Respecting the autonomy of disabled people is an important ethical issue for providers of long-term care. In this influential book, George Agich abandons comfortable abstractions to reveal the concrete threats to personal autonomy in this setting, where ethical conflict, dilemma and tragedy are inescapable. He argues that liberal accounts of autonomy and individual rights are insufficient, and offers an account of autonomy that matches the realities of long-term care. The book therefore offers a framework (...) for carers to develop an ethic of long-term care within the complex environment in which many dependent and aged people find themselves. Previously published as Autonomy and Long-term Care, this revised edition, in paperback for the first time, takes account of recent work and develops the author's views of what autonomy means in the real world. It will have wide appeal among bioethicists and health care professionals. (shrink)

Perhaps the change of title says it all. This is the revised edition of Agich’s Autonomy and Long Term Care, which was itself a seminal work. The new title gives us the main drift: if autonomy is important in old age, so too is dependence. Indeed, in the actual world in which Agich is keen to locate his study, autonomy and dependence intermingle as inescapable features of old age for real people. As he says: “Maintaining a sense (...) of autonomous wellbeing is consistent with dependencies on medication or professional care if those dependencies help to maintain a more basic sense of functional integrity in those areas of life that individuals value” .The present book retains and renews its standing as a first rate work in the field of philosophical medical ethics. It aims “to sketch a framework for respecting autonomy in long term care”, rather than to work out practical guidelines . Nevertheless, its strength lies in Agich’s ability to move from the real world of often dependent older people to the philosophical underpinnings of our thinking about how we care for them. In so doing, Agich mounts a powerful attack on what he sees as a prevailing tendency in bioethics. It is the tendency to define autonomy “primarily in terms of a concept of human persons as rational, independent agents and decision makers, who are assumed to be competent and who can be understood without serious reference to society or history” . As he says: “Influenced by liberal theory, autonomy is often treated in bioethics as a concept that primarily applies to the public realm …. (shrink)

The realities and myths of long-term care and the challenges it poses for the ethics of autonomy are analyzed in this perceptive work. The book defends the concept of autonomy, but argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long term care. The treatment of actual autonomy stresses the developmental and social nature of human persons and the priority of identification over autonomous choice. The work (...) balances analysis of the ethical concepts associated with autonomy with discussion of the implications of the ethical analysis for long term care. A central chapter involves a phenomenological analysis of four general features of everyday experience (space, time, communication, and affectivity) and explores their practical implications for long term care. This work concludes with a discussion of the advantages associated with a phenomenologically-inspired treatment of actual autonomy for the ethics of long-term care. (shrink)

Old age often brings with it chronic conditions that make it difficult to handle the activities of daily life. In the United States, unpaid family caregivers, predominantly women, provide most of this care. I explore why this situation has come about and persists and further ground my image of a dystopian future in neoliberalism, the policymaking process, and contemporary politics. I then offer an ethical and policy foundation for an alternative approach to providing needed long-term care (...) services and make provisional suggestions for actions that ought to be taken now and in the near future to avoid this dystopian future. (shrink)

The ageing populations of the Western world present a wide range of economic, social, and cultural implications, and given the challenges posed by deteriorating maintenance ratios, the scenario is somewhat worrying. In this paper, I investigate whether Martha C. Nussbaum's capabilities approach could secure dignity for older people in long‐term care, despite the per capita decreases in resources. My key research question asks, ‘What implications does Nussbaum's list of central human capabilities have for practical social care?’ (...) My methodology combines Nussbaum's list with ethnographic data gathered from a Finnish sheltered home for older people. On the basis of this study, it seems that the capabilities approach is a plausible framework for the ethics of care because it highlights differences in the ability to function and thus differences in opportunities to pursue a good life. The ideas presented in this article could assist social policy planners and executives in creating policies and practices that help old people to maintain their dignity until the end of their days. (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)

