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Frausing KP, Stamp AS. Making a difference: Students' experiences with a dementia care program. Gerontol Geriatr Educ 2021; 42:126-139. [PMID: 31442104 DOI: 10.1080/02701960.2019.1659256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As the number of elderly citizens in general and the number of persons with dementia in particular rises, the importance of educating geriatric health care professionals increases. Recruitment is, however, impaired by negative stereotypes and insecurity. Previous research has shown that contact with the field of dementia care is important for students' motivation for choosing this career path. This paper presents an extracurricular psychomotor intervention program in which students through eight visits to elderly persons with dementia carry out an intervention involving direct individual contact. Eight psychomotor therapy students participated in follow-up focus group interviews. The purpose was to explore the motivational dynamics that make these experiences meaningful to students. Qualitative analysis of the students' self-assessed outcomes revealed three themes: The relational encounter, Discovering the person, and Making a difference. In combination these themes show important nuances to existing literature on student career dreams by pointing to the benefits of attending to the moment to moment changes in the care situation.
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Affiliation(s)
- Kristian Park Frausing
- VIA Psychomotor Therapy, Faculty of Health Sciences, VIA University College, Randers, Denmark
- VIA Ageing & Dementia, Center for research, Faculty of Health Sciences, VIA University College, Holstebro, Denmark
| | - Anne Schinkel Stamp
- VIA Psychomotor Therapy, Faculty of Health Sciences, VIA University College, Randers, Denmark
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2
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Wyman MF, Voils CI, Trivedi R, Boyle L, Goldman D, Umucu E, Zuelsdorff M, Johnson AL, Gleason CE. Perspectives of Veterans Affairs mental health providers on working with older adults with dementia and their caregivers. Gerontol Geriatr Educ 2021; 42:114-125. [PMID: 32420824 PMCID: PMC7671942 DOI: 10.1080/02701960.2020.1764356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Continuing education directed at building providers' skills and knowledge in geriatrics represents a practical approach to addressing the geriatric mental health (MH) care workforce shortage. To inform the development of professional training curricula, we surveyed MH providers (N = 65) at a Veterans Affairs medical center on working with older persons with dementia (PwD) and informal caregivers. Providers rated service provision to PwD and caregivers as highly important but endorsed modest self-efficacy. Half of respondents were minimally confident in managing risk of harm to self or others in a PwD. Respondents believed PwD can benefit from MH treatments, yet identified several barriers to providing care, including inadequate time and staffing resources. Interest in geriatric training topics was high. Findings demonstrate that MH providers at this site value care provision to PwD and caregivers, and desire additional training to serve this population. System-level barriers to MH care for PwD should also be identified and addressed.
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Affiliation(s)
- Mary F. Wyman
- W.S. Middleton Memorial Veterans Hospital, Madison, WI
- University of Wisconsin School of Medicine & Public Health
| | - Corrine I. Voils
- W.S. Middleton Memorial Veterans Hospital, Madison, WI
- University of Wisconsin School of Medicine & Public Health
| | - Ranak Trivedi
- Stanford University, Palo Alto, CA
- VA Palo Alto Health Care System, Palo Alto, CA
| | - Lisa Boyle
- W.S. Middleton Memorial Veterans Hospital, Madison, WI
- University of Wisconsin School of Medicine & Public Health
| | | | - Emre Umucu
- University of Texas, El Paso, El Paso, TX
| | - Megan Zuelsdorff
- University of Wisconsin School of Medicine & Public Health
- School of Nursing, University of Wisconsin
| | - Adrienne L. Johnson
- W.S. Middleton Memorial Veterans Hospital, Madison, WI
- UW Center for Tobacco Research and Intervention, Madison, WI
| | - Carey E. Gleason
- W.S. Middleton Memorial Veterans Hospital, Madison, WI
- University of Wisconsin School of Medicine & Public Health
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3
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Kuziemsky CE, Hunter I, Gogia SB, Lyenger S, Kulatunga G, Rajput V, Subbian V, John O, Kleber A, Mandirola HF, Florez-Arango J, Al-Shorbaji N, Meher S, Udayasankaran JG, Basu A. Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems. Yearb Med Inform 2020; 29:44-50. [PMID: 32303097 PMCID: PMC7442533 DOI: 10.1055/s-0040-1701976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives. METHODS We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth. RESULTS Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts. CONCLUSIONS Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth.
