In this study we compared the ethical attitudes of a group of experienced, predominantly female, registered nurses (n = 67) with those of a group of final year, mixed sex, medical students (n = 125). The purpose was to determine the basis of differences in attitudes that could lead to ethical disagreements between these two groups when they came to work together. A questionnaire developed to explore ethical attitudes was administered and the responses of the two groups were compared using (...) t-tests. Because of the preponderance of females among the nurses an analysis of variance of the gender-adjusted scores for each group was also carried out. On comparing the responses, the nurses differed significantly from the medical students in a number of ethical domains. A potential source of conflict between these two groups is that the nurses were inclined to adopt the perspective of patients but the medical students identified with their profession. When corrected for the effects of gender, the differences persisted, indicating that it was discipline that determined the differences. We recommend that students of nursing and medicine receive ethics education together, and that more open dialogue between doctors and nurses with respect to their different ethical viewpoints is needed in the work setting. This article will be of interest to educators of students of medicine and nursing, as well as to doctors and nurses who are eager to improve their professional relations and thereby improve patient care. (shrink)

There have been serious controversies in the latter part of the 20th century about the roles and functions of scientific and medical research. In whose interests are medical and biomedical experiments conducted and what are the ethical implications of experimentation on subjects unable to give competent consent? From the decades following the Second World War and calls for the global banning of medical research to the cautious return to the notion that in controlled circumstances, medical research on human subjects is (...) in the best interest of the given individual and the broader population, this book addresses the key implications of experimentation on humans. This volume covers major ethical themes within biomedical research providing historical, philosophical, legal and policy reflections on the literature and specific issues in the field of research on human subjects. Focusing on special populations (the elderly, children, prisoners and the cognitively impaired) it represents the most up-to-date review of the special ethical and legal conflicts that arise with relation to experimentation on subjects from these groups. In the light of current initiatives for law reform pertaining to research ethics the world over, this volume provides a timely, comprehensive and provocative exploration of the field. The volume has been carefully organized to present important philosophical perspectives on organizing principles that should underlie any practical application. A forward-looking historical review of the regulatory regimes of principal jurisdictions, including of the legal controls already in place, provides the backdrop for future policy initiatives. Additionally, in the light of global restructuring of health care systems, several chapters have been devoted to epidemiological research and related issues. (shrink)

The II. constitutional period is a period of renewal in many areas. Political, social and educational changes also had influences in the field of religious education. One of the examples of these changes is the ʻAmelī I҆lmiḥal textbook written by Halim Sabit (DOD. 1946) in five volumes for both teachers and student. This study particularly aims to assess this textbook in terms of religious education. Accordingly, the following questions are addressed: “What are the topics covered in the ilmihal books written (...) for students and teachers? Is the content of the subjects taught appropriate for the religious education? Which methods, techniques, and essential matters are discussed in the ilmihal books for teachers? As having first grade elementary school textbooks for both teachers and students, the research is made just based on these books. Data were collected through the examination of the document, and the texts in Ottoman Turkish were transcribed into Turkish. Content analysis method was used in the analysis of the data. By examining both books, this study shows that belief, worship, and social issues were taught, and prayers and sūras were addressed as need to be memorized knowledge in the book. The books included inappropriate contents for first grade children regarding the belief issues such as fear of Allah, hell, and the hereafter. Summary: Education I҅lmiḥal, occupies an important place in the history of Islamic religious education. According to the religion of both adults and children to learn the principles of faith and worship, it is aimed to shape the daily life. In this context, for example, during the Ottoman period, In the period of II. Mahmut, boys were required to attend the primary school. Thus, it was ensured that children could learn I҅lmiḥal and Islamic sharia properly. Children are taught alif ba for Qurʾān readings in primary schools, as simple as required by religious duties, writing skills have been acquired and the four processing rules are memorized. The II. constitutional period is a period of renewal in many areas. Extreme innovative thinking is also reflected in education. Especially after the Balkan wars, the idea that the collapsing state would be saved through education was dominant. For the first time, a higher education institution for girls and a kindergarten for young children were opened. By recognizing the importance of pedagogy knowledge in teaching, the students have switched to a system where they can search for observation and experiment. Innovations in educational methods have started to be seen. It was seriously opposed to memorization, and the question and answer was seen as old methods. Instead, it was proposed to use sightseeing observation and discovery. Political, social and educational changes are also reflected in the field of religious education. As a reflection of the newly introduced methods, there have been changes in the ʻAmelī I҆lmiḥal books prepared for children. One of the examples of this is the ʻAmelī ʻIlmiḥal textbook, which was written by Halim Sabit in five volumes. This ʻAmelī I҆lmiḥal was prepared in 5 volumes for teachers and students.The main purpose of this study is to evaluate ʻAmelī I҆lmiḥal textbook in terms of religious education This study particularly aims to assess this textbook in terms of reigious education. Accordingly, the following questions are addressed: “What are the topics covered in the ilmihal books written for students and teachers? Is the content of the subjects taught appropriate for the religious education? Which methods, techniques, and essential matters are discussed in the ilmihal books for teachers? As having first grade elementary school textbooks for both teachers and students, the research is made just based on these books. Data were collected through the examination of the document, and the texts in Ottoman Turkish were transcribed into Turkish. The textbook prepared for the students of the first year consists of 21 boards/sheets. The sentences are quite self and short. The contents of the board/sheet are well suited to be discussed and explained. There are no headlines on the boards/sheets. The language of text is Ottoman. It is possible to express the topics covered in the book under the following themes:Prayer and Sūras: Basmala, Kalima Tawḥīd, Kalima Shahāda, Fātiḥa, Subḥana Rabbiyal Aʿala, Subhana rabbiyal ʿAẓim, As-salāmu ʿalaykum va Raḥmatullah, Taḥiyyat, Salawat Sharif, Iḥlas, Kawthar, Subḥanaka Prayer, Qunut Prayers.Faith Issues: Allāh, the fear of Allāh, thanks to Allāh, the Qurʾān, Prophets, Prophet Muḥammad, The Hereafter, Heaven Hell, Angels.ʿIbādat Issues: Zakāt, Ablution, Prayer, Adhān, worship in General (Salāt, Ṣawm, Zakāt, Ḥajj)Social Issues: Friendship, affection for minors, affection for parents, Muslims are Brother, human love, respect for the elderly, respect for scholars.The textbook prepared for the teachers of the first year; consists of 21 pages, 69 pages and Ottoman. As the students do not include the topics in the textbook, it is appropriate to mention the names of the subjects in the textbook of the teacher:1. Subject: Memorization of the Word of Tawḥīd and word of Shahāda; 2. Topic: Raising ideas about the nation in children; 3. Subject: The adjectives of Allāh Almighty; 4. Subject: Love of Allāh; 5. Subject: Angels; 6. Subject: The Divine Books; 7. Subject: Prophets 8. Subject: The Hereafter; 9. Subject: Thank Allāh; 10. Subject: Repentance; 11. Topic: Protecting the language from bad words and threats; 12. Subject: Zakāt and charity; 13. Subject: Riya҆ and his goodness engrave; 14. Subject: Love to the prophet Muḥammad; 15. Subject: Parental love; 16. Subject: The brotherhood of Islam; Subject: Human love; 18. Subject: Ablution; Subject: Prayer; 20. Subject: Respect for the elderly; 21. Subject: Love to ʿulamāʾ; 22. Subject: Fear of Allāh.Halim Sabit also gave information about the methods and techniques to be used in the course and emphasized that the teacher told his / her not by looking at the book. He thought it would be only influence the student in this way. It is recommended to use the appropriate language for the child, to make an introduction in the subjects that will be learned in the new subjects and to draw attention to the subject and to teach the subject gradually. An important advice is the knowledge that the teacher wants him / her to do in the long-term memory in the present sense. The teacher must repeat a subject several times while teaching a subject, and should not immediately remind a student of forgotten subjects, talk to a student and has finded to him. A subject should not be passed without being thoroughly understood, and the classroom needs to be opened by the teacher in order not to forget the learned subjects. The first fifteen minutes of each course should be reserved for the repetition of previously learned subjects. Content analysis method was used in the analysis of the data. By examining both books, this study shows that belief, worship, and social issues were taught, and prayers and sūras were addressed as need to be memorized knowledge in the book. The books included inappropriate contents for first grade children regarding the belief issues such as fear of Allah, hell, and the hereafter. (shrink)

