p166 In February 1965, the United States escalated the war against South Vietnam radically, and also, on the side, began regular bombing of the North at a much lower level. That was a big public issue in the United States: Should we bomb North Vietnam? The bombing of the South was ignored. The same shows up in the internal planning, for which we now have an extremely rich record, not only from the Pentagon Papers, but from tons of declassified documents (...) that have been released in the last couple of years. It turns out again, one of the very few interesting revelations of the Pentagon Papers that there was no planning for the escalated bombing of the South. There was very meticulous planning about the bombing of the North carefully calibrated, when should we do it, and a lot of agonizing about it. The bombing of the South at triple the scale of the North is barely discussed. There are a few casual decisions here and there. The same shows up in McNamara's recent memoirs. He discusses at great length the bombing of the North. The bombing of the South he literally doesn't mention. He mentions what he did on January 21, 1965, a really important day: there was a big discussion about whether to bomb North Vietnam. He doesn't mention what we know from other documents, that on that same day, he authorized for the first time the use of jet planes to escalate the bombing of South Vietnam over and above the massive bombing that had been going on for years that's not even mentioned. (shrink)

Mysticism is condemned as often as it is praised. Much of the condemnation comes from mysticism’s apparent disregard of morality and ethics. For mystics, the experience of “union” transcends all moral concern. In this careful examination of the works of such practitioners or examiners of mysticism as Paul Tillich, Thomas Merton, Evelyn Underhill, and Martin Buber, the author posits a spectrum of uneasy relationships between mysticism and morality. Horne explores the polarities of apophatic (imageless) and imaginative mysticism, the contemplative and (...) the active life, and morality and amorality. He stresses the importance of the distinction between “proper-name” (entirely personal) morality and “social” morality, for the history of Christian mysticism is a mix of minimal moral concern, proper-name morality, and social morality. The volume will be of interest to students of religious experience, ethics, and the recent history of mysticism. Carefully reasoned and documented, the argument is couched in clear prose, easily accessible to lay readers as well as to scholars. (shrink)

The purpose of this study was to explore situations experienced by 12 health-care providers working in two nursing homes. Individual interviews, using a narrative approach, were conducted. A phenomenological–hermeneutical method, developed for researching life experiences, was applied in the analysis. The findings showed that good care situations are experienced when the time culture is flexible, the carers act in a sovereign time rhythm, not mentioning clock time or time as a stress factor. The results are discussed in terms (...) of anthropological and sociological theory: time as event and action and flexible time cultures. Care settings for persons with dementia represent many challenges, such as a heavy workload and time strain. Time ethics is a construction, understanding time used in caring for persons suffering from dementia, which involves a mature, responsible and flexible nursing approach to these patients. (shrink)

Background Care homes have been disproportionately affected during the COVID-19 pandemic. Practical challenges of enacting infection control measures in care home settings have been widely reported, but little is known about the ethical concerns of care home staff during the implementation of such measures.. Objectives To understand the ethical challenges perceived by care home staff during the early months of the COVID-19 pandemic. Research design An exploratory qualitative study. Participants and research context A (...) purposive sample of 15 care home staff in different roles and ranks in Hong Kong was recruited to take part in semi-structured interviews between June and August 2020. Ethical considerations Ethical approval for this study was obtained. Participation was voluntary and anonymous. Participants had the right to withdraw from the study at any time without reprisal. Findings Three themes were identified: unclear legitimacy regarding infection control measures, limited autonomy in choices over infection control measures and inevitable harms to residents’ well-being. While the participants expected that they would have legitimated power to implement infection control measures, they were resistant when their right to self-determination of testing and vaccination was infringed. They also felt trapped between ethical duties to protect care home residents from infection risk and the anticipated detrimental effects of infection control measures. Conclusions The findings of this study reveal tensions among the ethical obligations of care home staff in response to a public health emergency. They highlight the importance of strengthening ethical sensitivity and ethical leadership in identifying and resolving the challenges of pandemic responses. (shrink)

In recent years, a proportion of older Germans has been sent to relatively high‐end care homes within lower‐income countries where the care tends to be cheaper and more extensive than that in German care homes. Destination countries are found predominantly within Eastern Europe (e.g. Poland, Hungary, Czech Republic), but to a lesser extent also within South‐East Asia (e.g. Thailand). At the same time, these expatriations have caused much controversy, with some German commentators calling them ‘inhumane’ and ‘shameful’. (...) In this article, I argue that such criticisms are overdrawn. Although sending an older individual to a care home within a lower‐income country can be morally impermissible, I find that there are at least three sets of conditions under which it is not. (shrink)

