The problem of structure and agency has been the subject of intense debate in the social sciences for over 100 years. This book offers a solution. Using a critical realist version of the theory of emergence, Dave Elder-Vass argues that, instead of ascribing causal significance to an abstract notion of social structure or a monolithic concept of society, we must recognise that it is specific groups of people that have social structural power. Some of these groups are entities with (...) emergent causal powers, distinct from those of human individuals. Yet these powers also depend on the contributions of human individuals, and this book examines the mechanisms through which interactions between human individuals generate the causal powers of some types of social structures. The Causal Power of Social Structures makes particularly important contributions to the theory of human agency and to our understanding of normative institutions. (shrink)

Poverty observed from business in the academic field has evolved in some publications and is characterized as a multidimensional phenomenon, having several theoretical strands that add their attention to this problem. The objective of this study is to identify and cluster the variables of poverty in the business area through the network analysis. There were 1,745 keywords mentioned in 566 papers about the theme present in the Scopus database between 2000 and 2016. The results demonstrate a network with four clusters: (...) (a) Economy, government and people; (b) Community, institutions and market; (c) Business and environment; and (d) Social aspects and finance. From the network, it is possible to understand the most cited categories of variables (research methodology and business aspects), the most consolidated relations between categories of variables (poverty and economic aspects), the most studied area (Economy, government and people), and the gaps to be explored. (shrink)

Must the best friends necessarily be good people? On the one hand, as Aristotle puts it, ‘people think that the same people are good and also friends’. But on the other hand, friendship sometimes seems to require that one behave badly. For example, a normally honest person might lie to corroborate a friend's story. What I will call closeness, which I take to include sensitivity to friends' subjective values and concerns as well as an inclination to take (...) their subjective interests as reasons for action, is characteristic of friendship. But this seems to require that good friends should be morally flexible, more so than is compatible with a virtuous character. This would imply tension between ideals of friendship and ideals of character. But there is an important connection between virtue and friendship which arises precisely from friends' closeness, when concern for wellbeing, another important feature of friendship, is also taken into account. This helps mitigate the tension and shows how friendship and virtue are interconnected. The connection in turn provides friendship-based reason to think the best friends must be good people, even though concerns of friendship may occasionally clash with other moral concerns. (shrink)

Most contemporary metaphysicians are sceptical about the reality of familiar objects such as dogs and trees, people and desks, cells and stars. They prefer an ontology of the spatially tiny or temporally tiny. Tiny microparticles 'dog-wise arranged' explain the appearance, they say, that there are dogs; microparticles obeying microphysics collectively cause anything that a baseball appears to cause; temporal stages collectively sustain the illusion of enduring objects that persist across changes. Crawford L. Elder argues that all such attempts to (...) 'explain away' familiar objects project downwards, onto the tiny entities, structures and features of familiar objects themselves. He contends that sceptical metaphysicians are thus employing shadows of familiar objects, while denying that the entities which cast those shadows really exist. He argues that the shadows are indeed really there, because their sources - familiar objects - are mind-independently real. (shrink)

Various emerging technologies, from social robotics to social media, appeal to our desire for social interactions, while avoiding some of the risks and costs of face-to-face human interaction. But can they offer us real friendship? In this book, Alexis Elder outlines a theory of friendship drawing on Aristotle and contemporary work on social ontology, and then uses it to evaluate the real value of social robotics and emerging social technologies. In the first part of the book Elder develops a robust (...) and rigorous ontology of friendship: what it is, how it functions, what harms it, and how it relates to familiar ethical and philosophical questions about character, value, and well-being. In Part II she applies this ontology to emerging trends in social robotics and human-robot interaction, including robotic companions for lonely seniors, therapeutic robots used to teach social skills to children on the autism spectrum, and companionate robots currently being developed for consumer markets. Elder articulates the moral hazards presented by these robots, while at the same time acknowledging their real and measurable benefits. In the final section she shifts her focus to connections between real people, especially those enabled by social media. Arguing against critics who have charged that these new communication technologies are weakening our social connections, Elder explores ways in which text messaging, video chats, Facebook, and Snapchat are enabling us to develop, sustain, and enrich our friendship in new and meaningful ways. (shrink)

