The population ageing of Chinese society is deepening. The elderly care policy is a policy standard formulated by the government to protect the rights and interests of older people in the process of actively coping with the population ageing. It has crucial guiding significance for improving the elderly care services and carrying out pension practice. Since the reform and opening-up, China’s elderly care policy system has gone through three stages of initial construction, development, and (...) transformation, showing a development direction from aid to service, from one to multiple, from unique to general. In general, China has primarily formed a complete framework of the elderly care policy system, the rights, and interests of older people have been strongly guaranteed, the elderly care service industry has developed rapidly, and the quality of elderly care service has been effectively improved. However, in the process of policy development, there are still problems such as difficulty in implementing policies, low effectiveness, vague content, and fragmentation of policies. In the future, it is urgent to establish a complete, scientific, reasonable, and effective elderly care policy system. It should further expand the scope of benefits of old-age care policies, promote the coordinated development of the elderly care policies between urban and rural areas and among regions, strengthen the guiding and leading role of the government, and refine policies on personnel training, so as to form a powerful driving force for old-age care. (shrink)

Caregiving robots are often lauded for their potential to assist with geriatric care. While seniors can be wise and mature, possessing valuable life experience, they can also present a variety of ethical challenges, from prevalence of racism and sexism, to troubled relationships, histories of abusive behavior, and aggression, mood swings and impulsive behavior associated with cognitive decline. I draw on Confucian ethics, especially the concept of filial piety, to address these issues. Confucian scholars have developed a rich set of (...) theoretical resources for dealing with beloved but imperfect elders, and navigating the challenges of supporting seniors whose ethical commitments are unreliable. These resources provide a way to reconcile two important but conflicting desiderata: to value and care for seniors, but also to clear-mindedly deal with their moral shortcomings. In particular, they articulate a duty to remonstrate with our elders when they err. Confucian filial piety can helpfully inform robot design and use in geriatric care. They can be used to strengthen and protect emotional connections in important relationships, but should not be used to reinforce patient preferences when doing so damages relationships or their ability to act morally. Rather than conceive of patient wellbeing as in tension with moral behavior, and care as a burden for caregivers, not a source of value and meaning, Confucian accounts of filial piety help identify both new areas of concern and new potential in the development of caregiving technologies, ones which see these goods as complementary. (shrink)

Proprioception, a sense of bodily position and movement, is rarely the focus of conscious experience. If we are ordinarily conscious of proprioception, we seem only peripherally so. Thus, evidence that proprioception is present in the periphery of at least some conscious experiences seems to be good evidence that conscious experience is fairly rich. Anosognosia for paralysis is a denial of paralysis of one's limbs, usually in the wake of brain damage from stroke. Because anosognosic patients overlook their paralysis, anosognosia seems (...) be a counter-example to the claim that proprioception exists in the periphery of conscious experience. However, careful consideration of the data shows that anosognosia makes a poor counterexample to a rich theory of consciousness. Thus, we retain reason to believe that proprioception exists in the periphery of conscious experience, and so to conclude that conscious experience is relatively rich. (shrink)

The elderly face very challenging situations due to their mental and physical conditions. Like the other country in the world, Bangladesh Government has enacted laws to protect the elderly rights. However, the law does not seem to represent what the elderly actually needs. Therefore, 385 elderly people, aged between 60 and 90 years were surveyed to understand their expectations from family, society, and government. There were 57.1% men and 42.9% women. Most of the elderly (80%) (...) were educated. Just over half (53.5%) had ordinary mental and physical health, while a quarter (31.4%) had good status. More than half (53%) of the participants required 2000–5000 BDTK (Bangladeshi Taka) equivalent to $20-50 to cover monthly treatment expenditures. The majority (67.3%) felt government Old Age Allowance should be increased to BDT 5,000 ($50). Of 13.8% of individuals experienced harsh discourse from family because of the cost of therapy. However, 16.9% of people choose not to respond to this question. More than half (57.4%) of the respondents’ thought caregivers were insufficient. One-third felt that legislation should be changed to take care of parents (33.5%) and One-third felt that children should take care of more (33.5%). Some (3.6%) thought that children should act as they did in their childhood respectively. Almost half (44.2%) of respondents did not know that the elderly should receive a separate senior citizen card for preferential treatment, yet 51.9% thought this. Some (44.7%) felt the elderly should get priority in any queue and discounts in Bus/Uber/Rickshaw. Results also showed that expectation is more than the service provided. Further, a one-stop elderly care clinic is required to provide integrated care and support for the quality of life of the elderly. (shrink)