In recent years, a proportion of older Germans has been sent to relatively high‐end care homes within lower‐income countries where the care tends to be cheaper and more extensive than that in German care homes. Destination countries are found predominantly within Eastern Europe (e.g. Poland, Hungary, Czech Republic), but to a lesser extent also within South‐East Asia (e.g. Thailand). At the same time, these expatriations have caused much controversy, with some German commentators calling them ‘inhumane’ and ‘shameful’. (...) In this article, I argue that such criticisms are overdrawn. Although sending an older individual to a care home within a lower‐income country can be morally impermissible, I find that there are at least three sets of conditions under which it is not. (shrink)

The COVID-19 pandemic has had a devastating impact on care homes in the United Kingdom, particularly for those residents living with dementia. The impetus for this article comes from a recent review conducted by the authors. That review, a qualitative media analysis of news and academic articles published during the first few months of the outbreak, identified ethical care as a key theme warranting further investigation within the context of the crisis. To explore ethical care further, a (...) set of salient ethical values for delivering care to care home residents living with dementia during the pandemic was derived from a synthesis of relevant ethical standards, codes and philosophical approaches. The ethical values identified were caring, non-maleficence, beneficence, procedural justice, dignity in death and dying, well-being, safety, and personhood. Using these ethical values as a framework, alongside examples from contemporaneous media and academic sources, this article discusses the delivery of ethical care to care home residents with dementia within the context of COVID-19. The analysis identifies positive examples of ethical values displayed by care home staff, care sector organisations, healthcare professionals and third sector advocacy organisations. However, concerns relating to the death rates, dignity, safety, well-being and personhood – of residents and staff – are also evident. These shortcomings are attributable to negligent government strategy, which resulted in delayed guidance, lack of resources and Personal Protective Equipment, unclear data, and inconsistent testing. Consequently, this review demonstrates the ways in which care homes are underfunded, under resourced and undervalued. (shrink)

Client participation in elderly care organizations requires shifting traditional power relations and establishing communicative action that involves the lifeworlds of clients and professionals alike. This article describes a particular form of client participation in which one client was part of a team of professionals in a residential care home. Their joint remit was to plan the implementation of a new personal care file for residents. We describe the interactions within this team through an ethnodrama, based on (...) participant observations and the embodied presence of the researcher (first author). The narratives and voices of all team members are dramatized in this ethnodrama. Throughout the project the team members experienced confusion relating to the confrontation between lifeworld and system, as experienced by the client and professionals in the team. We analyze these tensions by making use of a Habermasian theoretical framework. We conclude that forms for collective client participation in residential care homes should be developed based on communicative action between clients and professionals, with room for emotional engagement. (shrink)

Some care home residents with dementia have the capacity, some do not. Staff may need to make decisions about administering care interventions to someone whom they believe lacks the capacity to consent to it, but also resists the intervention. Such intervention can be termed forced care. The literature on forced care (especially reflecting empirical work) is scant. This study aims to investigate how the ethics of forced care is navigated in practice, through ten semi-structured (...) interviews with staff in 1 care home in the North East of England. Participants generally avoided situations where there was overt restraint, taking a flexible approach by either modifying their own behaviour or using covert techniques. The underlying justification given for decisions or actions tended to be that the recipients of care should be valued because of their intrinsic worth as fellow human beings. Participants attempted to put themselves in the position of the resident or think about what a beloved elderly relative would want. The intervention seemed acceptable to staff if the resident was not distressed. When staff were presented with scenario-based questions around capacity they were more successful than when asked direct questions relating to the Mental Capacity Act. Scenario-based training may be helpful to reinforce familiarity and facility with the principles of the Mental Capacity Act. (shrink)

Client participation in elderly care organizations requires shifting traditional power relations and establishing communicative action that involves the lifeworlds of clients and professionals alike. This article describes a particular form of client participation in which one client was part of a team of professionals in a residential care home. Their joint remit was to plan the implementation of a new personal care file for residents. We describe the interactions within this team through an ethnodrama, based on (...) participant observations and the embodied presence of the researcher (first author). The narratives and voices of all team members are dramatized in this ethnodrama. Throughout the project the team members experienced confusion relating to the confrontation between lifeworld and system, as experienced by the client and professionals in the team. We analyze these tensions by making use of a Habermasian theoretical framework. We conclude that forms for collective client participation in residential care homes should be developed based on communicative action between clients and professionals, with room for emotional engagement. (shrink)

