Age is determined by the amount of time that someone or something has existed. For example, a person born in 1980 and a 1980 vintage wine would each be 40 years old in 2020. Recently, Joona Räsänen has challenged this belief, arguing that in some cases one’s age is not determined by how long one has existed, but by some feature or set of features about one’s biology, experiences, and/or beliefs about themselves. In many cases, age is an ad hoc (...) indicator of physical health, psychological development, and the like, but for Räsänen, it seems age isn’t merely an indicator of such things; it’s derived from these things! Here I argue Räsänen’s alternatives to chronological age are ontologically burdensome and inconsistent with our intuitions in both normal and weird cases. (shrink)

This is the first extensive study of ecological virtue ethics and the new rhetoric of environmentalists. Based on a wide-ranging survey of environmental literature, Louke van Wensveen offers an overview of current "green" virtue language and proposes the basic elements of a matching ecological virtue theory, dubbed "dirty virtues" by ecological philosophers.Environmental ethics is not exhausted by debates about the need to preserve rivers, our duties to bioregions, and the intrinsic value of nonhuman nature; rather, ecoliterature also contains a rich (...) virtue language. Highlighting the integrity, diversity, internal tensions, dynamism, and visionary character of this ecological virtue language, the author shows both its historical roots and innovative features. Van Wensveen illustrates a widespread awareness of attitudes and habits that help or harm our relations with the nonhuman world. She includes a unique catalog of 189 virtues and 174 vices that mark the vision and praxis of people committed to ecological flourishing.The second part of Dirty Virtues presents carefully crafted criteria to help discern genuine virtue and vice in an ecological age. Her arguments are distinguished by a critical balance of moral sources, including Aristotelian virtue theory, Christian tradition, women's experiences, psychological theory, and metaphorical representations of nonhuman nature.Methodologically innovative and boldly interdisciplinary, Dirty Virtues will challenge and inspire virtue theorists, as well as environmental ethicists and theologians. (shrink)

Department of Political Studies, Queen's University, 99 University Avenue, Kingston, Ontario, Canada, K7L 3N6. Email: farrelly{at}queensu.ca ' + u + '@' + d + ' '//--> Abstract Should we invest more public funding in basic aging research that could lead to medical interventions that permit us to safely and effectively retard human aging? In this paper I make the case for answering in the affirmative. I examine, and critique, what I call the Fairness Objection to making aging research a greater (...) priority than it currently is. The Fairness Objection presumes that support for aging research is limited to a simplistic utilitarian justification. That is, a mode of justification that is aggregative and permits imposing high costs on a few so that small benefits could be enjoyed by numerous recipients. I develop two arguments to refute the Fairness Objection. The Fairness Objection mischaracterizes the utilitarian argument for retarding human aging. It does so by invoking the fallacious conceptual distinction between "saving lives" and "extending lives", as well as making a number of mistaken assumptions concerning the likely benefits of retarding human aging. Secondly, I argue that the case for tackling aging can be made on contractualist , in addition to utilitarian, grounds. Because the harms of senescence are "morally relevant" to the harms of disease, contractualists can permit aggregation within lives. And thus no one could reasonably reject, I contend, a principle that makes the aspiration to tackle human aging more of a priority than it currently is. CiteULike Connotea Del.icio.us What's this? (shrink)

BackgroundFor many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children of 11.2 (...) years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives.DiscussionAlthough assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad.SummaryPrevious research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated. (shrink)

Background: Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. Research questions: How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Research design: Quantitative analysis of a (...) questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Participants and research context: Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Ethical considerations: Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Findings: Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. Conclusion: The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team’s cohesion as mutual understanding for one another’s views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents. (shrink)

Background In neonatal intensive care, a child's death is often preceded by a medical decision. Nurses, social workers and pastors, however, are often excluded from ethical case deliberation. If multiprofessional ethical case deliberations do take place, participants may not always know how to perform to the fullest. Setting A level-IIID neonatal intensive care unit of a paediatric teaching hospital in the Netherlands. Methods Structured multiprofessional medical ethical decision-making (MEDM) was implemented to help overcome problems experienced. Important features were: all professionals (...) who are directly involved with the patient contribute to MEDM; a five-step procedure is used: exploration, agreement on the ethical dilemma/investigation of solutions, analysis of solutions, decision-making, planning actions; meetings are chaired by an impartial ethicist. A 15-item questionnaire to survey staff perceptions on this intervention just before and 8 months after implementation was developed. Results Before and after response rates were 91/105 (87%) and 85/113 (75%). Factor analysis on the questionnaire suggested a four-factor structure: participants' role; structure of MEDM; content of ethical deliberation; and documentation of decisions/conclusions. Effect sizes were 1.67 (p<0.001), 0.69 (p<0.001) and 0.40 (p<0.01) for the first three factors respectively, but only 0.07 (p=0.65) for the fourth factor. Nurses' perceptions of improvement did not significantly exceed those of physicians. Conclusion Professionals involved in ethical case deliberation perceived that the process of decision-making had improved; they were more positive about the structure of meetings, their own role and, to some extent, the content of ethical deliberation. Documentation of decisions/conclusions requires further improvement. (shrink)

Objective To assess whether the frequency of end-of-life decisions for children under 1 year of age in the Netherlands has changed since ultrasound examination around 20 weeks of gestation became routine in 2007 and after a legal provision for deliberately ending the life of a newborn was set up that same year. Methodology This was a recurrent nationwide cross-sectional study in the Netherlands. In 2010, a sample of death certificates from children under 1 year of age was derived from the (...) central death registry. All 223 deaths that occurred in a 4-month study period were included. Physicians who had reported a non-sudden death (n=206) were sent a questionnaire on the end-of-life decisions made. 160 questionnaires were returned (response 78%). Findings In 2010, 63% of all deaths of children under 1 year of age were preceded by an end-of-life decision—a percentage comparable to other times when this study was conducted (1995, 2001, 2005). These end-of-life decisions were mainly decisions to withdraw or withhold potentially life-sustaining treatment. In 2010, the percentage of cases in which drugs were administered with the explicit intention to hasten death was 1%, while in 1995 and 2001, this was 9% and in 2005, this was 8%. Discussion and conclusion There has been a reduction of infant deaths that followed administration of drugs with the explicit intention to hasten death. One explanation for this reduction relates to the introduction of routine ultrasound examination around 20 weeks of gestation. In addition, the introduction of legal criteria and a review process for deliberately ending the life of a newborn may have left Dutch physicians with less room to hasten death. (shrink)