This paper outlines a realist approach to the social ontology of discourse. It seeks to synthesise some elements of the approach to discourse found in the early work of Michel Foucault with a critical realist understanding of the causal power of social structures. It will argue that discursive structures can be causally significant when they are normatively endorsed and enforced by specific groups of people; that it is not discourse as such but these groups—discursive circles—that are causally effective; and (...) that such an account allows us to reconcile the role of discourse with that of the subject. (shrink)

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

The idea of a human-animal divide as reflective of both differences in kind and in evolutionary progress, has retained its power to produce and maintain racial and other forms of cultural difference. During the colonial period, representations of similarity were used to link subaltern groups to animals and thereby racialize and dehumanize them. In the postcolonial present, however, animal practices of subdominant groups are typically used for this purpose. Using data on cultural conflicts surrounding animal practices collected from media sources, (...) we show that such practices have become a key aspect of the human-animal boundary due to the radically changing time-space relations of postmodernity. Drawing on Spivak's notion of "wild practice, " we propose a radical democracy that includes animals as well as subaltern peoples, and argue for the rejection of dehumanization as a basis for cultural critique, given its role in perpetuating racialization and violence toward both human and non-human animals. (shrink)

This volume of the Thinker’s Guide Library offers a framework for ethical reasoning, illuminating powerful, universal tools for thinking through ethical questions. Linda Elder and Richard Paul discuss the main impediments to ethics and present ethical concepts and principles as guides for people of different backgrounds to find common ground.

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

“Congealing” is a word that evokes senses of unpleasantness where perhaps something inviting had once been. It also implies that things are becoming less fluid and more rigid. As we began organizing ETHICOMP 2018, we wanted a theme that reflected the impact of technologies on human cultures, practices and lives. Our initial draft of the theme was “Creating, Changing, and Congealing Ways of Life with Technologies.” And while we were eventually persuaded to use a more congenial way of putting the (...) idea (it became “Creating, Changing, and Coalescing Ways of Life with Technologies”), in some ways, it remains true for us that “congealing,” and its connotations of something less pleasant, gets at the original idea. As we incorporate technologies into our practices, much attention is paid to how they change our ways of doing things. But technologies can also help ways of life set-up and harden like yesterday’s leftovers – not appealing, yet difficult to budge and sometimes quite unhealthy. Once a particular process is built around a piece of technology, it can become entrenched and increasingly difficult to change. For a historical example, consider how difficult it was to adapt records and software on the eve of the 21st century in response to the so-called “Y2K” problem. In early software development, efficient use of memory was an important design consideration. It had become a standard practice to use a 2-digit field for the year, which would roll to from “99” to “00” in the year 2000, causing problems for datedependent functions. Technologies can also reflect and reinforce existing cultural tendencies. For a recent example, consider the human resources software created by Amazon that used its existing hiring data to train a machine-learning system to rate applicants. The resulting system turned out to be biased against women applicants, downranking resumes that included the word “woman” or “women’s.” Amazon ended up scrapping the project altogether. Because of these kinds of effects, we wanted to encourage people to think beyond well-worn paradigms like “technologies are disruptive” to consider other kinds of effects they can have. As it happened, the imagery of “congealing” proved distasteful enough that the steering committee opted for a more neutral term. But even with the less-dramatic wording the conference ended up attracting a rich and diverse range of papers that examined technological issues from a variety of angles, exactly as we had hoped. (shrink)

