Background: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce. Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes (...) in different parts of Norway. Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role. Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions. (shrink)

Most moral philosophers who have recently expressed sympathy with feminist or ‘care-based’ perspectives on ethical theory have thought that such perspectives can make valuable contributions to more comprehensive ethical theories. Few have thought that an ethics of care can offer a complete normative theory. However, Michael Slote is one of the ambitious few. In his recent book, The Ethics of Care and Empathy, he seeks to show that a care-based perspective can do a lot of service in first-order moral and (...) political theory as well as in metaethics. Here is a quick overview of the book's content: In Chapter 1, Slote explicates the notion of empathy that is central in his ethics of care, which he locates within the sentimentalist paradigm, stemming from philosophers such as Hume and Hutcheson. Slote's account of empathy and moral development draws substantially on work by the psychologist Martin Hoffman. Chapter 2 discusses care ethics and our obligation to help others, including both the near and the distant needy. Chapter 3 aims to show how the notion of empathy can further the case for deontology in ethics. Chapters 4 through 6 discuss the relation of care ethics to pivotal issues in political philosophy, such as autonomy, liberalism, social justice and rights. Slote maintains that autonomy …. (shrink)

The proposal that care ethic be subsumed under the framework of virtue ethic is both promising and problematic for feminists. Although some attempts to construe care as a virtue are more commendable than others, they cannot duplicate a freestanding feminist CE. Sander-Staudt recommends a model of theoretical collaboration between VE and CE that retains their comprehensiveness, allows CE to enhance VE as well as be enhanced by it, and leaves CE open to other collaborations.

Background: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce.Objectives: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.Design: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.Participants: 20 (...) physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.Results and interpretations: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients’ needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.Conclusion: The interviews in this study indicate that considerations of justice and patients’ perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients. (shrink)