Long-term care is controversial because it involves foundational disputes. Some are moral-economic, bearing on whether the individual, the family, or the state is primarily responsible for long-term care, as well as on how one can establish a morally and financially sustainable long-term-care policy, given the moral hazard of people over-using entitlements once established, the political hazard of media democracies promising unfundable entitlements, the demographic hazard of relatively fewer workers to support those (...) in need of long-term care, the moral hazard to responsibility of shifting accountability to third parties, and the bureaucratic hazard of moving from individual and family choice to bureaucratic oversight. These disputes are compounded by controversies regarding the nature of the family (Is it to be regarded primarily as a socio-biological category, a fundamental ontological category of social reality, or a construct resulting from the consent of the participants?), as well as its legal and moral autonomy and authority over its members. As the disputes show, there is no common understanding of respect and human dignity that will easily lead out of these disputes. The reflections on long-term care in this issue underscore the plurality of moralities defining bioethics. (shrink)

Many Western countries have introduced market principles in healthcare. The newly introduced financial instrument of “care-intensity packages” in the Dutch long-term care sector fit this development since they have some characteristics of a market device. However, policy makers and care providers positioned these instruments as explicitly not belonging to the general trend of marketisation in healthcare. Using a qualitative case study approach, we study the work that the two providers have done to fit these instruments (...) to their organisations and how that enables and legitimatises market development. Both providers have done various types of work that could be classified as market development, including creating accounting systems suitable for markets, redefining public values in the context of markets, and starting commercial initiatives. Paradoxically, denying the existence of markets for long-term care and thus avoiding ideological debates on the marketisation of healthcare has made the use of market devices all the more likely. Making the market invisible seems to be an operative element in making the market work. Our findings suggest that Dutch long-term care reform points to the need to study the ‘making’ rather than the ‘liberalising’ of markets and that the study of healthcare markets should not be confined to those practices that explicitly label themselves as such. (shrink)

The purpose of this commentary is to present and respond to the gap that currently exists in providing culturally inclusive residential long-term care options for Indigenous peoples in Ontario. After presenting statistics regarding the Indigenous population and long-term care options, we argue that we have an ethical responsibility to offer more culturally inclusive long-term care.

In industrialized democracies, contractionist social welfare policies have transformed healthcare systems. This has led to reallocations of long‐term care work that have perpetuated gender inequities. The appropriated work of female family caregivers substitutes for paid nursing work, and the household is the primary site for long‐term care delivery. In this article, central premises of critical social theory are used to analyse current long‐term care policy and to explicate how research facilitated the (...) development of mixed economies of care. Problematic consequences of home caregiving are revealed through a depiction of contemporary Canadian families, a critique of the related empirical research literature, and a discussion of the assumptions that underlie long‐term care policies. The article concludes with suggestions which nurse researchers could use to contribute to the reformulation of policies to render them just and equitable. (shrink)

It has become common in medical ethics to discuss difficult cases in terms of the principles of respect for autonomy, beneficence, nonmaleficence, and justice. These moral concepts or principles serve as maxims that are suggestive of appropriate clinical behavior. Because this language evolved primarily in the acute care setting, I consider whether it is in need of supplementation in order to be useful in the long-term care setting. Through analysis of two typical cases involving residents of (...) long-term care facilities, I argue for the additional principles of candor and responsibility for narrative integrity. (shrink)

Lisa A. Eckenwiler, Long-term care, globalization, and justice, Baltimore: The Johns Hopkins University Press, 2012, reviewed by Lynette Reid.

The realities of long‐term care call for a refurbished, concrete concept of autonomy that systematically attends to the history and development of persons and takes account of the experiences of daily living.

The American system of long‐term care is disorganized and expensive. Obtaining care for a loved one is a confusing and difficult journey. When it comes to paying for that care, a bit over half who receive care are supported at least partially by insurance, and those with no insurance pay entirely out of pocket. The costs are exorbitant. What makes the system function is reliance on unpaid family members, who care for their loved (...) ones often at considerable cost to themselves.As the baby boom generation ages, this creaky system will become increasingly dysfunctional, and a likely shortage of caregivers will be at the heart of the difficulties. The supply of unpaid family caregivers will become limited, as the ratio of people in the category of ages forty‐five to sixty‐four compared to those who are eighty and older shrinks from just above seven to one in 2010 to just above four to one in 2030. Paid caregivers will be needed to take up the slack, yet they are poorly paid, work under very difficult conditions, and receive little respect from the health care system. In this essay, I discuss the circumstances facing these paid home‐care workers and a possible path forward, illustrating the current problems by drawing on interviews I conducted for a book‐length study published in 2017. (shrink)

