Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term (...) conditions. A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom -based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician’s duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to. (shrink)

The policy of government procurement of elderly care services has the vulnerability characteristics that all complex systems have. To maintain the policy’s robustness, this paper studies the vulnerability of government procurement of elderly care services from the perspective of complex network. Case analysis and sample statistics are used to obtain the vulnerability influencing factors of the policy. Then, complex network diagram of vulnerability influencing factors is constructed through Pajek software. The compatibility coefficient is used (...) to investigate the network’s overall vulnerability from a macro perspective. From a micro perspective, a vulnerability index of the complex network is applied to measure each node’s vulnerability value, and the vulnerability priority of the nodes is established. Results show that government purchasing power and supervisory bodies’ diversity are at the first priority. The remaining vulnerability influencing factors are at the second and the third priority. (shrink)

Home-based service jobs have developed considerably across Western societies. In fact, chances are high that a working-class woman in France today will, at some point in her life, be a house cleaner, home-based child care provider, or home aide for the elderly. Going against political, scholarly, and everyday discourses that, saturated with the double prejudices of gender and class, treat all these home service occupations, which require little prior training, the same, this article illuminates the variability of the (...) forms of subordination experienced by women practicing these occupations in France. Comparing these jobs with the ensemble of low-skill jobs and with each other exposes what is specific to the particular form of subordination each job type entails, in terms of the extent of job supervision and the nature of the home where it is practiced, the presence or absence of relations with coworkers and/or a “public,” and the nature of this “public.” It mobilizes nationwide statistical data in a new way to shift attention to these numerous ordinary work situations, which are much less studied than those of the domestic workers of the wealthiest cities of the Western world. (shrink)

This article argues that the social quality approach can be usefully applied to studying “models of elderly care“ that enhance the wellbeing of the elderly and empower them to participate in social activities. Examining three cases in Japan and another three cases in e Netherlands, the study identifies actors, institutions and processes that have provided services for the elderly, highlighting the importance of history and culture in influencing the “social“ of the elderly. The article (...) deals with a range of opportunities and possibilities for optimizing care for the elderly, both as individuals and as a group, through promoting their social inclusion, social cohesion, socio-economic security and social empowerment. Grounded in community networks, as well as in social and intergenerational interaction, these “models“ demonstrate how care-givers, including nurses and family members, are also empowered in these processes. These discussions, reflecting empirical reality and conceptual insights, provide the basis of sustainable welfare policies that improve the social quality of the elderly. (shrink)

Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an (...) appropriate response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation’s policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes. (shrink)

Workplace learning and competence development in work are frequently used concepts. A wide spread notion is that societal, institutional, and organizational changes require the development of knowledge, methods and strategies for learning at workplaces, in both public and private enterprises. In research on learning and competence development at work, the organizational learning and development as well as individual accomplishments are investigated from various perspectives and in different contexts. The theoretical base for research projects can, accordingly, be focused at a number (...) of organizational and system levels. This paper describes a research project called "Workplace development and learning in elder care" in which learning and knowledge were key issues and where Activity Theory was used as the theoretical base. The project was joint project between two research and development field units. These were UFFE, a municipal social services’ field research unit, and Äldrecentrum Västerbotten, a county council field research unit which aims to serve the interests of the elderly. The project was launched in the fall of 2000 and ended in the summer of 2003. I was employed part-time as a research leader at the municipal research unit and became the research leader for this particular project. A number of students, as well as employees from the county council geriatric care services and the municipal elder care participated in the project. The general aims of the project were to: a) investigate the prerequisites for development and learning; b) test and evaluate interventions at a workgroup level; and c) identify the need for new knowledge. The results were expected to be useful for the field research units as well as for the municipal and county eldercare services in their research and development work. I start with a presentation of the theoretical concepts and apply them in order to form a tentative hypothesis on the status of learning and knowledge in elder care. The next section contains a short description of the different parts of the project and the main results are presented. Finally, the results are discussed and related to the conditions and impact of workplace interventions. (shrink)

The growing gap between demands and resources is putting immense pressure on all government spending in Sweden. The gap is especially apparent in care and services for elderly people in light of the rapid aging of the population. The article considers the decisions and priorities concerning resource allocation in the welfare sector in general and in elderly care in particular. The aim is to describe the political and administrative setting and to provide a conceptual structure (...) that outlines the nature of the problem. Various levels of decision making are identified and discussed in the context of political accountability. Current transitions in elderly care are described with respect to service provision, marketisation, coverage rates, and eligibility standards. Basic principles of distribution are highlighted in order to clarify some central concepts of efficiency and justice, and a number of strategies for actual prioritising are identified. The article concludes with an endorsement of more conscious decisions in resource allocation. Existing knowledge and information concerning the effects of various strategies must be utilised, and the values and assumptions used for setting priorities must be made explicit. (shrink)