As a disabled activist, I much prefer Aristotle's concept of ‘eu zen’, or ‘living well’ to that of ‘well-being’. ‘Eu zen’ is part of Aristotle's treatise on ‘eudaimonia’, which Grayling describes as: ‘…. a strong and satisfying sense of well-being and well-doing, of flourishing as only a rational and feeling human individual can flourish when his life and relationships are good’ (emphasis added). Aristotle's concepts are preferable because they promote ‘well-being’ through familial, social and civic activity, whilst recognising that such (...) activity requires resources, both human and material. These concepts are akin to those advocated by disabled people within the ‘independent living movement’; i.e. that the individual's ‘choice’, ‘control’, ‘dignity’ and ‘freedom’, over their lives and lifestyles, are supported by an inclusive community. However, both sets of principles are now being undermined by neoliberal managerial social work practice, which not only deny basic human rights which underpin ‘eu zen’, but lead to fear and a sense of ‘commodification’ or de-personalisation among disabled recipients. Relevant examples will come from experience, both personal as well as that from other disabled people. (shrink)

This article takes the form of a debate between the two authors on the social ontology of propositional culture. Archer applies the morphogenetic approach, analysing culture as a cycle of interaction between the Cultural System and Socio-Cultural Interaction. In this model, the Cultural System is comprised of the objective content of intelligibilia, as theorized by Karl Popper with his concept of objective World 3 knowledge. Elder-Vass agrees that culture works through an interplay between subjective belief and an external objective moment, (...) but argues that the external moment cannot take the form of ‘objective knowledge’ as this is understood by Popper. Instead, the external moment of culture takes the form of normative pressures exerted by groups of people: norm circles. Ultimately both authors share a commitment to a similar critical realist ontological framework, while offering alternative accounts of the nature of culture within that framework. (shrink)

Beginning in his PhD program, and over a period of years in the 1960s, Richard Paul thoughtfully examined and deliberately critiqued existing theories of logic and reasoning. He took what was a very narrow conception of reasoning and broadened it to more accurately represent human thinking when people reason. He captured the idea of universal intellectual standards by exploring standards typically used by skilled reasoners, and assembled these standards into a constellation of ideas that is easily understandable. Following the (...) tradition of Socrates, Paul continually emphasized the importance of developing conceptual understandings based in foundational ideas and principles of analysis, and tested through life experience. His work laid the groundwork for what may be termed first principles in critical thinking and for a legitimate field of critical thinking studies. (shrink)

Research involving transgender and gender diverse people (TGD) increased in the last years, mostly concerning healthcare associated to this population. Few studies dedicated their analysis to the impact of parental support on transgender people, even though this is an important aspect in creating a safe environment on which these individuals can build their identity. In addition, the link between family support, TGD identity and homelessness is not completely established. Thus, due to the specificities of the family context of (...) TGD individuals, the aim of this study is to investigate the association between family support and TGD in different moments of the process of gender affirmation. In addition, this study also aims to explore the relationship between a lack of social support and low self-esteem, home abandonment, and dwelling in the street. The survey was designed based on the TransPULSE project and was made available in electronic format. The sample was constituted of 423 TGD residents in two Brazilian states. A Structural Equation Model analysis suggested that the impact of gender affirmation status on homelessness was mediated by parental support, through self-esteem, and the need to move from home. The association between the status of the gender affirmation procedures, family support and self-esteem was significant and indicated that the further TGD individuals advanced in gender affirmation, the more self-esteem and family support they would have. The association between family support and self-esteem indicated that family support was associated with higher self-esteem. Low family support was associated with the willingness to move from home due to one’s TGD status and there was also a significant correlation between low self-esteem and the willingness to move from home due to one’s TGD status. Finally, homelessness was associated with the willingness to move with a large effect size. Limitations include the sample that was constituted by individuals with Internet access and who had more contact with TGD communities. The findings indicate directions for interventions involving TGD people and their families, considering the parental relationship as a critical variable to improve TGD quality of life in the process of gender affirmation. (shrink)