As human longevity increases, with people living well into their seventies and eighties, the need for long-term care for the elderly most certainly will grow. The longer people live, the more likely they fall prey to chronic disease, as well as to the standard toll the aging process takes on human bodies and psyches. In this article, I examine some of the concerns that a wide variety of governments, individuals, and families have expressed about meeting the (...) class='Hi'>long-term care needs of large numbers of people over sixty-five. I then claim that each of these groups must do its share of long-term care for the elderly, depending on its ability to do so. Finally, I conclude that the more committed a country is to the deconstruction of ingrained notions about who should care and who should work, the more able it will be to meet the long-term care needs of the elderly and other vulnerable populations fairly. (shrink)

This article reveals the outcome of a study on the perceptions of elders, family members, and healthcare professionals and administration providing care in a range of different long-term care facilities in Hong Kong with primary focus on the concepts of autonomy and dignity of elders, quality and location of care, decision making, and financing of long term care. It was found that aging in place and family care were considered the best (...) approaches to long term care insofar as procuring and balancing the values of dignity, autonomy, family integrity and social sustainability were concerned. An elder having the final say was generally accepted. The results also initiated the importance of sharing of financial responsibility among elders, children and government albeit the emphasis was placed on individuals. Furthermore, dignity of elders was not considered purely a synonym of autonomy, but it had also to do with respect, family and social connections. (shrink)

Conducting nursing research in long-term care facilities and with samples of older people requires careful attention to research ethics and the ethical conduct of the study. This review analysed the research ethics of the empirical studies that focus on older people in long-term care settings as research participants. Articles (n = 66) focussing on older people in long-term care settings as research informants were retrieved from an electronic search of MEDLINE (1990 (...) to February 2012) using the MESH terms ‘Nursing’ AND ‘Long-term care’ (578 citations) and ‘Institutionalization’ and ‘Nursing’ (89 citations). Ethical approval procedure was reported in more than half of the studies (58%) and informed consent in two-thirds of the studies (70%). Ethical issues in data collection were described in most of the articles, but only a few reported ethics in problem statement, reporting or presenting implications. There is a need to focus on reporting research ethics and procedures in empirical research on vulnerable people. (shrink)

The realities and myths of long-term care and the challenges it poses for the ethics of autonomy are analyzed in this perceptive work. The book defends the concept of autonomy, but argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long term care. The treatment of actual autonomy stresses the developmental and social nature of human persons and the priority of identification over autonomous choice. The work (...) balances analysis of the ethical concepts associated with autonomy with discussion of the implications of the ethical analysis for long term care. A central chapter involves a phenomenological analysis of four general features of everyday experience (space, time, communication, and affectivity) and explores their practical implications for long term care. This work concludes with a discussion of the advantages associated with a phenomenologically-inspired treatment of actual autonomy for the ethics of long-term care. (shrink)

I argue that a particular epistemological approach, “ecological thinking,” helps to demonstrate that long-term care work is organized transnationally—through health, economic, labor, and immigration policies established primarily by governments, transnational corporations, other for-profit entities, and international lending bodies—to create and sustain injustice against the dependent elderly and those who care for them, and to weaken the care capacities of countries and their health systems, especially those of source countries. An ecological approach also helps to reveal (...) the grounding of global responsibilities and an alternative conception of justice for long-term care and global health equity more generally. (shrink)

Background Professional care workers face ethical issues in long-term care settings (LTCS) for older adults. They need to be independent and responsible, despite limited resources, a shortage of skilled professionals, global and societal changes, and the negative reputation of LTCS work. Research aim Our aim was to describe the care workers’ lived experiences of ethical issues. The findings can be used to gain new perspectives and to guide decision-making to improve the quality of care, (...) occupational well-being and nursing education. Research design Focus group interviews were analyzed using a hermeneutic-phenomenological method. The analysis comprised three steps: naïve reading, structural analysis, and comprehensive understanding. Participants and research context We randomly sampled LTCS service providers in Finland and 53 care workers with different educational backgrounds from seven organizations participated in focus group interviews in 2021. Ethical considerations This was a sensitive study, which was connected to the participants’ individual views of the world, professional ethics and social and health care legislation. The participants' provided informed consent and their anonymity was guaranteed. Findings Care workers spoke about their lived experiences of ethical issues in an emotional way, using practical examples. They talked about how they were experts at caring and advocating for residents, balanced the responsibilities of their different roles, and defended their work to the wider society. The care workers said that ethical aspects of their work were too difficult to solve on their own. There were elements of their working environment and practices that caused unnecessary strain and they needed the commitment of managers, organizations, and society to solve ethical issues in LTCS. Conclusions Ethical issues were related to the well-being of both residents and care workers and reflected both internal and external pressures. Some issues could not be resolved by individuals and needed input from managers, organizations, and society. (shrink)