This study examines elderly residential life in long-term care settings, focusing on the ways residents interact with their physical and social environments. It further proposes that the residential environment is an important player for everyday ethics in long-term care settings, and is also an important factor in enhancing the quality of life for residents. By employing the theories of place identity and environmental meanings and listening to the voices of the elderly collected through an (...) ethnographic field study in elderly homes of life care, the study reveals the residents’ experiences of going through declining health and moving through the stages of care. Two major themes were identified. The first theme of liminal life portrays the elders’ fears as they move through the stages of care. This theme includes four sub-themes: the loss of home and the loss of autonomy; impending loss and its constant reminders; the social classification of “us” and “them”; the irreversibility of moving. The second theme of relational life describes the keys to successful transitions as experienced and told by the residents. The second theme includes three sub-themes: shifting identity and the acceptance of old age; human interdependence and building trust; an accompanied death. Study implications are further discussed, including specific suggestions for social programs and revisions to the physical environments. A more fundamental question about place-based staged care is also raised so as to serve as a point of departure for reflections and discussions amongst health professionals, planners and designers, and other decision-makers. (shrink)

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

The American system of long‐term care is disorganized and expensive. Obtaining care for a loved one is a confusing and difficult journey. When it comes to paying for that care, a bit over half who receive care are supported at least partially by insurance, and those with no insurance pay entirely out of pocket. The costs are exorbitant. What makes the system function is reliance on unpaid family members, who care for their loved (...) ones often at considerable cost to themselves.As the baby boom generation ages, this creaky system will become increasingly dysfunctional, and a likely shortage of caregivers will be at the heart of the difficulties. The supply of unpaid family caregivers will become limited, as the ratio of people in the category of ages forty‐five to sixty‐four compared to those who are eighty and older shrinks from just above seven to one in 2010 to just above four to one in 2030. Paid caregivers will be needed to take up the slack, yet they are poorly paid, work under very difficult conditions, and receive little respect from the health care system. In this essay, I discuss the circumstances facing these paid home‐care workers and a possible path forward, illustrating the current problems by drawing on interviews I conducted for a book‐length study published in 2017. (shrink)

As human longevity increases, with people living well into their seventies and eighties, the need for long-term care for the elderly most certainly will grow. The longer people live, the more likely they fall prey to chronic disease, as well as to the standard toll the aging process takes on human bodies and psyches. In this article, I examine some of the concerns that a wide variety of governments, individuals, and families have expressed about meeting the (...) class='Hi'>long-term care needs of large numbers of people over sixty-five. I then claim that each of these groups must do its share of long-term care for the elderly, depending on its ability to do so. Finally, I conclude that the more committed a country is to the deconstruction of ingrained notions about who should care and who should work, the more able it will be to meet the long-term care needs of the elderly and other vulnerable populations fairly. (shrink)

This article reveals the outcome of a study on the perceptions of elders, family members, and healthcare professionals and administration providing care in a range of different long-term care facilities in Hong Kong with primary focus on the concepts of autonomy and dignity of elders, quality and location of care, decision making, and financing of long term care. It was found that aging in place and family care were considered the best (...) approaches to long term care insofar as procuring and balancing the values of dignity, autonomy, family integrity and social sustainability were concerned. An elder having the final say was generally accepted. The results also initiated the importance of sharing of financial responsibility among elders, children and government albeit the emphasis was placed on individuals. Furthermore, dignity of elders was not considered purely a synonym of autonomy, but it had also to do with respect, family and social connections. (shrink)

In his article "Thoughts" (MIND, July 1960) William Ginnane argues that "thought is pure intentionality," and that our thoughts are not embodied essentially in the mental imagery and other elements of phenomenology that cross our minds along with the thoughts. Such images merely illustrate out thoughts. In my discussion I resist this claim pointing out that our thoughts are often embodied in events that can be described in pheno¬menological terms, especially when our reports of our thinking are introduced by the (...) colorful phrases that Ginnane himself suggests, such as "It crossed my mind that.." or "It occurred to me that…" It is true that we also have a mode of speech in which we report what we have thought in well-formed sentences. Sometimes the very utterance of such sentences is what we call thinking out loud. More often than not, however, our thoughts are fragmentary enough so that if someone asks us what we were thinking, we must stop and rather carefully formulate the expression of those thoughts. In this case there has been nothing running through our minds which can be phenomenologically described as complete sentences, yet in formu¬lating the significance of what has been passing through our minds we do use complete sentences. It is true that one of the confusions we have been bothered by in the past is the idea that in describing the contents of our minds we must somehow find there a proto-type of the report we give in propositional form. The philosopher's phrase "entertaining a proposition" only encour¬ages this confusion, as it looks like an attempt to describe one's mental history phenomenologically. Nevertheless, the successive phenomenological events that occur in our minds often seem to be not merely illustrations accompanying our thoughts, but to embody what we say occurred to us. -/- . (shrink)

Book reviewed in this article: Long Term Care: Principles, Programs and Policies. By Rosalie A. Kane and Robert L. Kane. Long Term Health Care: providing a Spectrum of Services to the Aged. By Philip W. Brickner, Anthony J. Lechich, Roberta Lipsman, and Linda K. scharer.