Healthcare is becoming increasingly automated with the development and deployment of care robots. There are many benefits to care robots but they also pose many challenging ethical issues. This paper takes care robots for the elderly as the subject of analysis, building on previous literature in the domain of the ethics and design of care robots. Using the value sensitive design approach to technology design, this paper extends its application to care robots by integrating (...) the values of care, values that are specific to AI, and higher-scale values such as the United Nations Sustainable Development Goals. The ethical issues specific to care robots for the elderly are discussed at length alongside examples of specific design requirements that work to ameliorate these ethical concerns. (shrink)

Patient and public involvement is widely thought to be important in the improvement of health care delivery and in health equity. Purpose: The article examines the role of experiential knowledge in service co-production in order to develop opiate substitution treatment services (OST) for high-risk opioid users. Method: Drawing on social representations theory and the concept of social identity, we explore how experts’ by experience and registered nurses’ understandings of OST contain discourses about the social representations, identity, and citizenship (...) of the participants and the effects these may have on developing or hindering inclusive and bottom-up forms of patient and public involvement. Results: The meeting sessions that potentially offer room for creativity and problem-solving fail to provide any new propositions for fixing the system. The health care professionals primarily identify themselves as regulators who protect the correctness of their actions and show little interest in considering experiential knowledge on opioid addiction. Conclusion: The participation of patients has been one of the prominent reforms implemented in health care. The goal of client-centered thinking is often emphasised; however, the implementation is not simple due to the strongly institutionalised knowledge and related working patterns and practices in health care. (shrink)

Background: Educated women tend to have a greater awareness of the existence of ANC services, more aware of health problems, know more about the availability of health care services, and utilize the information more effectively than non-educated women. Moreover, higher levels of education tend to positively affect healthseeking behaviors, and education may increase a woman’s control over her pregnancy and expose women to more health education messages and campaigns, enabling them to recognize danger signs and complications and take appropriate (...) action. In this study, we tried to analyze to what level the maternal education can influence the antenatal care services and childcare. Methods: A community-based cross-sectional study was conducted on 93 randomly selected mothers who have children less than 7 years by using a pre-tested structured questionnaire for data collection at various tribal villages, at an average 25 kms away from Adilabad town from April-October 2019. Analysis was done using SPSS for windows version 16, Microsoft excel and Open epi website. Results: Out of 93 study subjects, 19.3% (18) of the study subjects were not registered for the antenatal services. Higher the maternal education higher the age at pregnancy (p<0.05), was associated with more preference for deliveries by doctors (p<0.05). More the frequency of exclusive breast feeding, long lasting breast feeding was associated more than a year (p<0.05), a smaller number of children with wasting (p<0.05). Conclusion: This study revealed that utilization of ANC services was relatively better for the mother’s educated higher than secondary school, but they are still low. Educational status is important in having more health seeking behavior. In this study, it proves that health education is more important than the mere school education which can help to improve knowledge on ANC. (shrink)

The growing proportion of elderly people in society, together with recent advances in robotics, makes the use of robots in elder care increasingly likely. We outline developments in the areas of robot applications for assisting the elderly and their carers, for monitoring their health and safety, and for providing them with companionship. Despite the possible benefits, we raise and discuss six main ethical concerns associated with: (1) the potential reduction in the amount of human contact; (2) an (...) increase in the feelings of objectification and loss of control; (3) a loss of privacy; (4) a loss of personal liberty; (5) deception and infantilisation; (6) the circumstances in which elderly people should be allowed to control robots. We conclude by balancing the care benefits against the ethical costs. If introduced with foresight and careful guidelines, robots and robotic technology could improve the lives of the elderly, reducing their dependence, and creating more opportunities for social interaction. (shrink)

