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

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)

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

In this study we compared the ethical attitudes of a group of experienced, predominantly female, registered nurses (n = 67) with those of a group of final year, mixed sex, medical students (n = 125). The purpose was to determine the basis of differences in attitudes that could lead to ethical disagreements between these two groups when they came to work together. A questionnaire developed to explore ethical attitudes was administered and the responses of the two groups were compared using (...) t-tests. Because of the preponderance of females among the nurses an analysis of variance of the gender-adjusted scores for each group was also carried out. On comparing the responses, the nurses differed significantly from the medical students in a number of ethical domains. A potential source of conflict between these two groups is that the nurses were inclined to adopt the perspective of patients but the medical students identified with their profession. When corrected for the effects of gender, the differences persisted, indicating that it was discipline that determined the differences. We recommend that students of nursing and medicine receive ethics education together, and that more open dialogue between doctors and nurses with respect to their different ethical viewpoints is needed in the work setting. This article will be of interest to educators of students of medicine and nursing, as well as to doctors and nurses who are eager to improve their professional relations and thereby improve patient care. (shrink)

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

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

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

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

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

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

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

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)

A growing phenomenon in contemporary society is adult children caring for their elderly parents. Although some interest has been directed to the question of filial piety in general, surprisingly, scant attention has been focused on the ethical dimensions of caring for elderly parents. This article explores the contribution that Aquinas’s theory of the virtues of filial piety and prudence can make to the ethical dilemmas of elder care. In examining Aquinas’s theory, I explicate the relationship between moral agency (...) and prudence, with a special emphasis on the relationship between the integral parts of prudence and the exercise of moral virtue. In doing so, I suggest how Aquinas’s theory can shape and guide contemporary filial piety in order to advance quality elder care. (shrink)

In Western countries a considerable number of older people move to a residential home when their health declines. Institutionalization often results in increased dependence, inactivity and loss of identity or self-worth (dignity). This raises the moral question as to how older, institutionalized people can remain autonomous as far as continuing to live in line with their own values is concerned. Following Walker's meta-ethical framework on the assignment of responsibilities, we suggest that instead of directing all older people towards more autonomy (...) in terms of independence, professional caregivers should listen to the life narrative of older people and attempt to find out how their personal identity, relations and values in life can be continued in the new setting. If mutual normative expectations between caregivers and older people are not carefully negotiated, it creates tension. This tension is illustrated by the narrative of Mr Powell, a retired successful public servant now living in a residential home. The narrative describes his current life, his need for help, his independent frame of mind, and his encounters with institutional and professional policies. Mr Powell sees himself as a man who has always cared for himself and others, and who still feels that he has to fulfil certain duties in life. Mr Powell's story shows that he is not always understood well by caregivers who respond from a one-sided view of autonomy as independence. This leads to misunderstanding and an underestimation of his need to be noticed and involved in the residential community. (shrink)

The migration of elder-care workers appears to be a zero-sum game. This naturally offends our sense of justice, especially when the host populations are richer. In this article, I argue that we ought to look beyond the short run. Once we look at the long run, we will see possibilities of non-zero-sum games that are mutually beneficial.