Cultural diversity between residents and staff is significant in aged care homes in many developed nations in the context of international migration. This diversity can be a challenge to achieving effective cross‐cultural communication. The aim of this study was to critically examine how staff and residents initiated effective cross‐cultural communication and social cohesion that enabled positive changes to occur. A critical hermeneutic analysis underpinned by Giddens’ Structuration Theory was applied to the study. Data were collected by interviews with residents (...) or their family and by focus groups with staff in four aged care homes in Australia. Findings reveal that residents and staff are capable of restructuring communication via a partnership approach. They can also work in collaboration to develop communication resources. When staff demonstrate cultural humility, they empower residents from culturally and linguistically diverse backgrounds to engage in effective communication. Findings also suggest that workforce interventions are required to improve residents’ experiences in cross‐cultural care. This study challenges aged care homes to establish policies, criteria and procedures in cross‐cultural communication. There is also the challenge to provide ongoing education and training for staff to improve their cross‐cultural communication capabilities. (shrink)

Many higher-income countries are struggling to make decent and affordable care available to their older populations. In response, some Germans are sending their ageing relatives to relatively high-end care homes within Eastern Europe and South-East Asia where the care tends to be more comprehensive and a lot cheaper. At the same time, this practice has caused much controversy within Germany, with some commentators calling it “inhumane” and “shameful.” The aim of this article is to show that such (...) criticisms are exaggerated. Whereas sending people to care homes in lower-income countries can be immoral, I argue that the most promising objections against it do not always apply and, to the extent that they do, do not always provide decisive reasons against sending people abroad. These objections maintain that such expatriations harm three different groups of individuals, namely the emigrants themselves; their friends and relatives; and vulnerable members of the receiving societies. (shrink)

BackgroundVideo-calls have proven to be useful for older care home residents in improving socialization and reducing loneliness. Nonetheless, to facilitate the acceptability and usability of a new technological intervention, especially among people with dementia, there is a need for user-led design improvements. The current study conducted focus groups with an embedded activity with older people to allow for a person-centered design of a video-call intervention.MethodsTwenty-eight residents across four care homes in the South West of England participated in (...) focus groups to aesthetically personalize and ‘dress-up’ the equipment used in a video-call intervention. Each care home was provided with a ‘Skype on Wheels’ device, a wheelable ‘chassis’ comprising an iPad or tablet for access to Skype, and a telephone handset. During the focus group, residents were encouraged to participate in an activity using colorful materials to ‘dress-up’ SoW. Comments before, during and after the ‘dress up’ activity were audio recorded. Framework analysis was used to analyze the focus group data.ResultsOlder people, including seven with dementia were able to interact with and implement design changes to SoW through aesthetic personalization. Themes arising from the data included estrangement, anthropomorphism, reminiscence, personalization, need for socialization versus fear of socialization and attitudes toward technology. After this brief exposure to SoW, residents expressed the likelihood of using video-calls for socialization in the future.ConclusionCare home residents enjoy engaging with new technologies when given the opportunity to interact with it, to personalize it and to understand its purpose. Low cost aesthetic personalization of technologies can improve their acceptability, usability, and implementation within complex care environments. (shrink)

Faced with relatively old and ageing populations, a growing number of higher-income countries are struggling to provide affordable and decent care to their older citizens. This contribution proposes a new policy for dealing with this challenge. Under certain conditions, I argue that states should pay their citizens to move to foreign care homes in order to ease the pressure on domestic care institutions. This is the case if—but not necessarily only if— a significant proportion of resident citizens (...) do not currently have access to adequate aged and nursing care; the care in the foreign care homes is not worse than the one that is available in domestic care homes; sending states conduct regular checks to ascertain that the level of care abroad is not worse or delegate this task to reliable local monitoring bodies; appropriate measures have been taken to ensure that this type of migration does not harm local residents; and the public money spent on the payments is not better spent on other ways of easing the pressure on domestic care institutions. I end by defending the proposed payments against the objection that they create morally problematic inequalities by exerting greater pressure on members of lower socioeconomic classes to migrate than on their more affluent compatriots. (shrink)