This article analyzes the contribution Christian ethics might be able to make to the ethical debate on policy and caregiving in health and social care in the United Kingdom. The article deals particularly with the concepts of solidarity and subsidiarity which are essential in Christian social ethics and health care ethics, and which may be relevant for the ethical debate on health and social caregiving in the United Kingdom. An important argument in the article is that utilitarian and (...) market-driven policies in the National Health Service (NHS) and the social care system have marginalized the position of the elderly and have seriously impoverished the quality of care for the elderly. The neglect of the elderly and other vulnerable groups is also the result of widespread consumerist attitudes among patients and of libertarian models of noninterference which are affirmed by a public ethos of self-sufficiency and counter-dependency. Those who need care dare not make their need known to others and ask for help, while simultaneously those who could help are so intimidated by the public affirmation of privacy and negative rights that they do not dare to offer help except if this is explicitly demanded. This distant and standoffish attitude is in an important way responsible for the fact that the voice of those in need is altogether lost to the public forum. Christian ethics puts much emphasis on responsibility and solidarity with the needy other but is not able to have much impact on the delivery of care in a secularized society and health care system like the NHS. Nonetheless, Christianity still has a powerful and respected voice, by speaking up for those who cannot speak for themselves, such as the elderly and the handicapped. Christians can find allies in the ethics of care and other relational approaches in health care ethics in order to combat libertarianism, consumerism, and utilitarianism. (shrink)

With the accelerating aging of the population and the worsening psychological conditions of older people, the traditional mode of family support for the elderly in China does not always meet the physical and psychological needs of the elderly, and more social support modes for the elderly are needed. Based on 3,513 valid questionnaires on the long-term care and protection needs of Chinese residents, this paper uses a logit regression model to analyze the factors influencing the willingness (...) of the elderly to choose nursing care. The results show that intergenerational family support for the elderly is a significant psychological driver on the willingness of the elderly to choose nursing care. Compared with the elderly living with family, empty nesters or older people living alone are more inclined to select nursing care when they have difficulties taking care of themselves. The physical health of the elderly affects their willingness to choose nursing care, and elderly individuals with more hospitalizations are less likely to select nursing care. In addition, elderly females who are relatively young, have a high level of education, have a high income, have a nursing home near the residence, and are already covered by medical insurance are more willing to choose nursing care. The results of this study are of great importance for improving the medical services and aging care services for the elderly and providing theoretical support for alleviating the psychological and social pressure brought by population aging. (shrink)

Is there an alternative course to one which sets up hypotheses as to the nature of poetry and then proceeds to illustrate them? Happily, there is. Rather than beginning with the hypothesis we may begin with the fact, and let what may emerge. That is, rather than beginning with some notion of the nature of poetry, we may begin with individual poems and discover what we may of their nature or form. This procedure evidently involves four phases: examination of the (...) characteristics of individual poems, discovery, by comparison with other poems, of likenesses and differences, decision as to which of these likenesses and differences are relevant to poetic form, and the statement of form itself. Once we have discovered a given form, we shall be in a position to discuss the principles underlying the construction of such form, the various possibilities of such construction, and what constitutes excellence in a given form. Elder Olson, poet, critic, and Distinguished Service Professor in the department of English at the University of Chicago, is the author of six volumes of verse, including Collected Poems and Olson's Penny Arcade, and of numerous works of literary criticism. His previous contributions to Critical Inquiry are "The Poetic Process" and "On Value Judgments in the Arts" , the title essay on his most recent collection of criticism. Among the many awards which he has received are the Academy of American Poets award, the Longview Foundation award, the Emily Clark Balsh award and, for Olson's Penny Arcade, the Society of Midland Authors award. Both his poetry and his criticism are the subject of a book by Thomas E. Lucas. Part II of "A Conspectus of Poetry" will appear in the Winter 1977 issue of Critical Inquiry. (shrink)

Is there an alternative course to one which sets up hypotheses as to the nature of poetry and then proceeds to illustrate them? Happily, there is. Rather than beginning with the hypothesis we may begin with the fact, and let what may emerge. That is, rather than beginning with some notion of the nature of poetry, we may begin with individual poems and discover what we may of their nature or form. This procedure evidently involves four phases: examination of the (...) characteristics of individual poems, discovery, by comparison with other poems, of likenesses and differences, decision as to which of these likenesses and differences are relevant to poetic form, and the statement of form itself. Once we have discovered a given form, we shall be in a position to discuss the principles underlying the construction of such form, the various possibilities of such construction, and what constitutes excellence in a given form. Elder Olson, poet, critic, and Distinguished Service Professor in the department of English at the University of Chicago, is the author of six volumes of verse, including Collected Poems and Olson's Penny Arcade, and of numerous works of literary criticism. His previous contributions to Critical Inquiry are "The Poetic Process" and "On Value Judgments in the Arts", the title essay on his most recent collection of criticism. Among the many awards which he has received are the Academy of American Poets award, the Longview Foundation award, the Emily Clark Balsh award and, for Olson's Penny Arcade, the Society of Midland Authors award. Both his poetry and his criticism are the subject of a book by Thomas E. Lucas. Part II of "A Conspectus of Poetry" will appear in the Winter 1977 issue of Critical Inquiry. (shrink)