The ageing society poses significant challenges to Europe’s economy and society. In coming to grips with these issues, we must be aware of their ethical dimensions. Values are the heart of the European Union, as Article 1a of the Lisbon Treaty makes clear: “The Union is founded on the values of respect for human dignity…”. The notion of Europe as a community of values has various important implications, including the development of inclusion policies. A special case of exclusion concerns the (...) gap between those people with effective access to digital and information technology and those without access to it, the “digital divide”, which in Europe is chiefly age-related. Policies to overcome the digital divide and, more generally speaking, e-inclusion policies addressing the ageing population raise some ethical problems. Among younger senior citizens, say those between 65 and 80 years old, the main issues are likely to be universal access to ICT and e-participation. Among the older senior citizens, say those more than 80 years old, the main issues are mental and physical deterioration and assistive technology. An approach geared towards the protection of human rights could match the different needs of senior citizens and provide concrete guidance to evaluate information technologies for them. (shrink)

The ageing society poses significant challenges to Europe’s economy and society. In coming to grips with these issues, we must be aware of their ethical dimensions. Values are the heart of the European Union, as Article 1a of the Lisbon Treaty makes clear: “The Union is founded on the values of respect for human dignity…”. The notion of Europe as a community of values has various important implications, including the development of inclusion policies. A special case of exclusion concerns the (...) gap between those people with effective access to digital and information technology and those without access to it, the “digital divide”, which in Europe is chiefly age-related. Policies to overcome the digital divide and, more generally speaking, e-inclusion policies addressing the ageing population raise some ethical problems. Among younger senior citizens, say those between 65 and 80 years old, the main issues are likely to be universal access to ICT and e-participation. Among the older senior citizens, say those more than 80 years old, the main issues are mental and physical deterioration and assistive technology. An approach geared towards the protection of human rights could match the different needs of senior citizens and provide concrete guidance to evaluate information technologies for them. (shrink)

Räsänen draws a distinction between chronological age and biological age and argues that biological ageing is (sometimes) desirable. To demonstrate this, he asks us to consider the case of April, who like Karel Čapek’s Elina Makropulos, has stopped biologically ageing. Unlike Makropulos, though, April’s biological ageing was halted before puberty, so she will never mature into adulthood. Räsänen contends this case shows ageing can be desirable, but this equivocates between maturing and ageing. Here I argue biological ageing, or (...) the wear and tear normally associated with chronological ageing, isprima facieundesirable, but that maturing can beprima faciedesirable. (shrink)

We explore aspects of an experimental approach to mathematical proof, most notably number crunching, or the verification of subsequent particular cases of universal propositions. Since the rise of the computer age, this technique has indeed conquered practice, although it implies the abandonment of the ideal of absolute certainty. It seems that also in mathematical research, the qualitative criterion of effectiveness, i.e. to reach one’s goals, gets increasingly balanced against the quantitative one of efficiency, i.e. to minimize one’s means/ends ratio. Our (...) story will lead to the consideration of some limit cases, opening up the possibility of proofs of infinite length being surveyed in a finite time. By means of example, this should show that mathematical practice in vital aspects depends upon what the actual world is like. (shrink)

This article examines implications of computer-sifted information: What happens when that information is reshuffled and used for other purposes than originally intended? Historical concepts of the philosophy of privacy are examined, essentially to demonstrate that a lack of clear precedent further confuses a fast-changing situation. The author argues that, a 100-odd years ago, advancing media technology prompted Louis Brandeis to proclaim a right to be let alone - but in the intervening years we have not been particularly effective in developing (...) proactive ethics and policy to deal with privacy issues. One case, a bill to restrict access to motor vehicle information, is cited as an example of proactive legislation; without advocating specific legislation, the author calls for increased foresight in the issue of technology and privacy. (shrink)