Book reviewed in this article: Long Term Care: Principles, Programs and Policies. By Rosalie A. Kane and Robert L. Kane. Long Term Health Care: providing a Spectrum of Services to the Aged. By Philip W. Brickner, Anthony J. Lechich, Roberta Lipsman, and Linda K. scharer.

The international migration of health workers, including long-term care workers for aging populations, contributes to a shortage of these workers in many parts of the world. In the Anglophone Caribbean, LCW shortages and the migration of nurses to take on LCW positions abroad threaten the health of local populations and widen global inequities in health. Many responses have been proposed to address the international migration of health workers generally, including making it more difficult for these workers to (...) emigrate and increasing and improving local employment opportunities. In this article, we suggest an additional means of ethically reducing health worker migration, targeting the Anglophone Caribbean specifically. Countries in this region can take advantage of their warmer climate and well-trained work force to encourage aging populations in the global north to emigrate temporarily or permanently through international retirement migration. As a result, countries in the Anglophone Caribbean can not only decrease the international migration of trained health workers through the provision of well-paying, local jobs, but potentially reverse this flow by drawing on the international diaspora of their workers. International retirement migration, if carefully managed, can reduce global inequities in health while treating both retirees and LCWs ethically. (shrink)

Worldwide, the literature reports that many residents in long‐term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, (...) Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add‐on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC. (shrink)

Houston, Texas, is a major U.S. city with, like many, a growing aging population. The purpose of this study and ultimate book chapter is to explore the views and perceptions of long-term care (LTC) residents, family members and health care providers. Individuals primarily in independent living and group residential settings were interviewed and studied. Questions emphasized the concepts of personal autonomy, dignity, quality and location of care and decision making. Although a small sample of participants (...) were involved, consistency was noted. Keeping the elderly in caring and loving home situations (theirs or family) was most preferred. Personal choice and independence were emphasized by residents, but family members needed to act as advocates. We also noted that the legal system emphasizes family control over individual decision making as competency declines with aging. Optimal personal decision making in the residents' best interest also became more difficult with loss of individual mental capacity. (shrink)

To analyze the influence of the integration of piano art and media on long-term care of the elderly in the aging society, and to improve the living standard and happiness of the elderly, based on educational psychology, several scales of self-compiled personal information, the Ackerson personality inventory, and the memorial university of Newfoundland happiness scale were introduced for statement, and questionnaire method was adopted for information collection. Then, the mechanism of the integration of piano art and media (...) on the happiness of the elderly was summarized. The results showed that there were significant differences in the happiness of the elderly in terms of monthly average income, economic pressure, health status, and living conditions. The happiness of the elderly with a monthly income of more than 5,000 yuan was significantly higher than that of the elderly with a monthly income of <3,000 yuan. The happiness of the elderly with low economic pressure was significantly higher than that of the elderly with high economic pressure. The happiness of the elderly with good living conditions was significantly higher than that of the elderly with ordinary living conditions. The happiness score and positive experience of the elderly with learning over 5 years were significantly higher than those with learning <5 years and the non-piano learning group. The total score of happiness in the piano learning group was significantly positively correlated with positive affection and PE, and negatively correlated with neuroticism and psychosis. It is concluded that the piano art learning process based on educational psychology can improve the subjective well-being of the elderly. In addition, the elderly who have been exposed to piano art for a long time are more active in life. Piano art edification is an important factor affecting the psychological well-being of the elderly. The research has a good guiding significance for improving the happiness of the elderly. (shrink)