Legal frameworks are in place to protect those who lack the capacity to consent to research, such as the Mental Capacity Act in the UK. Assent is sought instead from a proxy, usually a relative. However, the same legislation may, perversely, affect the welfare of those who lack capacity and of others by hindering the process of recruitment into otherwise potentially beneficial research. In addition, the onus of responsibility is moved from those who know most about the study (ie, the (...) scientific community) to those who know less (the proxies). In this paper, we describe the characteristics of a sample at different stages of the recruitment process of an influenza vaccine-based randomised control trial in elderly care home residents (the FEVER study). 62% (602/968) of potential subjects lacked capacity but only 29% (80/277) of those actually randomised. Older age, being female and living in an Elderly Mentally Ill care home were the only variables associated with lacking capacity. Considering this was a study based in a care home setting where the prevalence of dementia approximates 80%, the trial, like many others, was thus significantly biased. We believe that difficulties seeking proxy assent contributed significantly to this problem. Further thought should be given to how assent to enter research for those who lack capacity should be provided, and we suggest avenues for further discussion such as independent risk/benefit expert panels. (shrink)

Abstract This article explores interview data from a study of 50 Norwegian generalist nurses' focus group accounts of caring for dying patients in the hospital and care home. An eclectic discourse analytic approach was applied to nurses' accounts of the patient and three discursive contexts of reference to the patient were identified: the 'taken as read' patient, the patient paired with particular characteristics and the patient as psychologically present. Talk about the patient falls mainly into the first two (...) contexts, which position the patient in relation to three closely related discursive processes: individualization, anonymization and objectification. The third context presents the patient as a person with a particular identity. The analysis is discussed in a broader philosophical and sociological context in which we return to some of the theoretical work on death and dying of the 1990s and the topic of sequestration. We suggest that nurses' talk about the patient can be heard to participate in a continuing sequestration of the dying patient in healthcare institutions focused on 'result-oriented' care. (shrink)

Canada’s population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as (...) healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs’ experiences of ethically challenging situations is warranted.We conducted a phenomenological study to access the lived experience of HCAs (N=12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care. (shrink)

There is a growing research interest in the value of participative arts-based strategies for enhancing wellbeing amongst adults living with dementia. One such intervention, centred around literature, is the group activity called Shared Reading. The purpose of this case study of weekly Shared Reading sessions of poetry in a care home in Merseyside is to investigate instances of how participants with mild to moderate dementia collaborate in processes of meaning-making that allow them shared experiences of being moved by (...) poetry. An under-thematised aspect of psychological wellbeing is the capacity for being moved and for sharing such moments. This article addresses the following question: how can the specific multimodality of the text in the Shared Reading model help to bring about such experiences? Using Stern’s concepts of Now Moments and Moments of Meeting, this case study discusses various instances of unpredictable, surprising and spontaneous intersubjective moments between participant and poem, participant and reader leader, participant and staff, participant and relative. (shrink)

Background: Human rights are an important part of nursing practice. Although there is increasing recognition regarding the importance of including human rights education in nursing education, few studies have focused on nursing students’ perspectives and experiences in relation to human rights in nursing, especially regarding older nursing home residents’ right to food. Objective: To explore nursing students’ perspectives and experiences in relation to the right to food. Research design: The study followed a qualitative interpretative research design. Data were collected (...) from multistage focus groups before, during and after clinical placement in a nursing home and analysed through thematic analysis. Participants and research context: Participants were 18 first-year nursing students; the study was conducted in 2017. Ethical considerations: This study was approved by the Norwegian Centre for Research Data. Findings: Students’ understanding of older nursing home residents’ right to food was a dynamic process. Their perceptions evolved from a polarized perspective to a reality orientation and finally to retrospective reflection. Discussion: The article discusses how nursing students learn about and understand human rights within and throughout their placements. Conclusion: The study bridges human rights theory and practice. Findings suggest that the human right to food must be enacted in daily practice for students to learn in context. Human rights education, specifically pertaining to nutritional care, thus benefits from a practice-oriented approach preparing students to face ‘real life’ challenges and ethical dilemmas. Findings will help nurse educators tailor education in this field. (shrink)

Jones, Kate Too many young people live in aged care nursing homes in Australia because there is a shortage of suitable alternatives. The Young People in Nursing Homes National Alliance confirms this, and advises that one young person is admitted into nursing home care every day. Part two of this article will follow in the next issue of this Bulletin.