This is a delightful book which tries to solve the puzzle of Nicomachean Ethics 5.5: did Aristotle make a contribution to economic theory or are his statements without significance? Meikle argues that what Aristotle does in this chapter is analyze a property of things, namely their exchange value. Such things as houses, horses, beds are not really commensurable, but the degree to which people need them is. Their value in money is the conventional representation of this need. However, Aristotle (...) has no theory of economic value. He regards the development of exchange as part of the emergence of the polis from the family and the village. The breeding of money from money is unnatural. Aristotle is concerned about the invasion of the whole political and ethical life by the pursuit of money. Those who condemn this position overlook that the criticism is aimed at the effect money has on the arts when they are pursued for the sake of it. While Marx endorses most of Aristotle’s conclusions, Schumpeter rejected the view that exchange values cannot be expressed in terms of use values. For Aristotle, exchange value is intrinsic; for positivists it is extrinsic. Meikle sides with Aristotle. He also defends Politics 1.5, a chapter which has often been dismissed as a muddle. Aristotle’s analysis of exchange value is a great achievement. The Stagirite investigated the conceptual problems that arise when one tries to define exchange value. How do things which are incommensurable become commensurable in exchange? (shrink)

The two last chapters of the book are a personal addition of Aquino giving a communal dimension to the illative sense and mapping how people ordinarily reach certitude by transmission of knowledge and by relying on the reason of others. He leaves behind certain limitations of Newman, his “personality quirks and cultural biases”, and stresses the need of the virtues and the damaging influence of the vices on the illative sense. Christian wisdom is a mature form of the illative (...) sense. In chapter 5 we are told that even in theology one needs this communal exchange to reach an informed judgment. Instead of solitary theological discernment we must form “communities of theological judgment.” This part of the book describes what happens in teaching and learning as an application of Newman’s illative sense. A good number of modern authors are quoted to strengthen the argument. (shrink)

Dr. Barraza submits a detailed study of utilitarianism and its offspring, consequentialism, and purports to show why it is not an acceptable moral system. As G. Anscombe pointed out, it arose when ethics was no longer based on the virtues and people looked for a way to evaluate moral actions in conformity with the predominant technological outlook. Consequentialism holds that the criterion of morality is that of the best overall result possible, whereas for utilitarianists it is the greatest amount (...) of pleasure, satisfaction, or happiness. John Stewart Mill’s utilitarianism is examined in great detail. Mill felt that the criterion of morality cannot be something intuitively known, but has to be easily recognizable, as, for instance, the consequences of our acts, namely the greatest happiness proper to man as a human being. Mill experienced some difficulties when trying to integrate duties with regard to others. His answers to eight objections raised against his theory are seen as insufficient by Barraza, as is Mill’s justification of the principle of “the greatest happiness.” Mill’s ethics is profoundly marked by the spirit of the Enlightenment, that is, by a type of rationalism related to the empirical sciences; everything was to be explained by one simple principle, without any reference to religion. Important points in the system are the stress on freedom and equality, freedom being the primary value. Mill seeks to secure the greatest possible space for personal freedom, which, however, is limited by the interests of others. Equality results from impartiality which demands that the happiness of the agent is not placed above that of others. Furthermore, Mill’s ethics is characterized by its optimism and its social orientation, aiming as it does at the well-being of the greatest number. However, despite a semblance of coherence Mill’s work is full of ambiguities. A glaring difficulty is that the intention of the agent has nothing to do with the results and their evaluation. (shrink)

This beautifully presented volume is a reprint of two series of, respectively, four and five dialogues by the French sceptical philosopher La Mothe Le Vayer, originally published about 1631. The dialogues are a sparkling display of humanist learning and make pleasant reading, although philosophically their quality is rather poor. If we say that La Mothe was a sceptic, this assertion must immediately be qualified. From the dialogue "In Defence of Scepticism," we learn that in La Mothe's eyes a sceptic is (...) a person who doubts about everything, but not unreasonably--rather he goes along with what now appears. We would perhaps call this position critical rather than sceptical. La Mothe dwells on the variety of opinions and beliefs held by different people to point out that one can hardly be totally certain in one's evaluation of what is true and what is false and of what is right or wrong. The French humanist is at his best when he describes the enormous variety of customs. He introduces numerous quotations from Greek and Latin authors as well as from the letters of missionaries in the Far East or Latin America. One admires his versatility, his command of history, and his acquaintance with philosophers and theologians. Less admirable is his satisfaction with his own sceptical epochë not to accept anything as entirely certain, except, as it seems, the dogmas of the Christian faith. (shrink)

