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The paradox of theAgedCare Act 1997: the marginalisation of nursing discourse This paper examines the marginalisation of nursing discourse, which followed the enactment of theAgedCare Act 1997. This neo‐reform period inagedcare, dominated by theories of economic rationalism, enshrined legislation based upon market principles and by implication, the provision ofcare at the cheapest possible price. This paper exposes some of the gaps in the neo‐reform period and challenges (...) the assertion that the amalgamation of nursing homes and hostels in such an environment can provide better quality ofcare and life for residents. It argues that this amalgamation entails a transformation towards a social model ofcare and fails to address the professional healthcare needs of the acutely sick and complex extreme old person and makes evident new gaps in the provision ofagedcare services. The paper proceeds to present strategies where the future for nursing practice inagedcare necessarily involves a judicious balancing of individual cases alongside economic prescriptions ofcare and ever‐changing public policy initiatives. It concludes that this can be achieved through a more interactive public, professional and advocacy discourse. The methodology involves extensive analysis of public documents including media, academic journals, government reports and interviews with recognised leaders in the field ofagedcare. The study utilises a critical interpretative framework consistent with the logic of Michel Foucault. (shrink)

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In this paper I describe a future in which persons in advanced old age are cared for entirely by robots and suggest that this would be a dystopia, which we would be well advised to avoid if we can. Paying attention to the objective elements of welfare rather than to people’s happiness reveals the central importance of respect and recognition, which robots cannot provide, to the practice ofagedcare. A realistic appreciation of the current economics of the (...)agedcare sector suggests that the introduction of robots into anagedcare setting will most likely threaten rather than enhance these goods. I argue that, as a result, the development of robotics is likely to transformagedcare in accordance with a trajectory of development that leads towards this dystopian future even when this is not the intention of the engineers working to develop robots foragedcare. While an argument can be made for the use of robots inagedcare where the people being cared for have chosen to allow robots in this role, I suggest that over-emphasising this possibility risks rendering it a self-fulfilling prophecy, depriving those being cared for of valuable social recognition, and failing to provide respect for older persons by allowing the options available to them to be shaped by the design choices of others. (shrink)

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It is remarkable how much robotics research is promoted by appealing to the idea that the only way to deal with a looming demographic crisis is to develop robots to look after older persons. This paper surveys and assesses the claims made on behalf of robots in relation to their capacity to meet the needs of older persons. We consider each of the roles that has been suggested for robots inagedcare and attempt to evaluate how successful (...) robots might be in these roles. We do so from the perspective of writers concerned primarily with the quality ofagedcare, paying particular attention to the social and ethical implications of the introduction of robots, rather than from the perspective of robotics, engineering, or computer science. We emphasis the importance of the social and emotional needs of older persons—which, we argue, robots are incapable of meeting—in almost any task involved in theircare. Even if robots were to become capable of filling some service roles in theaged-care sector, economic pressures on the sector would most likely ensure that the result was a decrease in the amount of human contact experienced by older persons being cared for, which itself would be detrimental to their well-being. This means that the prospects for the ethical use of robots in theaged-care sector are far fewer than first appears. More controversially, we believe that it is not only misguided, but actually unethical, to attempt to substitute robot simulacra for genuine social interaction. A subsidiary goal of this paper is to draw attention to the discourse aboutagedcare and robotics and locate it in the context of broader social attitudes towards older persons. We conclude by proposing a deliberative process involving older persons as a test for the ethics of the use of robots inagedcare. (shrink)

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Strategies to support the psychosocial well-being of older adults living inaged-care are needed; and evidence points toward music listening as an effective, non-pharmacological tool with many benefits to quality of life and well-being. Yet, the everyday listening practices of older adults living in residentialaged-care remain under-researched. The current study explored older adults’ experiences of music listening in their daily lives while living in residentialaged-care and considered how music listening might support their (...) well-being. Specifically, what might go into autonomous listening activities? 32 Australian residents living in two Australiancare facilities participated in semi-structured interviews. The results of a qualitative thematic analysis revealed three themes pertaining to “previous music experiences and interest,” “current music listening,” and “barriers to listening.” While an interest in and access to music did not necessarily result in everyday listening practices, of those participants who did listen to music, perceived benefits included outcomes such as entertainment, enjoyment, relaxation, and mood regulation. Drawing on Ruud’s notion of music as a “cultural immunogen” supporting well-being and Self-Determination Theory, theoretical implications of the findings are addressed, relating to how to create and support music activities inaged-care facilities so that they are engaging, meaningful, and promote emotional regulation, community, and well-being. (shrink)

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This article explores staff work patterns in an Australian residentialagedcare facility and the implications for high‐qualitycare. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses andcare staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min); multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to (...) explore the concepts of high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in theagedcare sector. (shrink)