Background: To place a dependent with severe dementia in a nursing home is a painful and difficult decision to make. In collectivistic oriented societies or families, children tend to be socialised to care for ageing parents and to experience guilt and shame if they violate this principle. Leaving the care to professional caregivers does not conform with the cultural expectations of many ethnic groups and becomes a sign of the family’s moral failure. Research design: Qualitative design with individual (...) in-depth interviews with nurses, family members and dementia care coordinators in Norway, Montenegro, Serbia and South Africa. Braun and Clarke’s six analytic phases were used. Ethical considerations: The project was approved by the Regional Committee for Research, South-Eastern Norway; the Norwegian Centre for Research Data; the Ethics Committee; University of Limpopo, MEDUNSA Campus, South Africa; and by the local heads of the respective nursing homes or home care services. Interviewees were informed orally and in writing and signed an informed consent form. Findings: Healthcare professionals tend to be contacted only when the situation becomes unmanageable. Interviewees talked about feelings of obligation, shame and stigma in their societies regarding dementia, particularly in connection with institutionalisation of family members. Many lacked support during the decision-making process and were in a squeeze between their own needs and the patients’ need of professional care, and the feeling of duty and worry about being stigmatised by their surroundings. This conflict may be a source of pre-decision regret. Conclusion: Family caregivers need help to understand the behaviours of persons with dementia and how to access the formal and informal services available. Thus, they may provide effective support to patients and family carers alike. Supportive interventions for caregivers need to be tailored to meet the individual needs of both the caregiver and the persons with dementia. (shrink)

In the course of demographic change, the proportion of older people in many countries is rising continuously and more and more people are experiencing a long time together as a couple. In old age, subjective wellbeing and health aspects are associated with partners’ satisfaction with couple relationship. The need for couple counseling in old age is growing in parallel with demographic developments. However, empirical studies on couple therapy with older people in long-term couple relationships exist to date (...) only to a limited extent. The present contribution deals with this knowledge gap. In an explanative two phases design, research has been conducted with long-term couples in couple counseling of which we would like to present here the central qualitative study. The aim is to be able to describe details of these factors. Older couples who have lived in long-term couple relationships were interviewed after using standardized questionnaires concerning the individual and couple-related stress factors and problems at the beginning and the end of their couple counseling process. Five couples from this study were the interviewees for the following study. The couples were interviewed separately. In this interview study and central part of this contribution, the stress factors, problem areas and coping processes of the older couples were examined. The results serve as a suggestion for further research and can only be interpreted with caution due to the small sample of five case studies: The central results of the study are summarized in a circular process model and are discussed in the light of relevant theoretical approaches. The culmination of massive chronic and acute strains and losses associated with feelings of excessive demands and desperation gave rise to emotional alienation of the partners. In the course of couple therapy, the partners mutually opened their thoughts and emotions and modified their previous dysfunctional pattern of interaction. Thus, emotional and physical rapprochement of the partners was fostered with the effect that subjective load of the partners and dissatisfaction of the couple relationship decreased, and subjective emotional wellbeing increased. To prevent negative emotions and destructive conflicts with their spouse, some of the interviewed partners actively used avoidance strategies in couple interactions. Upon completion of couple therapy changes in the couple relationships appeared instable as soon as overcharging stress factors occurred again. The results suggest that an approach to couple therapy for older people in long-term couple relationships should prioritize emotional safeness and attachment in couple relationship to facilitate constructive conflict management. The couple therapy process should emphasize emotion regulation strategies based on age-related strengths and consider age-related vulnerabilities. Moreover, long-term couples may benefit from catamnestic consultation appointments to consolidate the developed changes. (shrink)

Sexual activity between spouses in long-term care settings has received increasing attention recently. This article considers the special case of sexual activity between spouses in long-term care when one spouse has dementia. The complex and interrelated issues of aging, sexuality, and dementia are reviewed, first through examination of a recent court case. Then, issues of sexuality and aging, assessment of capacity and competency in dementia, and institutional responses to these situations are considered in light (...) of Catholic bioethical tradition. The argument is made that Catholic long-term health care facilities ought to proactively address these issues, and some concrete suggestions are offered to address clinical care and risk management in these settings. (shrink)

The tension between the popular embrace of same-sex marriage and the queer critique of homonormativity prompts the contributors to Long Term to explore queer commitments as they are more broadly conceived. The essays contained here de-familiarize the idea of commitment and extend the category of significant others to include animals, possessions, institutions and disciplines. Revitalizing the concerns of queer theory beyond the commitment to anti-normativity, these essays contribute to interdisciplinary scholarship in queer temporality studies, disability studies, autotheory, and (...) the emergent sub-field of age studies. Long Term includes an introduction on notions of the long term and essays that specifically address a number of topics-the commitment to palliative care; long-term attachment and loss; long-term pharmaceutical use; the commitment to pets; fear of commitment and institutionalization; long-term debt and financialization; the racial dimensions of long-term incarceration and voluntarism; queer kinship and racialized reproductive technologies; serial commitment; and the commitment to friendship. (shrink)