One of the most common contemporary approaches for developing an ethics of artificial intelligence (AI) involves elaborating guiding principles. This essay explores the limitations of this approach, using the history of bioethics as a comparative case. The examples of bioethics and recent AI ethics suggest that principles are difficult to implement in everyday practice, fail to direct individual action, and can frequently result in a pure proceduralism. The essay encourages an additional attention to virtue, which forms the dispositions of actors, (...) directs them to valued ends, and encourages right action in particular situation to complement principles. Practices and professions like medicine or warfighting that already have rich traditions of reflection on virtue ethics will be especially fruitful fields for developing an AI ethics of virtue. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medicine-Based Values?Åge Wifstad (bio)KeywordsEthics committees, judgment, common moralityToulmin's DiagnosisIn his classical article with the unforgettable title "How medicine saved the life of ethics" (Toulmin 1982), Stephen Toulmin claims that medicine saved ethics by giving the philosophers a positive reality check through medical challenges: (1) Ethics in medicine is a serious topic, not just something to discuss at seminars. If, for example, both A and B need treatment and there (...) are only enough resources for one, the fundamental interests of these two people compete against each other. (2) In clinical medicine, the individual case might demand a different approach than that suggested by theory. Similarly, an ethicist who is confronted by a diversity of medical cases becomes aware of the fact that solutions drawn from ethical theory can be irrelevant in practice. (3) The moral philosopher has often focused on the individual and his or her universal commitments. The fact that ethical dilemmas can have deep roots in practical challenges and must be understood within a certain context has been "forgotten." (4) In clinically relevant ethics, it is important to find solutions that all involved parties find reasonable. This revitalizes central Aristotelian schools of thought on, for example, ethical judgment and situational understanding.Today, there is a common understanding that in both the education of doctors and in the implementation of medical knowledge and technology there needs to be ethical guidelines and control. Toulmin wants us to see that the background for this agreement is multifaceted. It was not just the ethicists who saved the doctors. The doctors helped the ethicists to escape their academic isolation.Ethics CommitteesThe establishment of ethics committees is perhaps the most interesting example of this. Here it is especially clear how ethical judgment establishes a basis for decision making: Each case presented to an ethics committee is special because one cannot reference decisions made in similar cases. At the same time, we are expected to handle similar cases equally. Consideration of the concrete, individual case must be balanced with the principle of similar treatment. Second, as a committee member, one must interpret and respect ethical principles that cannot be easily defined. Every principle must be interpreted and implemented within a specific and concrete context. Third, one must consider the law, but seen isolated, the implications of relevant rules can be difficult to determine. Fourth, the status of principles and rules are open for interpretation. The most important example of this is the Declaration of Helsinki, which was established through cooperation between the worlds' doctors unions. The strength and end result of such a document can be discussed. Fifth, multiple but partly conflicting juridical and ethical considerations can be [End Page 179] relevant at the same time. An example: Decisions about confidentiality can prevent data gathering that is crucial in ensuring that a research project is scientifically acceptable. Two important ethical considerations are then put up against one another. As a sixth and final point, it can be mentioned that the ethics committee is expected to make a qualitative, scientific judgment. But what kind of quality judgment and how detailed it should be is up for discussion.Two Definitions of Ethical JudgmentThe fact that the committee must base their holistic decision on ethical judgment means that the committee, in an important sense of the word, stands freely: It can be difficult to refer to specific ethical rules or laws when making an external review of the committee's decision. Unless the committee has clearly not followed known principles and rules, then the committee is able to confront criticism by replying that the decision is based on holistic considerations, where many views have been taken into account. In this way, the usage of ethical judgment makes sure that the committee has freedom to act. The catch here is that the committee's responsibility becomes even more obvious. One cannot simply say that the decision is made based on rules and principles formulated by others, such as the state. The committee must, as a unit, be able to defend their decision.The complexity of the work of the committee can, however, make it more tempting to think about ethics in... (shrink)

With dying increasingly becoming a medicalised experience in old age, we are witnessing a shift from concern over death itself to an interest in dying ‘well’. Fierce discussions about end-of-life decision making and the permissibility of medical intervention in dying, discursively structured around the notion of a ‘good’ death, are evidence of this shift. This article focuses on ‘autonomy’ and ‘dignity’ as key signifiers in these discussions. Rather than being fully fixed and stable, both signifiers are contingent and carry a (...) variety of meanings within different discursive projects. The article aims to distinguish the varieties of these signifiers by elaborating existing theoretical perspectives on autonomy and dignity, and also, starting from a perspective on mass media as sites of meaning production and contestation, to study the contingency of autonomy and dignity in Belgian newspaper coverage of four prominent euthanasia cases. By means of a discourse-theoretical textual analysis, this study exposes a dominant—yet contested—articulation of rational-personal autonomy and of dignity in external terms as something that can be obtained, retained or lost, rather than in terms of intrinsic human integrity. These logics of representation reflect a more general late modern dominance of liberal autonomy and of dignity as being closely connected to self-identity, but at the same time result in limited visibility of alternative ways of experiencing an autonomous and dignified death. (shrink)

Moral Constraints on War offers a principle-by-principle presentation of the transcultural roots of the ethics of war in an age defined by the increasingly international nature of military intervention.

OBJECTIVES: To identify the factors that influence the assessment of reported cases of physician-assisted death by members of the public prosecution. DESIGN/SETTING: At the beginning of 1996, during verbal interviews, 12 short case-descriptions were presented to a representative group of 47 members of the public prosecution in the Netherlands. RESULTS: Assessment varied considerably between respondents. Some respondents made more "lenient" assessments than others. Characteristics of the respondents, such as function, personal-life philosophy and age, were not related to the assessment. Case (...) characteristics, i.e. the presence of an explicit request, life expectancy and the type of suffering, strongly influenced the assessment. Of these characteristics, the presence or absence of an explicit request was the most important determinant of the decision whether or not to hold an inquest. CONCLUSIONS: Although the presence of an explicit request, life expectancy and the type of suffering each influenced the assessment, each individual assessment was dependent on the assessor. The resulting danger of legal inequality and legal uncertainty, particularly in complicated cases, should be kept to a minimum by the introduction of some form of protocol and consultation in doubtful or boundary cases. The notification procedure already promotes a certain degree of uniformity in the prosecution policy. (shrink)

Increasing attention to the issue of child labor has been reflected in codes of conduct that emerged in the past decade in particular. This paper examines the way in which multinationals, business associations, governmental and non-governmental organizations deal with child labor in their codes. With a standardized framework, it analyzes 55 codes drawn up by these different actors to influence firms' external, societal behavior. The exploratory study helps to identify the main issues related to child labor and the use of (...) voluntary instruments such as codes of conduct. Apart from a specific indication of the topics covered by the code, especially minimum-age requirements, this also includes monitoring systems and monitoring parties. Most important to company codes are the sanctions imposed on business partners in case of non-compliance. Severe measures may be counterproductive as they do not change the underlying causes of child labor and can worsen the situation of the child workers by driving them to more hazardous work in the informal sector. This underlines the importance of a broad rather than a restrictive approach to child labor in codes of conduct. The paper discusses the implications of this study, offering suggestions for future research. (shrink)