This article aims to present the problem of the impact of artificial intelligence on respect for human dignity in the sphere of care for people who, for various reasons, are described as particularly vulnerable, especially seniors and people with various disabilities. In recent years, various initiatives and works have been undertaken on the European scene to define the directions in which the development and use of artificial intelligence should go. According to the human-centric approach, artificial intelligence should be developed, (...) used and monitored with people in mind, their needs and rights. It is artificial intelligence that should adapt to the rules set by people, not the other way around. The source of all human rights and freedoms is respect for human dignity. This is evidenced by numerous European, international, national regulations and documents. Respecting this value is also one of the works on the AI development. One of the areas of our life into which AI enters more and more boldly and which in the near future, due to demographic reasons and aging population, may be almost dominated by modern technologies, is the medical and care system. The usefulness of industrial co-robots made us think about the possibility of using similar devices in the non-industrial sphere, including in the sphere of care, nursing and therapy. Actually, despite the impressive development of technology and AI, intelligent robots/devices used for care, nursing or therapy (so-called care/nursing or therapy robots) perform rather simple activities. They provide information, navigate, bring something and give it (e.g. medicines, food), help to get up. They are an important support for medical staff in this respect. Performing tasks that are more complex in terms of technology and movement, such as feeding, washing, intimate hygiene, dressing or undressing, is still beyond the reach of the currently used robots. The question we must ask ourselves is whether, in the future, care robots will be able to perform such tasks, and should they do so? Will this lead to the replacement of human medical personnel in the performance of the above-mentioned activities with such robots. Would anyone want to be "looked after" by a soulless machine? Should potential wards/patients, in other words all of us in fact, have the right to object to being taken into the care of an intelligent robot? There is no doubt that intelligent robots have great potential, especially when it comes to ensuring or maintaining the independence or mobility of people with various health limitations. However, we must not forget about the risks and dangers they may generate. Even a simple robot generates serious legal and ethical problems. Who should be liable for damage caused in connection with improper care performed with the participation of a robot? Robots based on AI systems are able to collect a significant amount of sensitive data, for example through the face and speech recognition function. There is considerable scope for abuse in this area, not only in terms of personal data protection but also in terms of informational self-determination, privacy and dignity. Bearing in mind the above risks, the creation of a new right to object to being looked after by a robot should be considered. (shrink)

Scientific progress in the areas of health and biological science is phenomenal. Still, current health policies limit optimal benefit for our peoples. Our present system costs too much, delivers too little, is not comprehensive, coherent, or cost-effective, does not allow choice, is not equitable, and is not universal. We must overcome many crises if we are to create a healthy people fro the twenty-first century in the US. We will need to use multiple strategies to achieve the nation's goals of (...) Healthy People 2010, which are to: 1) increase the quality and years of healthy live; 2) eliminate health disparities; 3) provide access to primary preventive care for all citizens. We are the richest country in the world and the only industrialized country that does not provide health care for its entire people. Health care costs are escalating and insurance is out of reach for many. Public policy changes are necessary to provide universal access to basic health care. We have advances in sciences; now we need the science delivered to our people in an equitable way. Politicians will respond proportionately to the insistence of the people. Healthcare professionals and scientists should lead the way. (shrink)

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)

Caregiving robots are often lauded for their potential to assist with geriatric care. While seniors can be wise and mature, possessing valuable life experience, they can also present a variety of ethical challenges, from prevalence of racism and sexism, to troubled relationships, histories of abusive behavior, and aggression, mood swings and impulsive behavior associated with cognitive decline. I draw on Confucian ethics, especially the concept of filial piety, to address these issues. Confucian scholars have developed a rich set of (...) theoretical resources for dealing with beloved but imperfect elders, and navigating the challenges of supporting seniors whose ethical commitments are unreliable. These resources provide a way to reconcile two important but conflicting desiderata: to value and care for seniors, but also to clear-mindedly deal with their moral shortcomings. In particular, they articulate a duty to remonstrate with our elders when they err. Confucian filial piety can helpfully inform robot design and use in geriatric care. They can be used to strengthen and protect emotional connections in important relationships, but should not be used to reinforce patient preferences when doing so damages relationships or their ability to act morally. Rather than conceive of patient wellbeing as in tension with moral behavior, and care as a burden for caregivers, not a source of value and meaning, Confucian accounts of filial piety help identify both new areas of concern and new potential in the development of caregiving technologies, ones which see these goods as complementary. (shrink)

Proprioception, a sense of bodily position and movement, is rarely the focus of conscious experience. If we are ordinarily conscious of proprioception, we seem only peripherally so. Thus, evidence that proprioception is present in the periphery of at least some conscious experiences seems to be good evidence that conscious experience is fairly rich. Anosognosia for paralysis is a denial of paralysis of one's limbs, usually in the wake of brain damage from stroke. Because anosognosic patients overlook their paralysis, anosognosia seems (...) be a counter-example to the claim that proprioception exists in the periphery of conscious experience. However, careful consideration of the data shows that anosognosia makes a poor counterexample to a rich theory of consciousness. Thus, we retain reason to believe that proprioception exists in the periphery of conscious experience, and so to conclude that conscious experience is relatively rich. (shrink)