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The death of a resident, caused by another resident in ResidentialAgedCare Facilities (RACFS) is uncommon, yet under‐reported. The perpetrator of the violent act may not be legally culpable, and the act may be unintended; however, media reports suggest that this is an increasing phenomenon. This article reports an integrated review that sought to critically report homicide or an unintentional incident where one resident causes the death of another in RACFs and to explain and understand how older (...) people are supported within and external to RACFs and their under‐representation in policy. The search was registered with PROSPERO registration number CRD42023409775. The databases CINHAL ultimate, Cochrane review, Embase, Psych Info, PubMed were searched. Additionally, a grey literature search was conducted of Analysis and Policy Observatory, Google Search, and Trove. Identified themes included: exhibitor and target attributes, incident details, staff and facility experiences, incident reporting and improved resident safety related to un/intentional homicide. From the findings, we extracted two discursive elements: (1) Space and perception of a person living with dementia and unequipped environments and (2) The disregarded deaths in RACFs and other systematic problems. Within RACFs factors, such as unacceptably low staffing numbers, a lack of clinically trained nurses, poorly designed environments and a lack of skills in caring for people who have dementia or mental illness were identified. More emphasis on research into this area is essential. Several key risk factors are identified in this review on the issue of un/intentional homicides in RACFs. There is a need for governments and policy makers to consider different models ofcare, responsive to the needs of people who live with dementia. (shrink)

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Socially Assistive Robots are increasingly conceived as applicable tools to be used inagedcare. However, the use carries many negative and positive connotations. Negative connotations come forth out of romanticized views ofcare practices, disregarding their already established technological nature. Positive connotations are formulated out of techno-deterministic views on SAR use, presenting it as an inevitable and necessary next step in technological development to guaranteeagedcare. Ethical guidance of SAR use inspired by negative (...) connotations tends to be over-restrictive whereas positive connotations tend to provide over-permissive guidance. To avoid these extremes, we report on the development and content of 21 ethical orientations regarding SAR use inagedcare. These orientations resulted from a multi-phased project, which consisted of empirical-ethical research focusing on older adults’ intuitions regarding SAR use and philosophical-ethical research focusing on philosophical-ethical argumentations regarding SAR use. This project led to the Socio-historical contextualization of the ethics of SAR use, in which the ethical impact of SAR use is localized on three interrelated analysis levels: societal, organizational, and individual-relational. The 21 novel orientations regarding SAR use are structured according to these levels and further categorized into foundational and applied orientations. The first category leads to critical reflection on SAR use while the latter category inspires decision-making processes regarding this use. While going beyond thecare-romantic and techno-deterministic gaze of SAR use inagedcare, the described orientations balance themselves between their over-restrictiveness and over-permissiveness. (shrink)

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People with dementia at times exhibit threatening and physically aggressive behavior towardcare staff in residentialagedcare facilities (RACFs). Current clinical guidelines recommend judicious use of antipsychotic (AP) medications when there is an immediate risk of harm tocare staff in RACFs and non-pharmacological interventions have failed to avert the threats. This article examines an account of how this recommendation can be ethically defensible: caregivers in RACFs may have a prima facie ethical justification, in certain (...) cases, to use APs as an act of self-defense. The author examines whether such uses of APs meet the three commonly invoked conditions of ethically permissible acts of self-defense—namely, the conditions of liability, proportionality, and necessity—and argues that such conditions obtain only in a restricted range of cases. The liability constraint can be satisfied if residents are the only ones who are causally responsible for the threats they pose. Further, the condition of proportionality obtains if there is sufficient objective ground to demonstrate that the harm of using the medications does not outweigh the good to be secured. Lastly, the necessity condition obtains when the medications are used at their lowest effective dosage and caregivers in RACFs can reasonably assume that, for the purpose of averting threats posed by residents, the use of APs is the only available course of action. Not meeting any of these fairly stringent conditions renders uses of APs as acts of self-defense in RACFs morally impermissible actions. -/- . (shrink)

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Residentialagedcare facilities (RACF) are sites of high antibiotic use in Australia. Misuse of antimicrobial drugs in RACF contributes to antimicrobial resistance (AMR) burdens that accrue to individuals and the wider public, now and in the future. Antimicrobial stewardship (AMS) practices in RACF, e.g. requiring conformation of infection, are designed to minimise inappropriate use of antibiotics. We conducted dialogue groups with 46 participants with a parent receivingagedcare to better understand families’ perspectives on antibiotics (...) andcare in RACF. Participants grappled with value trade offs in thinking about their own parents’care, juggling imagined population and future harms with known short term comfort of individuals and prioritising the latter. Distributive justice in AMR relies on collective moral responsibility and action for the benefit of future generations and unknown others. In RACF, AMS requires value trade-offs and compromise on antimicrobial use in an environment that is heavily reliant on antimicrobial drugs to perform caring functions. In the context ofagedcare, AMS is a technical solution to a deeply relational and socio-structural problem and there is a risk that carers (workers, families) are morally burdened by system failures that are not addressed in AMS solutions. (shrink)