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Affiliation(s)
- Craig E Kuziemsky
- Office of Research Services and School of Business, MacEwan University, Edmonton, Alberta, Canada
| | - Inga Hunter
- School of Management, Massey University, New Zealand
| | - Shashi B Gogia
- Society for Administration of Telemedicine and Healthcare Informatics (SATHI), New Delhi, India
| | | | - Gumindu Kulatunga
- Postgraduate Institute of Medicine, University of Colombo, Sri Lanka
| | - Vije Rajput
- General Practitioner, Stonydelph Health Centre, Tamworth, UK
| | | | - Oommen John
- George Institute for Global Health, University of New South Wales, New Delhi, India
| | | | | | | | | | | | | | - Arindam Basu
- School of Health Sciences, University of Canterbury, New Zealand
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Koeberle S, Tannou T, Bouiller K, Becoulet N, Outrey J, Chirouze C, Aubry R. COVID-19 outbreak: organisation of a geriatric assessment and coordination unit. A French example. Age Ageing 2020; 49:516-522. [PMID: 32725209 PMCID: PMC7239239 DOI: 10.1093/ageing/afaa092] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Indexed: 12/24/2022] Open
Abstract
Older people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient's level of care and the organisation of specific networks is essential. To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level.To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist.To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service. This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory.
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Affiliation(s)
- Séverine Koeberle
- Geriatrics Department, CHU, Besançon, France
- “Ethics and Medical Progress” reseach team, INSERM CIC 1431, CHU Besançon, France
| | - Thomas Tannou
- Geriatrics Department, CHU, Besançon, France
- “Ethics and Medical Progress” reseach team, INSERM CIC 1431, CHU Besançon, France
- EA 481 Neurosciences, Université de Franche-comté, Besançon, France
- Research Centre, Geriatric University Institute of Montreal (IUGM), Montréal, Qc, Canada
| | - Kévin Bouiller
- Infectious Disease Department, CHU de Besançon, Besançon, France
| | | | - Justin Outrey
- Emergency Department, CHU de Besançon, Besançon, France
| | - Catherine Chirouze
- Infectious Disease Department, CHU de Besançon, Besançon, France
- Laboratoire Chrono-environnement - UMR 6249 CNRS-UFC, Besançon, France
| | - Régis Aubry
- Geriatrics Department, CHU, Besançon, France
- “Ethics and Medical Progress” reseach team, INSERM CIC 1431, CHU Besançon, France
- EA 481 Neurosciences, Université de Franche-comté, Besançon, France
- Palliative Care Department, CHU de Besançon, Besançon, France
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Affiliation(s)
- Laia Bécares
- School of Education and Social Work, University of Sussex, Falmer, UK
| | - Dharmi Kapadia
- School of Social Sciences, University of Manchester, Manchester, UK
| | - James Nazroo
- School of Social Sciences, University of Manchester, Manchester, UK
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Hillman A, Latimer J. Somaticization, the making and unmaking of minded persons and the fabrication of dementia. Soc Stud Sci 2019; 49:208-226. [PMID: 30834820 PMCID: PMC6902807 DOI: 10.1177/0306312719834069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article examines the strategies by which the different and variable signs of failing mental powers become known sufficiently for 'dementia' to be made into a stable bio-clinical entity, that can be tested, diagnosed and perhaps one day even treated. Drawing on data from ethnographic observations in memory clinics, together with interviews with associated scientists and clinicians, we document the challenges that clinicians face across the clinical and research domain in making dementia a stable object of their investigation. We illustrate how the pressure for early diagnoses of dementia creates tensions between the scientific representations of early dementia and its diagnosis in the clinic. Our aim is to highlight the extent to which the work of diagnosing dementia involves an intricate process of smoothing out seemingly insurmountable problems, such as the notoriously elusive connections between brain/mind and body/person. Furthermore, we show that a part of this process involves enrolling patients as minded, agentic subjects, the very subjects who are excluded from dementia science research in pursuit of biomarkers for the pre-clinical detection of dementia.
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Affiliation(s)
- Alexandra Hillman
- Alexandra Hillman, WISERD, School of Social Sciences, Cardiff University, 38 Park Place, Cathays, Cardiff CF10 3BB, UK.