Recent feminist literature has begun to call attention to the diverse linkages between work and family, including the extensive work married women often do for their husbands' careers. Using a longitudinal sample of American women born around 1910, this study employs quantitative and qualitative data to compare different aspects of wives' support and to develop an understanding of how women of their generation constructed their involvement. The authors begin their analysis by comparing wives' support across husbands' occupations and then examining (...) differences in activities and the ways in which women describe their relationships to their husbands' work. They find considerable variation in the way women constructed their relationships to husbands' careers. The evidence suggests that women who provided services directly related to their husbands' work may have been the most satisfied with their involvement. (shrink)

Reading Aristotle with Thomas Aquinas: His Commentaries on Aristotle's Major Works offers an original and decisive work for the understanding of the thought of Thomas Aquinas. For decades his commentaries on the major works of Aristotle have been the subject of lively discussions. Are his commentaries faithful and reliable expositions of the Stagirite's thought or do they contain Thomas's own philosophy and are they read through the lens of Thomas's own Christian faith and in doing so possibly distorting Aristotle? In (...) order to be able to provide clarity and offer a nuanced response to this question, a careful study of all the relevant texts is needed. This is precisely what the author sets out do to in this work. Each chapter is devoted to one of the twelve commentaries Thomas wrote on major works of Aristotle including both his massive and influential commentaries on the Metaphysics, Physics and Nicomachean Ethics as well as lesser known commentaries. Elders places Thomas's commentary in its historical context, reviews the Greek, Arabic and Latin translation and reception of Aristotle's text as well as contemporary interpretations thereof and presents the reader with a thorough presentation and analysis of the content of the commentary, drawing attention to all the places where Thomas intervenes and makes special observations. In this way the reader can study Aristotle's treatises with Thomas as guide. The conclusion reached is that Thomas's commentaries are a masterful and faithful presentation of Aristotle's thought and of that of Thomas himself. Thomas's Christian faith does not falsify Aristotle's text, but gives occasionally an outlook at what lies behind philosophical thought. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Ethics and the Elderly: The Challenge of Long-Term Care by Sarah M. Moses, and: Loving Later Life: An Ethics of Aging by Frits de LangeDolores L. ChristieEthics and the Elderly: The Challenge of Long-Term Care Sarah M. Moses maryknoll, ny: orbis, 2015. 206 pp. $38.00Loving Later Life: An Ethics of Aging Frits de Lange grand rapids, mi: eerdmans, 2015. 169 pp. $19.00Today many women (...) and men live beyond the so-called third age of life and enter their eighties, the "fourth age," during which the toll of time and the growing incidence of life-limiting conditions wear down even the best-preserved of the human species. Debilitating disease and normal ebbing of human function become more concentrated in this demographic bubble. As people enter their eighties, their world tends to narrow both physically and mentally, creating a need for increasing care. Often the elderly are rendered passive and dependent, forced to cede both autonomy and dignity. They become objects with little voice, requiring greater care and increasing cash. Likewise, as the baby boom generation enters this group, those living in the fourth age make up an increasing percentage of the population. Additionally, modern models of care for the elderly, often based on efficiency and cost-effectiveness, tend to erode their human dignity. Together these factors demonstrate a growing moral problem.What to do? These two books provide valuable road maps for how to proceed. They detail the reality and moral urgency of the situation. Both offer principles from philosophical and religious traditions that outline a good moral model: one of care, compassion, dignity, and community. They draw insights from Augustine and Thomas Aquinas, Karl Barth, and Dietrich Bonhoeffer, among [End Page 214] others. Both reference the Western biblical tradition, which honors the elderly even in the face of their limitations.Although the authors offer wise and thoughtful suggestions to address this growing moral crisis, they approach the serious moral issue very differently. Sarah Moses outlines a compelling case for a new interventional model for elderly living. While her book plays some muted chords that hint at "dissertation," the melody it conveys is strikingly forte and well worth the read.She presents two concrete examples of what good interaction with the elderly might look like. One draws from the international intentional outreach and residential community (the Community of Sant'Egidio), the other is a brick-and-mortar model (the Green House Project). Using both biblical paradigms and church teaching over the centuries, Moses makes the case for treating all persons with dignity and promoting their involvement in decision making as much as possible. The scriptural message she highlights—both our duty to the elderly and the "disappointment and depression" (105) of growing old—is particularly compelling.In her examples of good long-term care, community development is important. In the Sant'Egidio model, volunteers share a common life "through gathering for prayer and various outreach services to the poor" (39). There is motivation to support elderly in their own homes, but the project promotes small, family-like resident facilities when this is not possible. The physical place is less emphasized than the relationship among various age and economic groups.The Green House Project is based in a new vision of homes for the challenged elderly. Results of the project show that not only did staff remain in their jobs longer (nursing home employment turnover is extensive) but visitation by family members increased. Even such a simple thing as a different physical model for the actual building—replacing long halls and routinization with a more home-like environment—has positive results.Moses calls on leadership in church and community to educate, to designate funds for elder care, and to look beyond the caring and the construction of good facilities. She notes how important it is to work politically to change attitudes and actions.She sees care for all dependent people as a responsibility of both the church community and society in general. This includes fostering awareness, encouraging ongoing participation of the elderly in life—including church life—and allocating public resources. Bottom line: she calls for smaller institutions, meaningful opportunities for the... (shrink)