This book explores the phenomenology of learning with particular focus on the 'closeness' or 'proximity' of the knowledge that impacts on learners, young and old. Studying the power of learning to transform human beings, this book offers an in-depth discussion of how different phenomenologists understand this 'proximate' power. It draws on ideas of encounter from Husserl, care from Heidegger, bodily learning from Merleau-Ponty, language from Foucault, and recognition from Honneth. The book examines how phenomenological insight can explain the character (...) of radical learning. The book will appeal to academics and post-graduate students in the fields of philosophy of education, educational psychology, teaching and learning. (shrink)

What would the constitution of a free nation look like? In trying to answer that question we immediately think in terms of a Bill of Rights, restrictions on governmental power, and so forth. And any constitution worth having would certainly include those things. But if a constitution is to be more than a wish list, it must also specify the political structure necessary to ensure that these freedoms are not eroded or ignored. Consider the old Soviet Constitution, which guaranteed all (...) sorts of fine sounding freedoms for its citizens -- but which in practice proved only an empty promise, since its interpretation and enforcement lay in the hands of an unfettered monolithic centralized state. (shrink)

PurposeScarce evidence exists regarding end-of-life decision (EOLD) in neurocritically ill patients. We investigated the factors associated with EOLD making, including the group and individual characteristics of involved healthcare professionals, in a multiprofessional neurointensive care unit (NICU) setting.Materials and methodsA prospective, observational pilot study was conducted between 2013 and 2014 in a 10-bed NICU. Factors associated with EOLD in long-term neurocritically ill patients were evaluated using an anonymised survey based on a standardised questionnaire.Results8 (25%) physicians and 24 (75%) (...) nurses participated in the study by providing their ‘treatment decisions’ for 14 patients at several time points. EOLD was ‘made’ 44 (31%) times, while maintenance of life support 98 (69%) times. EOLD patterns were not significantly different between professional groups. The individual characteristics of the professionals (age, gender, religion, personal experience with death of family member and NICU experience) had no significant impact on decisions to forgo or maintain life-sustaining therapy. EOLD was patient-specific (intraclass correlation coefficient: 0.861), with the presence of acute life-threatening disease (OR (95% CI): 18.199 (1.721 to 192.405), p=0.038) and low expected patient quality of life (OR (95% CI): 9.276 (1.131 to 76.099), p=0.016) being significant and independent determinants for withholding or withdrawing life-sustaining treatment.ConclusionsOur findings suggest that EOLD in NICU relies mainly on patient prognosis and not on the characteristics of the healthcare professionals. (shrink)

As the world’s most populous country, China is experiencing unprecedented magnitude and speed of population ageing since it entered the ageing society two decades ago. The rapid population ageing- driven by decreasing fertility rate and prolonged life expectancy- has profound impacts on economic development and poses significant challenges for formal and informal care provision. Although the Chinese government has implemented a series of progressive policy reforms on pension, healthcare, and long-term care systems, the capacity gaps regarding (...) the coverage, adequacy, affordability, and sustainability remain large. At the same time, social and economic changes have eroded the supportive role of family, especially for rural-dwelling, childless, and empty-nest older adults. This chapter documents the statistical and social reality of ageing in China, introduces a series of policy reforms implemented by the Chinese government in response to population ageing, and describes the family dynamics and intergenerational support patterns under the changing socioeconomic background. Besides pressing challenges of ageing for family and society, this chapter also looks at the emerging lifestyle and proactivity for active ageing in China. (shrink)