In the six remarkable elegidia transmitted in the Tibullan corpus as 3.13–18 we appear to possess the writings of an educated Roman woman of aristocratic family and high literary connections: a woman, moreover, who participates as an equal in one of the most distinguished artistic salons of the age, and composes poetry in an obstinately male genre on the subject of her own erotic experience, displaying a candour and the exercise of a sexual independence startingly at odds with the ideology (...) of her class. Such a figure is either, depending on one's viewpoint, too good to be true or too embarrassing to be tolerated. The case could easily be put that Sulpicia, more perhaps even than Sappho, has found her poems condemned by accident of gender to a century and a half of condescension, disregard, and wilful misconstruction to accommodate the inelastic sexual politics of elderly male philologists. Certainly even the most sympathetic of recent comment is prone to lapse into a form of critical language outlawed in Catullan scholarship thirty years ago. Yet feminist critics have been strangely cautious in their response. A scholar who rose swiftly to the defence of Erinna when that elusive poet's identity was impugned has notoriously written of Sulpicia: ‘She was not a brilliant artist: her poems are of interest only because the author is female.’ Five years late, Sulpicia has found a place in the major sourcebook on ancient women, but with the cycle of poems violently reordered after the judgment of a nineteenth-century critic, anxious to restore his poetess's chastity against the disconcerting frankness of the texts. (shrink)

Attitudes toward robots influence the tendency to accept or reject robotic devices. Thus it is important to investigate whether and how attitudes toward robots can change. In this pilot study we investigate attitudinal changes in elderly citizens toward a tele-operated robot in relation to three parameters: (i) the information provided about robot functionality, (ii) the number of encounters, (iii) personality type. Fourteen elderly residents at a rehabilitation center participated. Pre-encounter attitudes toward robots, anthropomorphic thinking, and personality were assessed. Thereafter the (...) participants interacted with a tele-operated robot (Telenoid) during their lunch (c. 30 min.) for up to 3 days. Half of the participants were informed that the robot was tele-operated (IC) whilst the other half were naïve to its functioning (UC). Post-encounter assessments of attitudes toward robots and anthropomorphic thinking were undertaken to assess change. Attitudes toward robots were assessed with a new generic 35-items questionnaire (attitudes toward social robots scale: ASOR-5), offering a differentiated conceptualization of the conditions for social interaction. There was no significant difference between the IC and UC groups in attitude change toward robots though trends were observed. Personality was correlated with some tendencies for attitude changes; Extraversion correlated with positive attitude changes to intimate-personal relatedness with the robot (r = 0.619) and to psychological relatedness (r = 0.581) whilst Neuroticism correlated negatively (r = -0.582) with mental relatedness with the robot. The results tentatively suggest that neither information about functionality nor direct repeated encounters are pivotal in changing attitudes toward robots in elderly citizens. This may reflect a cognitive congruence bias where the robot is experienced in congruence with initial attitudes, or it may support action-based explanations of cognitive dissonance reductions, given that robots, unlike computers, are not yet perceived as action targets. Specific personality traits may be indicators of attitude change relating to specific domains of social interaction. Implications and future directions are discussed. (shrink)

The discovery of the inscription with the name of [M]iltiades, which confirmed the statement in Dionysius Halicarnassensis 7. 3. 1 that a Miltiades was archon at Athens in 524/3, prompts a reconsideration of the problems presented by the accounts in Herodotus and in Marcellinus Life of Thucydides concerning the Philaid family. To the question, who is this Miltiades, the following answers have been given. ‘He is not a Philaid.’ The objection to this answer is that the Peisistratids either occupied the (...) archonship themselves or gave it to members of leading families, such as Cleisthenes the Alcmeonid in 525/4; if then this Miltiades was a member of a leading family, he is almost certainly a member of the Philaid family. ‘He is the elder Miltiades who founded the settlement in the Chersonese.’ In Herodotus' account Miltiades left Athens, where he was already powerful, at the beginning of a tyranny by Peisistratus; then after several operations in the Chersonese Miltiades was rescued by Croesus. The year in which Miltiades left Athens was either 561/0 or 556/5 and almost certainly the latter; for in 561/0 Croesus was not on the throne. The year 546 may be excluded; for in 546 autumn and winter Croesus had neither the time nor the opportunity to concern himself with Miltiades, since Cyrus was then at war with Lydia and seized Sardis.2 If Miltiades was powerful in 556/5, he was at that date no youngster but at least in his thirties—a man born say c. 590. In 524/3, being well on in his sixties and having spent thirty years and more in the Chersonese, this Miltiades is unlikely to have been the eponymous archon. We conclude, then, that the archon Miltiades in 524/3 was a different and younger Miltiades. Having cleared the ground on these two points, I turn to the central problem, whether there were two men called Miltiades, one born c. 590 and the other the general who died of a wound soon after 489, or whether there were three men called Miltiades, one of whom was in a generation intermediate between Miltiades born c. 590 and Miltiades dead c. 489. Either solution is chronologically possible. (shrink)

This study assessed the International Critical Thinking Essay Test (ICTET-A) for inter-rater reliability, internal reliability, and criterion validity. A self-selecting sample of participants (N = 100) completed the ICTET-A and a comparison test online. We found the ICTET-A items to have moderate to good levels of inter-rater reliability, and overall excellent inter-rater consistency for total test scores. The test had good internal reliability. There was a strong correlation between scores on the ICTET-A and the comparison test. Factor analysis showed that (...) scores were best explained with one factor, suggesting the test measures a single construct. The ICTET-A can therefore be considered a valid measure of critical thinking. Additionally, we propose a short form of the test. (shrink)

A central feature of Confucianism is the doctrine that an adult child has, for want of a better word, the ‘duty’ to care for his elderly parents1. Whether this doctrine should be framed in terms of an ethic of duties as opposed to an ethic of virtues is a vexed question. It might be argued that the doctrine is best framed in terms of the behaviour and dispositions appropriate to an agent who is, within the Confucian moral vision, good. Nonetheless, (...) in both popular discourse and in much the secondary literature, the doctrine is characterized in terms of a moral ‘ought’. We will adopt this perspective, and talk of the ‘filial duty of care’. We investigate the empirical question of whether Chinese communities still have a strong sense of this duty. We conclude that although there is a widespread perception among Chinese communities that their sense of filial duty of care has been eroded, in fact the adherence to it remains robust. (shrink)

Decisions about cardiopulmonary resuscitation may be based on medical prognosis, quality of life and patients' choices. Low survival rates indicate its overuse. Although the concept of medical futility has limitations, several strong predictors of non-survival have been identified and prognostic indices developed. Early results indicate that consideration of resuscitation in the elderly should be very selective, and support "opt-in" policies. In this minority of patients, quality of life is the principal issue. This is subjective and best assessed by the individual (...) in question. Patients' attitudes cannot be predicted reliably and surrogate decision-making is inadequate. Lay knowledge is poor. However, patients can use prognostic information to make rational choices. The majority welcome discussion of resuscitation and prefer this to be initiated by their doctors; many wish to decide for themselves. There is little evidence that this causes distress. The views of such patients, if competent, should be sought actively. (shrink)