Respecting the autonomy of disabled people is an important ethical issue for providers of long-term care. In this influential book, George Agich abandons comfortable abstractions to reveal the concrete threats to personal autonomy in this setting, where ethical conflict, dilemma and tragedy are inescapable. He argues that liberal accounts of autonomy and individual rights are insufficient, and offers an account of autonomy that matches the realities of long-term care. The book therefore offers a framework (...) for carers to develop an ethic of long-term care within the complex environment in which many dependent and aged people find themselves. Previously published as Autonomy and Long-term Care, this revised edition, in paperback for the first time, takes account of recent work and develops the author's views of what autonomy means in the real world. It will have wide appeal among bioethicists and health care professionals. (shrink)

The aim of this study was to explore ethically problematic situations in the long-term nursing care of elderly people. It was assumed that greater awareness of ethical problems in caring for elderly people helps to ensure ethically high standards of nursing care. To obtain a broad perspective on the current situation, the data for this study were collected among elderly patients, their relatives and nurses in one long-term care institution in Finland. The patients (...) (n=10) were interviewed, while the relatives (n=17) and nurses (n=9) wrote an essay. Interpretation of the data was based on qualitative content analysis. Problematic experiences were divided into three categories concerning patients’ psychological, physical and social integrity. In the case of psychological integrity, the problems were seen as being related to treatment, self-determination and obtaining information; for physical integrity, they were related to physical abuse and lack of individualized care; and for social integrity, to loneliness and social isolation. This study provided no information on the prevalence of ethical problems. However, it is clear from the results that patient integrity warrants more attention in the nursing care of elderly patients. (shrink)

Although nurses in almost every long-term care facility face daily challenges involving issues related to residents' sexual lives, guidelines for ethically supporting sexual activity are rare and inadequate. A decision-making framework was developed to guide care providers in responding to the sexual expression of residents in long-term care. The framework recommends that nurses should weigh the documented substantial benefits of having a sexual life against harm to the resident and others, and against offence (...) to others. This article illustrates the use of this ethical decision-making framework by using the example of nurses supporting a resident's expression of his sexuality. It is suggested that nurses use this framework to guide their practice when related ethical issues arise. (shrink)

Conducting nursing research in long-term care facilities and with samples of older people requires careful attention to research ethics and the ethical conduct of the study. This review analysed the research ethics of the empirical studies that focus on older people in long-term care settings as research participants. Articles (n = 66) focussing on older people in long-term care settings as research informants were retrieved from an electronic search of MEDLINE (1990 (...) to February 2012) using the MESH terms ‘Nursing’ AND ‘Long-term care’ (578 citations) and ‘Institutionalization’ and ‘Nursing’ (89 citations). Ethical approval procedure was reported in more than half of the studies (58%) and informed consent in two-thirds of the studies (70%). Ethical issues in data collection were described in most of the articles, but only a few reported ethics in problem statement, reporting or presenting implications. There is a need to focus on reporting research ethics and procedures in empirical research on vulnerable people. (shrink)

Background: A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population. Research aim: To identify challenges in implementing the ‘Let Me Decide’ advance care planning programme in long-term-care. Research design: This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families. Participants and research context: long-term- (...) class='Hi'>care residents in two nursing homes and one community hospital. Ethical considerations: The local research ethics committee granted ethical approval. Findings: Following implementation, over 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training. Discussion: The challenges encountered were largely concerned with preserving resident’s autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources. Conclusions: Although it may be too late for many long-term-care residents to complete their own advance care directive, the ‘ Let Me Decide’ programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice. (shrink)