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This article uses critical discourse analysis to investigate artificial intelligence (AI) generated images ofagedcare nurses and considers how perspectives and perceptions impact upon the recruitment and retention of nurses. The article demonstrates a recontextualization ofagedcare nursing, giving rise to hidden ideologies including harmful stereotypes which allow for discrimination and exploitation. It is argued that this may imply that nurses require fewer clinical skills inagedcare, diminishing the value of working (...) in this area. AI relies on existing data sets, and thus represent existing stereotypes and biases. The discourse analysis has highlighted key issues which may further impact upon nursing recruitment and retention, and advocates for stronger ethical consideration, including the use of experts in data validation, for the way thatagedcare services and nurses are depicted and thus valued. (shrink)

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Sexual self-determination is considered a fundamental human right by most of us living in Western societies. While we must abide by laws regarding consent and coercion, in general we expect to be able to engage in sexual behaviour whenever, and with whomever, we choose. For older people with dementia living in residentialagedcare facilities (RACFs), however, the issue becomes more complex. Staff often struggle to balance residents' rights with their duty ofcare, and negative attitudes towards (...) older people's sexuality can lead to residents' sexual expression being overlooked, ignored, or even discouraged. In particular, questions as to whether residents with dementia are able to consent to sexual activity or physically intimate relationships pose a challenge to RACF staff, and current legislation does little to assist them. This paper will address these issues, and will argue that, while every effort should be made to ensure that no resident comes to harm, RACFs must respect the rights of residents with dementia to make decisions about their sexuality, intimacy and physical relationships. (shrink)

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

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Typically seniors like others choose to avoid institutionalcare. However, when age-related infirmity requires it, they not only enter into thecare of others, but they also do so as vulnerable members of society. As their frailty increases with age, so does their dependence on the professionals whocare for them and on the enforcement of policies concerning theircare. A qualitative case study involving seniors and their carers revealed that breaches of confidentiality, unprofessional behaviour and (...) the non-enforcement of policy, continue to hide the physical and emotional abuse perpetrated by nursing and other staff on vulnerable consumers. Professional ethics, including at a corporate level, enforcing policy, protecting whistleblowers and creating reporting mechanisms foragedcare researchers, are amongst the recommendations arising from this study. (shrink)

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Intimacy contributes to our well-being and extends into older age, despite cognitive or physical impairment. However, the ability to enjoy intimacy and express sexuality is often compromised—or even controlled—when one moves into residentialagedcare. The aim of this study was to identify what factors influence senior residentialagedcare staff when they make decisions regarding resident intimate relationships and sexual expression. The study used vignette methodology and a postal survey to explore reactions to a fictionalised (...) case study of a couple—Norm and Carol—who develop a close, mutually satisfying relationship. Staff were first asked whether they would intervene in the relationship. Using an innovative approach, several variations to the case study were then presented to explore whether views about intervening changed according to varying contextual factors. Findings indicated that over 90% of respondents initially agreed that the relationship should continue, and only 10% indicated they would intervene. However, when the case study was varied, respondents indicated they were more likely to intervene, particularly if Norm was exhibiting distress in Carol’s presence (89%), but also if Norm was married and his wife was living in the community (40%). Other factors including level of cognitive impairment and family disapproval were also found to influence staff views. This study provides insight into how residentialagedcare staff make decisions regarding the intimacy and sexuality of older people living in residentialagedcare and how personal views and values likely guide practice in the absence of formal policies. (shrink)

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

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XIAO LD, KELTON M and PATERSON J.Nursing Inquiry2012;19: 322–333 Critical action research applied in clinical placement development inagedcare facilitiesThe aim of this study was to develop quality clinical placements in residentialagedcare facilities for undergraduate nursing students undertaking their nursing practicum topics. The proportion of peopleaged over 65 years is expected to increase steadily from 13% in 2006 to 26% of the total population in Australia in 2051. However, when demand is (...) increasing for a nursing workforce competent in thecare of older people, studies have shown that nursing students generally lack interest in working with older people. The lack of exposure of nursing students to quality clinical placements is one of the key factors contributing to this situation. Critical action research built on a partnership between an Australian university and fiveagedcare organisations was utilised. A theoretical framework informed by Habermas’ communicative action theory was utilised to guide the action research. Multiple research activities were used to support collaborative critical reflection and inform actions throughout the action research. Clinical placements in eight residentialagedcare facilities were developed to support 179 nursing students across three year‐levels to complete their practicum topics. Findings were presented in three categories described as structures developed to govern clinical placement, learning and teaching in residentialagedcare facilities. (shrink)