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Ludlow K, Churruca K, Ellis LA, Mumford V, Braithwaite J. Understanding the priorities of residents, family members and care staff in residential aged care using Q methodology: a study protocol. BMJ Open 2019; 9:e027479. [PMID: 30850419 PMCID: PMC6429870 DOI: 10.1136/bmjopen-2018-027479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Residential aged care facilities (RACFs) are under increasing pressure to provide high-quality, round the clock care to consumers. However, they are often understaffed and without adequate skill mix and resources. As a result, staff must prioritise care by level of importance, potentially leading to care that is missed, delayed or omitted. To date, the literature on prioritisation and missed care has been dominated by studies involving nursing staff, thereby failing to take into account the complex networks of diverse stakeholders that RACFs comprise. This study aims to investigate the priorities of residents, family members and care staff in order to make comparisons between how care is prioritised in RACFs by the different stakeholder groups. METHODS AND ANALYSIS This study comprises a Q sorting activity using Q methodology, a think-aloud task, a demographics questionnaire and semi-structured interview questions. The study will be conducted in five RACFs across NSW and QLD, Australia. Using purposive sampling, the project will recruit up to 33 participants from each of the three participant groups. Data from the Q sorting activity will be analysed using the analytic software PQMethod to identify common factors (shared viewpoints). Data from the think-aloud task and semi-structured interviews questions will be thematically analysed using the Framework Method and NVivo qualitative data analysis software. ETHICS AND DISSEMINATION The study has been approved by St Vincent's Health and Aged Care Human Research and Ethics Committee and Macquarie University Human Research Ethics Committee. It is expected that findings from the study will be disseminated: in peer-reviewed journals; as an executive report to participating facilities and a summary sheet to participants; as a thesis to fulfill the requirements of a Doctor of Philosophy; and presented at conferences and seminars.
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Affiliation(s)
- Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Rocha É, Sousa P, António N, Medeiros S, Julião M. [Letter to the Editor: The Concept of Dignity in Non-institutionalized Elderly People Cared for in Primary Health Care: A Preliminary Empirical Model]. ACTA MEDICA PORT 2018; 31:441-442. [PMID: 30189175 DOI: 10.20344/amp.10943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/02/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Érica Rocha
- Unidade de Saúde Familiar AlphaMouro. Rio de Mouro. Portugal
| | - Paulo Sousa
- Unidade de Saúde Familiar AlphaMouro. Rio de Mouro. Faculty of Medicine. University of Lisbon. Lisboa. Portugal
| | - Nuno António
- ISCTE - Instituto Universitário de Lisboa. Lisboa. Portugal
| | - Susana Medeiros
- Unidade de Saúde Familiar AlphaMouro. Rio de Mouro. Portugal
| | - Miguel Julião
- Life and Health Sciences Research Institute (ICVS). School of Medicine. University of Minho. Braga. ICVS/3B's. Portuguese Government Associate Laboratory. Braga/Guimarães. School of Medicine. University of Minho. Braga. Portugal
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Ehni HJ, Kadi S, Schermer M, Venkatapuram S. Toward a global geroethics - gerontology and the theory of the good human life. Bioethics 2018; 32:261-268. [PMID: 29676503 DOI: 10.1111/bioe.12445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 12/05/2017] [Accepted: 02/28/2018] [Indexed: 06/08/2023]
Abstract
Gerontologists have proposed different concepts for ageing well such as 'successful ageing', 'active ageing', and 'healthy ageing'. These conceptions are primarily focused on maintaining health and preventing disease. But they also raise the questions: what is a good life in old age and how can it be achieved? While medical in origin, these concepts and strategies for ageing well also contain ethical advice for individuals and societies on how to act regarding ageing and old age. This connection between gerontology and ethics is overlooked by both schools of thought. We thus develop this research programme for a systematic geroethics in four steps. First, we analyze 'successful ageing' as put forward by Rowe and Kahn as a paradigmatic example of a gerontological conception of ageing well. Then, in a second step, we move from criticisms within gerontology to an ethical perspective; in particular, we want to clarify the problem of the claim of universal validity of conceptions of the good life. In a third constructive step, we explain how the 'capabilities approach' could be applied in this context as a normative foundation for the implicit normative assumptions of gerontological conceptions of ageing well, such as a particular choice of functionings, the ethical relevance of human agency, and the resulting claims of individuals towards society. Finally, using a concept developed by the German philosopher Ursula Wolf, we systematically develop the different aspects of the connection between ageing well and the theory of the good life in their full complexity and show their interconnectedness.