Despite their status as high-income food producing nations, children and their caregivers, both in the United States (U.S.) and Australia can experience food insecurity. Nutrition researchers formed a joint U.S.-Australia collaboration to help advance food security for households with young children aged 0–5 years. This study investigated food insecurity from the perspective of caregivers, especially their perceptions of the impact of food insecurity on their own childhood, their current life, and for the children in their care. Semi-structured interviews were conducted (...) from July to September 2020 during the COVID-19 pandemic. Participants were recruited in Omaha, Nebraska, U.S. (_n_ = 19) and Melbourne, Victoria, Australia (_n_ = 22), during periods of stay-at-home public health orders. These two case study sites enabled an exploration of some universal, and some context-specific, social, economic, and health conditions that buffer, or exacerbate, food insecurity for families in these neo-liberal political settings. An inductive thematic analysis was conducted and established six themes:_growing up poor_, _lessons learned_,_ feeding a family amidst a pandemic_,_ caregiver coping strategies_, _food security in the early years_ and _protecting (young) children_. Perspectives on local anti-hunger strategies were organized to outline participant’s preferred solutions. Household food insecurity is conceptualized in public policy in the U.S. and Australia as a short-term crisis for people, justifying austere, time-limited and patchwork solutions. A narrative of caregivers’ lived experience of food insecurity suggests that it is inter-generational, and exacerbated by a food system shock (i.e., COVID-19). These findings from two varying cities and nations offer a different conceptualization of the timespan and nature of the phenomenon of food insecurity, challenging a dominant policy narrative and highlighting the inadequacy of current so-called solutions. (shrink)

Besides offering opportunities in both clinical and non-clinical domains, the application of novel neuroimaging technologies raises pressing dilemmas. ‘Responsible Research and Innovation’ (RRI) aims to stimulate research and innovation activities that take ethical and social considerations into account from the outset. We previously identified that Dutch neuroscientists interpret “responsible innovation” as educating the public on neuroimaging technologies via the popular press. Their aim is to mitigate (neuro)hype, an aim shared with the wider emerging RRI community. Here, we present results of (...) a media-analysis undertaken to establish whether the body of articles in the Dutch popular press presents balanced conversations on neuroimaging research to the public. We found that reporting was mostly positive and framed in terms of (healthcare) progress. There was rarely a balance between technology opportunities and limitations, and even fewer articles addressed societal or ethical aspects of neuroimaging research. Furthermore, neuroimaging metaphors seem to favour oversimplification. Current reporting is therefore more likely to enable hype than to mitigate it. How can neuroscientists, given their self-ascribed social responsibility, address this conundrum? We make a case for a collective and shared responsibility among neuroscientists, journalists and other stakeholders, including funders, committed to responsible reporting on neuroimaging research. (shrink)

To commemorate 40 years since the founding of the Journal of Business Ethics, the editors in chief of the journal have invited the editors to provide commentaries on the future of business ethics. This essay comprises a selection of commentaries aimed at creating dialogue around the theme Business versus Ethics?. The authors of these commentaries seek to transcend the age-old separation fallacy :409–421, 1994) that juxtaposes business and ethics/society, posing a forced choice or trade off. Providing a contemporary take (...) on the classical question “if it’s legal is it ethical?”, David Hess explores the role of the law in promoting or hindering stakeholder-oriented purpose and governance structure. Jeffrey Harrison encourages scholars to move beyond the presupposition that businesses are either strategic or ethical and explore important questions at the intersection of strategy and ethics. The proposition that business models might be inherently ethical or inherently unethical in their design is developed by Sheila Killian, who examines business systems, their morality, and who they serve. However, the conundrum that entrepreneurs are either lauded for their self-belief and risk-taking, or loathed for their self-belief and risk-taking, is discussed by M. Tina Dacin and Julia Roloff using the metaphor of taboos and totems. These commentaries seek to explore positions that advocate multiplicity and tensions in which business ethics is not either/or but both. (shrink)

Ethical questions about information and communications technologies have been debated since World War II. Western democracies have had more than 50 years of experience in addressing and organising the ethical, social and legal aspects of scientific and technological developments. However, this expertise, tradition and experience are not enough to manage the most urgent ethical and social issues and contemporary challenges involving ICT. A systematic and institutional organisation of social values in the context of modern ICT tools is needed.This paper focuses (...) on four major areas: developing a specific approach to ethical issues raised by ICT; describing in more detail the age-related digital divide in Europe; identifying technology trends and emerging challenges; and defining the legal framework for inclusion of senior citizens in the digital society. The paper then concludes with a summary of its key points on the basis of which it makes three proposals as a contribution to efforts aimed at overcoming the exclusion of senior citizens from today's Information Society. (shrink)

In this article we focus upon the embodiment of vulnerability as an area in which medicine, society and the humanities can be profitably conjoined. We illustrate our argument with two interrelated case studies of narratives of the embodiment of ageing and longevity. First, we draw upon Leoš Janáček’s opera The Makropulos Case (1926) as a locus for debates about human longevity. Second, we discuss 70-year-old Janáček’s decade of unrequited love for a woman 37 years younger than himself, through an (...) examination of their intimate letters. We suggest that both the opera and elements of Janáček’s biography illuminate the passionate emotions that are often hidden behind ‘the mask of ageing’. Finally, we propose that a focus on the embodiment of vulnerability is a productive catalyst for research on narratives of ageing. (shrink)

Background: Metaphors are often used within the context of ethics and healthcare but have hardly been explored in relation to moral reasoning. Objective: To describe a central set of metaphors in one case and to explore their contribution to moral reasoning. Method: Semi-structured interviews were conducted with 16 parents of a child suffering from the neurodegenerative disease CLN3. The interviews were recorded, transcribed, and metaphors were analyzed. The researchers wrote memos and discussed about their analyses until they reached consensus. Ethical (...) considerations: Participants gave oral and written consent and their confidentiality and anonymity were respected. Findings: A central set of metaphors referred to the semantic field of the hands and arms and consisted of two central metaphors that existed in a dialectical relationship: grasping versus letting go. Participants used these metaphors to describe their child’s experiences, who had to “let go” of abilities, while “clinging” to structures and the relationship with their parent(s). They also used it to describe their own experiences: participants tried to “grab” the good moments with their child and had to “let go” of their child when (s)he approached death. Participants, in addition, “held” onto caring for their child while being confronted with the necessity to “let go” of this care, leaving it to professional caregivers. Discussion: The ethical analysis of the findings shows that thinking in terms of the dialectical relationship between “grasping” and “letting go” helps professional caregivers to critically think about images of good care for children with CLN3. It also helps them to bear witness to the vulnerable, dependent, and embodied nature of the moral self of children with CLN3 and their parents. Conclusion: Metaphorical reasoning may support the inclusion of marginalized perspectives in moral reasoning. Future studies should further explore the contribution of metaphorical reasoning to moral reasoning in other cases. (shrink)