Background Few empirical studies have been found that explore ethical challenges among persons in high public positions that are responsible for elder care. The aim of this paper was to illuminate the meaning of being in ethically difficult situations related to elder care as experienced by high level decision-makers. Methods A phenomenological-hermeneutic method was used to analyse the eighteen interviews conducted with political and civil servant high level decision-makers at the municipality and county council level from (...) two counties in Sweden. The participants worked at a planning and control as well as executive level and had both budget and quality of elder care responsibilities. Results Both ethical dilemmas and the meaning of being in ethically difficult situations related to elder care were revealed. No differences were seen between the politicians and the civil servants. The ethical dilemmas mostly concerned dealings with extensive care needs and working with a limited budget. The dilemmas were associated with a lack of good care and a lack of agreement concerning care such as vulnerable patients in inappropriate care settings, weaknesses in medical support, dissimilar focuses between the caring systems, justness in the distribution of care and deficient information. Being in ethically difficult situations was challenging. Associated with them were experiences of being exposed, having to be strategic and living with feelings such as aloneness and loneliness, uncertainty, lack of confirmation, the risk of being threatened or becoming a scapegoat and difficult decision avoidance. Conclusion Our paper provides further insight into the ethical dilemmas and ethical challenges met by high level decision-makers', which is important since the overall responsibility for elder care that is also ethically defensible rests with them. They have power and their decisions affect many stakeholders in elder care. Our results can be used to stimulate discussions between high level decision-makers and health care professionals concerning ways of dealing with ethical issues and the necessity of structures that facilitate dealing with them. Even if the high level decision-makers have learned to live with the ethical challenges that confronted them, it was obvious that they were not free from feelings of uncertainty, frustration and loneliness. Vulnerability was revealed regarding themselves and others. Their feelings of failure indicated that they felt something was at stake for the older adults in elder care and for themselves as well, in that there was the risk that important needs would go unmet. (shrink)

A proper understanding of the Islamic perspective on old age with particular consideration of significant current changes and adaptations affecting Muslim elderly’s emotional, cultural and socio-economic needs, transitions and transformations requires a degree of acquaintance with Islam’s religious principles and values. This paper discusses a number of theological and moral concepts and themes pertaining to the elderly in Islam while highlighting the moral and ethical value system underlying Muslims’ position on ageing and old age. This study shows the extent to (...) which the axiomatic perspective of Islam on old age is essentially shaped by religious beliefs, laws and spiritual practice. This inquiry into Muslim values on old age and elderly care would be of benefit to researchers on religious and cultural values; particularly in multicultural contexts, and yet again more instrumental to health professionals, counselors and social workers interacting with the Muslim elderly. (shrink)

The discussion about robots in elderly care is populated by doom scenarios about a totally dehumanized care system in which elderly people are taken care of by machines. Such scenarios are helpful as they attend us to what we think is important with regard to the quality elderly care. However, this article argues that they are misleading in so far as they (1) assume that deception in care is always morally unacceptable, (2) suggest that robots (...) and other information technologies necessarily deceive elderly people by creating a “virtual” world as opposed to a “real” world, (3) assume that elderly people of the future have similar ICT skills and interests as the elderly people of today, and (4) assume a simplistic view of technologies. The article suggests an approach to evaluating care robots and ICT in health care which acknowledges and addresses a number of ethical problems raised by robotic care—for instance disengagement problems—while taking into account that some elderly people may need care that does not treat them as (empirically) autonomous, that many the elderly of the future are likely to be digital natives, and that the task of evaluating technologies in care is more complicated than the discussion of deception suggests. (shrink)

The authors explore the changing dynamics of gendered familial caregiving in urban China within the context of economic reforms and the continued cultural influence of xiao. Data collected in China through interviews with 110 familial caregivers were used to examine cultural and structural influences on the caregiving behavior of adult children. Results from multiple regression analyses provide evidence of a gendered division of parental care tasks, a decline in the patrilocal tradition of caregiving, and a strong social pressure that (...) influences caregiving behavior. Structural factors linked to caregiving performance included family size, lack of pensions for elders, and caregivers’ employment status and income. Findings portend deleterious effects for the women who are now caregivers as they are likely to live longer but be more financially dependent and have fewer children available to help them. (shrink)