With the ageing of the Portuguese population, there are more people in dependency situations and needing long-term care (LTC). In this context, it is important to ensure the quality of life (QoL) of those individuals, and that quality can be measured through their health-related quality of life (HRQoL) and overall well-being. Also, understanding how perceived service quality (PSQ) can be related to how people perceive their QoL is pertinent since service quality is an important factor to achieve (...) patient health outcomes. To develop this project, a LTC unit located in the district of Lisbon was chosen, the LTC unit of Arruda dos Vinhos. The main objective was to assess the relation between the PSQ, the HRQoL and the overall well-being of patients receiving LTC at the LTC unit of Arruda dos Vinhos. A project based on a case study was performed, through interviews based on the items of the SERVPERF, EQ-5D and ICECAP-O questionnaires, which were then analysed through content analysis. Results showed there is a relation between PSQ and HRQoL and between HRQoL and overall well-being. It was also possible to realise that to better evaluate the quality of this specific service, other subjects as the activities performed at the LTC unit, the physiotherapy service and the food provided, should be taken in consideration. Concluding, there is a relation between PSQ and the QoL of the patients receiving LTC at the LTC unit of Arruda dos Vinhos, when quality of life is measured through HRQoL. (shrink)

The study investigated factors that influence the uptake of maternal healthcare services by women in Zimbabwe, using a logit model. Data from the Zimbabwe Demographic Health Survey (ZDHS, 2015) was used. Deteriorating maternal health indicators motivated the study. The effect of socio-economic and demographic factors on the probability of utilising maternal healthcare services was examined. Descriptive statistics and a logit model were used for data analysis. Results from the logit model show that region of residence, insurance cover, educational level, employment (...) status, maternal age, birth order, place of residence, number of living children, maternal age and household income all influence the utilisation of maternal healthcare services by women in Zimbabwe. Basing on research findings, the study recommends that relevant authorities make more available vocational training centres and education institutions since education was found to influence the uptake of maternal healthcare services. There is need to encourage family planning so as to reduce the number of children, especially among the apostolic sect, which affects the uptake of maternal healthcare. Compulsory national health insurance schemes could be adopted to mitigate the effect of low income that discourages the use of institutional facilities for delivery. The issue of balanced regional development needs to be pursued through accelerating devolution to ensure equal access to maternal healthcare facilities in all provinces. (shrink)

We provide to readers the 11th volume of the "Czech-Polish-Slovak Studies in Andragogy and Social Gerontology" series. We are delighted to announce that the presented study is the result of the work of scientists from seven countries: Austria, China, Ghana, Hungary, Japan, Poland, and Russia. This international collection of texts is part of the global discourse on the determinants of adult education and the functioning of people in late adulthood. The 11th volume is a collection of research results that show (...) both the positive and negative dimensions of ageing through the prism of research experience from various geographical and cultural areas. The researchers invited to the presented volume tried to illustrate the issues assigned to the following topics: ageing with dignity; retirement age; assumptions and conditions resulting from living in the home; the relationship between challenges concerning life expectancy and needs; care and ageing services; and foundations and potential changes in pension systems. The research results presented in this volume have a common denominator, which is caring for the quality of life of the older people regardless of their place of residence. Thus, the study "Between Successful and Unsuccessful Ageing: Selected Aspects and Contexts" brings new insights from scientists who scrupulously characterize the complexity of processes that affect the positive and negative conditions of functioning in old age, which is a mosaic of various nuances. Inviting readers to familiarize themselves with the content of the monograph, we would like to thank the reviewers who contributed to the improvement of the quality of the texts and open new fields for participation in further joint publishing projects. (shrink)

Older people are encouraged to participate more in the economic, social, and governmental sectors as part of progressive aging policies worldwide. Very little is known about applying engagement techniques or carrying out strategies in Bangladesh that are important for involving seniors in social engagement. Therefore, this qualitative research was conducted in Dhaka, Bangladesh, among 385 people aged sixty or above to assess their understanding of the quality of life and the gap in government policy. Results showed that between 60 and (...) 65 were more mobile, creative, engaged in productive activity, and had significantly higher decision-making power (p<0.000). Aging greatly enhances dependency (p<0.000). Lower-educated people were significantly dependent on their families (p<0.000).Moreover, elderly income and the cost of treatment were significantly correlated to abuse (p<0.001). Furthermore, 10% of participants reported negative relationships with family members (p<0.031). However, most (61.6%) were unaware of the 2013 Parent's Care Act. Though most participants (73.2%) knew of the government-funded Old Age Allowance, 92.5% received no non-governmental assistance. The research concluded that education and economic condition have a long-term relationship with reducing dependency. In recommendation, Government can increase the retirement age from 59 to 65 years which may increase self of security, respect, and self-esteem and reduce harassment. Parent's Care Act 2013 should implement. Government should include Community Health and Social Service centers for the quality of life of the elderly. (shrink)