The dominant view of women has changed radically during the last century. These changes have had an important impact on the way of life of women in general and, undoubtedly, on women as patients. So far, gender differences have received little attention when developing healthcare services. Stroke hits a great number of elderly women. Wyller et al. found that women seemed to be harder hit by stroke than men; they achieved lower scores in tests of motor, cognitive and ADL functions, (...) both in the acute phase and 1 year after stroke. It is reasonable to expect that differences in outcome among male and female sufferers may in part be explained by the fact that rehabilitation services are designed primarily to meet the needs of men. de Beauvoir's feminist theory maintains that one's body is fundamental in creating the person, which is a lifelong process. Traditionally, the female body has been exposed to alienation and oppression through life. This has led women to develop a life in immanence. This we feel can be of significance in connection with rehabilitation after a stroke, particularly for elderly women. In this article we will discuss how de Beauvoir's theory can throw new light on the experiences and rehabilitation of elderly women and point to ways of improving the process of rehabilitation. (shrink)

The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral intuitions. Our study aimed to explore general public views in the UK on (...) the role of age, and related factors like frailty and quality of life, in triage during the COVID-19 pandemic. We held online deliberative workshops with members of the general public. Participants were guided through a deliberative process to maximise eliciting informed and considered preferences. Participants generally accepted the need for triage but strongly rejected ‘fair innings’ and ‘life projects’ principles as justifications for age-based allocation. They were also wary of the ‘maximise life-years’ principle, preferring to maximise the number of lives rather than life years saved. Although they did not arrive at a unified recommendation of one principle, a concern for three core principles and values eventually emerged: equality, efficiency and vulnerability. While these remain difficult to fully respect at once, they captured a considered, multifaceted consensus: utilitarian considerations of efficiency should be tempered with a concern for equality and vulnerability. This ‘triad’ of ethical principles may be a useful structure to guide ethical deliberation as societies negotiate the conflicting ethical demands of triage. (shrink)

Purpose. The purpose of this paper is to investigate the anthropological and socio-philosophical dimensions of human existence of the older age group given the challenges of pandemic threats caused by COVID-19. To this end, it is planned to solve a number of tasks, among which one should distinguish the following: 1) to investigate the manifestations of age discrimination in the context of the social and labor areas of human existence; 2) to focus on the asymmetry of the behavior of society (...) and the state relative to persons of the older age group in the field of healthcare in the context of a pandemic crisis; 3) to represent the anthropological features of changes in the socialization and activity of older people under the current conditions of globalization-pandemic challenges. Theoretical basis. Despite such a broad representation of the age-related issue in public relations, there are still no practical guarantees that would apply to discriminatory aspects of older age groups in various areas of their manifestation. The synergistic evolution of social reality requires substantive analysis of the issue under the current conditions for the transformation of social life, which is affected by globalization crises caused by the pandemic threats of COVID-19. Originality. The stereotypical assumptions underlying legal policy and established social relations are based solely on the application of chronological age. The novelty is in justifying an individual approach to the elderly through the personification of the personal characteristics of a person. The study of anthropological and socio-philosophical dimensions of the existence of a person of the older age group in the face of the challenges of pandemic threats caused by COVID-19 has made it possible to analyze the destructive nature of age discrimination in the context of the social and labor areas of human existence. As well as focus on the asymmetry of the behavior of society and the state in relation to these persons in the field of health care, and emphasize the anthropological features of changes in the socialization and human activity under the current conditions of globalization-pandemic challenges. Conclusions. External threats to human existence call for special attention to the implementation and protection of human rights, freedoms, individual freedoms, and identity. Pandemic threats have transformed all dimensions of human existence, especially for those groups of society that are less socially protected. The pandemic crisis has created additional grounds for discrimination against older people in various areas of human existence. Equalization of persons by age without personifying the personal characteristics of an individual is discrimination on an age basis, which violates the principles of democracy and humanism in the society, leads to stigmatization of the person, is the cause of the anthropological crisis of a person. (shrink)

Both older persons and those who havedisabilities can encounter discrimination whenthey seek medical care. Just as ageism andstereotypes about older persons mayinappropriately limit medical care for theelderly, limits may be placed on medical carefor those who are disabled simply because ofthe presence of a disability. At the sametime death is the natural end of the lifespanfor all individuals and there are situationswhen aggressive medical care is not indicated. It is not right to always insist on ``doingeverything'' for a person even (...) if that personmay be at risk otherwise for discrimination. Using the example of the elderly, this paperexamines the risks of discrimination and thedangers of overtreatment in caring for olderpersons and suggests parallels in theappropriate care of those who havedisabilities. (shrink)