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

노인 돌봄의 문제는 세대와 성별 등을 초월한 전 인류가 직면하고 있는 문제로서 모두가 함께 나누어 가져야 할 책임의 문제로 여겨야 한다. 현대 사회에서 개인의 자유는 무엇보다 소중하며 보호되어야 하지만 함께 살아가는 공동체의 구성원으로서 개인은 우리 모두가 관심을 가져야 하는 공동의 문제에 대해 간과할 수 없다. 사회 전체가 함께 해결해야할 공동의 문제에 대해 서로 소통함으로써 해결 방안을 찾기 위한 노력을 하지 않는다면 개인들이 지닌 다원적이며 상대적인 가치들로 인해 사회적 갈등은 증폭될 수 밖에 없을 것이다. 이러한 점에서 하버마스는 개인들의 가치를 인정하면서도 담론을 (...) 통해 강제적이지 않는 방식으로 사회적 합의에 도달하고자 하였으며, 이것이 바로 의사소통적 이성인 것이다. 다시 말해 하버마스에 의하면 사회 구성원들은 상호 간의 언어 행위를 통해 서로 이해하고 합의하는 과정이 필요하며, 이로써 사회적 갈등을 합리적으로 해결할 수 있다. 노인돌봄 체계의 공적 가치를 논의함에 있어 사회에 존재하는 다양한 의견을 인정함과 동시에 담론의 과정을 통해 사회적 합의를 이끌어내는 것은 무엇보다 중요하다. 이러한 점에서 고령사회에 노인 돌봄의 가치에 대한 성찰과 공적 체계 구축을 위한 절차로서 담론 윤리에 대해 논의하는 것은 고령사회의 급격하게 증가하는 노인의 보호를 넘어 사회적으로 취약한 상황에 있는 사람들에 대한 논의 절차를 마련하기 위한 기초가 된다는 점에서 의의를 가질 것이다. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). (...) Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Clinical ethics support mechanisms in healthcare are increasing but little is known about the specific developments in elderly care. The aim of this paper is to present a systematic literature review on the characteristics of existing ethics support mechanisms in institutional elderly care. A review was performed in three electronic databases . Sixty papers were included in the review. The ethics support mechanisms are classified in four categories: ‘institutional bodies’ ; ‘frameworks’ ; ‘educational programmes and moral case deliberation’; (...) and ‘written documents and policies’. For each category the goals, methods and ways of organising are described. Ethics support often serves several goals and can be targeted at various levels: case, professional or organisation. Over the past decades a number of changes have taken place in the development of ethics support in elderly care. Considering the goals, ethics support has become more outreaching and proactive, aiming to qualify professionals to integrate ethics in daily care processes. The approaches in clinical ethics support have become more diverse, more focused on everyday ethical issues and better adapted to the concrete learning style of the nursing staff. Ethics support has become less centrally organised and more connected to local contexts and primary process within the organisation. (shrink)

Ethics support is called for to improve the quality of care in elderly institutions. Various forms of ethics support are presented, but the needs for ethics support remain unknown. Using a mixed-methods design, this article systematically investigates the specific needs for ethics support in elderly care. The findings of two surveys, two focus groups and 17 interviews demonstrate that the availability of ethics support is limited. There is a need for ethics support, albeit not unconditionally. Advice-based forms of (...) ethics support are less appropriate as they are removed from practice. Ethics support should be tailored to the often mundane and easily overlooked moral issues that arise in long-term care. Attention should also be given to the learning styles of nurses who favour experiential learning. Raising awareness and developing a climate of openness and dialogue are the most suitable ways to deal with the mundane moral issues in elderly care. (shrink)

Ethics & Behavior, Volume 21, Issue 3, Page 260-261, May-June 2011.

One of the major issues in the debate about the future of health care is how to keep costs under control while meeting growing demands for care. Addressing that, especially on an international scale, is far from easy. How are we to determine what the demands for care will most likely be? Even if it is not possible to estimate the future number of dependent elderly persons with any precision, it is hard to ignore the most probable (...) scenario: a substantial increase in the number of the oldest old. (shrink)

Healthcare is becoming increasingly automated with the development and deployment of care robots. There are many benefits to care robots but they also pose many challenging ethical issues. This paper takes care robots for the elderly as the subject of analysis, building on previous literature in the domain of the ethics and design of care robots. Using the value sensitive design approach to technology design, this paper extends its application to care robots by integrating the (...) values of care, values that are specific to AI, and higher-scale values such as the United Nations Sustainable Development Goals. The ethical issues specific to care robots for the elderly are discussed at length alongside examples of specific design requirements that work to ameliorate these ethical concerns. (shrink)