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BackgroundVulnerability is a key concept in traditional and contemporary bioethics. In the philosophical literature, vulnerability is understood not only to be an ontological condition of humanity, but also to be a consequence of contingent factors. Within bioethics debates, vulnerable populations are defined in relation to compromised capacity to consent, increased susceptibility to harm, and/or exploitation. Although vulnerability has historically been associated with older adults, to date, no comprehensive or systematic work exists on the meaning of their vulnerability. To fill this (...) gap, we analysed the literature onagedcare for the meaning, foundations, and uses of vulnerability as an ethical concept.MethodsUsing PRISMA guidelines, we conducted a systematic review of argument-based ethics literature in four major databases: PubMed, Embase®, Web of Science™, and Philosopher’s Index. These covered biomedical, philosophy, bioethical, and anthropological literature. Titles, abstracts, and full texts of identified papers were screened for relevance. The snowball technique and citation tracking were used to identify relevant publications. Data analysis and synthesis followed the preparatory steps of the coding process detailed in the QUAGOL methodology.ResultsThirty-eight publications met our criteria and were included. Publication dates ranged from 1984 to 2020, with 17 publications appearing between 2015 and 2020. Publications originated from all five major continents, as indicated by the affiliation of the first author. Our analyses revealed that the concept of vulnerability could be distinguished in terms of basic human and situational vulnerability. Six dimensions of older adults’ vulnerability were identified: physical; psychological; relational/interpersonal; moral; sociocultural, political, and economic; and existential/spiritual. This analysis suggested three ways to relate to older adults’ vulnerability: understanding older adults’ vulnerability, takingcare of vulnerable older adults, and intervening through socio-political-economic measures.ConclusionsThe way in which vulnerability was conceptualised in the included publications overlaps with distinctions used within contemporary bioethics literature. Dimensions ofagedcare vulnerability map onto defining features of humans, giving weight to the claim that vulnerability represents an inherent characteristic of humans. Vulnerability is mostly a value-laden concept, endowed with positive and negative connotations. Most publications focused on and promotedagedcare, strengthening the idea thatcare is a defining practice of being human. (shrink)

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This paper addresses the issue of whether robots could substitute for humancare, given the challenges inagedcare induced by the demographic change. The use of robots to provide emotionalcare has raised ethical concerns, e.g., that people may be deceived and deprived of dignity. In this paper it is argued that these concerns might be mitigated and that it may be sufficient for robots to take part in caring when they behave *as if* they (...)care. (shrink)

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Different embodiments of technology permeate all layers of public and private domains in society. In the public domain ofagedcare, attention is increasingly focused on the use of socially assistive robots (SARs) supporting caregivers and older adults to guarantee that older adults receivecare. The introduction of SARs inaged-care contexts is joint by intensive empirical and philosophical research. Although these efforts merit praise, current empirical and philosophical research are still too far separated. Strengthening (...) the connection between these two fields is crucial to have a full understanding of the ethical impact of these technological artefacts. To bridge this gap, we propose a philosophical-ethical framework for SAR use, one that is grounded in the dialogue between empirical-ethical knowledge about and philosophical-ethical reflection on SAR use. We highlight the importance of considering the intuitions of older adults and their caregivers in this framework. Grounding philosophical-ethical reflection in these intuitions opens the ethics of SAR use inagedcare to its own socio-historical contextualisation. Referring to the work of Margaret Urban Walker, Joan Tronto and Andrew Feenberg, it is argued that this socio-historical contextualisation of the ethics of SAR use already has strong philosophical underpinnings. Moreover, this contextualisation enables us to formulate a rudimentary decision-making process about SAR use inagedcare which rests on three pillars: (1) stakeholders’ intuitions about SAR use as sources of knowledge; (2) interpretative dialogues as democratic spaces to discuss the ethics of SAR use; (3) the concretisation of ethics in SAR use. (shrink)

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McGovern, Kevin Pope Francis's Evangelii Gaudium calls us to both service and silence. This article explores the theological underpinning of this call, and considers its implications for Catholic health,aged and communitycare services in Australia.