Photo by Jonathan Ford on Unsplash ABSTRACT Since 2008, an average of twenty million people per year have been displaced by weather events. Climate migration creates a special setting for a duty to rescue. A duty to rescue is a moral rather than legal duty and imposes on a bystander to take an active role in preventing serious harm to someone else. This paper analyzes the idea of expanding a duty to rescue to climate migration. We address who should have (...) the duty and to whom the duty should extend. The paper discusses ways to define and apply the duty to rescue as well as its limitations, arguing that it may take the form of an ethical duty to prepare. INTRODUCTION Climate migration creates a special setting for a duty to rescue. A duty to rescue is a moral rather than legal duty and imposes on a bystander to take an active role in preventing serious harm to someone else. Examples of circumstances range from person-to-person intimate rescue to saving those in poverty, even in distant parts of the world.[1] Since 2008, an average of twenty million people per year have been displaced by weather events.[2] Circumstances like being thrust from homes under the threat of fire, mudslide, and flooding vary greatly from long-term changes like land becoming too arid for crops or temperatures increasing annually gradually pushing up the number of heat-related deaths, with the area slowly becoming uninhabitable. Imminence in fleeing affects resettling and need for rescue with important implications for how the duty to rescue might apply. This paper reevaluates the ethical framing of the duty to rescue and, while it is arguably a stretch, applies it to climate migration. Climate migration has become common and is expected to increase due to rises in sea level, increases in weather events that make areas uninhabitable, and changes to land that preclude farming or other necessary land uses. We argue that a duty to rescue may help highlight who has moral obligations to whom. Because the problem is so large in scope, we suggest a change in the ethical limits to humans' duty to rescue other humans who are in distress. We imagine an expansion or extension of the duty to rescue to meet some of the basic needs created by climate migration. Yet how it should expand, and how much depend on ethical framing and practical limitations. l. Expanding the Geographical Boundaries Two commonly recognized emergencies, Hurricane Katrina in the case of weather events and the current COVID-19 pandemic, provide a historical and current backdrop to evaluate ethical obligations as more disasters displace people. A significant reassessment of the ethical scope of an obligation to rescue in the case of weather events will be limited by the ability to render aid to those in distress in the case of a planet-wide weather catastrophe. The problems may overwhelm the ability to rescue or the reasonableness of attempting rescue. The extent of the moral obligation borne by humans to other humans in the case of a weather event has been largely defined by its locality and limited geographic influence. Whether we are imagining the scope of ethical obligation in the case of hurricane, flood, tornado, drought, or wildfire events, the perceived ethical obligation is significantly defined by the limited impact of these weather events on people outside the zone of the weather event's direct impact, yet close to that zone. A hurricane affecting New Orleans will not have immediate impact on the residents of California or even those on the northeast coast of the United States until a later time. Wildfires in the Pacific Northwest do not impair the ability of those in the rest of the country to come forward with assistance. But as climate migration crosses international borders, and climate events occur simultaneously in many regions, a more expansive duty to rescue may provide the ethical impulse to help those who live afar or migrate long distances. In this respect, the need for help in the event of widespread climate migration due to global warming is more like a pandemic than a weather event. Its broad impact area diminishes the capability of nearly the entire balance of the human population to help due to those populations' awareness that they will, in short order, have the same need for the same resources, from the same cause. Those living near current flood zones may find their historically safe havens are also a flood zone. Those previously best positioned to rescue may find themselves also needing to relocate. Thus, we may observe the need for new rescuers. ll. The Rule of Rescue The Rule of Rescue as defined by Al Jonsen describes the moral impetus or knee jerk reaction to save identifiable people facing death.[3] A duty to rescue has since been expanded beyond imminent death and beyond the near and identifiable. But there are limitations. For example, by most accounts, the ethical duty tends not to require extreme bodily risk or financial depletion. In comparing Good Samaritans to humanitarians, Scott M. James argues the duty to rescue arises from unique dependence, but the ethical obligation to help strangers through humanitarian aid is of a different nature.[4] The wrongness of failing to help is arguably more egregious when one is in a unique position to help. Like in the tragedy of the commons, where there is no unique positioning, when the global community is called upon to help, each individual in it may feel less obliged to do so. Climate migration falls in between—it requires helping strangers, yet it may move forward without anyone seeing themselves as uniquely positioned to help until those strangers become part of communities, at which time, there may be more moral justification to help a community member in need. Generally, arguments about Good Samaritans hinge on extraordinary acts, praiseworthy because they are acts of compassion, not obligation. Now all US states have Good Samaritan laws[5] which protect helpers from liability for help gone wrong or for a failure to succeed once engaged in an act of rescue. Extraordinary help as a moral good is thus somewhat encouraged through legal protection, but not imposed. Conversely, jobs like firefighting, search and rescue, and emergency medical care tend to oblige employees to take on risks that would be extraordinary if undertaken by the average bystander, yet they are rendered ordinary rescue as part of the job. Three states, Minnesota, Rhode Island, and Vermont have a broad duty to rescue, adding legal considerations to an otherwise moral conundrum. The laws do not require bystanders to take on risk for the sake of rescuing strangers.[6] The moral duty will require looking beyond law, but it is unclear how the moral duty to rescue should be distributed in the case of climate migration. A bare minimum would prevent taking advantage of newcomers, paying sub-minimum wage, and discriminating against them. Yet such a minimum is hardly rescue. lll. An Ethical Rather than Legal Duty The difficulty in defining the duty to rescue as a legal obligation is that it is difficult to determine the extent of risk a rescuer ought to be required to take. The nature of this ethical duty is also arguably tied to the experiences of both the rescuer and the rescued. There are subjective aspects like what someone perceives as a danger that make it difficult to write enforceable laws requiring rescue. It is one thing to expect a rescuer to step into several inches of relatively warm water to lift a person lying face down in a pond and enable them to breathe. It is something altogether different to expect that rescuer to dive into frigid water and attempt to extricate someone trapped in a submerged automobile. As the legal philosopher H.L.A. Hart observed, it is always easier to define application of the core intention of any rule, whether law or ethical norm. It is more difficult to create legal certainty about how the law applies to what he described as “penumbra circumstances”. In the case of a hurricane, it is easier to define what surplus resources are available in areas geographically remote from the impact of the storm and demand, as a moral obligation, that those nearby but outside the area provide assistance. It is more difficult to obligate people, organizations, or governments to supply a quantity of medication or some number of ventilators to an adjacent community when they expect to imminently need them for their own community. In the early stages of climate migration, the ethics of extreme weather event assistance, a common application of the duty to rescue, will be useful and appropriate. The rising sea levels first experienced by island nations in the South Pacific[7] will not render those living in other coastal communities, those with greater available “high ground”, unable to supply resources to those in need. But when sea level rise and climate change affect more communities simultaneously, albeit in varying degree, the task of defining what response is ethically obligatory becomes increasingly complicated. Pinpointing the obligations of those communities which are resource rich to those communities which are resource deprived, and of those partly affected to those more severely affected may become necessary. The limitations of the traditional duty to rescue could expand to meet the needs. lV. Contribution to the Problem Many argue that the duty to rescue may depend on any appropriate claim of those needing rescue. One issue is whether preferential claims among those who can identify the source of the harm should call for a greater duty or whether everyone in need should be approached as like candidates for rescue, shaping the duty as equal across those on the receiving end. As climate change does have human-made causes, there are strong arguments to impose a greater ethical duty on any entity that caused the climate-related problems leading to the mass exodus. While the global north is often implicated in pollution that causes migration, industries like energy, transportation, and agriculture are tied to climate change and associated with significant greenhouse gas emissions.[8] Practices like directing agriculture to less sustainable single crop growth generally made land less farmable. Yet it is difficult to place blame and identify specific causal relationships as most migration is due to many factors. A movement toward greater accountability can be reframed as a greater duty to rescue, a duty to engage in the extraordinary. The fossil fuel industry, for example, should have a larger obligation than the average person. Similarly, some may argue anyone unjustly enriching themselves while contributing to climate change or people who over-consume have an elevated duty to rescue.[9] Climate change lawsuits demonstrate an eagerness to hold governments and corporations accountable, despite difficulty proving causation. V. The Most Vulnerable One ethical dimension of climate migration that remains unexplored is how a duty to rescue applies to vulnerable populations who stand to be left behind or unable to migrate without assistance. Researchers from the Global North working across the Global South are increasingly observing the phenomenon of ethics dumping, where the research ethics of some countries are imposed on research subjects in other countries.[10] In that vein, rescuers should be careful not to impose unwelcome cultural standards or exploit people who are in the process of migrating. There is a gap in discussions reflecting voices that have been left out. The duty to rescue is incomplete without an attempt to understand the ethical experiences of those being rescued. The actual people affected by climate migration who are the least likely to have the means to migrate, or to do so without extreme hardship, should have a voice informing the global community including those in a position to carry out rescue. People who have the means and are young and healthy may easily make decisions to avoid the catastrophic consequences that climate migration brings. However, what about those who are left behind? For example, especially recognizing cultural differences, the homeless community, disabled community, refugees, the elderly community, and women[11] and children may suffer differently and call for more attention. In some parts of the world, human rights are severely constrained. An ethical duty to rescue, with many considerations and variables, may be more justified in the case of those most in need. As climate migration continues and increases significantly, it may be reasonable to ask the local and global community to focus on those least well positioned to migrate successfully. In this context, the use of phenomenology to understand the lived experiences of those migrating, sometimes termed “ethical experiences”, may help flesh out how a duty to rescue takes shape. The discussion of duty and obligation requires an articulation of the ethical experiences (how the local community in need of rescue views the proposed rescue). Then, the obligation to interpret the duty as ‘one shall not’ or ‘one must’ can be focused on the migrants’ needs rather than the rescuers’ feelings of obligation.[12] A revised theory of the duty to rescue taking into account the asymmetrical experiences of communities involved could ensure that the needs of people whose living situations, gender, ethnicity, age, or race impact their ability to even begin the migration process are considered. In this discussion, the rescuing is directed toward communities /collectives of persons migrating, whether at once or across a period of time. Often, the climate migrant may not be in a state to articulate the nature of this event when it happens, given its subjective proximity. Yet, when communities are given the space and opportunity to articulate their shared values, the ethical action of rescue derives its meaningfulness from the community rather than the rescuers. In other words, allowing climate migrants to explain their feelings can add complexity to what some see as a binary receiver-giver (of rescue) dynamic. This is necessary because the concept of vulnerable populations is fraught with problematic assumptions. There have been various definitions and criteria to determine what would constitute vulnerable populations.[13] For example, the United Nations Framework Convention on Climate Change[14] identifies and assesses vulnerable populations. These criteria may be helpful. However, they do not provide the full picture. Rather than identifying categorical criteria of vulnerable populations, engaging with people who are experiencing climate migration and listening to their current experiences and concerns helps determine need. Knowing what people need may prevent the kneejerk reaction to label people who are quite resilient yet have appropriate needs “vulnerable”. Proceeding with caution is important because the duty to rescue has hierarchical underpinnings of "us" and "them." Often when people swoop in to save, there are good and bad consequences of the intervention. We should proceed with caution because often the helper misses the actual needs of those in need. The only way to combat this would be to make sure that people are empowered to inform those agencies that are able to help. In addition to more practical approaches, large scale oral histories could allow those who have migrated already to share their experiences. It would be important to capture the lived experiences of people who are already experiencing the consequences of climate migration or of other migration like that due to political or economic extreme events. These experiences could shape our analysis of whether people in fact wish for rescue. If so, further conversations can determine best actions as well as give important insight into what resources might be necessary to empower people now and in the future. Vl. A Duty to Rescue as a Duty to Prepare If we view Good Samaritans as going above and beyond, then a duty to rescue, something ethically compelled, must bring rescue out of the framework of charity and place it in the context of humanity and obligations. Such a view would also support expanding the geographical reach of the otherwise more proximate duty. The duty may be stronger and take shape in a more workable way if it applies to preparing places expecting to see an influx of people due to climate migration and to helping those most in need. The duty may arise out of expectations of what type of community the place welcoming those migrating due to climate should be—does it want to offer good housing, schooling, and medical care as well as economic opportunity to new people? And if so, at what cost, or with which risks? If the newcomers are viewed as community members rather than strangers, a model of acceptance may lead to better preparation. Some considerations like whether the actions will reasonably help the persons in need of rescue[15] will shape the application of a duty to rescue in the context of climate migration. Similarly, ensuring that people have the chance to articulate their values may help communities support the newcomers. New relationships should not be defined as migrant and rescuer. Voluntariness in participation and not forcing any action deemed rescue would help ensure the human rights of those migrating. In the United States, President Biden issued an executive order addressing impending climate migration steeped in a duty to prepare by making plans for resettlement and to address the impact of climate migration.[16] Vll. At What Risk? As we investigate the ethical obligations to meet even basic needs, we must also ask what level of risk is ethically compelled. There is an extraordinary need to integrate newcomers successfully, but it is difficult to stretch an ethical duty to rescue to require all the prerequisites for successful climate migration. Even defining success would create deep ethical arguments. As observed in almost all migrations, extraordinary charitable acts may be the key to success, while an ethical duty to rescue must try to require the important government and community-based basics and ensuring respect for human rights. That is, the migrating people should be rescued from circumstances that contradict basic human rights. Rather than comparing communities to bystanders, mere places where people will arrive and need to hash out how to find housing, jobs, education, and opportunity, a duty of preparation may be the key to rescue those disenfranchised by migration. There are cultural, personal, physical, psycho-social, and geopolitical issues surrounding how to best help those needing to permanently relocate. Ethics arguments will certainly range from “do nothing”, which may fail people, to “do everything”, which could waste taxpayer money in futile over-preparation while failing to actually help. Communities must avoid planning exclusively for one scenario only to have it not take place. Striking the balance, a duty to rescue as it could apply to climate migration should set goals of societal integration, and providing the basics like education, housing, food, health care, and job opportunity, the precursors to flourishing. Recommending the extraordinary, morally preferred but perhaps not compulsory, when charitable actors are participating, or when wrongdoers are compensating, may be more workable than seeing the duty to rescue as compelling people or local governments to take on significant financial and personal risk for newcomers. While humanitarian ethics supports helping everyone, it is likely that people who resettle in advance of a need to flee will find themselves with more choices and opportunities. Help is warranted for those with more dire needs. Preparing for them may do just that. Vlll. Rescue Prior to Migration and Rescue in the Process of Resettlement The duty to enable the migration in the first-place hints to the inadequacy of a duty to prepare. The traditional duty to rescue perhaps steps in if rescue looks like those geographically just out of harm's way rescuing those in danger. That resembles the traditional moral requirement, or duty to rescue according to the Rule of Rescue. Humanitarian aid typically provided by many institutions makes sense and is in place, although financial support for additional humanitarian aid is always needed. Despite having moved to purportedly more capable communities, migrant communities may be able to develop more egalitarian orders of living. Rather than continually being identified as having been rescued, it is important to make sure people keep or make social ties during and after migration. Immigrants often face social isolation.[17] Small shifts in gestural language also have the potential to welcome people and show they are valued. For instance, some migrants may not like questions like “Where are you from?” and “What brings you here?” as they emphasize differences over fitting in. CONCLUSION The ethical duty to rescue should be expanded to better match those in need of relocation with a welcome environment and the resources needed to achieve success and fully integrate socially and culturally. Expanding a dialogue that includes the voices of people who have recently migrated whether due to violence, poverty, or climate, could properly frame the extent of the duty. If we are to apply the duty of rescue to climate migration, rescuers should avoid labeling people vulnerable, dependent, or needy, although there is reason to focus on those whose needs are the most dire. A soft duty to rescue people during the course of climate migration can come in the form of preparation. People will need help finding housing, education, access to food, and employment. Ultimately, to help them help themselves may be the best goal. While the obligations should be borne differently by people, whether due to a special responsibility, or a special relationship that creates a clearer duty, the global community must prepare for its role in rescuing those displaced by climate events. By helping those displaced at the start of the climate migration process according to a more commonly held notion of the duty to rescue, and by preparing to incorporate newcomers successfully according to an expanded duty to rescue, effectively a duty to prepare, countries that take on climate refugees may find themselves rewarded by the cultural diversity and workplace talents that people bring. A duty to those at a distance is a reasonable expansion of the duty to rescue. But what one ought to do in the global community varies somewhat from the traditional Rule of Rescue. - [1] Singer, P. (1972). Famine, Affluence, and Morality. Philosophy and Public Affairs, 1(3): 229-43. [2] Irfan, U. (2022, March 16). Why We Still Don’t Yet Know How Bad Climate Migration Will Get. Vox. https://www.vox.com/2022/3/16/22960468/ipcc-climate-change-migration-migrant-refugee, citing the International Panel on Climate Change (IPCC) (2022). Sixth Assessment Report, Climate Change 2022, Impacts, Adaptation, and Vulnerability. https://www.ipcc.ch/report/ar6/wg2/ [3] McKie, J., Richardson, J. (2003) The Rule of Rescue. Social Science & Medicine, 56(12): 2407-2419. https://doi.org/10.1016/S0277-9536(02)00244-7. [4] James, S.M. (2007). Good Samaritans, Good Humanitarians. Journal of Applied Philosophy, 24(3):238-254. [5] Overview of Good Samaritan laws. https://worldpopulationreview.com/state-rankings/good-samaritan-law-states [6] Fifield, J. (2017, Sept. 19). Why It’s Hard to Punish ‘Bad Samaritans’. Stateline Blog, Pew Charitable Trusts, https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/09/19/why-its-hard-to-punish -bad-samaritans [7] Cassella, C. (2019). There’s a Climate Threat Facing Pacific Islands That’s More Dire Than Losing Land, Science Alert, https://www.sciencealert.com/pacific-islanders-are-in-a-climate-crisis-as-rising-sea-levels-threaten -water; Hassan, H. R., and Cliff, V. (2019). For Small Island Nations, Climate Change is not a Threat. It’s Already Here, World Economic Forum, https://www.weforum.org/agenda/2019/09/island-nations-maldives-climate-change/ [8] For example, Lyons, K. (2019). Australia Coal use is Existential threat to Pacific Islanders, The Guardian. https://www.theguardian.com/world/2019/aug/12/australia-coal-use-is-existential-threat-to-pacific-is lands-says-fiji-pm [9] Cripps, E. (2013). Climate Change and the Moral Agent: Individual Duties in an Interdependent World. Oxford: Oxford University Press. [10] Schroeder, D., Chatfield, K., Singh, M., Chennells, R., and Herissone-Kelly, P.. Ethics Dumping and the Need for a Global Code of Conduct. In Cham. (Ed.)(2019). Equitable Research Partnerships. SpringerBriefs in Research and Innovation Governance. Springer. 2019. https://doi.org/10.1007/978-3-030-15745-6_1 [11] Giudice L.C., Llamas-Clark E.F., DeNicola N., Pandipati, S., Zlatnik, M.G., Decena, D.C.D., Woodruff, T.J., Conry, J.A. (2021). Climate Change, Women’s Health, and the Role of Obstetricians and Gynecologists in Leadership, International J Gynecol Obstet, 155(3), 345-356. 10.1002/ijgo.13958 [12] See Ferrarello, S. and Zapien, N. (2020). Ethical Experience: A Phenomenology, Bloomsbury. (for understanding phenomenological determinants of ethical action). [13] McLeman, R.A., Hunter, L.M., (2010). Migration in the context of vulnerability and adaptation to climate change: insights from analogues. Wiley Interdiscip Rev Clim Change, 1(3): 450-461. [14] Least Developed Countries Expert Group. (2018). Considerations Regarding Vulnerable Groups, Communities and Ecosystems in the Context of the National Adaptation Plans: United Nations Framework Convention on Climate Change. [15] Jecker, N.S. 2013. "The Problem with Rescue Medicine." J Med Philos, 38(1):64-81. [16] White House Report. (February 9, 2021), Executive Order (E.O.) 14013, “Rebuilding and Enhancing Programs to Resettle Refugees and Planning for the Impact of Climate Change on Migration.” (calls on the National Security Advisor to prepare a report on climate change and its impact on migration. “This report marks the first time the U.S. Government is officially reporting on the link between climate change and migration.” https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/27/executive-order-on-tackling -the-climate-crisis-at-home-and-abroad/ [17] Torres, J.M., Casey, J.A. (2017) The centrality of social ties to climate migration and mental health. BMC Public Health, 17: 600. https://doi.org/10.1186/s12889-017-4508-0. (shrink)