Old age represents a serious contemporary social issue. In the West, we have had a long history of derogating the old and the very status of old age. This has been true, with very limited exceptions, for the ancients, for Renaissance thinkers, and in modern times. With the greater incidence of longevity in our society, the inevitable question arises: what meanings shall we attach to old age? How can this period of the life-cycle be lived successfully given the problem (...) that old-age represents in moral and social terms? And what does “successful old age” mean?Drawing on the work of William James, particularly on some of his ethical and moral ideas, and on the specific case of Matisse, , I argue that a successful old age is possible. I argue that the key to the problem of living a successful old age requires that one leads a life of significance, where a life of significance” is one lived broadly in line with the kind of proposal advanced by William James, to wit, – that it requires a life lived with a commitment to and guided by ideals.The Jamesian ideas are unpacked. It is shown how some of the difficulties that life in old age presents can be seen in the light of a failure to find, defend, and to maintain a commitment to ideals set by oneself, thus providing confirmation of the plausibility of this Jamesian insight. (shrink)

in this article, we explore how responsible research and innovation (RRI) interacts with the current political context. We examine the (1) possible consequences for RRI and related agendas if values associated with ‘populist’ movements become more pervasive, (2) the role that a lack of RRI has potentially played in the development of this political context, and (3) how RRI as a concept, practice, and research agenda should respond. We argue that whilst RRI is threatened, it is now more important than (...) ever. We propose that RRI needs to go beyond being a method for facilitating societal input into research and innovation and for highlighting desired impacts. RRI needs to evolve to provide an effective conduit for criticisms and the input of critical thinking and reflexivity into science and innovation, including in terms of economic policy and politics. (shrink)

In the state of Victoria, Australia in the late 1950s and early 1960s, restorative treatment was introduced into the state‐subsidised benevolent homes, and they were reclassified as geriatric hospitals. In the process, the nursing care of incapacitated old people was identified in terms of particular skills and knowledge, and specific forms of training were established for nurses at two levels of training: nurses’ aides and supervisory nurses with a postbasic qualification. These institutional changes were complemented by the introduction of (...) a nursing role into the body responsible for overseeing care for the aged in Victoria. Little was made of this opportunity to establish a leading role for nurses in the field of care for the aged. However, this episode raises fertile questions for further research into the development of nursing in Australia, as a set of practices divided along the lines of acute and chronic illness. (shrink)

The realities of long‐term care call for a refurbished, concrete concept of autonomy that systematically attends to the history and development of persons and takes account of the experiences of daily living.

The rapidly increasing numbers of elderly people in our society have raised some important moral questions: How should we distribute social resources among different age groups? What does justice require from both the young and the old? In this book, Norman Daniels offers the first systematic philosophical discussion of these urgent questions, advocating what he calls a "lifespan" approach to the problem: Since, as they age, people pass through a variety of institutions, the challenge of caring for the elderly becomes (...) the prudent allocation of public resources among the various stages of people's lives. Using this philosophical approach, Daniels addresses specific public policy issues such as the allocation of medical funds, the adequacy of long-term care, current Medicare cost-containment measures, and the equitable distribution of income support over the lifespan and between generations. (shrink)

This volume-"Selected Contemporary Challenges of Aging Policy"-is the most international of all published monographs from the series "Czech-Polish-Slovak Studies in Andragogy and Social Gerontology." Among the scholars trying to grasp the nuances and trends of social policy, there are diverse perspectives, resulting not only from the extensive knowledge of the authors on the systematic approach to the issue of supporting older people but also from the grounds of the represented social gerontology schools. In the texts of Volume VII interesting are (...) both distinct and coherent elements presenting the role of local, regional and global policies in the prism of the countries from which the authors originate: the Czech Republic, Slovenia, Lithuania, Latvia, Poland, Slovakia, Italy, Turkey, and the United States. The chapters show a wealth of methodological approaches to the perception of social policy and its tools. In the texts there are issues related to the idea of active ageing, discrimination against older people in the workplace, comparability of solutions friendly to employment of older adults in the Czech Republic, Poland, and Slovakia as well as focused on the importance of educational forms determining an active life in old age. This monograph also attempted to answer the question regarding how to transfer the idea of intergenerational learning into the realm of practice. This issue complements the chapter on the implementation of intergenerational programs in institutions providing long-term care support. The book also outlines a public policy on ageing in the perspective of the changes over the last few decades and the case demonstrating solutions to accelerate self-reliance as a key to active ageing. We hope that seventh volume of our series will be an intellectual stimulus for further international research on change in social policy and will contribute to the dissemination of best practices as well as contribute to positive social change. (shrink)

Libertarianism needs a theory of class. This claim may meet with resistance among some libertarians. A few will say: “The analysis of society in terms of classes and class struggles is a specifically Marxist approach, resting on assumptions that libertarians reject. Why should we care about class?” A greater number will say: “We recognize that class theory is important, but libertarianism doesn't need such a theory, because it already has a perfectly good one.”.