Technological developments involving robotics and artificial intelligence devices are being employed evermore in elderly care and the healthcare sector more generally, raising ethical issues and practical questions warranting closer considerations of what we mean by “care” and, subsequently, how to design such software coherently with the chosen definition. This paper starts by critically examining the existing approaches to the ethical design of care robots provided by Aimee van Wynsberghe, who relies on the work on the ethics (...) of care by Joan Tronto. In doing so, it suggests an alternative to their non-principled approach, an alternative suited to tackling some of the issues raised by Tronto and van Wynsberghe, while allowing for the inclusion of two orientative principles. Our proposal centres on the principles of autonomy and vulnerability, whose joint adoption we deem able to constitute an original revision of a bottom-up approach in care ethics. Conclusively, the ethical framework introduced here integrates more traditional approaches in care ethics in view of enhancing the debate regarding the ethical design of care robots under a new lens. (shrink)

The healthcare industry has become a paramount concern for most people in Ghana and the quality of services rendered to the patients in the private hospitals cannot be overemphasized. Patients need quality of services most and are willing to seek better services. The government has been the main provider of health care services in Ghana but recently, some Non-Governmental Organization’s (NGO’s), private individuals and stakeholders also provide health care services which has surged the competitiveness in creating more healthcare (...) facilities in Ghana. This study seeks to explore patients' choice of selecting quality healthcare services and the factors that affect patient satisfaction in private hospitals using the case of Comboni Hospital in Sogakope, Ghana. The study therefore used the quantitative research method to collect the data and SPSS version 22 was used to analyze the data on high-quality healthcare. The SERVQUAL model was used as the measurement scale. Multiple regression analysis was used to reveal the effect of the independent variables (reliability, responsiveness, empathy, assurance, and tangibility) on the dependent variable (patient satisfaction). A detailed description in the analysis and the data processing identified the main factors affecting the general perceptions and patient preferences about their healthcare in the private hospital. The study revealed that there exist a positive result and perception for quality healthcare services without a negative expectation of the patient healthcare being compromised. The study recommends that both the government and the private agencies should consider the important aspects of the hospital’s healthcare management and also the policy and decision makers should have an efficient and effective standard that impact the quality of healthcare assessment in Ghana. (shrink)

To assess the perception regarding the quality of life, a qualitative study was conducted on 20 old people of balance gender in Dhaka, Bangladesh. Most of the participants of our study were upper poor class and literate. Male participants were a little higher than females. The majority were between 60 and 65years. They were significantly more active, independent, and took part in productive work contributing in the country’s economy, and had significantly greater decision power than other age group. Quality of (...) life of the elderly is related to physical and, economical wellbeing and coping mechanism during old age. The government of Bangladesh has taken varying degrees of initiative to improve the elder condition, but that was not publicized well. Old age Allowance should be increased to BDT 5000/ ($50). Family attachment and emotional support is also related to the self-assurance, self-respect, and self-drive of the elderly. Parent's Care Act 2013 should be implemented for retrospective care of seniors. (shrink)

As the world population is rapidly aging, stakeholders must address the care of the elderly with great concern. Also, loss of dignity is often associated with aging due to dementia, mobility problems and diminished functional autonomy. However, dignity is a polysemic term that is deemed useless by some ethicists. To counter this claim, we propose four concepts to define it better and make use accurately of this notion. These are human dignity, dignity of identity, dignities of excellence and (...) attributed dignities. Finally, we explain the importance of solicitude and human dignity in the care of the elderly. This will ensure the respect, friendship and dignity of the elderly in providing geriatric ethical care. (shrink)