BackgroundSexual minority (SM) older adults experience mental health disparities. Psychiatric disorders and neuropsychiatric symptoms (NPS) are risk factors for cognitive decline. Although older people in same-sex (SSR) compared to mixed-sex relationships (MSR) perform more poorly on cognitive screening tests, prior studies found no differences in rates of dementia diagnosis or neuropsychological profiles. We sought to explore the role of NPS on neurocognitive outcomes for SM populations. We compared cognitive performance and structural brain parameters of older adults in SSR and MSR.MethodsData (...) were originally collected at Alzheimer's Disease Research Centers (ADRCs). Inclusion criteria were: age of 55+ years, a study partner identified as a spouse/partner, and availability of T1-MRI brain volumes/thickness. Participants were labeled as either SSR or MSR based on their/their co-participant's reported sex. We identified 1,073 participants (1,037 MSR−555 cognitively unimpaired [CU]; 36 SSR−23 CU) with structural MRI data, Mini-Mental State Exam (MMSE), and Neuropsychiatric Inventory Questionnaire (NPI-Q) scores. A subset of the overall sample completed comprehensive neuropsychological assessment (n = 939; 908 MSR−494 CU; 31 SSR−22 CU). Covariates included in statistical models were age, sex, education, total intracranial volume, and apolipoprotein E genotype.ResultsMultivariate general linear models showed significant diagnosis-by-relationship interaction effects on the left parahippocampal gyrus volume. After stratification by relationship group, only cognitively impaired (CI) MSR had significantly smaller left parahippocampal volumes than MSR-CU. The SSR group showed better episodic memory performance. Severity of neuropsychiatric symptoms was negatively associated with volume/thickness of bilateral fronto-temporal areas and with MMSE scores, predominantly in the MSR group.ConclusionIn our study, MSR participants presented with a more compromised cognitive profile than SSR participants. MSR-CI participants showed significantly smaller left medio-temporal volumes, a neural signature of AD. Neuropsychiatric symptoms predicted smaller fronto-temporal volumes in the MSR more consistently than in the SSR group. These findings may be due to unexplored protective factors against cognitive decline in SM elders. Indeed, social support has been proposed as a protective factor warranting future investigation. (shrink)