Information communications technologies like laptops, smartphones and portable storage devices facilitate travel, communication and documentation for researchers who conduct fieldwork. But despite increasing awareness about the ethical complications associated with using ICTs among journalists and humanitarians, there are few reflections on digital security among researchers. This article seeks to raise awareness of this important question by outlining three sets of ethical challenges related to digital security that may arise during the course of field research. These ethical challenges relate to informed (...) consent and confidentiality, collecting, transferring and storing sensitive data, and maintaining the personal security and integrity of the researcher. To help academics reflect on and mitigate these risks, the article underscores the importance of digital risk assessments and develops ten basic guidelines for field research in the digital age. (shrink)

In this essay I first review Kaplan’s theory of linguistic character, and then explain and motivate a concept of doxastic character. I then develop some concepts for dealing with the topic of belief retention and then, finally, discuss Rip Van Winkle. I come down on Kaplan’s side with respect to the Frege-inspired strategy, narrowly construed. But I advocate something like the Frege-inspired strategy, if it is construed more broadly. On my view it is remarkably easy to retain a belief, and (...) I think Evans is quite wrong about Rip and Kaplan. The central concept I develop, however, that of an information game, is in the spirit of much of Evans’ work. I also borrow some of his terminology. (shrink)

Next SectionThe principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice (...) reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion. (shrink)

Everyone knows that Emerson was a moralist, but what does that really mean? In an attempt to answer that question, Gustaaf Van Cromphout provides in Emerson's Ethics a detailed and philosophically grounded discussion of Emerson's moral thought. In this first comprehensive study of Emerson's ethics in the broader context of ethical theory, Van Cromphout explores Emerson's answers to what he considered the basic question facing any thinking human being: "How should I live?" Van Cromphout begins by examining Emerson's college essays (...) on ethics--essays that reflect his response to the moral thought prevailing in his intellectual environment. He then discusses the mature Emerson's attempt to establish ethics on a surer foundation than the religion inherited from his forebears, showing that Emerson was influenced significantly by Kant's moral thought. He goes on to examine Emerson's search for a morally competent self in an age when the very notion of "self" was under serious threat. The ethical dimension of Emerson's politics and his theories of friendship and love, as well as the quest for a life worth living in the modern world, are also addressed. The last chapters are devoted to nature and literature. Van Cromphout explores Emerson's understanding of nature as a focus of ethical responsibility, and he examines the corruptibility of language, the ethics of self- expression, and the moral responsibilities of writers toward their audiences. Emerson believed that ethics permeated every aspect of human life. By examining Emerson's understanding of ethics and his contribution to ethical thought, Emerson's Ethics shows one of the truly great minds in American culture confronting issues of fundamental relevance to all human beings. Filling an important gap in Emerson studies, this book will appeal not only to readers interested in Emerson and his significance in American thought and literature but also to readers concerned with ethics and, more generally, with the interrelations of literature and philosophy. (shrink)

This book critically examines what role, if any, should the notion of perfection play in the debate regarding the ethics of human enhancement. It defends that the concept of -human perfection- needs to be central when morally assessing human enhancements.".

Can a subject who expresses a belief with ‘today’ on a given day, and subsequently loses track of time, retain and re-express that belief on a future, potentially distant day? Since Kaplan’s tentative remarks on Rip Van Winkle, it has become popular to answer this question in the positive. However, a remarkably simple variation of the Rip Van Winkle story can show that this kind of view leads to a puzzling dilemma: either subjects cannot re-express a belief with utterances of (...) ‘today’ on the same day, or else they may rationally exhibit conflicting stances toward the same ‘today’-belief. This result may be seen as supporting the claim that retention of ‘today’-belief over time requires the tracking of days. Yet it may also spur further research into the capacities involved in belief retention and re-expression to solve the puzzle. (shrink)

While certain substantial moral dilemmas in health care have been given much attention, like abortion, euthanasia or gene testing, doctors rarely reflect on the moral implications of their daily clinical work. Yet, with its aim to help patients and relieve suffering, medicine is replete with moral decisions. In this qualitative study we analyse how doctors handle the moral aspects of everyday clinical practice. About one hundred consultations were observed, and interviews conducted with fifteen clinical doctors from different practices. It turned (...) out that the doctors’ approach to clinical cases followed a rather strict pattern across specialities, which implied transforming patients’ diverse concerns into specific medical questions through a process of ‘essentialising’: Doctors broke the patient’s story down, concretised the patient’s complaints and categorised the symptoms into a medical sense. Patients’ existential meanings were removed, and the focus placed on the patients’ functioning. By essentialising, doctors were able to handle a complex and ambiguous reality, and establish a medically relevant problem. However, the process involved a moral as well as a practical simplification. Overlooking existential meanings and focusing on purely functional aspects of patients was an integral part of clinical practice and not an individual flaw. The study thus questions the value of addressing doctors’ conscious moral evaluations. Yet doctors should be aware that their daily clinical work systematically emphasises beneficence at the expense of others—that might be more important to the patient. (shrink)