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This paper argues that while regulatory frameworks inagedcare authorise restraints to protect vulnerable persons living with dementia from harm, they also serve as normalising practices to control challenging monstrous Others. This argument emerges out of an observed unease inagedcare discourse where older people living with dementia are described as ‘vulnerable’, while dementia behaviours are described as ‘challenging’. Using narrative analysis on a case study from the Final Report of the Australian Royal Commission (...) intoAgedCare Quality and Safety (RCAC), this paper investigates how the RCAC (re)produced constructions of persons with dementia as ‘vulnerable monsters’. Drawing upon monstrous theory about ‘unruly and leaky’ bodies, extracts from the case study reveal how the RCAC repeated and reinforced monstrous constructions of dementia. Dementia behaviours, particularly ‘wandering’, were constructed through a dehumanising crisis frame that produced ‘challenging’ bodies and legitimised ‘last resort’ normalising practices, such as physical and chemical restraints. In failing to resist monstrous constructions of dementia behaviours, the RCAC accepted and authorised a regime of scaled responses leading to restrictive practices for control of challenging bodies inagedcare. Although dementiacare and restrictive practices received substantial attention in the RCAC, this paper reveals a missed opportunity for deeper review of institutionalised use of restraints that has relevance for ongoing reform of Australianagedcare following conclusion of the RCAC. (shrink)

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With an estimated 12.1% of childrenaged 2–5 years already obese, prevention efforts must target our youngest children. One of the best places to reach young children for such efforts is the earlycare and education setting. More than 11 million U.S. children spend an average of 30 hours per week in ECE facilities. Increased attention at the national, state, and community level on the ECE setting for early obesity prevention efforts has sparked a range of innovative efforts. (...) To assist these efforts, CDC developed a technical assistance and training framework – the Spectrum of Opportunities for Obesity Prevention in the ECE setting – which also served as the organizing framework for the Weight of the Nation ECE track. Participants highlighted their efforts at national, state, and local levels pursuing opportunities on the Spectrum, the standards and best practices that had been the emphasis of their efforts, and common steps for developing, implementing, and evaluating initiatives. Strong leadership and collaboration among a broad group of stakeholders; systematic assessment of needs, opportunities and resources; funding sources; and training and professional development were reported to be integral for successful implementation of standards and best practices, and sustainability. (shrink)

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In 1991 the United Nations General Assembly adopted the Principles for Older Persons as a framework for international policy responses to population ageing. These principles promote independence, participation,care, self-fulfilment and dignity as legitimate entitlements of all older people. Although these principles, or variations of them, are embedded in standards of best-practice in residentialagedcare facilities, the literature shows that in reality institutionalcare can deny older people opportunities to exercise some of these entitlements. More (...) specifically, residentialagedcare facilities can deprive older people of access and support to pursue opportunities for the full development of their potential, i.e. their entitlement to self-fulfilment. This discussion article explores the influence of institutionalcare on older people’s ability to exercise their entitlement to self-fulfilment. We identify the characteristics of a ‘good life’ in institutionalcare, according toagedcare residents themselves. The Eden Alternative™ is presented as a model ofagedcare that aims to create the conditions for a ‘good life’ and self-fulfilment foragedcare residents. (shrink)

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Clinical decision-making in old-agecare is a complex and ethically sensitive process. Despite its importance, research addressing the challenges of clinical decision-making in old-agecare within this cultural context is limited. This study aimed to explore the challenges and ethical concerns in clinical decision-making in old-agecare in Ethiopia. This qualitative study employed an inductive approach with data collected via semi-structured interviews with 20 older patients and 26 health professionals recruited from healthcare facilities in Ethiopia. Data were (...) analysed using reflexive thematic analysis. Our analysis identified three key themes. First, participants highlighted perceptions that older patients’ religious beliefs interfere with the clinical decisions both older patients and health professionals make. Second, older patients often receive limited information from health professionals about their diagnosis and treatment. Third, families of older patients appear to strongly influence clinical decisions made by older patients or health professionals. This research enhances the understanding of clinical decision-making in old-agecare within Ethiopia, a context where such research is scarce. As a result, this study contributes towards advancing the deliberation of ethical dilemmas that health professionals who work with older patients in Ethiopia might face. A key implication of the study is that there is a need for more ethics and cultural competence training for health professionals working with older patients in Ethiopia. (shrink)

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McGovern, Kevin This is a slightly edited version of a talk given on 23 August 2010 at the Catholic Health Australia National Conference at the Adelaide Convention Centre. Three bioethicists were asked to reflect on Ethical Challenges Ten Years from Now. This talk focussed not on new issues but on current concerns which will continue to challenge us.