The article deals with such a phenomenon as the reorientation of bioethics in the era of change. Attention is focused on the fact that the COVID19 pandemic has exposed new problems in practical medicine. Special attention should now be paid to the vulnerable groups that have been most affected by the pandemic – children and the elderly. At the same time, the author disagrees with the unification of gerontology and geriatrics into one, exclusively medical, scientific specialty in the list of (...) the Higher Attestation Commission of 2022. The idea is expressed that bioethics can and should act as a phenomenon synthesizing all aspects of the accompaniment of old age. The author calls for the development of this direction, including on the pages of this magazine. (shrink)

Purpose. Aging is intricate process of self-transformation in view of involution of body, loss of sexual attractiveness, but at the same time, old age is a time for reconsideration of self-existence in time and in the world within coherence of life sense targets and their realization. Unique individual experience of growing old implemented in Ukrainian literature can complete the data received by gerontology. Moreover gender approach in literary gerontology highlights masculine / feminine phenotypical features of internal reverberating of aging. Theoretical (...) basis. To inquire into existential and psychological problems of aging exemplified in the twentieth-century Ukrainian Lyrics it is seems to be the most effective to employ philosophical and psychological approaches in gerontology, as well as feministic studies on elder female body discrimination, in particular in literature. Originality. This research paves the way to the development of gender and literary dimensions in Ukrainian gerontology and anthropology in general. Some of the existential and psychological problems of aging are revealed on the material of 20th-century Ukrainian poetry. The individual lyric experience of aging in different gender moods is anchored mostly in psychic, mental, sense-life strategies. Conclusions. Among the feminine strategies of aging self-reception there are observation of own elder body with anxiety and fear, its "invisibility", deepened feelings of loneliness, self-estrangement, but also finding the sense of life and soul harmony in own family, offspring. Masculine self-reception of aging deals with ideal spiritual model of Wise old man – more abstract than personal; masculine anxiety is caused by physical bodily declining, not attractiveness, but strength and power loosing. (shrink)

The octogenarian festival in Obosi is a festival that is celebrated with a huge fanfare of pumps and pageantries. It is celebrated every three years in March to rejoice with fathers and mothers on the attainment of the age of 80. The worry of the researchers now is how this festival will be handled amid the coronavirus disease 2019 pandemic in the absence of curative drugs. This article examines the octogenarian cultural festival during the COVID-19 pandemic in Obosi, Anambra State, (...) Nigeria. The article aims at narrating the history of octogenarians in Obosi, discussing the functions of age grades, and discussing its relevance and a discourse on this celebration amid the coronavirus. Historical and phenomenological methods were adopted for analytical purposes. The article found that the longevity of life among Obosi people has been strongly threatened by the delta variant and also that celebrants do not feel safe in sustaining the festival for fear of contracting the delta variant.Contribution: The Obosi’s Ito-ogbo celebration is a good one and it has become a homecoming for all. It has sparked a desire to provide more care to elderly parents, resulting in increased life expectancy. African traditional religion was implicated in this study. (shrink)

There are two women called Salpe who are said to have written books in antiquity: one is described by Athenaeus as the name or pseudonym of a writer of ‘Paignia’ the other is cited by Pliny the Elder who calls her at one point Salpe obstetrix. Salpe is a rare name in antiquity—I know of no other examples—and few ancient books were ascribed to women. That two of these rare female writers should be called by the same name is (...) something of a coincidence. That the name they shared was the very rare Salpe is a priori distinctly unlikely. It is much more plausible that they were one and the same. (shrink)