Ethics, Aging and Society...is the first major work in ten years to critically address issues and methodologies in aging and ethics...This well-organized volume begins theoretically and offers new ways of thinking about ethics that can handle the complexities and realities of aging in particular social contexts."--Choice This new research-based book, by experts in the field of ethics, is excellent and much-needed...I challenge you to consider reading this book and seeing all the ways in which you might be forced to rethink (...) things that most of us take as given for ethics and aging. I know you will not be disappointed and I guarantee you will end up thinking long and hard about personal and professional decisions you may have made as well as your assumptions about aging in America."--CFLE Network Newsletter This is a book that should be required reading for all involved in the ethical provision of services to the aging on any level, as well as for policy makers and administrators in positions of influence over the lives of older patients."--PsycCRITIQUES...the authors' application of feminist ethics to frail elders rings true to both my clinical experience working with frail elders, and my research experience trying to understand their quality of life concerns...there were true gems of ideas [in this book] that illuminated the limitations of the dominant paradigm of autonomy in bioethics. [The authors] make a compelling critique of end-of-life care."--GeriPal: A Geriatrics and Palliative Care Blog This book presents second generation issues in ethics, aging, and society by presenting critical outcomes that arise when ethics is applied to the practical concerns that occur in day-to-day elder care. The first volume in over 10 years to address ethics and gerontology, it is unparalleled in its comprehensiveness and integration of well-developed philosophical arguments with empirical research, humanistic scholarship, and insights gained from practical experience. This book challenges the tried and true approaches to ethical issues in aging and opens avenues for creative problem-solving. The authors' diverse backgrounds bring the advantages of both interdisciplinary scholarship and practical experience to this comprehensive textbook. It is an essential resource for those interested in, and working with, older people, from upper-level undergraduate students and graduate-division students, to gerontology practitioners in training. Key Features: Presents the first major work in over 10 years to integrate the disciplines of ethics and aging Includes case studies derived from day-to-day practice Addresses individual/clinical ethics in health and long-term care and ethical issues raised by public policy, cultural norms and social attitudes Examines such critical issues as Alzheimer's disease, long-term care, ageism, public policy, anti-aging medicine, elder abuse, and natural disasters Explores new directions in ethical and social philosophy as they pertain to gerontology and care. (shrink)

Ethical issues at the workplace have once again become topical and important due to considerable adverse publicity surrounding reports of unethical business practices by corporate managers. Accordingly, this paper re-visits the question of whether gender, age and work experience do have an effect on ethical judgement, using 655 business students as respondents. This is necessary as business students are likely to become managers during their career and will face complex ethical concerns and dilemmas in their daily, routine affairs. The findings (...) currently demonstrate that females are more ethically aware than their male counterparts – that is, there are differences between males and females regarding ethical judgement. There is also evidence to suggest that age is a factor that does impact on ethical judgement. However, we also found evidence to suggest that in some cases, the age factor does not necessarily have a significant impact on ethical awareness. The results further indicate that there is a difference in ethical judgement related to work experience. However, at the same time, in one question there is no evidence to suggest the claim that work experience does impact significantly on ethical judgement. Overall, it appears that ethical awareness does increase alongside work experience. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reading Paradise Regained EthicallyRobert B. PierceMuch modern criticism follows a long tradition by attending to the presumed effect of literature on our personal and political lives. Feminists, cultural materialists, new historicists, and postcolonialists frequently remind us that texts are "not innocent," and such analysts seek to make explicit the values and judgments that literary texts encourage in their readers. Whether in the vein of unmasking or of celebrating, we (...) critics often attribute great ethical and political significance to the works we study, but we are inclined to be vague about the mechanisms by which these effects occur. Given that I share this presumption that the texts we love to study matter to our lives, I would like to look more closely at how the process occurs, taking Milton's Paradise Regained as a test case.Does our reading of literary texts affect us ethically, and should it?1 An ancient and powerful critical tradition has taken for granted that the answer to both questions is yes. At the very least, good literature read properly is seen as one among the shaping forces of our education. But, beginning in the late eighteenth century, the theoretical movement to separate esthetics from ethics rendered this assumption problematic. Perhaps the beautiful is a value quite separate from the good. Later the literary school of estheticism brashly proclaimed the triumph of beauty over goodness under the banner of art for art's sake, [End Page 208] and Auden more modestly noted in "In Memory of W. B. Yeats" that "poetry makes nothing happen,"2 presumably including in the denial the moral betterment of its readers. The idea that literature is good for us has been almost embarrassing for the past century or so. On the other hand, many feminists and cultural critics have recently argued in effect that literature is often bad for us, that it is implicated in the ethical and political life of the time when it is produced and also in the time when it is received or consumed, so that it may tend to reinforce the ideology of one period or the other. In their assumption that literature is ethically significant they agree with most ordinary people and with the cultural right, especially in concern about its influence.What does this recent set of contentions entail? The term "implicated" that is characteristically used in such analysis claims at a minimum that the literary text in question has been shaped in production, consumption, or both by larger cultural forces, shaped in such a way as to incorporate certain values. Most such analyses go further to assert or suggest that the text under study helps to reinforce those values in the original audience or in later consumers (sometimes by attacking opposed values).3 The characteristic rhetorical stance in such readings is an implied warning to the reader against the insidious effect of the text lest it instill some fallacious, unethical, or politically harmful attitude or idea. Often the reader is rhetorically invited to share a position of intellectual superiority along with the critic, both of them above the corruption that afflicts an unspecified gullible audience. Thus many modern critics identify a romanticizing of war and the military hero in Shakespeare's Henry V, though they differ among themselves in that some locate both poison and cure in the text itself (suggesting, for example, that Shakespeare subverts the official ideology that he portrays), while some offer a "reading against the text," a cure administered by the critic against the wholly poisonous work.Such critics frequently manifest a reasonable caution about their own ethical and political stance. In an age of widespread pluralism and cultural relativism, we have learned to suspect self-confident proclamations of the ethical and political truth by critics as well as by literary authors, and in particular we are suspicious of official codes of conduct, including our own. Also we are (often at least) less confident than our forebears in purporting to state the meaning of a text. We have learned to heed the ambiguities and self-undermining elements in texts that complicate the capacity of any simple critical statement to reflect adequately what the text means. We no... (shrink)