Background Healthcare leader support and facilitation for ethics work are of great importance for healthcare professionals’ handling of ethical issues, moral distress, and quality care provision. A digital tool for ethical reflection in long-term care was developed in response to the demand for appropriate tools. Research aim This study aimed to explore healthcare leaders’ expectations of using a digital tool for ethical reflection among their home nursing care staff. Research design A qualitative research design with (...) vignettes and focus group interviews was used. The data were analyzed using reflexive thematic analysis. Participants and Research Context The sample comprised ten healthcare leaders from municipal long-term care in Norway. Ethical Considerations Participation was voluntary and based on informed consent. The Norwegian Agency for Shared Services in Education and Research approved this study. Findings The analysis resulted in the development of three themes representing leaders’ expectations of the tool: (i) giving staff a voice, (ii) revealing ethics in practice, and (iii) keeping the pot boiling. Discussion Leaders must be informed about the ethical issues experienced to engage in supportive measures for their staff. Digital channels can increase the democratization, safety, and efficiency of communication between employees and leaders and increase awareness of ethical aspects in daily care work. The leaders had positive expectations of employees’ activities and benefits from using the tool for ethical reflection. However, they admitted that realizing the tool’s potential to ensure continuity in ethics work requires considerable organizational and leader involvement. Conclusions This study shows that healthcare leaders are open to digital solutions for managing ethics work in home nursing care. Both opportunities and important prerequisites for successfully implementing the digital tool were identified. (shrink)

Justice, Care, and the Welfare State explores contemporary welfare state reform from a moral and philosophical perspective. It offers detailed arguments about the nature of justice in the areas of family policy, education, health care, old age pensions and long-term care, disability, and employment and poverty support. Challenging the ideal nature of much contemporary political philosophy, Engster applies political philosophy to public policy issues in order to generate concrete policy recommendations for better supporting social justice.

Although nurses in almost every long-term care facility face daily challenges involving issues related to residents' sexual lives, guidelines for ethically supporting sexual activity are rare and inadequate. A decision-making framework was developed to guide care providers in responding to the sexual expression of residents in long-term care. The framework recommends that nurses should weigh the documented substantial benefits of having a sexual life against harm to the resident and others, and against offence (...) to others. This article illustrates the use of this ethical decision-making framework by using the example of nurses supporting a resident's expression of his sexuality. It is suggested that nurses use this framework to guide their practice when related ethical issues arise. (shrink)

In this paper, I consider the question of where illegal immigrants should go once their lives have been saved in hospitals and they are ready to be transferred to long-term care situations. I highlight three recent cases in which such a decision was made. In one case, the patient was kept at the hospital, in another the patient was repatriated to his home country, and in the third, the patient was discharged to his family. I consider the (...) relevant moral values and argue that for reasons of fairness we must develop a policy that treats similar cases in similar ways. In order to best uphold patient well-being and minimize costs, the plan proposed here calls for illegal immigrants to be covered by insurance for long-term care. (shrink)

It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician’s concept of personhood, or “what makes you, ‘you’”, we adopt (...) Radha Krishna’s Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support. (shrink)

Perspective-taking is an important ability to imagine the world from another’s point of view. Prior studies have shown that younger adults are more likely to consider the opinions of age-based in-group members relative to out-group members. However, the cause of this priority is still unknown. We conducted three independent studies to explore the effect of intergenerational contact on younger adults’ PT toward older adults and the possible roles of stereotyping and intergroup anxiety. A total of 192 college students completed the (...) Perspective taking Scale in Study 1 after being primed with age-based intergroup relationships. The results indicated that younger adults found it more difficult to take the perspective of older adults than that of their peers. 200 college students completed the Prior Contact Scale, Intergroup Anxiety Scale, Negative Stereotype Scale, and PT Scale in Study 2. The results demonstrated that intergenerational contact improved PT toward older adults by disrupting negative stereotypes, and intergroup anxiety moderated this mediating relationship. A total of 215 college students completed the PT Scale in the context of imagining intergenerational contact in Study 3. Interestingly, imagined contact effectively increased younger adults’ ability to take older adults’ perspectives. The present research verifies that contact is important for influencing younger adults’ emotional and attitudinal factors that are critical to improving younger adults’ ability to take older people’s perspectives. This is of great significance for developing harmonious intergenerational relationships. (shrink)