The aim of the translator is to make his readers experience the freshness and novelty of the Greek text which, he believes, was not written for specialists, but for generally educated people... who are willing to think hard. Sachs sets out on a difficult task because the Metaphysics abound in plainly contradictory statements. According to Sachs, the main obstacle to the understanding of the Metaphysics is the fact that it has come to us via the Latin translations and versions (...) influenced by them. For this reason he avoids the use of certain traditional terms such as substance, actuality, sensation, principle, induction, and so forth, replacing them by terms such as thinghood, being-at-work, perception, source, and example. (shrink)

According to Professor Polin, in our era of constitutional crisis a study on the basic concepts of constitutionalism is welcome. By constitutionalism are meant arrangements such as separation of powers, checks and balances, the rule of law, and so forth, by which a country is reasonably governed for the good of the people.

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

The aim of this study was to obtain an increased understanding of the experiences of elderly people in geriatric care, with special reference to integrity. Data were collected through qualitative interviews with elderly people and, in order to obtain a description of caregivers’ integrity-promoting or non-promoting behaviours, participant observations and qualitative interviews with nursing students were undertaken. Earlier studies on the integrity of elderly people mainly concentrated on their personal and territorial space, so Kihlgren (...) and Thorsén opened up the possibility of considering the concept of integrity from a broader view by recognizing its relationship to the larger framework of the self-concept. Based on this, findings in the present study indicate that elderly people’s integrity relating to their corporal self were the least violated. On the other hand, their psycological, information and cultural selves were the most exposed. The study also identified a further dimension (i.e. one relating to social self), which should be included in the concept of integrity because respecting elderly people’s social self reduces their feelings of loneliness, isolation and seclusion. In summary, the results indicate that the concept of integrity is complex and has several dimensions. (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)

In any normal population, health is unequally distributed across different age groups. Are such age-based health inequalities unjust? A divide has recently developed within egalitarian theories of...

The increase in suicidal behaviour among elderly people makes it necessary to take action in the field of broadly understood prevention. This includes helplines, which play an essential role in anti-suicidal measures. The aim of this study was to obtain information about the experience of Polish helpline workers in communicating with older people in suicidal crisis. The study was conducted among 106 helpline workers from various helpline centres across Poland. It proved that helpline workers in Poland have (...) considerable experience in communicating with elderly people in suicidal crisis, albeit the majority of respondents feel they need additional training in the area of broadly understood suicidology. (shrink)

The focus of this article is perceptions of elderly patients and nurses regarding patients’ autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which (...) patients received information from nursing staff or were offered opportunities to make decisions.This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

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

The focus of this article is on elderly patients’ and nursing staff perceptions of informed consent in the care of elderly patients/residents in five European countries. The results suggest that patients and nurses differ in their views on how informed consent is implemented. Among elderly patients the highest frequency for securing informed consent was reported in Finland; the lowest was in Germany. In contrast, among nurses, the highest frequency was reported in the UK (Scotland) and the lowest (...) in Finland. In a comparison of patients’ and nurses’ perceptions, nurses had more positive views than patients in all countries except Finland. Patients with less need for nursing interventions in Greece and Spain gave their consent less often. The German and Greek patients were older, and the results also point to an association between this and their lower frequency of giving consent. In Spain, patients who were married or who had a family member or friend to look after their personal affairs were more likely to be included in the group whose consent was sought less often. This is the fourth of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

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

This article analyses the general ethical milieu in a nursing home for elderly residents and provides a decision-making model for analysing the ethical situations that arise. It considers what it means for the residents to live together and for the staff to be in ethically problematic situations when caring for residents. An interpretative phenomenological approach and Sandman’s ethical model proved useful for this purpose. Systematic observations were carried out and interpretation of the general ethical milieu was summarized as ‘being (...) in the same world without meeting’. Two themes and four subthemes emerged from the analysis. Three different ethical problems were analysed. The outcome of using the decision-making model highlighted the discrepancy between the solutions used and well-founded solutions to these problems. An important conclusion that emerged from this study was the need for a structured tool for reflection. (shrink)