An enormous challenge facing China is how to provide sustainable care for its rapidly-increasing elderly population. Its recent policy directives include three medical forms—the institution-cooperation-form, the institution-medical-form, and the family-physician-form—to integrate medical care into ordinary care for the elderly. This essay indicates that China will not be able to maintain sustainable elderly care unless it places emphasis on the family-physician-form that focuses on family physicians and the use of primary care services. (...) The essay constructs arguments for this policy suggestion based on China’s long-standing Confucian ethical resources of filial piety and family-based concerns for elderly care. (shrink)

Three female physicians were interviewed as part of a comprehensive investigation into the narratives of female and male physicians and nurses, concerning their experience of being in ethically difficult care situations in the care of elderly people. The interviewees expressed great concern for the low status of care for elderly people, and the need to fight for the specialty and for the care and rights of their patients. All the interviewees’ narratives concerned problems relating (...) to perspectives of both action ethics and relational ethics. The main focus was on problems concerning the latter perspective, expressed as profound concern and respect for the individual patient. Secondary emphasis was placed on relationships with relatives and other professionals. The most common themes in an action ethics perspective were too little treatment and the lack of health services for older patients, together with overtreatment and death with dignity. These results were discussed in the light of Løgstrup’s ethics, which emphasize that human life means expressing oneself, in the expectation of being met by others. Both Ricoeur’s concept of an ethics of memory and Aristotle’s virtue ethics are presented in the discussion of too little and too much treatment. (shrink)

The Australian Royal Commission into Aged Care Quality and Safety acknowledged understaffing and substandard care in residential aged care and home care services, and recommendations were made that that the Australian Government should promote assistive technology within aged care. Robotic care assistants can provide care and companionship for the elderly—both in their own homes and within health and aged care institutions. Although more research is required into their use, studies indicate (...) benefits, including enabling the elderly to live independently at home, assistance with medication and monitoring of safety. Nevertheless, there are inherent ethical challenges in the use of robots as carers, including loss of privacy, unwarranted restrictions on autonomy, lack of dignity, deception, and the exacerbation of loneliness. Ethics by design can counter these issues in development of robotics and clinical ethics committees have been put forward as a way of dealing with the ethical use of robotic care in healthcare institutions. In this paper I outline the ethical challenges of robotic care assistants and how these may be mediated in their design and use. (shrink)

Exchanges in the nineteenth century between Sir William Hamilton, James Frederick Ferrier and the French philosopher Victor Cousin are crucial to understanding contemporary efforts to preserve the continuity of the Scottish philosophical tradition on the part of those alive to new themes emanating from Kant and philosophy in Germany. Ferrier's strategy aimed at re-invigorating Descartes and Berkeley by drawing on elements in Adam Smith's social philosophy. But the promising steps taken in this direction in Ferrier's essays on consciousness were seriously (...) undermined, in Cousin's view, by the aprioristic character of his Institutes, in which he abandoned the careful empirical method characteristic of Scottish philosophy as practiced by Reid. (shrink)

This carefully edited book, complete with notes, a bibliography, and indexes, contains fourteen papers selected from those read at the yearly meeting of the Society for Ancient Greek Philosophy. The essays are divided into three groups dealing with logic, metaphysics, and the soul. John P. Anton argues that the categories do not mean predicates but fundamental types of attribution formulated in accordance with the ontology of first substance. D. Morrison points out that they stand for classes of being in the (...) universe. The question of why Plotinus dispensed with some of the categories is the subject of C. Evangeliou's paper: Plotinus tended to reduce even quantity and quality to relations and made action and passion species of motion, whereas Aristotle never referred to motion as a category. A. Urbanas presents a valuable study of the meaning of ὅπερ. (shrink)

In this paper we explore the intersection of three topics which have historically been singled out for ethical consideration in advertising and marketing: the use of fear appeals, marketing to the elderly, and the marketing of health care services and products. Issues relevant to using fear appeals in promoting health care issues to the elderly are explored with a consumer psychologist's theoretical view of fear appeals. Next the assumption of the elderly market's vulnerability and (...) indicants of social or psychological function which would differentiate the elderly recipients of marketing communications are examined both in terms of function and ethical concerns.Overall, our review of the theoretical underpinnings of fear-based communication and the psychological characteristics does not indicate that the elderly of today are particularlyvulnerable. While the elderly are probably somewhat more dogmatic than younger consumers and perhaps view outcomes from the perspective of their age, there are no indications that their psychological responses to fear-based appeals differ significantly from those of younger consumers. (shrink)

This is an important book. It consists of twenty-one essays, sixteen of which have not been published before, and sheds light on two of the most difficult points in the Poetics, imitation and catharsis. The order in which the papers are presented has been carefully chosen, so that the overall impression is that of a certain unity of interpretation. In this review we can only bring out a few of the more salient statements of the book.