In the development of new vaccines, many trials use age de-escalation: after establishing safety and efficacy in adult populations, progressively younger cohorts are enrolled and studied. Age de-escalation promotes many values. The responsibility to protect children from potential risks of experimental vaccines is significant, not only given increased risks of adverse effects but also because parents and medical professionals have a moral responsibility to protect children from harms associated with novel, uncertain interventions. Further, given that young children cannot provide informed (...) consent, acceptable risks for research requiring proxy consent are lower than for adults making decisions for themselves. Although age de-escalation approaches are widely used in vaccine trials, including notably in the recent development of pediatric COVID-19 vaccines, ethicists have not addressed the benefits and risks of these approaches. Their benefits are largely assumed and unstated, while their potential risks are usually overlooked. There are no official ethics guidelines for the use of age de-escalation in clinical research. In this paper, we provide a systematic account of key moral factors to consider when employing age de-escalation. Analyzing pediatric COVID-19 vaccine development as our key case study, we clarify the benefits, risks, and trade-offs involved in age de-escalation approaches and call for the development of evidence-based best practice guidelines to identify when age de-escalation is likely to be an ethical strategy in vaccine development. (shrink)

The aim of this paper is to reexamine the importance of Rip van Winkle’s case for the problem of cognitive dynamics. First I shall present the main problem of cognitive dynamics. Then I shall explain the relevance of Rip’s case to this problem. After that I shall provide a short presentation of the main solutions to this problem. I shall explicate the problem concerning the manner in which philosophers who propose those solutions defend their response to the question of Rip’s (...) case. My argument shall be that they defend their response either in overly dogmatic or in circular way. Finally, I shall suggest a way out of that problem. (shrink)

In the age of terrorism, the temptations of ruthlessness can be overwhelming. Yet a violent response to violence arguably makes us morally indistinguishable from our enemies. There is perhaps no greater political challenge today than trying to win the war against terror without losing our democratic souls. Michael Ignatieff confronts this challenge head-on, with the combination of hard-headed idealism, historical sensitivity and political judgement that has made him one of the most influential voices in international affairs today. Ignatieff argues that (...) we must not shrink from the use of violence. But its use - in a liberal democracy - must be measured. And we must not fool ourselves that whatever we do in the name of freedom and democracy is good. We may need to kill to fight the greater evil of terrorism, but we must never pretend that doing so is anything better than a lesser evil. In making this case, Ignatieff traces the modern history of terrorism and counter-terrorism, from the nihilists of Czarist Russia and the militias of Weimar Germany to the IRA and the unprecedented menace of Al Qaeda. (shrink)

People increasingly live online, sharing publicly what might have once seemed private, but at the same time are enraged by extremes of government surveillance and the corresponding invasion into our private lives. In this enlightening work, Adam Henschke re-examines privacy and property in the age of surveillance in order to understand not only the importance of these social conventions, but also their moral relevance. By analyzing identity and information, and presenting a case for a relation between the two, he explains (...) the moral importance of virtual identities and offers an ethically robust solution to design surveillance technologies. This book should be read by anyone interested in surveillance technology, new information technology more generally, and social concepts like privacy and property. (shrink)

Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. Mr. H is a ninety-year-old patient with end-stage kidney disease that is no longer (...) manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy). In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient’s daily life, can limit side effects and “dialysis shock”. An individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient’s choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients. (shrink)

People often say that humans are omnivores in order to justify eating meat as normal and veganism as abnormal. The is one of the arguments that vegetarians and vegans encounter when meat-eaters try to defend the moral acceptability of body parts on their plate. When responding to this argument, the position of the vegan is similar to the atheist who time and again is confronted with the same fallacious arguments in support of the existence of god(s). Veganism and atheism are (...) both ethical default positions. Similarly, not killing other people is also a default position. (shrink)

Socioemotional selectivity theory (SST), an influential life-span theory, suggests that older adults prefer persuasive messages that appeal to emotionally-meaningful goals over messages that appeal to knowledge-related goals, whereas younger adults do not show this preference. A mixed-factorial experiment was conducted to test whether older adults (≥65 years) differ from younger adults (25–45 years) in their preference for emotionally-meaningful appeals over knowledge-related appeals, when appeals are clearly developed in line with SST. For older adults we found the expected preference for emotionally-meaningful (...) appeals for cancer centers but not for grocery stores and travel organizations. As expected, in most cases, younger adults did not show a preference. Implications for SST-based communication research and for practice are discussed. (shrink)

How can humanist principles of respect, dignity, and care inform and improve design for non-human lifeforms? This paper uses ageing and dying urban trees to understand how architectural, urban, and landscape design respond to nonhuman concerns. It draws on research in plant sciences, environmental history, ethics, environmental management, and urban design to ask: how can more-than-human ethics improve multispecies cohabitation in urban forests? The paper hypothesises that concepts of dignity and respect can underline the capabilities of nonhuman lifeforms and lead (...) to improved designs for multispecies cohabitation. To investigate the implications of this ethical framework, we 1) indicate injustices of current management in relation to natural and cultural histories of trees; 2) outline a conceptual framework that includes large old trees as stakeholders in urban communities; and 3) use this framework in a thought experiment with urban trees in Melbourne, outlining comparative design outcomes. Our findings show that the expansion of dignity to include nonhuman life is possible and plausible. Such an extension can justify and encourage design innovation for multiple species and sites. The resulting design practices will lead to improvements by supporting communities of trees at all stages of their life-cycles, including old age, death, and rebirth. This approach requires substantial shifts in accepted thinking and practices including history, ethics, aesthetics, regulation, and education. Design can play a significant role in the necessary transitions by demonstrating tangible and positive outcomes. In this context, history emerges as an essential tool that can extend societal imagination by situating possible future places in the context of ancient and ongoing geological, evolutionary, ecological, and cultural processes. (shrink)