Previously diagnosed by symptoms alone, Alzheimer's disease is now also defined by measures of amyloid and tau, referred to as “biomarkers.” Biomarkers are detectible up to twenty years before symptoms present and open the door to predicting the risk of Alzheimer's disease. While these biomarkers provide information that can help individuals and families plan for long-term care services and supports, insurers could also use this information to discriminate against those who are more likely to need such services. (...) In this article, we evaluate whether state laws prohibit long-term care insurers from making discriminatory or unfair underwriting and coverage decisions based Alzheimer's disease biomarkers status. We report data demonstrating that current state laws do not provide meaningful protections from discrimination by long-term care insurers based on biomarker information. (shrink)

Background: The concept of dignity is recognised as a fundamental right in many countries. It is embedded into law, human rights legislation and is often visible in organisations’ philosophy of care, particularly in aged care. Yet, many authors describe difficulties in defining dignity and how it can be preserved for people living in long term care. Objectives: In this article, Nordenfelt’s ‘four notions of dignity’ are considered, drawing on research literature addressing the different perspectives of (...) those who receive, observe or deliver care in the context of the long-term care environment. Methods: A review of the literature was undertaken using the terms ‘nursing homes’, ‘residential care’ or ‘long-term care’. The terms were combined and the term ‘human dignity’ was added. A total of 29 articles met the inclusion criteria from the United Kingdom (14), United States (2), Australia (1), Sweden (3), Hong Kong (2), Norway (3), Nordic (1), Taiwan (1), Netherlands (1). Ethical Considerations: Every effort has been made to ensure an unbiased search of the literature with the intention of an accurate interpretation of findings. Discussion: The four notions of dignity outlined by Nordenfelt provide a comprehensive description of the concept of dignity which can be linked to the experiences of people living in long-term care today and provide a useful means of contextualising the experiences of older people, their families and significant others and also of staff in long-term care facilities. Of particular interest are the similarities of perspectives of dignity between these groups. The preservation of dignity implies that dignity is a quality inherent in us all. This links directly to the exploration and conclusions drawn from the literature review. Conversely, promoting dignity implies that dignity is something that can be influenced by others and external factors. Hence, there are a number of implications for practice. Conclusion: We suggest that two of Nordenfelt’s notions, ‘dignity of identity’ and ‘dignity of Menschenwüde’, are a common thread for residents, family members and staff when conceptualising dignity within long-term care environments. (shrink)

Certified nursing assistants (CNAs) provide up to 80% of the direct care to older adults in long‐term care facilities.CNAs are perceived as being at the bottom of the hierarchy among healthcare professionals often negatively affecting their job satisfaction. However, manyCNAs persevere in providing quality care and even reporting high levels of job satisfaction. The aim of the present investigation was to identify primary themes that may helpCNAs make meaning of their chosen career; thus potentially partially (...) explaining increases in job satisfaction among this group. Focus groups were conducted withCNAs at three long‐term care facilities. Four themes emerged from the data:CNAwork is good or special;CNAas relationship builder;CNAas expert;CNAas team member. These themes reflect the perceptions that theseCNAs held in regard to themselves and their relationships to others in the work environment and, when present, can contribute to intrinsic job satisfaction. Our meaning‐making themes support the premise thatCNAs do not passively accept the evaluations of others but instead actively frame identities that validate their importance to residents and the institution. (shrink)

This article documents the results of a study on the perceptions of long-term elder care in Beijing in the People's Republic of China by those most intimately involved. The study asked a sample of elderly, family members, and health care professionals, all of whom are involved in care at a variety of long-term care facilities in Beijing, about their perceptions of the care given at these facilities from their particular standpoints as (...) regards issues such as the quality and ideal location of care, decision-making regarding the care receiving, who should be responsible for the financing of care, and the meaning of dignity for the elderly in these facilities. The results showed adherence to traditional family values at least on one level regarding the ideal location of care being with the family and in the home, but also the desire to pass on financing of long-term care facilities and the health care they provide the elderly on to the government. These results are not altogether surprising, but they also clearly demonstrate the larger conflict between traditional views about morality and economic considerations regarding health care financing in the China. (shrink)

This article presents Mencius' concept of human dignity in the Chinese Confucian moral tradition, focused on the context of long-term care. The double nature of Mencius' notion of human dignity as an intrinsic quality of human beings qua being human is analyzed and contrasted with the dominant Western account of human dignity as grounded in personhood. Drawing on the heuristic force of an interview with an elder person in Hong Kong, the insights of the Mencian theory of (...) human dignity are used to provide a moral foundation for long-term care for elder persons in a context of diminishing personhood and shrinking autonomy. (shrink)