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Abstract
Little is known about older persons’ expectancies (or anticipations) about the possible actions of home-care professionals, although such data have implications for the ethics of home care and home-care policies. From a longitudinal study of older women’s experience of home care, findings are reported concerning their expectancies of professional home-care providers. A descriptive phenomenological method was used to detail the structure of the experience and its context. Data were analyzed from a series of interviews with 13 women aged 82 to 96 years. Among the five key structures of experience were ‘finding that someone has the job of helping me here’ and ‘determining where the helper’s field lies’. Two subsets within a category of expectancies were differentiated: speculations about helpers’ possible actions and expectancies about outcomes of helpers’ actions. As parameters of relational ethics, clients’ speculations and expectancies are appropriate bases for dialogue about older widows’ relationships with home-care professionals and the foci of home-care policies.
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Affiliation(s)
- Eileen J Porter
- MU Sinclair School of Nursing, University of Missouri-Columbia, Columbia, MO 65211, USA.
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11
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Abstract
Elderly people are a particularly vulnerable group in society and have special health problems. The world population of older people is increasing. People who are 65 years or older constitute 6% of the Turkish population, 90% of whom have chronic health problems. In Turkey, there is a high possibility that elderly people’s requirements are not met by today’s health care system in the way they would wish. They prefer not to be hospitalized when they have health problems. From a wider perspective, various countries are still seeking how to provide the best care for elderly people. Our goal was to characterize home-based care for elderly people using an ethical approach as an area of interest for nurses and other health care professionals now and in the future, both for Turkey specifically and from a global perspective. We studied four case histories and then prepared a composite scenario and a short questionnaire for elderly people living in a specific district of Istanbul to evaluate their expectations from the health care system. We compared our findings with situations in other countries and have proposed some practical solutions. The results showed that these older people preferred to receive nursing care at home instead of in hospital in Turkey, and also in many other countries. In this article we discuss our findings, comparing them with those in the literature, and suggest that there should be nursing care at home with insurance coverage while using a proper ethical approach.
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Mort M, Roberts C, Pols J, Domenech M, Moser I. Ethical implications of home telecare for older people: a framework derived from a multisited participative study. Health Expect 2015; 18:438-49. [PMID: 23914810 PMCID: PMC5060789 DOI: 10.1111/hex.12109] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 10/26/2022] Open
Abstract
CONTEXT Telecare and telehealth developments have recently attracted much attention in research and service development contexts, where their evaluation has predominantly concerned effectiveness and efficiency. Their social and ethical implications, in contrast, have received little scrutiny. OBJECTIVE To develop an ethical framework for telecare systems based on analysis of observations of telecare-in-use and citizens' panel deliberations. DESIGN Ethnographic study (observation, work shadowing), interviews, older citizens' panels and a participative conference. SETTING Participants' homes, workplaces and familiar community venues in England, Spain, the Netherlands and Norway 2008-2011. RESULTS Older respondents expressed concerns that telecare might be used to replace face-to-face/hands-on care to cut costs. Citizens' panels strongly advocated ethical and social questions being considered in tandem with technical and policy developments. Older people are too often excluded from telecare system design, and installation is often wrongly seen as a one-off event. Some systems enhance self-care by increasing self-awareness, while others shift agency away from the older person, introducing new forms of dependency. CONCLUSIONS Telecare has care limitations; it is not a solution, but a shift in networks of relations and responsibilities. Telecare cannot be meaningfully evaluated as an entity, but rather in the situated relations people and technologies create together. Characteristics of ethical telecare include on-going user/carer engagement in decision making about systems: in-home system evolution with feedback opportunities built into implementation. System design should be horizontal, 'two-way'/interactive rather than vertical or 'one-way'. An ethical framework for telecare has been developed from these conclusions (Table 1).