The author aims at providing a setting in which a modern reader can evaluate the meaning of what Plotinus has to say: it is more important to listen to Plotinus than to investigate the sources of his thought. Deck gives a careful description, even if largely in a negative approach, of the One, and turns next to the main characteristics of Nous, which represents an ideal of contemplation but also produces the universe. The difficulties inherent to Plotinus's concept of soul (...) are discussed. The last of the products of contemplation is nature, the lower part of soul. Plotinus's answer to the question whether nature is real is elusive: it is fully real, yet what is real appears to be the reflection of a form upon matter, which is a mirror reflecting being. But even this presentation must be qualified. The last chapter deals with efficient causality: contemplation is at the same time production. Plotinus seems to consider matter a product of the Nous. (shrink)

It is always difficult to present a collection of essays, and this the more so if written by twenty-eight authors. However, this imposing and beautifully printed volume has been planned very carefully, so that the various contributions create a fairly complete study of Aquinas’s thought in the Second Part of the Summa theologica. The essays have approximately the same length and are accompanied by numerous scholarly endnotes. L. E. Boyle recalls that St. Thomas’s intention was to connect moral theology to (...) dogmatics, the Second Part being foremost in his mind. It did indeed capture the attention of the students of his order. S. Pinckaers gives a fine survey of the sources used by Thomas in the I-II and brings out the place of the auctoritates in theology. S. J. Pope presents a compact summary of the contents of the Second Part but does not consider its relation to the Commentary on the Nicomachean Ethics. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of (...) health care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

Background Healthy aging is one of the essential aspects of a health promotion program in the elderly. Aim Exploring ethical challenges in healthy elderly care from the perspective of nurses, older adults, and families in the Iranian context. Research Design This qualitative study was conducted using a content analysis approach in 4 health centers in northeastern Iran from 2017 to 2019. Semi-structured interviews, observation, review of elderly files, and focus groups were used to collect data. Ethical (...) considerations The ethics committee of the university approved this study in Iran. This study adhered to the principles of the Helsinki Declaration. Ethical principles autonomy, confidentiality, and anonymity were considered for the participants. Participants were informed about the purpose of the study and submitted written informed consent regarding their participation. Findings The central theme was: An unfair approach to caring for healthy older adults. The three categories were as follows: Forgotten human care, disrespect, and lack of a meaningful and trustworthy relationship. The 14 subcategories highlighted the ethical challenges of healthy aging care in health centers. Discussion The findings showed that due to nurses’ unfamiliarity with the concept of healthy aging, older adults are discriminated against in care centers. Creating a standard care program for healthy older adults ensures that ethical principles are followed for these clients. Conclusion Various individual and organizational factors lead to an unfair approach to caring for healthy elderly in health centers. The following factors can help improve the care of healthy aging and reduce ethical challenges in this area: Introducing nurses to the concept of healthy old age and its dimensions, creating a community-based approach in health centers, prioritizing health issues over health issues, Involvement of families and older adults in needs assessment-goal setting-implementation and evaluation of health services, and design of home visit programs to provide services to healthy elderly. (shrink)

Research necessarily entails the close interrelation of concepts and arguments, including solutions to a range of meta-questions, whether acknowledged explicitly or not. Despite this, few detailed accounts currently exist that support researchers to develop their complex conceptual architectures, especially in critical realist spheres. Indeed, many published accounts often omit much of this ‘messiness’ that sits behind, yet is foundational to, research projects. Those accounts that do seek to portray how/why researchers have made decisions (e.g. about connections between research philosophy, methodology, (...) methods, theory and empirical evidence) tend to focus on one set of meta-questions, or occasionally on the relationships between two sets, at a time. Therefore, this paper presents a flexible framework – supported by specific examples from studies – that we hope will be useful in supporting researchers from all traditions, but especially critical realists, to carefully think through and develop more holistic connections in their conceptual architecture. (shrink)

This study examines public health nurses’ perceptions and concerns about the implications of Japan’s new long-term care insurance law concerning care provision for elderly people and their families. Respondents voiced their primary concern about this law as access to services for all elderly people needing care, and defined their major responsibility as strengthening health promotion and illness prevention programmes. Although wanting to expand their roles to meet the health care, social and public policy (...) advocacy needs of elderly persons and their families, respondents also stated their concern for the possible lack of enough resources for this expansion to support family caregivers adequately. They viewed their first function as developing collaborative relationships with local government officials to help to assure sufficient resources to provide the necessary foundation for long-term care programmes to deliver services to all those in need. These concerns fall within the larger ethical issue of distributive justice in a society based on the obligations of the state to citizens and the family to its members, especially elderly relatives, who, according to traditional Japanese values, retain respect. (shrink)