Dementia accompanies aging in certain susceptible individuals. The chemical function of the brain remains normal, but certain neurotransmitter-selective diseases, such as Parkinson's disease, Huntington's disease, and Alzheimer's disease occur more commonly with age.There are at least two issues troubling researchers of senile dementia at the moment. One is the contribution of cell death, as opposed to selective neuronal atrophy, to the pathology of degenerative disorders. The other is how early the onset of dementia might be detected. The resolution of such (...) issues is important for the design of therapies for the common and most serious chronic, rather than acute, neurodegenerative disease.Alzheimer's disease is one of the most devastating neurological disorders. The ethical debate is often related to when human biological life ceases or when a person ceases to exist. If the elder is still a person, he/she is no more the same person. Huntington's disease is inherited as a highly penetrant, autosomal dominant neuronal disorder. A genetic test can accurately predict a person's risk and that of the children. As the knowledge of the genetic basis is increasing and prenatal diagnosis gets easier, the possibilities to avoid child disorders will become greater, but genetic testing raises problematic ethical issues. Ethical action involves the right to know and the right not to know, it involves freedom of choice and freedom implies knowledge. It is ethical that relatives in age of procreation should be informed. In any case, efficacy and safety of the procedure, the risk-benefit ratio for a particular disease must be judged to be acceptable and understood through informed consent by the patient or the family or both. (shrink)

TheJournal of Medical Ethicspreviously published on the debate in the UK and the Netherlands concerning the legal age limits imposed on donor-conceived people for access to information about the identity of gamete and embryo donors. In that publication, three arguments were foregrounded against lowering these age limits as a general rule for all donor-conceived people. In this contribution, we engage with these arguments and argue why we think they are insufficient to maintain the age limits. In contrast, we argue for (...) a more suited, contextual and relational ethical framework based on care ethics, which emphasises relational autonomy and its dynamic, contextual development. This framework, we argue, provides a comprehensive approach for the analysis we made of the question of age limits and was applied in research performed in the Netherlands, commissioned by the Dutch Minister of Health. The framework enabled us to weigh the multidisciplinary—legal, psychological, phenomenological and ethical—findings of our research. (shrink)

Should a person who feels his legal age does not correspond with his experienced age be allowed to change his legal age? In this paper, I argue that in some cases people should be allowed to change their legal age. Such cases would be when: 1) the person genuinely feels his age differs significantly from his chronological age and 2) the person’s biological age is recognized to be significantly different from his chronological age and 3) age change would likely prevent, (...) stop or reduce ageism, discrimination due to age, he would otherwise face. I also consider some objections against the view that people should be allowed to change their legal age and find them lacking. (shrink)

Forensic age estimation in living subjects is an important task for forensic experts, especially in countries where birth records are not well maintained. The process often is used to confirm the chronological age of a criminal or victim when there is a lack of available evidence, such as birth records and witnesses. Focusing on the case of Turkey where the Greulich and Pyle method is often the only method used in forensic estimation of age, this paper seeks to discuss the (...) ethical implications of the process, which are of special concern for women. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Ethics and the Elderly: The Challenge of Long-Term Care by Sarah M. Moses, and: Loving Later Life: An Ethics of Aging by Frits de LangeDolores L. ChristieEthics and the Elderly: The Challenge of Long-Term Care Sarah M. Moses maryknoll, ny: orbis, 2015. 206 pp. $38.00Loving Later Life: An Ethics of Aging Frits de Lange grand rapids, mi: eerdmans, 2015. 169 pp. $19.00Today many women and men live beyond (...) the so-called third age of life and enter their eighties, the "fourth age," during which the toll of time and the growing incidence of life-limiting conditions wear down even the best-preserved of the human species. Debilitating disease and normal ebbing of human function become more concentrated in this demographic bubble. As people enter their eighties, their world tends to narrow both physically and mentally, creating a need for increasing care. Often the elderly are rendered passive and dependent, forced to cede both autonomy and dignity. They become objects with little voice, requiring greater care and increasing cash. Likewise, as the baby boom generation enters this group, those living in the fourth age make up an increasing percentage of the population. Additionally, modern models of care for the elderly, often based on efficiency and cost-effectiveness, tend to erode their human dignity. Together these factors demonstrate a growing moral problem.What to do? These two books provide valuable road maps for how to proceed. They detail the reality and moral urgency of the situation. Both offer principles from philosophical and religious traditions that outline a good moral model: one of care, compassion, dignity, and community. They draw insights from Augustine and Thomas Aquinas, Karl Barth, and Dietrich Bonhoeffer, among [End Page 214] others. Both reference the Western biblical tradition, which honors the elderly even in the face of their limitations.Although the authors offer wise and thoughtful suggestions to address this growing moral crisis, they approach the serious moral issue very differently. Sarah Moses outlines a compelling case for a new interventional model for elderly living. While her book plays some muted chords that hint at "dissertation," the melody it conveys is strikingly forte and well worth the read.She presents two concrete examples of what good interaction with the elderly might look like. One draws from the international intentional outreach and residential community (the Community of Sant'Egidio), the other is a brick-and-mortar model (the Green House Project). Using both biblical paradigms and church teaching over the centuries, Moses makes the case for treating all persons with dignity and promoting their involvement in decision making as much as possible. The scriptural message she highlights—both our duty to the elderly and the "disappointment and depression" (105) of growing old—is particularly compelling.In her examples of good long-term care, community development is important. In the Sant'Egidio model, volunteers share a common life "through gathering for prayer and various outreach services to the poor" (39). There is motivation to support elderly in their own homes, but the project promotes small, family-like resident facilities when this is not possible. The physical place is less emphasized than the relationship among various age and economic groups.The Green House Project is based in a new vision of homes for the challenged elderly. Results of the project show that not only did staff remain in their jobs longer (nursing home employment turnover is extensive) but visitation by family members increased. Even such a simple thing as a different physical model for the actual building—replacing long halls and routinization with a more home-like environment—has positive results.Moses calls on leadership in church and community to educate, to designate funds for elder care, and to look beyond the caring and the construction of good facilities. She notes how important it is to work politically to change attitudes and actions.She sees care for all dependent people as a responsibility of both the church community and society in general. This includes fostering awareness, encouraging ongoing participation of the elderly in life—including church life—and allocating public resources. Bottom line: she calls for smaller institutions, meaningful opportunities for the... (shrink)