The relevance of justice for the current debate on long-term care is explored on the basis of demographic and economic data, especially in the U.S. and Germany. There is a justice question concerning the quality and availability of long-term care for different groups within society. Mapping the justice debate by discussing the two main opponents, John Rawls and Robert Nozick, the article identifies fundamental assumptions in both theories. An exploration of the biblical concept of (...) the “option for the poor” and its influence on a new “ecumenical social teaching from below” leads to the conclusion that a Christian ethical account of long-term care will argue for a system that guarantees decent care to every citizen. The German model of Soziale Pflegeversicherung is presented as one possible option for putting this ethical guideline into political practice. In a final reflection, the role of religious affiliation for long-term care is discussed by looking at empirical data and by naming seven dimensions of faith-driven long-term care. (shrink)

Background Licensed nurses working in long-term care facilities experience ethical challenges if not resolved can lead to moral distress. There is a lack of an English-language validated tool to adequately measure moral distress in the long-term care setting. Aims To describe the modification and psychometric evaluation of the Moral Distress Questionnaire. Methods Instrument development and psychometric evaluation. Internal consistency using Cronbach’s α to establish reliability was conducted using SPSS version 27.0 while SPSS Amos version (...) 27.0 was used to perform a confirmatory factor analysis of the Moral Distress Questionnaire Participants A national sample of US-licensed nurses who provided direct resident care in long-term care settings were recruited via a targeted sampling method using Facebook from 7 December 2020 to 7 March 2021. Ethical Consideration The study was approved by the university’s human research protection program. Informed consent was provided to all participants. Results A total of 215 participants completed the surveys. Confirmatory analysis indicated that the 21-item scale with a 4-factor structure for the Moral Distress Questionnaire model met the established criteria and demonstrates an acceptable model fit (CMIN/DF = 2.0, CFI = 0.82, TLI = 0.77, RMSEA = 0.07). Factor loadings for each item depict a moderate to a strong relationship (range 0.36–0.70) with the given underlying construct. Cronbach’s α coefficient was 0.87 for the overall scale and 0.60–0.74 for its subscales which demonstrate good reliabilities. Discussion This is the first English-language validated tool to adequately measure moral distress in the long-term care setting experienced by US long-term care nurses. This reliable and well-validated tool will help identify moral distress situations experienced by US long-term care nurses. Conclusion The modified 21-item English version of the Moral Distress Questionnaire is reliable tool that demonstrates good psychometric properties to validly measure sources of moral distress among direct resident care nurses. (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)

Background Healthcare leader support and facilitation for ethics work are of great importance for healthcare professionals’ handling of ethical issues, moral distress, and quality care provision. A digital tool for ethical reflection in long-term care was developed in response to the demand for appropriate tools. Research aim This study aimed to explore healthcare leaders’ expectations of using a digital tool for ethical reflection among their home nursing care staff. Research design A qualitative research design with (...) vignettes and focus group interviews was used. The data were analyzed using reflexive thematic analysis. Participants and Research Context The sample comprised ten healthcare leaders from municipal long-term care in Norway. Ethical Considerations Participation was voluntary and based on informed consent. The Norwegian Agency for Shared Services in Education and Research approved this study. Findings The analysis resulted in the development of three themes representing leaders’ expectations of the tool: (i) giving staff a voice, (ii) revealing ethics in practice, and (iii) keeping the pot boiling. Discussion Leaders must be informed about the ethical issues experienced to engage in supportive measures for their staff. Digital channels can increase the democratization, safety, and efficiency of communication between employees and leaders and increase awareness of ethical aspects in daily care work. The leaders had positive expectations of employees’ activities and benefits from using the tool for ethical reflection. However, they admitted that realizing the tool’s potential to ensure continuity in ethics work requires considerable organizational and leader involvement. Conclusions This study shows that healthcare leaders are open to digital solutions for managing ethics work in home nursing care. Both opportunities and important prerequisites for successfully implementing the digital tool were identified. (shrink)