BackgroundFew studies have paid attention to ethical responsibility related to malnutrition in elder care. The aim was to illuminate whether politicians and civil servants reason about malnutrition in elder care in relation to ethical responsibility, and further about possible causes and how to address them.MethodEighteen elected politicians and appointed civil servants at the municipality and county council level from two counties in Sweden were interviewed. They worked at a planning, control and executive level, with responsibility for (...) both the elder care budget and quality of care. Qualitative method was used for the data analysis.ResultsTwo themes emerged from their reasoning about malnutrition related to ethical responsibility. The theme assumed role involves the subthemes quality of care and costs, competent staff and govern at a distance. Old and ill patients were mentioned as being at risk for malnutrition. Caregivers were expected to be knowledgeable and stated primary responsible for providing adequate nutritional care. Extended physician responsibility was requested owing to patients' illnesses. Little was reported on the local management's role or on their own follow-up routines. The theme moral perception includes the subthemes discomfort, trust and distrust. Feelings of discomfort concerned caregivers having to work in a hurried, task-oriented manner. Trust meant that they believed for the most part that caregivers had the competence to deal appropriately with nutritional care, but they felt distrust when nutritional problems reappeared on their agenda. No differences could be seen between the politicians and civil servants.ConclusionNew knowledge about malnutrition in elder care related to ethical responsibility was illuminated by persons holding top positions. Malnutrition was stressed as an important dimension of the elder care quality. Governing at a distance meant having trust in the staff, on the one hand, and discomfort and distrust when confronted with reports of malnutrition, on the other. Distrust was directed at caregivers, because despite the fact that education had been provided, problems reappeared. Discomfort was felt when confronted with examples of poor nutritional care and indicates that the participants experienced failure in their ethical responsibility because the quality of nutritional care was at risk. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). (...) Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

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

In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses’ decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a (...) nuanced and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses’ reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009–April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses’ decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly. (shrink)

The unique mix of modern Western and traditional Confucian values in Singapore presents young people with contradictory views on duties to aging parents. It remains to be seen whether the changing demands of modern life will result in new generations giving up Confucian family ethics or whether the Confucian dynamic will find a way to adapt to the new pressures. It is the opinion of this author that the Confucian family structure has mixed potential for the growing crisis of (...) class='Hi'>elder care. Alone, both Confucian traditions and typical Western institutional approaches toward elder care fall short of what is necessary for intergenerational social justice, yet a hybrid of the two has great potential for the growing aging crisis. To demonstrate this, I first give a brief account of the history of filial piety in Confucianism as well as the social environment from which it originated. Then I turn my attention to the present issues of an aging population and elder care that face much of the developed world in the twenty-first century. Finally, I show how adherence to Confucian filial traditions can both help to address many of these issues and how it can potentially leave unjust gaps in elder care. Ultimately, I conclude that the crisis of elder care may be best dealt with through a hybrid of Confucian values and Western approaches. (shrink)

Care workers frequently withdraw from elderly people in their care; this has resulted in a number of scandals in the media. Here I analyze an empirical scene observed at an old people’s home in Denmark, which contains behavioral patterns among the care workers which could be seen as withdrawal. At the same time it illustrates the care workers' commitment to the elderly. A paradoxical "empathy at a distance" is characteristic of the scene. When analyzing my written (...) observations in an interpretation group, my use of language was a point of discussion. What did it mean when I described the interactions between care workers and elderly residents in words commonly used to describe mother-child interactions? My use of language became a "hermeneutical key" which enabled a psychoanalytically inspired interpretation. This focuses on the care relationship as activating our earliest memories of our own care relations, independently of whether we are in the role of care providers or care receivers. Through collusion theory, the interpretation accepts both the anxiety which the helpless elderly people arouse in the care workers and their motivation for care work as two sides of a subjectively important theme. The article illustrates how working consciously with the researcher's subjectivity makes it possible to understand apparently irrational patterns. The insights thus gained may be used to prevent withdrawals in care work as an argument for care workers’ need for emotional supervision. (shrink)

