Online research in philosophy

The growing proportion of elderly people in society, together with recent advances in robotics, makes the use of robots in elder care increasingly likely. We outline developments in the areas of robot applications for assisting the elderly and their carers, for monitoring their health and safety, and for providing them with companionship. Despite the possible benefits, we raise and discuss six main ethical concerns associated with: (1) the potential reduction in the amount of human contact; (2) an increase in the feelings of objectification and loss of control; (3) a loss of privacy; (4) a loss of personal liberty; (5) deception and infantilisation; (6) the circumstances in which elderly people should be allowed to control robots. We conclude by balancing the care benefits against the ethical costs. If introduced with foresight and careful guidelines, robots and robotic technology could improve the lives of the elderly, reducing their dependence, and creating more opportunities for social interaction.

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

In this study caring is shown to be a membershipbound activity to kin and gender categories with strong moral connotations. Being a daughter or being a son are good enough reasons for becoming a caregiver, more so for women than for men. Caregivers were interviewed within the research project The role of women in family care of disabled elderly conducted by the Social and Economic Research Department of INRCA, Ancona, Italy. Transcripts of the interviews were analyzed through a detailed discourse analysis within an ethnomethodological framework. Interview data are treated as interactional encounters that occasion members to display relevant aspects of their identities and morally adequate images of being a caregiver. In the interview interaction, interlocutors display an orientation towards the production of a moral order in which duty and responsibilities are allocated on the basis of gender distinction. Males are generally described as not being responsible for caring tasks, except for situations in which females are absent or sick, that is, for serious reasons. Caregivers'' perception of time dedicated to caring is pervasive. Most caregivers said it occupied all their time, but gender differences were noticeable. Caring tasks are recognized as gender specific practices, thus failing to carry out these tasks is morally sanctionable when women are involved, but not so for men. Many caregivers described caring for older relatives as an intense source of stress, involving serious physical and psychological problems. The study on moral and identity issues related to caregiving highlights endangering constructions of caring.

Advance directives (ADs), which are also sometimes referred to as ‘living wills’, are statements made by a person that indicate what treatment she should not be given in the event that she is not competent to consent or refuse at the future moment in question. As such, ADs provide a way for patients to make decisions in advance about what treatments they do not want to receive, without doctors having to find proxy decision-makers or having recourse to the doctrine of necessity. While patients can request particular treatments in an AD, only refusals are binding. This paper will examine whether ADs safeguard the autonomy and best interests of the incompetent patient, and whether legislating for the use of ADs is justified, using the specific context of the legal situation in the United Kingdom to illustrate the debate. The issue of whether the law should permit ADs is itself dependent on the issue of whether ADs are ethically justified; thus we must answer a normative question in order to answer the legislative one. It emerges that ADs suffer from two major problems, one related to autonomy and one to consent. First, ADs’ emphasis on precedent autonomy effectively sentences some people who want to live to death. Second, many ADs might not meet the standard criteria for informed refusal of treatment, because they fail on the crucial criterion of sufficient information. Ultimately, it transpires that ADs are typically only appropriate for patients who temporarily lose physical or mental capacity.

Advance patient directives are various forms of anticipatory medical directives made by competent individuals for the eventuality of future incompetence. They are therefore appropriate instruments for competent patients in the early stage of Alzheimer's disease to document their self-determined will in the advanced stages of dementia. Theoretical objections have been expressed against the concept of advance patient directives (problems of authenticity and identity) which, however, cannot negate the fundamental moral authority of advance patient directives. Therefore, patients, family members, and physicians should make use of the appropriate form of advance directive as part of common treatment and care planning. Advance directives, when utilized intelligently, represent appropriate instruments for shared decision-making by patient, family members and physician. They should be utilized to a greater extent, particularly for the treatment planning of demented patients.

This book is the most comprehensive treatment available of one of the most urgent--and yet in some respects most neglected--problems in bioethics: decisionmaking for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly, and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike.

Today many adult children find themselves in the position of caring for elderly parents and attending to the other demands of life. Because of the unique balance of power in the adult child/elderly parent relationship as well as other negative influences, many adult children find caring for parents a frustrating task. This article argues a solution to this dilemma can be found in a renewed appreciation of filial piety as it specifically relates to caring for elderly parents. Using the moral insights of Aristotle and Aquinas, this paper develops a contemporary theoretical framework for geriatric filial piety that incorporates the traditional virtues of gratitude, respect, honor and obedience. It also illustrates their practical application so that adult children can find caring for their elderly parents a meaningful activity.

This essay explores the preferences, anticipations and expectations of the elderly regarding the role of family members in making health care decisions for them should they become decisionally incapacitated. Findings are presented from a series of in-depth interviews of men and women aged 67–91 years. Following a discussion of the uncertain legal status of familial surrogate decision-making, we argue that the family unit's autonomy is sufficient to justify the elderly's preferred reliance on their own family. Further, we suggest that social and legal policy changes should facilitate, rather than impede, familial decision-making.