Home care is one of the fastest‐growing industries in the United States, providing valuable opportunities for millions of older adults and people with disabilities to live at home rather than in institutional settings. Home care workers assist clients with essential activities of daily living, but their wages and working conditions generally fail to reflect the importance of their work. Drawing on the work of Eva Feder Kittay and other care ethicists, we argue that good (...) care involves attending to the needs of another out of a concern for their well‐being. Such care should be standard in the home care system. Yet, because of the pervasive racial, gender, and economic inequalities that the home care industry perpetuates, home care workers and their clients cannot reasonably be expected to care about each other. We endorse reforms aimed at enabling home care workers and their clients to form and maintain professional relationships that cultivate care.. (shrink)

The purpose of this study was to investigate nurses’ decisions about priorities in home-based nursing care. Qualitative research interviews were conducted with 17 nurses in home-based care. The interviews were analyzed and interpreted according to a hermeneutic methodology. Nurses describe clinical priorities in home-based care as rationing care to mind the gap between an extensive workload and staff shortages. By organizing home-based care according to tight time schedules, the nurses’ are able (...) to provide care for as many patients as possible. Furthermore, legal norms set boundaries for clinical priority decisions, resulting in marginalized care. Hence, rationing care jeopardizes important values in the nurse-patient relationship, in particular the value of individualized and inclusive nursing care. The findings are highly relevant for clinical practice, since they have major implications for provision of nursing care. They revive debates about the protection of values and standards of care, and nurses’ role and responsibility when resources are limited. (shrink)

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of (...) contextual changes. Nurses hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development of home‐care nursing. (shrink)

In this paper, I will argue that there is a deep connection between home-based care, technology, and the self. Providing the means for persons to receive care at home is not merely a kindness that respects their preference to be at home: it is an important means of extending their selfhood and respecting the unique selves that they are. Home-based technologies like telemedicine and robotic care may certainly be useful tools in providing (...) class='Hi'>care for persons at home, but they also have important implications for sustaining selfhood in ways that are of value to individuals and those who care for them. I will argue, by appealing to Hilde Lindemann’s notion of “holding” persons’ identities in place, that technological interventions are not only useful tools for improving and sustaining health and good care at home, but that they may also help to extend our personal identities and relational capacities in ways that are practically and ethically good. Because of these important goods, I will claim that there is a prima facie moral duty to do this “holding” work and that it is best done by family members and loved ones who are well suited to the job because of their history and relationship with the individual that needs to be “held” in place. (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)

An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children (...) are likely to become involved in the caring process and informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care and the subsequent impact on the care recipient and formal- and informal care providers. (shrink)

The notion of home is well known from our everyday experience, and plays a crucial role in all kinds of narratives about human life, but is hardly ever systematically dealt with in the philosophy of medicine and health care. This paper is based upon the intuitively positive connotation of the term “home.” By metaphorically describing the goal of palliative care as “the patient’s coming home,” it wants to contribute to a medical humanities approach of medicine. (...) It is argued that this metaphor can enrich our understanding of the goals of palliative care and its proper objectives. Four interpretations of “home” and “coming home” are explored: (1) one’s own house or homelike environment, (2) one’s own body, (3) the psychosocial environment, and (4) the spiritual dimension, in particular, the origin of human existence. Thinking in terms of coming home implies a normative point of view. It represents central human values and refers not only to the medical-technical and care aspects of health care, but also to the moral context. (shrink)

This commentary responds to “Home Care in America: The Urgent Challenge of Putting Ethical Care into Practice,” by Coleman Solis and colleagues, in the May‐June 2023 issue of the Hastings Center Report. More specifically, we respond to the authors’ call for “inquiry into the nature, value, and practice” of home care. We argue that the most urgently needed normative reset for thinking about care work is the replacement of dominant individualistic thinking with systemic thinking. (...) Deepening a focus on the social, economic, and historical forces that shape the state of contemporary care work will help bioethicists to argue more effectively for improvements to working conditions. In turn, better working conditions will ease the oppositional stance between caregivers and receivers that has been set up by the current system, enabling all parties involved to better pursue the feminist ethical ideal of care. (shrink)