The three dialogues in this contribution concern 21st century application of life‐like robots in the care of older adults. They depict conversations set in the near future, involving a philosopher (Dr Phonius) and a nurse (Dr Myloss) who manages care at a large facility for assisted living. In their first dialogue, the speakers discover that their quite different attitudes towards human‐robot interaction parallel fundamental differences separating their respective concepts of consciousness. The second dialogue similarly uncovers deeply contrasting notions (...) of personhood that appear to be associated with respective communities of nursing and robotics. The additional key awareness that arises in their final dialogue links applications of life‐like robots in the care of older adults with potential transformations in our understandings of ourselves – indeed, in our understandings of the nature of our own humanity. This series of dialogues, therefore, appears to address a topic in nursing philosophy that merits our careful attention. (shrink)

The moral and epistemic significance of emotions has been increasingly emphasized in recent philosophy. The focus has been mostly on metaethical questions. We add a new perspective by considering the practical importance of gauging, reacting to, enhancing, or reducing the emotions of others and oneself. We focus particularly on the collective aspect of emotion development and regulation, how emotions are entangled with values, and how they may be used constructively for handling otherwise difficult situations. We use the case of elderly (...) care, drawing on a qualitative study from a Danish municipality, to illustrate the complex and multifarious ways in which emotions shape the normative landscape in which attempts to maintain or improve well-being take place. (shrink)

고령화 사회로 접어들면서 그간 가족관계 속에서 행해졌던 돌봄은 여성의 사회 진출 확대, 핵가족화, 출산율 저하 등의 문제로 인해 가족 단위로는 감당하기 어려운 상황에 직면하게 되었다. 이에 따라 고령화 사회의 노인 돌봄을 위한 체계는 가족과 같은 사적 차원을 넘어서서 노인요양보험 등 사회 제도에 기초한 공적 차원으로 전환되고 있는 추세이다. 에바 키테이(Eva F. Kittay)는 모든 인간은 누군가에게 의존을 해야 생존할 수 있고 이로 인해 모든 인간은 돌봄을 제공하고 동시에 돌봄을 받는 상호 간의 윤리적 의무가 있다고 주장하면서 돌봄의 문제를 사회적 책임으로 확장시키고자 하였다. (...) 인류가 무리 생활을 통해 정서적 유대를 기초로 고도의 사회성을 발전시켜 성공한 종이라는 점에서 이러한 주장은 설득력을 가진다. 노인 돌봄 역시 세대 간의 감정적 유대감 형성과 같은 정서적 영역의 토대를 마련할 수 있다면 사회적 책임이 가지는 의무론적인 형식성을 극복하게 될 것이다. 공감은 이러한 점에서 인간 소통과 유대의 결과인 사회성 형성의 강력한 정서적 연결 고리가 될 수 있다. 막스 셸러(Max Scheler)에 따르면 공감은 타인에 대한 인격적 존중을 바탕으로 타인을 나와 같이 느끼고 이해하는 것으로서 인간이라면 누구나 지니고 있는 보편적 능력이다. 따라서 고령화 사회에서의 노인 돌봄은 노인에 대한 존중을 바탕으로 그들의 삶과 고통을 느끼고 이해하는 공감 형성을 통해 실천될 때 비로소 진정한 사회적 책임의 영역으로 승화될 수 있을 것이다. 이에 본 논문에서는 고령화 사회의 바람직한 노인 돌봄 문화를 형성하기 위한 토대로서 공감에 근거한 사회적 책임에 대해 논의해 보고자 한다. (shrink)

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

The development of increasingly intelligent and autonomous technologies will eventually lead to these systems having to face morally problematic situations. This is particularly true of artificial systems that are used in geriatric care environments. The goal of this article is to describe how one can approach the design of an elder care robot which is capable of moral decision-making and moral learning. A conceptual design for the development of such a system is provided and the steps that (...) are necessary to implement it are described. (shrink)