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Affiliation(s)
- Maggie Mort
- Department of Sociology and Division of MedicineLancaster UniversityLancasterUK
| | - Celia Roberts
- Department of SociologyLancaster UniversityLancasterUK
| | - Jeannette Pols
- Section of Medical Ethics, Department of General PracticeAcademic Medical CentreAmsterdamThe Netherlands
| | - Miquel Domenech
- Department of Social PsychologyAutonomous University of BarcelonaBarcelonaSpain
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Prosser B, Davey R, Gibson D. Progress in centralised ethics review processes: Implications for multi-site health evaluations. Eval Program Plann 2015; 49:117-123. [PMID: 25666881 DOI: 10.1016/j.evalprogplan.2014.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 09/30/2014] [Accepted: 12/08/2014] [Indexed: 06/04/2023]
Abstract
Increasingly, public sector programmes respond to complex social problems that intersect specific fields and individual disciplines. Such responses result in multi-site initiatives that can span nations, jurisdictions, sectors and organisations. The rigorous evaluation of public sector programmes is now a baseline expectation. For evaluations of large and complex multi-site programme initiatives, the processes of ethics review can present a significant challenge. However in recent years, there have been new developments in centralised ethics review processes in many nations. This paper provides the case study of an evaluation of a national, inter-jurisdictional, cross-sector, aged care health initiative and its encounters with Australian centralised ethics review processes. Specifically, the paper considers progress against the key themes of a previous five-year, five nation study (Fitzgerald and Phillips, 2006), which found that centralised ethics review processes would save time, money and effort, as well as contribute to more equitable workloads for researchers and evaluators. The paper concludes with insights for those charged with refining centralised ethics review processes, as well as recommendations for future evaluators of complex multi-site programme initiatives.
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Affiliation(s)
- Brenton Prosser
- Centre for Research and Action in Public Health, University of Canberra, Bruce, ACT 2617, Australia.
| | - Rachel Davey
- Centre for Research and Action in Public Health, University of Canberra, Bruce, ACT 2617, Australia.
| | - Diane Gibson
- Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia.
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Johnstone MJ. Call for a convention on the rights of older people. Aust Nurs Midwifery J 2015; 22:30. [PMID: 26485807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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McNally M, Lahey W. Frailty's Place in Ethics and Law: Some Thoughts on Equality and Autonomy and on Limits and Possibilities for Aging Citizens. Interdiscip Top Gerontol Geriatr 2015; 41:174-85. [PMID: 26301989 DOI: 10.1159/000381235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Consideration of ethical and legal themes relating to frailty must engage with the concern that frailty is a pejorative concept that validates and reinforces the disadvantage and vulnerability of aging adults. In this chapter, we consider whether a greater focus on frailty may indeed be part of the solution to the disadvantages that aging adults face in achieving equality and maintaining their autonomy within systems that have used their frailty to deny them equality and autonomy. First, by examining equality both as an ethical norm and as a requirement for protections against discrimination, we raise questions about the grounds on which health providers and health systems can be required to give equal concern and respect to the needs of frail older persons. Second, we explore autonomy and identify the tension between meaningful self-determination and prevailing ethical and legal norms associated with informed choice. Third, we argue that a proper understanding of frailty is essential within both of these themes; it respects equality by enabling health providers and systems to identify and address the distinct care needs of aging adults and helps to align informed choice theory with appropriate processes for decision-making about those needs.
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Affiliation(s)
- Mary McNally
- Faculties of Dentistry and Medicine, Dalhousie University, Halifax, N.S., Canada
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Deb S. Are we treating our geriatric population ethically?--Views of a resident doctor. Indian J Med Ethics 2015; 12:49-51. [PMID: 25716441 DOI: 10.20529/ijme.2015.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With the improvement in health services and continuing advancements in medicine, people are living longer all over the world. Thus the proportion of patients in the elderly age group is also increasing. How ethically are we treating our geriatric patients in India and what does the future hold for them?
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Affiliation(s)
- Samujjala Deb
- Post Graduate Student, Department of Dermatology Venereology and Leprology, Burdwan Medical College and Hospital, Burdwan, West Bengal 700 084 India
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Yao CS, MacEntee MI. Inequity in oral health care for elderly Canadians: part 2. Causes and ethical considerations. J Can Dent Assoc 2014; 80:e10. [PMID: 24598327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Canadian Health Measures Survey, conducted between March 2007 and February 2009, revealed unmet dental needs among older adults in Canada. This article, the second of a 3-part series, explains that the inequity in oral care faced by elderly Canadians is due largely to the current fee-for-service dental service system. However, the inequity has arisen because of financial, behavioural and physical barriers, and both the community at large and the dental profession have a social responsibility to reduce this unfairness and provide equitable access to oral care for older people.