Because of the gradual aging of the population, hospital facilities for socio-sanitary care of the elderly are quite scarce relative to the very high number of elderly people present in the country. This has pushed a high number of families to privately hire home-care workers. The scientific literature gives a picture of the psycho-physical risks that this type of profession is exposed to; however, there is still a need for a more systemic reflection with regard to representations (...) about their role and competences. The aim of the present study is to outline the representations of the role and the skills it requires from home-care workers’ point of view. We reconstructed how home-care workers perceive and define the profession, and understand the necessary skills required from their point of view. Our results show that the professional profile of home-care workers still remains poorly defined and that professionals themselves struggle to find value and recognition, and to articulate what the skill set they develop is formed of. (shrink)

Background:Within nursing, the concepts of home and homelike have been used indiscriminately to describe characteristics of healthcare settings that resemble a home more than an institution.Objectives:The aim of this study was to investigate the concept of home. The main questions were as follows: What does the concept of home entail etymologically and semantically? Of what significance is the meaning of the concept to caring science and nursing?Design and methods:This study had a qualitative design with a hermeneutical (...) approach guided by Gadamer. Eriksson’s model of concept determination was partly used to determine the etymology and semantics, the essence and epistemic category of the concept of home. In this study, etymological dictionaries and 17 Swedish language dictionaries published between 1850 and 2001 were investigated.Ethical consideration:In all parts of this study, ethical guidelines have been followed concerning both gathering data from dictionaries and other sources and during the interpretation of these sources.Findings:The home, framed as the ethos of caring, can be drawn as a three-dimensional picture where the three dimensions have a common core, enclosed and inviolable. Symbolically, the picture of home can be seen as the ethos of the human being’s innermost room, the human being’s manner of being and the tone expressed in the external or abstract room where the human being lives and interacts with others.Conclusion:Based on the findings in this study, we conclude that home as ethos is an inner ethical dimension within the human being. Human beings who are in contact with their ethos, the self, feel at home and dare to follow the voice of their heart. Nurses who experience at-homeness have an ability to invite the patient into a caring relationship. The home and the feeling of being at home have significant meaning in terms of human beings’ health and well-being. (shrink)

Background Migrant live-in care workers are a main pillar of long-term care in many countries, including Germany. Several studies examining their working and living conditions reveal serious problems. However, a key element of live-in arrangements, namely the relationship between the individuals involved, has not yet been systematically investigated from an ethical perspective. Aim Building on previous socioempirical work that explored and set out the meaning of “care networks”, we start from the premise that live-ins are embedded in (...) a network of relationships which are essential for their employment and living situation. Methods The theoretical analysis draws on a network approach that takes care–ethical considerations into account. Using Joan Tronto’s four care–ethical phases, existing dependencies are described and reflected upon using the corresponding four care–ethical dimensions. The central questions are how dependencies in the live-in arrangement can be characterised based on the existing body of empirical studies and with a focus on the elements of power, dependency and trust in the ethical reflection on care. Results Based on this analysis, it becomes apparent that the ambivalence resulting from the simultaneity of different forms of asymmetry and mutual dependence is omnipresent in live-in arrangements and gives rise to seemingly contradictory forms of relationships and emotions. Responsibilities are vague and are constantly renegotiated on the basis of implicit assumptions and problematic role expectations and are also assigned without negotiation. Conclusions In the future, it will not only be necessary to better understand and clarify responsibilities at the micro level of the individual care arrangement from the various positions and roles and with a view to the changing processes of caring for another, but also to address the pressing ethical questions and problems in live-in arrangements at the meso and macro levels—enriched by care–ethical perspectives. (shrink)

Elderly people are a particularly vulnerable group in society and have special health problems. The world population of older people is increasing. People who are 65 years or older constitute 6% of the Turkish population, 90% of whom have chronic health problems. In Turkey, there is a high possibility that elderly people’s requirements are not met by today’s health care system in the way they would wish. They prefer not to be hospitalized when they have health problems. From a (...) wider perspective, various countries are still seeking how to provide the best care for elderly people. Our goal was to characterize home-based care for elderly people using an ethical approach as an area of interest for nurses and other health care professionals now and in the future, both for Turkey specifically and from a global perspective. We studied four case histories and then prepared a composite scenario and a short questionnaire for elderly people living in a specific district of Istanbul to evaluate their expectations from the health care system. We compared our findings with situations in other countries and have proposed some practical solutions. The results showed that these older people preferred to receive nursing care at home instead of in hospital in Turkey, and also in many other countries. In this article we discuss our findings, comparing them with those in the literature, and suggest that there should be nursing care at home with insurance coverage while using a proper ethical approach. (shrink)