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We argue thatAged ResidentialCare (ARC) facilities should be allowed to create and adopt an informed “No Chest Compression” (NCC) policy. Potential residents are informed before admission that staff will not provide chest compressions to a pulseless resident. All residents would receive standard chokingcare, and a fully discussed advance directive would be utilized to determine if the resident wanted a one-minute trial of rescue breaths (to clear their airway) or utilization of the automatic defibrillator in (...) case of arrest. The benefits of chest compressions for residents in ARC are dubious, and the burdens are high. For frail elderly people without a pulse, chest compressions are arguably unethical because the chance of benefit is minuscule, the procedure is violent, painful, and challenging to perform correctly, and procedures detract from a peaceful end of life. These burdens fall on residents, their families, ARC facilities providers, and society. We further argue that limitations on universal invasive resuscitation, such as advance directives, need to be more consistently sought and applied. The goals of an informed NCC policy are twofold: removing added suffering from a person’s end-of-life experience and increasing ARC residents’ understanding of the burdens of ineffective treatments for pulselessness. (shrink)

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Many higher-income countries have shortages ofcare-workers, which is unlikely to change in the foreseeable future as virtually all of these societies are ageing. The philosophical literature on this problem has concentrated mostly on the merits and demerits of different policy solutions, especially on the recruitment of foreigncare-workers and on investments incare robots and other relevant technologies. However, the question of what moral duties, if any, private individuals have to help addresscare-worker shortages has (...) been entirely neglected. In this article, I help to fill this lacuna by arguing that some inhabitants of higher-income countries have moral duties to age abroad in order to reduce the pressure on theagedcare-systems of their current societies, whereby ‘ageing abroad’ is defined narrowly as moving to a foreign country to receive residential or non-residentialagedcare. As I show, these duties are dependent on a number of conditions being met, including the requirement that the host populations not be made worse off. (shrink)

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McNamara, Laurence J Person-centredcare is the mantra of contemporary health andagedcare. Delivering suchcare effectively is an enormous challenge. Much effort goes into the basics ofcare delivery. In an era of limited resources and financial constraints the temptation arises foragedcare in particular to ignore some of the non-measurable dimensions ofcare. This paper puts forward a range of issues that merit greater attention as we reflect on (...) the realities of human ageing in Australia today. If taken seriously, I suggest, they will contribute to the delivery and quality of person-centredcare. (shrink)

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Howcare can resist the stifling force of the neoliberal paradigm In a world brimming with tremendous wealth and resources, too many are suffering the oppression of precarious existences--and with no adequate relief from free market-driven institutions.Care Ethics in the Age of Precarity assembles an international group of interdisciplinary scholars to explore the question ofcare theory as a response to market-driven capitalism, addressing the relationship of three of the most compelling social and political subjects today: (...)care, precarity, and neoliberalism. Whilecare theory often centers on questions of individual actions and choices, this collection instead connects theory to the contemporary political moment and public sphere. The contributors address the link between neoliberal values--such as individualism, productive exchange, and the free market--and the pervasive state of precarity and vulnerability in which so many find themselves. From disability studies and medical ethics to natural-disaster responses and the posthuman, examples from Māori, Dutch, and Japanese politics to the COVID-19 pandemic and the Black Lives Matter movement, this collection presents illuminating new ways of considering precarity in our world.Care Ethics in the Age of Precarity offers a hopeful tone in the growing valorization ofcare, demonstrating the need for an innovative approach to precarity within entrenched systems of oppression and a change in priorities around the basic needs of humanity. Contributors: Andries Baart, U Medical Center Utrecht, Tilburg U, and Catholic Theological U Utrecht, the Netherlands; Vrinda Dalmiya, U of Hawaii, Mānoa; Emilie Dionne, U Laval; Maggie FitzGerald, U of Saskatchewan; Sacha Ghandeharian, Carleton U; Eva Feder Kittay, Stony Brook U/SUNY; Carlo Leget, U of Humanistic Studies in Utrecht, the Netherlands; Sarah Clark Miller, Penn State U; Luigina Mortari, U of Verona; Yayo Okano, Doshisha U, Kyoto, Japan; Elena Pulcini, U of Florence. (shrink)

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The age-rationing debate of fifteen years ago will inevitably reemerge as healthcare costs escalate. All age-rationing proposals should be judged in light of the current system of rationing healthcare by price in the U.S., and the resulting pattern of excess and deprivation. Age-rationing should be rejected as public policy, but recognized as a personal virtue of stewardship among the elderly.