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Berlinger N, Kaebnick R. Whose hands? Global migration, elder care, and the mothers of others. Virtual Mentor 2013; 15:761-766. [PMID: 24021104 DOI: 10.1001/virtualmentor.2013.15.9.jdsc1-1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Nancy Berlinger
- Research scholar at The Hastings Center in Garrison, New York
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Abstract
Drawing on perspectives from the governmentality literature and the sociology of risk, this article explores the strategies, tools and mechanisms for managing risk in acute hospital trusts in the United Kingdom. The article uses qualitative material from an ethnographic study of four acute hospital trusts undertaken between 2008 and 2010 focusing on the provision of dignified care for older people. Extracts from ethnographic material show how the organisational mechanisms that seek to manage risk shape the ways in which staff interact with and care for patients. The article bridges the gap between the sociological analysis of policy priorities, management strategy and the organisational cultures of the NHS, and the everyday interactions of care provision. In bringing together this ethnographic material with sociological debates on the regulation of healthcare, the article highlights the specific ways in which forms of governance shape how staff care for their patients challenging the possibility of providing dignified care for older people.
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Abstract
BACKGROUND Patient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error. METHOD The Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated (1) the definition of patient neglect, (2) the forms of behaviour associated with neglect, (3) the reported frequency of neglect, and (4) the causes of neglect. RESULTS Patient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients. CONCLUSION A social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of i) differences between patients and healthcare staff in how they perceive neglect, ii) the association with patient neglect and health outcomes, iii) the relative importance of system and organisational factors in causing neglect, and iv) the design of interventions and health policy to reduce patient neglect.
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Affiliation(s)
- Tom W Reader
- Institute of Social Psychology, London School of Economics, Houghton Street, London WC2A 2AE, UK
| | - Alex Gillespie
- Institute of Social Psychology, London School of Economics, Houghton Street, London WC2A 2AE, UK
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Doomen J. Should human dignity be upheld at all costs? Am J Bioeth 2013; 13:24-25. [PMID: 23862595 DOI: 10.1080/15265161.2013.802064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Jasper Doomen
- Law Department, Leiden University, Leiden, The Netherlands.
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Abstract
Societal aging raises challenging ethical questions regarding the just distribution of health care between young and old. This article considers a proposal for age-based rationing of health care, which is based on the prudential life span account of justice between age groups. While important objections have been raised against the prudential life span account, it continues to dominate scholarly debates. This article introduces a new objection, one that develops out of the well-established disability critique of social contract theories. I show the implications of this critique for the prudential life span account and for the special case of age-group justice. The result is that age-based rationing based on the prudential life span approach is not supported, and that the prudential life span approach itself is not the best way to think about allocating health care between age groups. I propose an alternative approach that avoids the disability objection, and consider its implications for specific proposals for age-based rationing of health care.
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Affiliation(s)
- Nancy S Jecker
- School of Medicine, Department of Bioethics & Humanities, University of Washington, Seattle, WA 98195–7120, USA.
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Lanoix M. From normal species functioning to capabilities, is it enough? Am J Bioeth 2013; 13:20-21. [PMID: 23862593 DOI: 10.1080/15265161.2013.804337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Monique Lanoix
- Appalachian State University, Philosophy and Religion, Boone, NC 28608-2104, USA.
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Affiliation(s)
- William Simkulet
- University of Kansas, 311 Sunnyslope Ct. S., Andover, KS 67002, USA.
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Affiliation(s)
- Laurence B McCullough
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza MS 420, Houston, TX 77030-3411, USA.
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Capitaine L, Pennings G, Sterckx S. Why Jecker's capabilities approach to age-based rationing is incapable of containing health care costs. Am J Bioeth 2013; 13:22-23. [PMID: 23862594 DOI: 10.1080/15265161.2013.802069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Laura Capitaine
- Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, Ghent, Belgium.
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Kärki A, Sävel J, Sallinen M, Kuusinen J. Ethicted (evaluation process model to improve personalised ICT services for independent living and active ageing)--future scenario. Stud Health Technol Inform 2013; 189:50-55. [PMID: 23739356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
ICT innovations are constantly developed, and there is no lack of elderly customers, as the number of the elderly is dramatically increasing. Elderly are willing to use ICT to increase their own safety and social activity, but they need trust on the reliability, accessibility and other ethical aspects of ICT including the maintenance of privacy and self-determination. Ethical standards for ICT are usually not considered. "Ethicted" characterizes an ICT service or product as ethically evaluated. As a standardized procedure, it will not only increase the acceptability of ICT, but also provide services for ICT developers. In the future scenario, ICT under development should be evaluated by using a process model that is specifically built to find the lacks in ethical aspects. The model would then be tested by end-users, the formal and informal care givers, to receive direct feedback for redeveloping solutions. As final outcomes, there should be standards for ICT in elderly care and a service for ICT developers to utilize the evaluation model. This future scenario work included partners from 6 EU member countries. The combination of academic research and industrial/commercial interest of ICT developers should and can bring new value to assistive ICT for elderly care.