Long-term care is controversial because it involves foundational disputes. Some are moral-economic, bearing on whether the individual, the family, or the state is primarily responsible for long-term care, as well as on how one can establish a morally and financially sustainable long-term-care policy, given the moral hazard of people over-using entitlements once established, the political hazard of media democracies promising unfundable entitlements, the demographic hazard of relatively fewer workers to support those (...) in need of long-term care, the moral hazard to responsibility of shifting accountability to third parties, and the bureaucratic hazard of moving from individual and family choice to bureaucratic oversight. These disputes are compounded by controversies regarding the nature of the family (Is it to be regarded primarily as a socio-biological category, a fundamental ontological category of social reality, or a construct resulting from the consent of the participants?), as well as its legal and moral autonomy and authority over its members. As the disputes show, there is no common understanding of respect and human dignity that will easily lead out of these disputes. The reflections on long-term care in this issue underscore the plurality of moralities defining bioethics. (shrink)

It has become common in medical ethics to discuss difficult cases in terms of the principles of respect for autonomy, beneficence, nonmaleficence, and justice. These moral concepts or principles serve as maxims that are suggestive of appropriate clinical behavior. Because this language evolved primarily in the acute care setting, I consider whether it is in need of supplementation in order to be useful in the long-term care setting. Through analysis of two typical cases involving residents of (...) long-term care facilities, I argue for the additional principles of candor and responsibility for narrative integrity. (shrink)

Conducting nursing research in long-term care facilities and with samples of older people requires careful attention to research ethics and the ethical conduct of the study. This review analysed the research ethics of the empirical studies that focus on older people in long-term care settings as research participants. Articles (n = 66) focussing on older people in long-term care settings as research informants were retrieved from an electronic search of MEDLINE (1990 (...) to February 2012) using the MESH terms ‘Nursing’ AND ‘Long-term care’ (578 citations) and ‘Institutionalization’ and ‘Nursing’ (89 citations). Ethical approval procedure was reported in more than half of the studies (58%) and informed consent in two-thirds of the studies (70%). Ethical issues in data collection were described in most of the articles, but only a few reported ethics in problem statement, reporting or presenting implications. There is a need to focus on reporting research ethics and procedures in empirical research on vulnerable people. (shrink)

As long-term childhood cancer survivors are at risk for late effects, ongoing medical care is crucial to detect and treat physical illnesses as early as possible. However, previous research from around the world has shown that many adult survivors did not participate in long-term medical follow-up. This study aimed to provide insight into German survivors’ care situation, with a particular focus on barriers to follow-up care. We investigated a sample of adult CCS drawn (...) from the German Childhood Cancer Registry’s oldest cohort. Our analyses included data from a standardized medical examination, a self-report questionnaire, and in-depth interviews with a subsample. Half of the participants reported participating in some kind of medical follow-up. In a logistic regression analysis, attendance of medical follow-up care was associated with higher age. Reasons for non-attendance were assigned to four categories: lack of information about medical follow-up and/or its purpose, termination by the health care provider, structural barriers, and emotional-motivational aspects. The interviews contributed to a better understanding of how these reported barriers played out in the care of individual survivors. Further, they revealed that some survivors currently in medical follow-up had had periods without follow-up care in the past—which were also in many cases related to a lack of information, both on the part of health care providers and CCS themselves. The results indicated that a large proportion of long-term CCS do not receive the recommended follow-up care. Further, there is a great need for more information regarding the aims of long-term medical follow-up and available offers. This is an important prerequisite for CCS to make informed decisions. (shrink)

A homage in the guise of an essay, this is the story of the last course Reiner Schürmann taught. As a text, it attempts to describe, situate, and come to terms with the power of Schürmann’s teaching in the context of his last lectures on Heidegger’s Being and Time. But if it is to be true to the deepest lessons of Schürmann’s thinking, it will also need to be heard as an invitation to interpret together the significance of his reading (...) so that it may be permitted to shape the course of the lives of those who encounter it. (shrink)