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Goh, Michelle Christian discipleship is to live faithfully Jesus' commandment of love-of God and of our neighbour. The commandment to love especially those who are poor or in need was emphasised by Jesus in his actions and his teachings. Jesus' parable of the Good Samaritan has traditionally been an influential model ofcare and compassion. We are given an example of how we ought to extend ourselves tocare for each other, especially those who are helpless, suffering or (...) isolated.1 It is increasingly recognised that elderly persons are amongst those who are in need in modern society. This article discusses how the trinitarian perspective of God can enrich ourcare and service of ageing persons beyond the Good Samaritan paradigm. (shrink)

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A critique and provincialization of Western social science and Global Northern academia by the author of The Digital Coloniality of Power, exposing shared colonial and extractive rationalities and histories of research, higher education, digitalization and bioeconomy while proposing in the idea of BluesCollarship a sketch for an alternative culture of worlding and commoning knowledge work and for makingcare matter in research and higher education. In a discourse analysis and provincialization of research and higher education, a tradition of elitarian (...) White Collaredness in academia and in the social sciences in general is criticized and an alternative attitude towards the production, transfer and use of knowledge - BluesCollarship - is proposed. The latter is rooted in a different idea of what 'infrastructure' is and in practices of decoloniality. Noting the current political climate of propaganda and populism, the persistence of social inequalities as well as of racism and misogynism, it is proposed that how people give warrant for knowledge claims should be reviewed under different terms. A coherent theme is that there is a genealogical root for current neo-extractive and neo-colonial rationalities in the Athenian idea of oikos conflating family, household, and property. In taking a distinctly writerly approach - rather than giving ready-made answers - the book aims at permanently provoking readers at every turn to think further, as well as before-and-beyond what is written, but to do so in thinking together with Others. Thereby the book addresses scholars and students from across the social sciences who seek challenges to established ways of thinking in academia without simply replacing one canon for merely another. This book is for those who think of themselves as knowledge and cultural laborers in this age of precarization who seek to replace the university and cognitive capitalism with a pluriversity and an infrastructure build on knowledge and culture as fundamental value. (shrink)

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In his 1917 lecture “Science as a Vocation,” Max Weber challenged current and aspiring scholars to abandon any pretense that science bears within itself any meaning. In a disenchanted age, he argued, science could at best offer “knowledge of the techniques whereby we can control life... through calculation,” and any meaning or moral direction to scientific research—including religious meaning—must be imposed on it from without. Weber presciently anticipated that many present-day healthcare practitioners would struggle to find meaning for (...) their work within complex “state-capitalist” healthcare systems, along with predictable quasi-religious responses. But how are Christian practitioners to practice faithfully in a disenchanted age? The authors of this special issue lean deeply into the loci of Christian theology and Christian practice, some challenging the views of the body and of nature that informed Weber’s theory of disenchantment, and all offering resources and paths by which practitioners might “look the fate of the age full in the face” with courage and wisdom. (shrink)

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In virtually all the developed countries of the Western world, people are living longer and reproducing less. At the same time, costs for thecare of the elderly and infirm continue to rise dramatically. Given these facts, it should come as no surprise that we are experi encing an ever-increasing concern with questions relating to the propercare and treatment of theaged. What responsibilities do soci eties have to their aging citizens? What duties, if any, do (...) grown chil dren owe their parents? What markers should we use to determine one's status as "elderly"? Does treatment of pain inaged patients present special medical and/or moral problems? How can the com peting claims of autonomy and optimal medicalcare be reconciled for elderly persons who require assisted living? When, if ever, should severely demented patients be included in nontherapeutic clinical tri als? These questions, and others of similar interest to those con cerned with the proper treatment of theaged, are discussed in depth in the articles included in this text. The essays in this volume of Biomedical Ethics Reviews fall loosely into two broad categories. The first four articles-those con tributed by Sheila M. Neysmith, Allyson Robichaud, Jennifer Jackson, and Susan McCarthy-raise general questions concerning the propri ety of Western society'S current mechanisms for dealing with and treat ing elderly citizens. The remaining four articles-those by Simon Woods and Max Elstein, Marshall B. (shrink)

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Peterson et al. (2023) outline a broad ethics agenda for imminent research on psychedelic agents for Alzheimer’s disease and related dementias (AD/ADRD) by acknowledging the therapeutic promise of...

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Population aging is becoming an inevitable phenomenon in Albanian post-socialist society, posing multi-faceted challenges to its individuals, families and society as a whole. Since 1991, the Albanian population has been exposed to intensive demographic changes caused by unintended aspects of socio-economic transition from a planned socialist economy to a market-oriented capitalist one. Ongoing processes of re-organization of social institutions increased its socio-economic insecurity leading to the application of various coping mechanisms. While adjusting themselves to other aspects of life, people changed (...) their decisions of having children and leaving the country. On the other hand, replacement of former traditional extended family forms with diverse living arrangements and family structures has been the outcome of the combination of three factors: falling fertility, increasing life expectancy and increasing migration. However, family remains the basic social unit that provides support,care and protection for its old members even though its capacities are diminishing. Family Life Cycle Theory views family development as a series of stages where family members deal with various developmental tasks and play different roles as they move from one stage to another. This paper examines population aging in Albanian post-socialist society. Based on Family Life Cycle Theory and Family Development Theory, it reviews literature and uses secondary data to discuss its implications for elderlycare and family life. It concludes that population aging requires better understanding of this process in order to facilitate a series of family adaptations to respond to the changing needs of its elderly members. (shrink)