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Affiliation(s)
- Anne Kärki
- Satakunta University of Applied Sciences, Pori, Finland
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Barina R. Whose dignity, which capacity? Am J Bioeth 2013; 13:18-20. [PMID: 23862592 DOI: 10.1080/15265161.2013.804331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Rachelle Barina
- St. Louis University, Center for Health Care Ethics, 3545 Lafayette Avenue, St. Louis, MO 63104, USA.
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de Vevey P. [Anne, my sister, can't you see...]. Rev Med Suisse 2012; 8:1748. [PMID: 23029991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Kricheldorff C, Oswald F. [Value(s) of age]. Z Gerontol Geriatr 2012; 45:584. [PMID: 22936115 DOI: 10.1007/s00391-012-0398-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C Kricheldorff
- Soziale Arbeit in gerontologischen Arbeitsfeldern und im Gesundheitswesen, Katholische Hochschule Freiburg, Karlstr. 63, 79104, Freiburg i. Br., Deutschland.
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Nau JY. [What will you do with your Life expectancy?]. Rev Med Suisse 2012; 8:914-915. [PMID: 22611631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Wise J. Hospitals need to change to ensure older people are treated with dignity, says commission. BMJ 2012; 344:e1538. [PMID: 22374929 DOI: 10.1136/bmj.e1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Albeck E, Eilfeldt J. [Imprisonment for over 62-year-olds in Singen: "Concern does not mean pampered law enforcement" (interview by Urs Lüthi)]. Krankenpfl Soins Infirm 2012; 105:14-69. [PMID: 23210202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Pérez-Jara Carrera J. [Ethical issues in older admitted patients. Experience in the United Kingdom]. Cuad Bioet 2011; 22:517-533. [PMID: 22332983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/12/2011] [Indexed: 05/31/2023]
Abstract
The United Kingdom is a rapidly aging society. More than half of the hospital beds are occupied by older people. They are considering increasingly themselves as able to flourish, enjoying a fulfilling live and with the same rights and dignity than the rest of the population. Keeping independence is one of their main objectives. However, this society realized that the Health Service were outdated and not suited to the correct needs of the elderly. A new organization of the National Health Service, the National Service Framework was developed in 2001 which led to a health and social care more appropriate. New ethical principles as respect to the person, non-discrimination by age and Person Centred Care were focused in this new organization. This means providing the comprehensive geriatric assessment, rationalization of care with the union of social and health services and the pursuit of high levels of quality of care for the elderly. The ethical principles of action with older people also represent standards of conduct for doctors, nurses and other healthcare professionals aimed at enabling the elderly to make decisions that affect them, to keep their dignity and to be given a fair deal and proper care.
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Pedra M. [Caring for patients with dementia, a challenge to overcome]. Soins Gerontol 2011:22. [PMID: 21416900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Koskas P, Misme A, Lepresle C, Drunat O. [Setting up of a community/hospital network providing care for patients and their families]. Soins Gerontol 2011:18-21. [PMID: 21416899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
With the ageing of the population, dementia has become a public healthcare priority. A network designed to help the families of patients suffering from dementia on a medical as well as a social and psychological level has been set up. This structure has been developed in close coordination with community practitioners and physicians and in line with the latest recommendations in particular with regard to ethics. Its first three years of existence confirm the importance of this type of approach which complements the care provided by hospitals.
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Johnstone MJ. Health care justice for the ageing. Aust Nurs J 2010; 17:29. [PMID: 20449967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Kapp MB. Health care technology, health care rationing, and older Americans: enough already! Care Manag J 2010; 11:245-248. [PMID: 21197931 DOI: 10.1891/1521-0987.11.4.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Marshall B Kapp
- Center for Innovative Collaboration in Medicine and Law, Florida State University College of Medicine and College of Law, Tallahassee 32306-4300, USA.