Acceptance of elderly or marginal health individuals as kidney donors is debated, with practices varying between centres. Transplant recipients, live kidney donors and health-care professionals caring for patients with renal failure were surveyed regarding their views on live donor kidney transplantation (LDKT) of marginal health (diabetes, hypertension, atherosclerosis, obesity, etc.) and elderly donors. Participants were recruited within a tertiary renal and transplant centre and invited to participate in focus groups and structured interviews. They also completed an anonymous questionnaire. Of 464 (...) participants who completed the questionnaire (36% health-care professionals and 64% patients), 49% and 64%, respectively, stated that marginal and elderly donors should be accepted for LDKT. In the structured interviews, emphasis was given to presenting to donor, recipient and their respective families a calculated risk regarding the effect that either a nephrectomy or transplant has on long-term quality of life. Participants stated that an independent third party in addition to the transplant team should discuss involved risks. Issues of ‘how desperate’ the recipient's situation is should also be considered. Health-care professionals stated that regardless of the strength of will of an individual to donate a kidney (despite age, health problems or personal risk), they should always have the right to say ‘no’ if performing a specific LDKT was against their professional and ethical values. About half of those surveyed considered that marginal health and elderly donors were acceptable for LDKT. Emphasis was given to the explanation to donors and recipients of the risks involved in such transplantation. (shrink)

The subject of sexuality among elderly patients with dementia was examined, focusing on two main aspects: the sexual behaviour of institutionalized elderly people with dementia; and the reactions of other patients, staff and family members to this behaviour. The behaviour was found to be mostly heterosexual and ranged from love and caring to romance and outright eroticism. Reactions varied, being accepting of love and care but often objecting to erotic behaviour. Understanding of the sexual needs of elderly people should become (...) an integral part of the training and continued education of health care staff, thus helping to resolve conflicts and clarify common misconceptions. (shrink)

Deprescribing is the term used to describe the process of withdrawal of an inappropriate medication supervised by a clinician. This article presents a discussion of how the Four Principles of biomedical ethics that may guide medical practitioners’ prescribing practices apply to deprescribing medications in older adults. The view of deprescribing as an act creates stronger moral duties than if viewed as an omission. This may explain the fear of negative outcomes which has been reported by prescribers as a barrier to (...) deprescribing. Respecting the autonomy of older adults is complex as they may not wish to be active in the decision-making process; they may also have reduced cognitive function and family members may therefore have to step in as surrogate decision-makers. Informed consent is intended as a process of information giving and reflection, where consent can be withdrawn at any time. However, people are rarely updated on the altered risks and benefits of their long-term medications as they age. Cessation of inappropriate medication use has a large financial benefit to the individual and the community. However, the principle of justice also dictates equal rights to treatment regardless of age. (shrink)

Heidegger’s two modes of thinking, calculative and meditative, were used as the thematic basis for this qualitative study of physicians from seven countries . Focus groups were conducted in each country with 69 physicians who cared for the elderly. Results suggest that physicians perceived ethical issues primarily through the lens of calculative thinking with emphasis on economic concerns. Meditative responses represented 24% of the statements and were mostly generated by Canadian physicians whose patients typically were not faced with economic barriers (...) to treatment due to Canada’s universal health care system. (shrink)

Leah Andress,1 Anjali Gupta,2 Nida Siddiqi,3 Kwaku Marfo2,3 1University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Buffalo, 2Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine Department of Abdominal Organ Transplant Program, Bronx, 3Montefiore Medical Center, Department of Pharmacy, Bronx, NY, USA: Rabbit anti-thymocyte globulin has proven benefit as induction therapy in renal transplant recipients, achieving reduced acute rejection rates and better short-term allograft function, with slightly higher rates of complications such as (...) infections and malignancy. Compared with other agents, the most benefit from rATG induction has been observed in renal transplant recipients at high immunologic risk for rejection. However, in special populations, such as pediatrics, the elderly, and hepatitis C-positive and human immunodeficiency virus-positive renal transplant recipients, additional information is needed to delineate the absolute benefit of rATG induction compared with other induction agents. Selection of rATG as the choice of induction therapy in renal transplant recipients should be guided by a cost-effective approach in balancing efficacy, safety, and cost. This review summarizes the published literature on efficacy, safety, and cost of rATG induction in renal transplantation. Keywords: anti-thymocyte globulin, renal transplantation, induction therapy. (shrink)

Research on elders’ acceptance of virtual technologies is much needed. Here we studied the user experience of elders (N = 10, mean age = 88.2 years) during virtual biking, an exergame where participants pedal on a cycle ergometer and wear a Head-Mounted Display that provides them an immersive experience of a bike ride. We tested the effects of augmented gaze on user experience. Augmented gaze is a condition in which horizontal head turns yield amplified visual shifts, which is assumed to (...) facilitate visual exploration. User experience was measured by asking participants to rate satisfaction, motivation, sense of presence and sense of safety. We found a very good acceptance of virtual biking and no signs of negative effects of augmented gaze. These preliminary observations suggest that augmented gaze may be a viable optimization of elders’ experience with certain virtual reality applications. (shrink)

Older people living in a residential setting have the right to respectful care based on professional ethics. The aim of this study was to describe employees' and clients' lived experiences of elder abuse. A qualitative phenomenological method was used with 26 employees and 20 residents from four homes for elderly people in the town of Ostrava, Czech Republic, and two managers from outside these institutions. All complaints about elder abuse (n 5 11) received by Ostrava Municipal Authority during (...) the period 2003 to 2007 were examined. Two main dimensions of the examined phenomenon were identified: forms of elder abuse and causes of elder abuse. Established forms of elder abuse were summarized as rights violation, financial abuse, psychological abuse, physical abuse and neglect. Causes of elder abuse included institution, employee and client characteristics. It is necessary in residential settings to create preventive policies that will focus on supervision regarding elderly people's rights violation and psychological and physical abuse, as well as on building organizational cultures that will respect ethical principles. (shrink)

Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons (n = 20) in order to explore and describe their moral orientation based on the paradigms of justice (Kohlberg) and care (Gilligan). The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men’s moral reasoning was dominated by caring, but justice dominated the (...) reasoning of four women. The implications for ethical decision-making and future research are discussed. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

The aim of this study was to explore ethically problematic situations in the long-term nursing care of elderly people. It was assumed that greater awareness of ethical problems in caring for elderly people helps to ensure ethically high standards of nursing care. To obtain a broad perspective on the current situation, the data for this study were collected among elderly patients, their relatives and nurses in one long-term care institution in Finland. The patients (n=10) were interviewed, while the relatives (n=17) (...) and nurses (n=9) wrote an essay. Interpretation of the data was based on qualitative content analysis. Problematic experiences were divided into three categories concerning patients’ psychological, physical and social integrity. In the case of psychological integrity, the problems were seen as being related to treatment, self-determination and obtaining information; for physical integrity, they were related to physical abuse and lack of individualized care; and for social integrity, to loneliness and social isolation. This study provided no information on the prevalence of ethical problems. However, it is clear from the results that patient integrity warrants more attention in the nursing care of elderly patients. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Ethical issues in the care of elderly people have been identified in many countries. We report the findings of a comparative research project funded by the European Commission, which took place between 1998 and 2001. The project explored the issues of autonomy (part I), privacy (part II) and informed consent (part III) in nursing practice. Data were collected from elderly residents/patients (n = 573) and nursing staff (n = 887) in five European countries: Finland, Spain, Greece, Germany and the UK (...) (Scotland). Questionnaires were used as the data collection tool (self-completion questionnaires for staff, structured interviews for the elderly participants). Four basic nursing interventions in the care of elderly people were targeted: hygiene, fluid intake and nutrition, medication, and elimination. The data were analysed statistically. The results indicated differences within all five countries between staff and patient perceptions of autonomy, privacy and informed consent. There were also similar differences between individual countries. Conclusions were reached concerning practice, education and research. This is the first of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