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Policies that determine whether someone is allowed access to reproductive healthcare or not vary widely among countries, especially in their age requirements. This raises the suspicion of arbitrariness, especially because often no underlying justification is provided. In this article, we pose the question—under which circumstances is it morally acceptable to use age for policy and legislation in the first place? We start from the notion that everyone has a _conditional positive_ right to fertility treatment. Subsequently, we set off to formulate (...) a framework that helps to determine who should be excluded from treatment nonetheless. The framework’s three core elements are: choosing and ethically justifying exclusion criteria (target), determining the actual limit between in- and exclusion (cut-off), and selecting variables that help to predict the exclusion criteria via correlation (as they are not directly measurable) (proxy). This framework allows us to show that referring to age in policy and legislation is only ethically justifiable if there is a sufficiently strong correlation with a non-directly measurable exclusion criterion. Moreover, since age is only one of many predicting variables, it should therefore not be ascribed any special status. Finally, our framework may be used as an argumentative scheme to critically assess the ethical legitimacy of policies that regulate access to (fertility) treatments in general. (shrink)

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Simonet, Emanuel Nicolas Cortes A Voice at the Table: An Integrated Model for PastoralCare inAged Mental Health, written by Rosemary Kelleher with Olga Yastrubetskaya, describes a practical model for integrating pastoralcare practitioners into multidisciplinary teams withinaged mental health services. While highlighting the importance of spiritualcare within healthcare, the book also emphasises the need for pastoralcare practitioners to have the essential skills and knowledge vital to being significant members of (...) the multidisciplinary team. This article offers a concise review of a most valuable resource. (shrink)

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Feminist literature oncare has extensively addressed inequalities that cut across the social categories of gender, class and ethnicity in relation tocare work. One category that has received less attention in theories of caregiving so far is age. Built on the feminist literature ofcare and taking young (female) carers as its subject matter, this article tackles age as a third social category of intersectional inequalities along with class and gender. Firstly, through dealing with Nancy Fraser’s (...) justice framework of participatory parity, it is argued that addressing the intersectional inequalities that young (female) carers face necessitates a justice framework that contemplates both the distributional and recognitional aspects ofcare. In this respect a dual conceptualisation ofcare is presented – both as a social good and a social process. Secondly, a critical analysis will be presented of the elements of the justice framework of Fraser, where the notion of subordinated status will be related to the identities of young carers. Lastly, the normative framework participatory parity will be discussed in relation to the politics of need, ascare practices define the needs of young carers that are contextualised in thecare processes, but also in a childhood space. (shrink)

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Aging brings about the ordeal of coping. Younger people also cope, but for those in old age, the ordeal is so often elegiac, forced upon the self by changing functions within the body and by the outside social world, with its many impediments to the continuity of former roles, pursuits, and self‐identities. Coping with change can be affirming, but when what is being forgone seems more valuable than what lies ahead, it is travail. For most, the coping is managed more (...) moderately by a sense of resignation. This is especially true for those who survive into profound old age, when one is viewed as if being old is one’s essential identity and nature. We must recognize and affirm difference and change without stigmatizing or losing sight of the specific capabilities and circumstances of the individual. This is what I think the often‐used, but less often clearly defined, notion of a “person‐centered” orientation should signify.Individuals age, but so do societies, not simply because they have a large population over age sixty‐five, but in the sense that societies as a whole are also buffeted by significant disruption in orders of meaning. Aging has a public as well as a private manifestation, a social as well as a personal embodiment, and how it is paid attention to in culture, politics, and policy makes a great difference to how aging is concretely experienced in human lives. In this essay, I explore how the moral imagination nurtured by the practices of solidarity andcare—and nurturing them in turn—can come of age—and how these practices can take their rightful place in an ethically mature political culture. (shrink)

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The debate around age-based healthcare rationing was precipitated by two books in the late 1980s, one by Daniel Callahan and the other by Norman Daniels. These books ignited a firestorm of criticism, best captured in the claim that any form of age-based healthcare rationing was fundamentally ageist, discriminatory in a morally objectionable sense. That is, the elderly had equal moral worth and an equal right to life as the nonelderly. If an elderly and nonelderly person each had essentially the same (...) medical problem requiring the same medical treatment, then they had an equal right to receive that treatment no matter what the cost of that treatment. Alternatively, if cost was an issue because the benefits of the treatment were too marginal, then both the elderly and nonelderly patients requiring that treatment ought to be denied it. If there were something absolutely scarce about the treatment, then some fair process would have to be used to make an allocation decision. (shrink)

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