When elderly people are ideating on manners to end their lives, because they feel life is over and no longer worth living, it is important to understand their lived experiences, thoughts and behaviour in order to appropriately align care, support and policy to the needs of these people. In the literature, the wish to die in elderly people is often understood from a medical, psychopathological paradigm, referred to as cognitive impairment, depressive disorder, pathological bereavement, and (...) suicidality. In this paper, we evaluate this dominant paradigm by considering three serious limitations, namely: (1) the risk of epistemic transformation; (2) the risk of reduction; and (3) the risk of obscuring the social and cultural embeddedness. Drawing on insights from our empirical–phenomenological research on the issue of elderly and the self-chosen death, this paper argues for a phenomenological perspective to counteract the medicalisation of death wishes in elderly people. (shrink)

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

This article gives a practice-based and theoretical overview of the transformation from a traditional hierarchical organization in the care and cure sector towards a so-called Community-driven organization providing human happiness to 6000 elderly people. The actual case study is intertwined with conceptual information for better understanding of the innovative transition which took place at Humanitas. The case description includes its initial situation, its new core values, mission and objectives and shows the sequence of emerging policies and interventions that (...) resulted in a stakeholder oriented business model for the care sector. The selected concepts are Graves' Emerging Cyclical Level of Existence Theory (or Spiral Dynamics), Ken Wilber's Four Quadrant Model, Roberts Simons' Four Levers of Control and various elements from the European Corporate Sustainability Framework sponsored by the European Commission. The conclusion marks the match between theory and practice in transforming Humanitas Rotterdam into providing cure, care, housing and well-being to elderly people. (shrink)

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

The care of elderly people with dementia poses ethical problems in several respects. This paper considers the problems in relation to treatment, withdrawal of treatment (including nutrition and hydration) in terminal care, and consent to involvement in research. It is ultimately the responsibility of the physician to take the decision about whether or not to proceed with treatment, according to the best interests of the patient, but nurses, families and significant others can be involved in making the decision. (...) When withdrawal of treatment or withdrawal of nutrition and hydration in the terminal stages of dementia are being considered it is necessary to take into account the nature of the treatment, whether or not it is extraordinary, and the goals of continued nutrition. In some circumstances it may be possible for them to be withdrawn. Only research which is aimed at evaluating treatment for dementia may involve subjects who are suffering from dementia.Soigner des personnes âgés souffrant de la démence pose plusieurs problèmes éthiques. Cet article considère les problèmes concernant le traitement, cessation de traitement (y inclus nutrition et hydration) dans la phase terminale, et consentement de participation dans les recherches. C'est ultimement la décision du docteur si oui ou non de continuer avec le traitement selon les meilleurs intérêts du malade, mais les infirmiers/ères, les familles et les personnes importantes autour du malade peuvent jouer un rôle dans les décisions. Si la cessation de traitement ou cessation de nutrition et hydration dans la phase terminale de démence est envisagée il est nécessaire de tenir compte de la nature du traitement, s'il est 'extraordinaire' ou non, et le but de nutrition si on continuait. Dans quelques circonstances il est possible de les discontinuer. Seuls les recherches qui ont pour but d'évaluer les traitements pour la démence peuvent utiliser des personnes souffrant de démence.Die Pflege von älteren Personen mit Demenz stellt einige ethische Probleme. Dieser Artikel betrachtet die Probleme in Beziehung auf die Pflege, Zurückziehung von Pflege (auch von Nahrung und Getrank) der Sterbenden und der Entscheidung, in der Forschung beteiligt zu sein. Der Arzt hat die schlussendliche Verantwortung über die Entscheidung ob mit der Pflege weitergefahren werden soll oder nicht nach dem besten Interesse der Patienten. Aber das Krankenpflegepersonal, die Familie und bedeutende Andere können auch an dieser Entscheidung teilnehmen. Wenn es sich um Zurückziehung der Pflege, oder Zurückziehung von Nahrung oder Getrank in der Sterbepflege von Personen mit Demenz handelt, is es nötig, das Wesen der Pflege und die Ziele einer fortfahrenden Nahrung zu kennen. In gewissen Fällen ist es möglich, diese zurück zu ziehen. Es sollen nur Patienten mit Demenz an Forschungen teilnehmen die über die Pflege der Demenz einschätzt. (shrink)