The issues involved in decision making about the aggressiveness of future medical care for older persons are explored. They are related to population trends, the heterogeneity of older persons and a variety of factors involved in individual preferences. Case studies are presented to illustrate these points, as well as a review of pertinent literature. The argument is offered that, considering these many factors, a system of flexible, individualized care by informed patient preference, is more rational than the rationing (...) of technological services by age. (shrink)

Despite moves to enhance the autonomy of clients of health care services, the use of a variety of physical restraints on the freedom of movement of frail, elderly patients continues in nursing homes. This paper confronts the use of restraints on two grounds. First, it challenges the assumption that use of restraints is necessary to protect the welfare of frail, elderly patients by drawing on a range of data indicating the limited efficacy of restraints. Secondly, it (...) argues that the duty to respect individual autonomy extends to a duty to respect the autonomy of patients who are elderly, frail and living in nursing homes. (shrink)

‘Client involvement’ has been a mantra within health policies, education curricula and healthcare institutions over many years, yet very little is known about how ‘client involvement’ is practised in home‐care services. The aim of this article is to analyse ‘client involvement’ in practise seen from the positions of healthcare professionals, an elderly person and his relative in a home‐care setting. A sociologically inspired single case study was conducted, consisting of three weeks of observations and interviews. The (...) study has a focus on the relational aspects of home care and the structural, political and administrative frames that rule home‐ care practice. Client involvement is shown within four constructed analytical categories: ‘Structural conditions of providing and receiving home care’; ‘Client involvement inside the home: performing a professional task and living an everyday life’; ‘Client involvement outside the home: liberal business and mutual goal setting’; and ‘Converting a home to a working place: refurnishing a life’. The meaning of involvement is depending on which position it is viewed from. On the basis of this analysis, we raise the question of the extent to which involvement of the client in public home‐care practice remains limited. (shrink)

Norwegian health professionals, elderly people and family members experience ethical problems involving end-of-life decision making for elders in the context of the values of Norwegian society. This study used ethical inquiry and qualitative methodology to conduct and analyze interviews carried out with 25 health professionals, six elderly people and five family members about the ethical problems they encountered in end-of-life decision making in Norway. All three participant groups experienced ethical problems involving the adequacy of health care for (...) elderly Norwegians. Older people were concerned about being a burden to their families at the end of their life. However, health professionals wished to protect families from the burden of difficult decisions regarding health care for elderly parents at the end of life. Strategies are suggested for dialogue about end-of-life decisions and the integration of palliative care approaches into health care services for frail elderly people. (shrink)

Twenty-five years ago, robotics guru Joseph Engelberger had a mission to motivate research teams all over the world to design the ‘Elderly Care Giver’, a multitasking personal robot assistant for everyday care needs in old age. In this article, we discuss how this vision of omnipotent care robots has influenced the design strategies of care robotics, the development of R&D initiatives and ethics research on use of care robots. Despite the expectations of robots revolutionizing (...) care of older people, the role of robots in human care has remained marginal. The value of world trade in service robots, including care robots, is rather small. We argue that the implementation of robots in care is not primarily due to negative user attitudes or ethical problems, but to problems in R&D and manufacturing. The care robots currently available on the market are capable of simple, repetitive tasks or colloquial interaction. Thus far, also research on care robots is mostly conducted using imaginary scenarios or small-scale tests built up for research purposes. To develop useful and affordable robot solutions that are ethically, socially and ecologically sustainable, we suggest that robot initiatives should be evaluated within the framework of care ecosystems. This implies that attention has to be paid to the social, emotional and practical contexts in which care is given and received. Also, the political, economic and ecological realities of organizing care and producing technological commodities have to be acknowledged. It is time to openly discuss the drivers behind care robot initiatives to outline the bigger picture of organizing care under conditions of limited resources. (shrink)

In aged societies, the rise of chronic diseases and the health care costs from the aging population are becoming social and economic problems. The emergence of these problems in health care provides an opportunity to shift from a disease paradigm to a preventive paradigm. A preventive paradigm is realized in the form of patient-centered care, and ICT is recommended in health care services as an appropriate alternative. This article analyzes the ethical problems that could arise (...) in ICT healthcare for the elderly in aged societies by applying the ethics of e-Medicine. The ethics of e-Medicine consists of the principle of the doctor-patient relationship, the principle of responsibility, and the principle of autonomy. (shrink)