Background: As a non–European Union member state, Albania is increasingly orienting itself on Western models regarding human rights, patient rights, and legal regulations for healthcare. Due to its limited fiscal and legal power, enforcing legal and ethical regulations poses a major problem. Aim: The aim of this study is to investigate nurse’s knowledge and experiences regarding ethical and legal issues in Albanian elder care in state-funded and privately run institutions. Research design: The study was conducted using an inductive (...) and qualitative design, utilizing a focused ethnographic approach, based on Roper and Shapira’s framework. Method: Data were collected between June 2017 and September 2018 using participant observation, field notes, and semi-structured interviews with 15 nurses in seven different elder care institutions. In total, 100 h of observation and 15 interviews were performed. Data analysis was based on Mayring’s qualitative content analysis. Ethical consideration: The approval for the study was obtained from UMIT—The Health and Life Sciences University, Austria. Findings: The findings of the study fell into the following main categories: “Everyday care issues,” “End-of-life issues,” “Legal issues,” and “Ethical-legal education and conflicts.” Discussion: The participants reported many ethical and legal issues when describing their everyday challenges and displayed a strong lack of ethical and legal education. Despite a wide spectrum in the quality of care between private and state-funded nursing homes, older people mostly do not know their own diagnosis. Conclusion: This study indicates that further ethical and legal education is needed. Furthermore, nurses need to be better prepared for ethical conflicts with families, as strengthening patient rights could come into conflict with traditional rights of the Albanian family. (shrink)

: Filial piety is a core value in ancient Chinese culture, and it still exerts significant influence on the attitudes, behavior and daily life of Chinese people today. At present, China is facing an increasingly aging population and the concern how to properly care for the elderly. Through the vertical review of filial piety in China’s history, two constant elements, namely support and respect, stands out among China’s traditions. There is an argument that addressing the contemporary elderly care (...) problem requires the adequate support from two perspectives, material support from families and societies for the aged and spiritual caring for them. It is further argued that any approaches aimed at addressing contemporary elderly care issue should take into consideration the actual social and culture conditions in China, including the cultural traditions of filial piety. Resumo: A piedade filial era um valor central na cultura chinesa antiga, e ainda exerce influência significativa nas atitudes, comportamento e vida cotidiana do povo chinês. Atualmente, a China está enfrentando uma população cada vez mais envelhecida e as preocupações associadas a como cuidar adequadamente dos idosos do país. Através da revisão vertical da piedade filial, ao longo da história da China, para este trabalho, dois elementos constantes emergiram nas tradições, a saber, apoio e respeito. Argumenta-se que a abordagem do problema contemporâneo do cuidado ao idoso exigirá a incorporação adequada de ambas as dimensões, ou seja, fornecer não apenas apoio material ao idoso, na família e na sociedade, mas também prover seu cuidado espiritual. Argumenta-se ainda que quaisquer abordagens destinadas a tratar da questão devem ser baseadas nas condições sociais e culturais reais, na China, incluindo e passando além das tradições culturais de piedade filial. (shrink)

After four decades of China’s family planning policy, the shrinking family size and increasing life expectancy pose special challenges for the one-child generation in terms of providing care for aging parents. The current study explored young adults’ responses to such pressure by examining their concerns about elder care, attitudes toward nursing homes, and living arrangement after marriage in a sample of 473 Chinese working young adults from six cities in China. Results showed that although most of the (...) young adults reported to have thought about the issue of parents’ elder care, the majority did not worry a lot about it. Only children expressed similar levels of worrying as those with siblings did. However, educational level, rather than sibling status, was systematically related to concerns about parents’ elder care and attitudes toward nursing homes. People with higher education tended to worry less about elder care, and were less likely to consider placing parents in nursing homes as a violation of filial piety. Analyses of the married sub-sample revealed that only children were more likely to co-reside with parents after marriage than those with siblings. And the main reason for co-residence was that the younger generation needed their parents’ help for childcare, rather than to better take care of their parents. Implications for parents’ elder care among Chinese only children were discussed. (shrink)