The care of elderly people with dementia poses ethical problems in several respects. This paper considers the problems in relation to treatment, withdrawal of treatment (including nutrition and hydration) in terminal care, and consent to involvement in research. It is ultimately the responsibility of the physician to take the decision about whether or not to proceed with treatment, according to the best interests of the patient, but nurses, families and significant others can be involved in making the decision. (...) When withdrawal of treatment or withdrawal of nutrition and hydration in the terminal stages of dementia are being considered it is necessary to take into account the nature of the treatment, whether or not it is extraordinary, and the goals of continued nutrition. In some circumstances it may be possible for them to be withdrawn. Only research which is aimed at evaluating treatment for dementia may involve subjects who are suffering from dementia. Soigner des personnes âgés souffrant de la démence pose plusieurs problèmes éthiques. Cet article considère les problèmes concernant le traitement, cessation de traitement (y inclus nutrition et hydration) dans la phase terminale, et consentement de participation dans les recherches. C'est ultimement la décision du docteur si oui ou non de continuer avec le traitement selon les meilleurs intérêts du malade, mais les infirmiers/ères, les familles et les personnes importantes autour du malade peuvent jouer un rôle dans les décisions. Si la cessation de traitement ou cessation de nutrition et hydration dans la phase terminale de démence est envisagée il est nécessaire de tenir compte de la nature du traitement, s'il est 'extraordinaire' ou non, et le but de nutrition si on continuait. Dans quelques circonstances il est possible de les discontinuer. Seuls les recherches qui ont pour but d'évaluer les traitements pour la démence peuvent utiliser des personnes souffrant de démence. Die Pflege von älteren Personen mit Demenz stellt einige ethische Probleme. Dieser Artikel betrachtet die Probleme in Beziehung auf die Pflege, Zurückziehung von Pflege (auch von Nahrung und Getrank) der Sterbenden und der Entscheidung, in der Forschung beteiligt zu sein. Der Arzt hat die schlussendliche Verantwortung über die Entscheidung ob mit der Pflege weitergefahren werden soll oder nicht nach dem besten Interesse der Patienten. Aber das Krankenpflegepersonal, die Familie und bedeutende Andere können auch an dieser Entscheidung teilnehmen. Wenn es sich um Zurückziehung der Pflege, oder Zurückziehung von Nahrung oder Getrank in der Sterbepflege von Personen mit Demenz handelt, is es nötig, das Wesen der Pflege und die Ziele einer fortfahrenden Nahrung zu kennen. In gewissen Fällen ist es möglich, diese zurück zu ziehen. Es sollen nur Patienten mit Demenz an Forschungen teilnehmen die über die Pflege der Demenz einschätzt. (shrink)

IntroductionIncorporating technology in cognitive interventions represents an innovation, making them more accessible, flexible, and cost-effective. This will not be feasible without adequate user-technology fit. Bearing in mind the importance of developing cognitive interventions whose technology is appropriate for elderly people with cognitive impairment, the objective of this systematic review was to find evidence about usability and user experience measurements and features of stimulation, training, and cognitive rehabilitation technologies for older adults with mild cognitive impairment or dementia.MethodThe Medline, PubMed, (...) Scopus, ScienceDirect, and PsycINFO databases were searched for literature published in the last 10 years, and three researchers independently reviewed potentially eligible studies, following specific inclusion criteria. A systematic review of the studies was conducted, presenting a qualitative synthesis of usability and UX measures with their outcomes, study characteristics and features of the cognitive intervention technologies.ResultsTen studies were selected: five were cognitive stimulation and five were cognitive training. Most of them were computer-based programs with a serious game format. Efficiency and effectiveness were the most frequent measurements used for collecting objective usability data, showing that elderly people with cognitive impairment require more time and help but can complete tasks. Regarding UX or subjective usability data, questionnaires and scales were the most used methods, reporting positive experience despite certain difficulties with the interface in five studies.ConclusionMeasuring usability and UX in cognitive intervention technologies for older adults with MCI or dementia provides an integrated view that can contribute to their development according to the needs and characteristics of the target population. More research is required to include this population group in usability and UX studies, as well as standardized tools and consensus on the relationship of these terms to guarantee the future effectiveness of cognitive intervention technologies.Review registrationThis review was registered in the PROSPERO International Register of Systematic Review Protocols. (shrink)