In Bangladesh due to improved quality of life the number of people over 60 years is increasing rapidly. This should be seen as an emerging challenge as the elderly will have special needs and require different care-giving services. Since Bangladesh does not have a social welfare system there will be competition for inadequate resources specially health and medical services. It is envisaged that due to more elderly population the demographic structure will undergo a slow change (...) from the present pyramid structure. The growing trend towards nuclear family or where children live abroad will put the elderly parents in a dilemma-the financial and social support that is essential for them has not yet emerged. The nutrition and health status of elderly people depend on adequate food safe water, proper sanitation facilities and maintaining hygienic standards. To provide special medical care for the elderly there is a need to establish WHO recommended Age-Friendly Primary Health Care centers and separate wards /units are to be set up in the hospitals. To reduce vulnerability of older women there is a need to distribute assets and properties according to the law.. Our new generations have to be responsive, informed and attentive about their duties and responsibilities towards the elderly people. Taking proper care of the elderly is our ethical duty and responsibility. (shrink)

Current advances in connectivity, sensor technology, computing power and the development of complex algorithms for processing health-related data are paving the way for the delivery of innovative long-term health care services in the future. Such technological developments will, in particular, assist the elderly and infirm to live independently, at home, for much longer periods. The home is, in fact, becoming a locus for health care innovation that may in the future compete with the hospital. However, along (...) with these advances come valid privacy and security questions arising from the fact that the data collected and transmitted through these technologies could also allow for individual monitoring as well as unauthorized access to critical diagnostic and other health data. (shrink)

Working with elders around the world has taught me that those living in grass huts in Africa with children at their feet are often happier than people in assisted‐living homes with a chandelier over their heads. My work in design consultancy and in fifteen years of running a nonprofit, Ibasho, that aims to co‐create socially integrated and sustainable communities that value their elders has allowed me to learn much about how architects and designers can contribute to helping people live a (...) good life in late life. People often need supportive services or other adaptations as they age, but do they really need—or want—the luxury environment few are accustomed to? The challenge for architects and designers is not to create a built environment whose carefully curated facades hide lives of quiet desperation. It is to help elders access the support they need without upending their lives or severing virtually all ties to their communities. (shrink)

Paid care services such as child care, elder care, teaching, and nursing are vulnerable to competitive pressures that often generate low-pay/low-quality outcomes. Both workers and consumers suffer as a result. This article develops an economic analysis of the “care sector” that emphasizes the potential to build political coalitions that could push for a high-pay/high-quality alternative.

Goh, Michelle Christian discipleship is to live faithfully Jesus' commandment of love-of God and of our neighbour. The commandment to love especially those who are poor or in need was emphasised by Jesus in his actions and his teachings. Jesus' parable of the Good Samaritan has traditionally been an influential model of care and compassion. We are given an example of how we ought to extend ourselves to care for each other, especially those who are helpless, suffering or (...) isolated.1 It is increasingly recognised that elderly persons are amongst those who are in need in modern society. This article discusses how the trinitarian perspective of God can enrich our care and service of ageing persons beyond the Good Samaritan paradigm. (shrink)

In this analysis I apply a Foucauldian approach to ethics to examine the politically prescribed moral and ethical character required of carers of aged persons at home in Australia and the role of nurses in shaping these behaviours. The work that spousal carers provide, although often founded on love and/or obligation, has been formalized through a variety of policy initiatives and technologies that serve to construct the moral approach they must adopt. This shaping of conduct at the most personal level (...) takes place through the application of codes of behaviour policed largely by nurses. These codes redefine the mode of coexistence between an aged husband and wife and propose a new form of relationship that is derived from and supports policies of the deinstitutionalization of care services for elderly persons. In this way modern carer policy has drawn on knowledge and governance of the self to produce a morality of caring that is both authoritative and scientific. (shrink)

The Fourth Edition of this bestselling, highly regarded book has been fully revised to incorporate changes in law and clinical guidance making a vital impact on patient management, encompassing: The Equalities Act 2010 which provides a right of older people to treatment without discrimination ; Case law on withdrawing nutrition and hydration ; Updated guidance on resuscitation from the Resuscitation Council, the British Medical Association and the Royal College of Nursing ; The redefining of good medical practice by the General (...) Medical Council ; The abolition of the Liverpool Care Pathway with an updated guidance on end of life care and advance care planning. Expanded throughout, this new edition also integrates two entirely new chapters covering testamentary capacity and role of the physician, and religious beliefs and end of life issues. Its practical, reflective and informative approach continue to make it essential reading for all health professionals, particularly trainees, involved in making difficult decisions in the care of older persons. It is also highly recommended for undergraduate medical students. (shrink)

A notable feature of post-Fordist economies is the increase in service jobs, which includes care occupations such as child care and elder care (Folbre 2001, 182). The commodification of caring activities raises issues surrounding the reception and dispensation of these services, and this is particularly salient to the focus of this paper, elder care. Because the demand for this type of care has greatly increased in recent decades (Glendinning, Schunk, and McLaughlin 1997; Kaye et (...) al. 2006) and also in recognition of the impact of caring activities on families, many countries have sought to initiate policies to provide state-funded services or to compensate family caregivers for their care work.1If help with the .. (shrink)