Background Clients are invited to play a role in decisions about their care. Collaborative deliberation comprises constructive engagement, recognition of alternative actions, comparative learning, construction and elicitation of preferences and preference integration. Collaborative deliberation between clients and professionals is a process that requires an interest in each other, sharing of views on alternatives and preferences and integrating into decisions. The aim is to gain insight into collaborative deliberation in consultations and the clients’ perception of arranging long-term (...) class='Hi'>care. Design A descriptive qualitative study to explore collaborative deliberation in consultations between clients and professionals. Six organisations providing long-term care were included. Data collection of nine clients involved observations of consultation with field notes and audio-records, interviews with clients and professionals shortly and 3–6 months after the consultation and questionnaires to collect background information. The data were analysed by deductive content analysis. Findings Constructive engagement was visible in all consultations. Clients and professionals showed respect, empathy and curiosity towards each other. In most consultations, two or more alternative actions are recognised and discussed. Comparative learning appears to be two sided, the client and the professional learn from each other's knowledge and experiences. Construction and elicitation of preference, and preference integration, seems to be present, but difficult to recognise in all consultations. Discussion/conclusion Although all propositions could be identified, there seems room for improvement in preference elicitation and integration of these preferences in the discussions on courses of action. Assistance seems needed with preference elicitation, both for the clients and for the professional. (shrink)

The ageing populations of the Western world present a wide range of economic, social, and cultural implications, and given the challenges posed by deteriorating maintenance ratios, the scenario is somewhat worrying. In this paper, I investigate whether Martha C. Nussbaum's capabilities approach could secure dignity for older people in long‐term care, despite the per capita decreases in resources. My key research question asks, ‘What implications does Nussbaum's list of central human capabilities have for practical social care?’ (...) My methodology combines Nussbaum's list with ethnographic data gathered from a Finnish sheltered home for older people. On the basis of this study, it seems that the capabilities approach is a plausible framework for the ethics of care because it highlights differences in the ability to function and thus differences in opportunities to pursue a good life. The ideas presented in this article could assist social policy planners and executives in creating policies and practices that help old people to maintain their dignity until the end of their days. (shrink)

The nursing gaze, that is the specific ways of observing the patient in nursing practice, has been the object of ethical debates for decades. It has been argued that the specific feature of observing patients in nursing is the stereoscopic vision that allows nurses to see the patient at the same time as a subject and a body. However, with the increased use of technology in nursing and the focus on quantifiable biomedical data, some commentators see a shift from the (...) view of the patient as subject to the patient as body, which results in a de‐humanisation and objectification of patients. The new digital technologies in patient monitoring and surveillance add a further dimension to this topic. It is yet unclear how digital technologies affect the nursing gaze, and with it, nursing practice. Furthermore, the ethical implications of the digitally enhanced nursing gaze have yet to be analysed. It is the purpose of this study to make a first step in this direction. By focusing on digitally enhanced monitoring technologies in long‐term care, these technologies are interpreted as liquid surveillance, an approach introduced by Zygmunt Bauman. The Baumanian concept of adiaphorisation, that is the detachment of social action from moral evaluation, is used as normative framework of the analysis. The analysis shows that the tendency to remove surveillance practices from moral evaluation by framing them as enablers of an active, healthy life and as tools for caring for the vulnerable, the stereoscopic vision of the nursing gaze is undermined. (shrink)

This article presents Mencius' concept of human dignity in the Chinese Confucian moral tradition, focused on the context of long-term care. The double nature of Mencius' notion of human dignity as an intrinsic quality of human beings qua being human is analyzed and contrasted with the dominant Western account of human dignity as grounded in personhood. Drawing on the heuristic force of an interview with an elder person in Hong Kong, the insights of the Mencian theory of (...) human dignity are used to provide a moral foundation for long-term care for elder persons in a context of diminishing personhood and shrinking autonomy. (shrink)

In this article, the relevance of justice in care is discussed, with special regard to long-term care. After a short introduction laying out the conceptual framework of justice and care, followed by an exploration of some special challenges within long-term care, this article consists of two main parts. The first part deals with justice as a general (secular) philosophical phenomenon and draws especially upon principles of justice as developed by John Rawls. Both (...) the principle of fair equality of opportunity and the difference principle, according to which an unequal treatment may be justified, provided that those “worst off” benefit mostly and are relevant within the field of care. The feminist debate about an ethics of care is also considered since its more recent contributions offer interesting attempts to mediate between justice and care. The second part of the article introduces a Christian perspective on justice, with relevance for (long-term) care. From a Christian point of view, one will even more strongly than Rawls argue for a conception of justice, which gives priority to those worst off. It is also argued that justice and care converge in the practice of diakonia. Diakonia, in many traditions synonymous with the caring dimension of the church, always had a special focus on long-term care. In this kind of church-based practice, justice and care are reconciled. (shrink)