The purpose of this study was to compare nursing students' perceptions of self-determination in elderly patients before and after clinical training in long term care institutions as a part of their course in gerontological nursing. A pre- post-test design was employed. The data were collected by questionnaires completed by students at one nurse education organization college in Finland (pre-test n ± 120, response rate 95%; post-test n ± 115, response rate 91%). The students' perceptions of elderly patients' self-determination were more (...) positive after their clinical training period concerning to what extent elderly patients are able to control their treatment and what kind of support they received from nurses to exercise their self-determination. The students' perceptions remained stable concerning how important self-determination is to elderly patients, and how willing and knowledgeable they are about using their self-determination. Ethics teaching, together with high quality clinical training placements, should be assured early during nursing studies. (shrink)

The modern form of realism about properties has typically been far more austere than its Platonic ancestor. There is nothing especially austere about denying, as most modern property realists do, the reality of “disjunctive properties”—properties which would correspond, in the world, to disjunctive predicates such as “is an apple or an ocean,” “is observed by now and green or not observed by now and blue,” etc. But modern property realists typically deny far more. It has been argued, for example, that (...) the only real properties there are are properties flanked by contrary opposites—so that there is no real property corresponding, for example, to the predicate “is self-identical.” Perhaps the biggest step in the direction of austerity is the argument, offered by a number of modern property realists, that there can be in the world no “determinable properties” corresponding to such determinable predicates as “has mass,” “is colored,” or “has a valence.” For these arguments are said to establish that not even such familiar properties as redness or painfulness really exist; to predicates such as “is red” and “is painful,” no real property corresponds. The business of this paper is to examine the prevailing arguments against “determinable properties,” and to argue that the ontology which they entail is decidedly less austere than is commonly supposed. The motivation is mainly just to get a more accurate ontology of properties. But a side benefit, if my arguments are correct, will be an increased appreciation for the treatment of vague predicates that posits truth-value gaps—and with it, increased ease with the idea that corresponding to vague predicates there really are, in the world, vague properties. (shrink)

This paper opposes universal mereological composition. Sider defends it: unless UMC were true, he says, it could be indeterminate how many objects there are in the world. I argue that there is no general connection between how widely composition occurs and how many objects there are in the world. Sider fails to support UMC. I further argue that we should disbelieve in UMC objects. Existing objections against them say that they are radically unlike Aristotelian substances. True, but there is a (...) stronger objection. This is that they are characterized by no properties, and so fail to be like anything – even themselves. (shrink)

Historically, opponents of realism have managed to slip beneath a key objection which realists raise against them. The opponents say that some element of the world is constructed by our cognitive practices; realists retort that the element would have existed unaltered, had our practices differed; the opponents sometimes agree, contending that we construct in just such a way as to render the counterfactual true. The contemporary instalment of this debate starts with conventionalism about modality, which holds that the borders of (...) the world's kinds and the careers of individuals in those kinds obtain only relative to our conventions of individuation. Realists object that the kinds and careers in nature would still have obtained, had our conventions been different, but conventionalists claim to be able to agree. I argue that this claim is false, and that conventionalism contradicts itself. (shrink)

Common sense supposes thoughts can cause bodily movements and thereby bring about changes in where the agent is or how his surroundings are. Many philosophers suppose that any such outcome is realized in a complex state of affairs involving only microparticles; that previous microphysical developments were sufficient to cause that state of affairs; hence that, barring overdetermination, causation by the mental is excluded. This paper argues that the microphysical swarm that realizes the outcome is an accident (Aristotle) or a coincidence (...) (David Owens) and has no cause, though each component movement in it has one. Mental causation faces no competition “from below”. (shrink)

James decides that the best price today on pork chops is at Supermarket S, then James makes driving motions for twenty minutes, then James’ car enters the parking lot at Supermarket S. Common sense supposes that the stages in this sequence may be causally connected, and that the pattern is commonplace: James’ belief (together with his desire for pork chops) causes bodily behavior, and the behavior causes a change in James’ whereabouts. Anyone committed to the idea that beliefs and desires (...) are states installed by evolution must, it seems, think something similar. For how can one see beliefs and desires as conferring selective advantage if not by supposing that, by causing bodily behavior in their subjects, they brought about changes in their subjects’ surroundings? Yet many, many philosophers currently think or worry that mental causation is illusory (see, e.g., Heil and Mele 1993, or Macdonald and Macdonald 1995). Any physical changes which a mental state appears to cause can be viewed as a complex event involving microparticles, and for any such complex event, many philosophers suppose, there will have been previous microphysical occurrences sufficient to cause it. Barring routine overdetermination of such complex events, the apparent causation of mental events seems to be excluded. Nor does it help to say that some salient segment of the previous microphysical event just is the mental event, differently described (Davidson 1970). For describing the previous events as microphysical seems to spotlight the very features in virtue of which they did their causal work; the mental features seem epiphenomenal (Yablo 1992b: pp. 425-36; Yablo 1992a). This paper argues that the complex physical events, which mental events seem excluded from causing, are not caused at all. For they are either accidents, in something like Aristotle’s sense (Sorabji 1980: pp. 3-25), or coincidences, in a sense which David Owens has recently sharpened (Owens 1992). (shrink)

The modern form of realism about properties has typically been far more austere than its Platonic ancestor. There is nothing especially austere about denying, as most modern property realists do, the reality of “disjunctive properties”—properties which would correspond, in the world, to disjunctive predicates such as “is an apple or an ocean,” “is observed by now and green or not observed by now and blue,” etc. But modern property realists typically deny far more. It has been argued, for example, that (...) the only real properties there are are properties flanked by contrary opposites—so that there is no real property corresponding, for example, to the predicate “is self-identical.” Perhaps the biggest step in the direction of austerity is the argument, offered by a number of modern property realists, that there can be in the world no “determinable properties” corresponding to such determinable predicates as “has mass,” “is colored,” or “has a valence.” For these arguments are said to establish that not even such familiar properties as redness or painfulness really exist; to predicates such as “is red” and “is painful,” no real property corresponds. The business of this paper is to examine the prevailing arguments against “determinable properties,” and to argue that the ontology which they entail is decidedly less austere than is commonly supposed. The motivation is mainly just to get a more accurate ontology of properties. But a side benefit, if my arguments are correct, will be an increased appreciation for the treatment of vague predicates that posits truth-value gaps—and with it, increased ease with the idea that corresponding to vague predicates there really are, in the world, vague properties. (shrink)

Common sense believes in objects which, if real, routinely lose component parts or particles. Statues get chipped, people undergo haircuts and amputations, and ships have planks replaced. Sometimes philosophers argue that in addition to these objects, there are others which could not possibly lose any of their parts or particles, nor have new ones added to them--objects which could not possibly have been bigger or smaller, at any time, than how they actually were.1 (Sometimes the restriction on size is argued (...) independently of the restriction on switches of parts.2) If these other objects are real at all, they are alarmingly abundant. Exactly where the statue sits, there sits a parcel or piece of clay which would cease to be itself, and hence cease to exist, were even so small a part as the statue's nose removed.3 In exactly the place where the recently reconditioned ship is found, there is a mass of wood which never contained, and never could contain, any particles of wood--or bits of wood-stuff--other than those it now has.4 Moreover, since masses of matter (or "aggregates") can continue to exist even if divided into separate parts, while parcels cannot, the abundance is two-fold: where every parcel is found, there is also a mass.5 But how can there be room for all these additional objects if, at any time, two different objects cannot occupy exactly the same place? Or, worse, if even some of these additional objects are real, how can room remain for familiar objects? Recent treatments of this ancient puzzle have urged that we retain both "the principle of one object to a place" and the other ontological assumptions which make that principle seem to force a choice between affirming the reality of familiar objects, and that of the strangely brittle intruders.6 But all the recent treatments have left standing the reality of at least some of these brittle objects.7 By doing so they have passed up what is, perhaps, the simplest and safest response to the ancient puzzle.. (shrink)