asbury Seminary, provides what he calls (...) a [End Page 203] “comprehensive resource” for evangelicals, and promises better understandings of their perspectives and commitments for those who are baffled or frustrated by the actions and claims of those on the religious right.Thobaben casts a wide net when defining those he includes as “evangelicals”—Southern Baptists, members of Campus Crusade, Pentecostals, the Holiness movement, neoevangelicals, charismatics, and Anabaptists. These diverse groups are evangelicals because of their “consistency on moral choices,” doctrinal orientation, and styles of social advocacy (24). Although they differ in a number of ways, they all share having been influenced in some way by John and Charles Wesley, Jonathan Edwards, and the Reformation. All stress conversion in that “one must say yes to the divine Jesus Christ” and become identified with the community of faithful believers (57). And in recent decades, they have become a potent political force with regard to the issues of abortion and homosexuality.Thobaben covers a wide range of topics in this book: from a general discussion of theodicy and healing to bioethics, disability, sickness, family and congregational care, professional truthfulness, managing care, end-of-life decisions, assisted reproduction, organ donation, and death. Yet, although he claims to provide a “comprehensive resource” on evangelical Christian health care ethics, he fails to provide a thorough examination of his subject matter. For example, Thobaben pays little attention to the historic beginnings of the religious right. One misses any mention of political action groups or the coalitions formed with or by conservative Christian groups to pursue social reforms, or of why such disparate groups have cooperated for political or social goals under the same umbrella. He focuses solely on identifying and articulating the consensus among those who embrace certain moral values on the current scene. Thobaben’s uncritical approach to his subject matter leaves the impression that this book is essentially an apology for evangelical, right-wing Christian social thought. One searches in vain for any critical discussion of the beliefs and values he presents or any thoughtful engagement with those who might view the stances he presents as an assault against women’s rights or an attack on the rights of gays, lesbians, and transsexuals.Moreover, in a book like this, one would have expected a more careful assessment of biblical passages and historical precedents. Thobaben does not provide much rationale for his method for moving from the Bible to current social issues. For example, no prohibition against abortion is found in the Bible and the few passages about homosexual practices hardly add up to the fierce opposition to gays found among strident evangelicals. Moreover, Thobaben does not mention that in 1965 laws against contraceptives were declared unconstitutional by the Griswold vs. Connecticut decision, the Supreme Court’s rejection of a ban supported by an evangelical crusade led by Anthony Comstock. [End Page 204]It is interesting to note that Thobaben holds a strongly qualified commitment to religious liberty and only a “thin” version of the social contract basic to the Bill of Rights (37). He argues that in at least some situations “intolerance is not only morally understandable but strongly preferable,” as in the examples of the “abolition of slavery and prolife/antiabortion advocacy” (29) or, in another context—where he distinguishes between tolerance toward those outside the church and intolerance toward those within it—with regard to homosexuality and alcohol intoxication (30).The task of Christian ethics is to enlighten believers and the general citizenry by a careful exposition of the sources of wisdom available to those who want to think and think morally about issues of importance to human flourishing. That task is especially important in an age of demagogic hostility toward unpopular groups. Sadly, this book does not engage such critical questions. It may prove... (shrink)