The focus of this article is on elderly patients’ and nursing staff perceptions of privacy in the care of elderly patients/residents in five European countries. Privacy includes physical, social and informational elements. The results show that perceptions of privacy were strongest in the UK (Scotland) and weakest in Greece. Country comparisons revealed statistically significant differences between the perceptions of elderly patients and also between those of nurses working in the same ward or long-term care facility. Perceptions of (...) privacy by patients and their nursing staff were quite similar in Finland, Germany and the UK. In contrast, in Greece and Spain these perceptions were different: nurses believed that they took account of their patients’ privacy needs more often than the patients themselves felt this was the case. Among Spanish and UK patients, an association was found between lower levels of independence and comparatively less positive perceptions of privacy. No associations were established between nurses’ perceptions and their demographic factors. This is the third of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

This article discusses nurses’ and elderly patients’ perceptions of the realization of autonomy, privacy and informed consent in five European countries. Comparisons between the concepts and the countries indicated that both nurses and patients gave the highest ratings to privacy and the lowest to informed consent. There were differences between countries. According to the patient data, autonomy is best realized in Spain, privacy in the UK (Scotland), and informed consent in Finland. For the staff data, the best results tended (...) to concentrate in the UK. The conceptual and methodological limitations of the study are identified and discussed. Implications of the results are divided into three areas: nursing practice, education and research. In practice, the analysis of patients’ values and the ethical sensitivity of nurses are important as part of ethically good care. In nurse education, students should learn to recognize ethical problems, generally and particularly, among vulnerable groups of patients. Multicultural international research is needed in this area. This is the last of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

Evaluation scales are used in the care of elderly people. They are useful for estimating the workload, the necessary resources, the care cost, the patient’s dependency or autonomy in daily life, and/or the patient’s needs. The large number of grids already indicates their insufficiency.This article explores the stakes implied by the evaluations, which use concepts more or less clearly defined as autonomy, dependency, deficiency, incapacity. It also questions our understanding of interdependence, vulnerability, and responsibility, and their implications in (...) the care relations with elderly people. (shrink)

As case management is under development in France for elderly people, this study sets out to identify and analyse key situations responsible for ethical dilemmas for French case managers. We based our study on the analyses of individual interviews made with case managers and focus-group discussions, bringing together all case managers working in local organisations running for at least a year. We identified three situations giving rise to ethical dilemmas: in the order of importance, the refusals of care, (...) the practicalities of collecting and sharing personal data and the allocation of resources. These three situations can lead to conflict between the principle of beneficence and those of respect for autonomy, non-maleficence and justice. We describe here how French case managers practically deal with these situations. (shrink)

The purpose of this mini-review is to investigate if there are any cognitive benefits of computer-based foreign language training for healthy older individuals aged 55+ years. The author conducted a literature search of peer-reviewed English written research articles found in Pub Med, Web of Science and Scopus. The findings of this mini-review reveal that the research on the cognitive benefits of computer-based foreign language training for healthy older individuals is small-scale. The limited research findings of only three relevant studies indicate (...) that these computer-based foreign language training programs may bring cognitive benefits for healthy elderly people, especially as far as the enhancement of their cognitive functions such as working memory are concerned. In addition, the authors of these studies suggest that foreign language learning is a useful activity for healthy older adults since it has the benefits of being meaningful and provides the chance for acquiring important skills that can benefit other aspects of life, such as travel or communication. In conclusion, the author of this mini-review also provides several implications for practice and future research. (shrink)