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Abstract
Optimal care for elderly cancer patients requires empathy and alertness about impaired autonomy and an exceptional quality of care. Specific to geriatric oncology is the particular need of attention and care for the patients. Most important from a conceptual point of view is to identify that this will result in additional demands. To care for these patients will require more time as any intervention must be adapted to age specific capabilities. The difficult task of shared decision-making should be preferably based on the quality of life assessment of the individual patient and their needs. The process of assessing quality of life is in itself already an act of enhancing autonomy, because it respects the individual's subjectivity. Many ethical questions arise between the contradictory contexts of paternalism and autonomy. There are conditions to be met and limits of autonomy to be considered, which differ for the elderly patients because of their vulnerability and particular dependencies. As the elderly patient is closer to death and dying, questions of care in these situations are frequently more pressing. It is important to distinguish actively intended euthanasia from the goals and concerns of modern palliative care in order to enable dying with dignity.
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Thomas E, Wingert P, Smalley S, Kalb C. The case for killing granny. Rethinking end-of-life care. Newsweek 2009; 154:34-40. [PMID: 19806817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Brauer S. Age rationing and prudential lifespan account in Norman Daniels' Just health. J Med Ethics 2009; 35:27-31. [PMID: 19103939 PMCID: PMC2603281 DOI: 10.1136/jme.2008.024398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 04/22/2008] [Indexed: 05/27/2023]
Abstract
Could age be a valid criterion for rationing? In Just health, Norman Daniels argues that under certain circumstances age rationing is prudent, and therefore a morally permissible strategy to tackle the problem of resource scarcity. Crucial to his argument is the distinction between two problem-settings of intergenerational equity: equity among age groups and equity among birth cohorts. While fairness between age groups can involve unequal benefit treatment in different life stages, fairness between birth cohorts implies enjoying approximate equality in benefit ratios. Although both questions of fairness are distinct, the resolution of the one depends on resolution of the other. In this paper, I investigate whether Daniels' account of age rationing could be defended as a fair way of setting limits to healthcare entitlements. I will focus on two main points. First, I will consider whether the age group problem could be resolved without appealing to a conception of the good. Second, I will demonstrate that the connection between the age group problem and the birth cohort problem runs deeper than Daniels initially thought-and that it ultimately suggests a method for prioritisation in problem solving strategies.
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Affiliation(s)
- S Brauer
- Institute of Biomedical Ethics, University of Zurich, Zollikerstrasse 115, 8008 Zurich, Switzerland.
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Nortvedt P, Pedersen R, Grøthe KH, Nordhaug M, Kirkevold M, Slettebø A, Brinchmann BS, Andersen B. Clinical prioritisations of healthcare for the aged--professional roles. J Med Ethics 2008; 34:332-335. [PMID: 18448710 DOI: 10.1136/jme.2007.020693] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians' considerations in clinical prioritisation within this field is scarce. OBJECTIVES To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. DESIGN A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. PARTICIPANTS 20 physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway. RESULTS AND INTERPRETATIONS The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians' role. CONCLUSION Distributing healthcare services in a fair way is generally not described as integral to the clinicians' role in clinical prioritisations. If considerations of justice are not included in clinicians' role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions.
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Affiliation(s)
- P Nortvedt
- Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, PO Box 1130 Blindern, NO-0318 Oslo, Norway.
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Sister Kathleen Popko. Developing an aging strategy for the future. Catholic Health East establishes a 2017 preferred health care delivery model. Health Prog 2008; 89:31-6. [PMID: 18247007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Abstract
The escalating demand for trained direct long-term care (DLTC) workers, those individuals with the most sustained direct contact with vulnerable older adults in homes and facilities, is a consequence of our rapidly aging population. Research documents the present and projected shortages of DLTC workers, and developed nations are increasingly turning to immigrant women to fulfill these workforce needs. The authors identify international trends that influence the availability of these workers. Following a broad overview of the DLTC workforce, they turn to a specific examination of immigrants working in long-term care settings in the United States. The authors raise a number of questions about this changing workforce profile. They outline four ways that institutes of higher education can help improve the DLTC workforce in the United States and suggest that colleges and universities work in partnership with policy makers and the long-term care industry to this end.
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Affiliation(s)
- Colette V Browne
- School of Social Work, University of Hawai'i, Honolulu, HI 96822, USA.
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