Violence has become a common phenomenon that affects women and children, particularly during the coronavirus disease 2019 (COVID-19) pandemic. While the lockdown regulations were meant to save lives by preventing further spread of the virus, another virus called ‘violence against women’ encroached the space which is supposed to be the safest for women and children. For women, homes have now been turned into cages of violence and slaughterhouses. Toxic masculinity is seen at play as all dominant and power ideologies are (...) employed against women. This article deals with these challenges of violence against women in Botswana from a pastoral care point of view. Firstly, it provides an overview of the current gender-based violence (GBV) situation in Botswana through empirical data from other social scientists. It then highlights some forms and the causes linked to the problem of GBV in Botswana. Secondly, it brings in pastoral care work, particularly mutual care, as a relevant tool for the church in addressing GBV. Lastly, it suggests ways in which the church could contribute in pursuit of gender justice and building a violence-free society. Contribution: While the article grapples with the challenges of GBV and persistent toxic masculinities from a theological point of view, the implications of the outcome are multidisciplinary. They aim to respond and raise awareness about the need to build a violence-free society, and to deal with the challenges of oppression, toxic masculinity and manhood ideologies which result in the domination and killing of women. (shrink)

Nel Noddings, one of the central figures in the contemporary discussion of ethics and moral education, argues that caring--a way of life learned at home--can be extended into a theory that guides social policy. Tackling issues such as capital punishment, drug treatment, homelessness, mental illness, and abortion, Noddings inverts traditional philosophical priorities to show how an ethic of care can have profound and compelling implications for social and political thought. Instead of beginning with an ideal state and then (...) describing a role for home and family, this book starts with an ideal home and asks how what is learned there may be extended to the larger social domain. Noddings examines the tension between freedom and equality that characterized liberal thought in the twentieth century and finds that--for all its strengths--liberalism is still inadequate as social policy. She suggests instead that an attitude of attentive love in the home induces a corresponding responsiveness that can serve as a foundation for social policy. With her characteristic sensitivity to the individual and to the vulnerable in society, the author concludes that any corrective practice that does more harm than the behavior it is aimed at correcting should be abandoned. This suggests an end to the disastrous war on drugs. In addition, Noddings states that the caring professions that deal with the homeless should be guided by flexible policies that allow practitioners to respond adequately to the needs of very different clients. She recommends that the school curriculum should include serious preparation for home life as well as for professional and civic life. Emphasizing the importance of improving life in everyday homes and the possible role social policy might play in this improvement, _Starting at Home_ highlights the inextricable link between the development of care in individual lives and any discussion of moral life and social policy. (shrink)

“The current crisis in home care suggests we must meet immediately to discuss how Ontario can best meet its commitment to all those who require home care services and to the workers who provide the...

“The current crisis in home care suggests we must meet immediately to discuss how Ontario can best meet its commitment to all those who require home care services and to the workers who provide the...

Unionization of home care has depended on the state location of the occupation. Government social policies and funding created home care, shaping the structure of the industry and the conditions of work. The welfare nexus, linking old age, disability, health, and welfare policies, however, also transformed care hidden in the home into a public service. Through case studies of California and Oregon, leaders in deinstitutionalizing care of the elderly and disabled, we explore the (...) social struggles that forced the state to recognize its invisible workforce. The home location of personal attendants and other health aides has entailed not only organizing challenges but policy innovation as well. Using the welfare state location of the labor, workers allied with consumers to develop the public authority as a newstructure of representation. The history of home care shows that social welfare and health policy have long been entangled with labor policy. (shrink)

The high-tech health service work done by amateur family caregivers in U.S. homes challenges the conventional division of the social world into public and private. Under new federal reimbursement systems, the diagnosis-related groups, patients are being discharged sicker than before from hospitals and nursing homes, or after treatments in outpatient clinics. Health care facilities depend on a work transfer, shifting their earlier responsibilities for the sick to the family. There, women family members do for free the work once done (...) by paid health service workers in health care facilities, caring for family members who need their nursing and housekeeping services. Women's unpaid work knits together “public” and “private,” demonstrating how capitalism reorganizes the labor process to make use of free service labor. (shrink)