Background: The concept of digital twins has great potential for transforming the existing health care system by making it more personalized. As a convergence of health care, artificial intelligence, and information and communication technologies, personalized health care services that are developed under the concept of digital twins raise a myriad of ethical issues. Although some of the ethical issues are known to researchers working on digital health and personalized medicine, currently, there is no comprehensive review that maps (...) the major ethical risks of digital twins for personalized health care services. Objective: This study aims to fill the research gap by identifying the major ethical risks of digital twins for personalized health care services. We first propose a working definition for digital twins for personalized health care services to facilitate future discussions on the ethical issues related to these emerging digital health services. We then develop a process-oriented ethical map to identify the major ethical risks in each of the different data processing phases. Methods: We resorted to the literature on eHealth, personalized medicine, precision medicine, and information engineering to identify potential issues and developed a process-oriented ethical map to structure the inquiry in a more systematic way. The ethical map allows us to see how each of the major ethical concerns emerges during the process of transforming raw data into valuable information. Developers of a digital twin for personalized health care service may use this map to identify ethical risks during the development stage in a more systematic way and can proactively address them. Results: This paper provides a working definition of digital twins for personalized health care services by identifying 3 features that distinguish the new application from other eHealth services. On the basis of the working definition, this paper further layouts 10 major operational problems and the corresponding ethical risks. Conclusions: It is challenging to address all the major ethical risks that a digital twin for a personalized health care service might encounter proactively without a conceptual map at hand. The process-oriented ethical map we propose here can assist the developers of digital twins for personalized health care services in analyzing ethical risks in a more systematic manner. (shrink)

Cancer care has transitioned from clinical-based to home-based care to support longterm care in a more familiar and comfortable environment. This care transition has put family caregivers (FCGs) in a strategic position as care providers. Cancer care at home involves psychological and emotional treatment at some point, making FCGs deal with the stress of cancer patients frequently. Due to their limited care competencies, they need supportive care from healthcare professionals in cancer stress (...) management. This study aims to examine how types of demanded healthcare information affect the FCG’s role in reducing the stress of female cancer patients. The mindsponge theory was used in conceptual development and interpretation. Bayesian Mindsponge Framework (BMF) analytics were used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of healthcare information, FCGs with higher demand for cancer-specific information were more likely to need support in reducing the stress of female cancer patients. Meanwhile, FCGs with a higher demand for information about support services were less likely to need support to reduce cancer patients’ stress. Other types of healthcare information have ambiguous effects on the need for support in reducing cancer-induced stress. This study reveals that the demanded cancer-specific information, e.g., cancer prognosis or likely outcome, must be prioritized to assist FCG’s role in managing cancer stress. (shrink)

This paper explores the relationship between dignity and robot care for older people. It highlights the disquiet that is often expressed about failures to maintain the dignity of vulnerable older people, but points out some of the contradictory uses of the word ‘dignity’. Certain authors have resolved these contradictions by identifying different senses of dignity; contrasting the inviolable dignity inherent in human life to other forms of dignity which can be present to varying degrees. The Capability Approach (CA) is (...) introduced as a different but tangible account of what it means to live a life worthy of human dignity. It is used here as a framework for the assessment of the possible effects of eldercare robots on human dignity. The CA enables the identification of circumstances in which robots could enhance dignity by expanding the set of capabilities that are accessible to frail older people. At the same time, it is also possible within its framework to identify ways in which robots could have a negative impact, by impeding the access of older people to essential capabilities. It is concluded that the CA has some advantages over other accounts of dignity, but that further work and empirical study is needed in order to adapt it to the particular circumstances and concerns of those in the latter part of their lives. (shrink)

Parenthood is one of the best gifts nature and god has given to humans. Being a parent is a feeling that can be compared to none other but as a baby caretaker a nanny can do this. As a parent, we always strive to provide the best of everything to our children. This however often comes at a price. Mostly it means that both the parents have to be working in order to provide the best facilities and at the same (...) time secure the future of their children and Newborn Baby. Even if one of the parent chooses to sacrifice the career and stay at home, raising a child in a nuclear family set up is still a challenge. -/- This is when an experienced and gentle baby caretaker can be of utmost help. However such caretaker who can be entrusted with the care and security of your child is often hard to find. Especially in cities like NOIDA baby caretaker are available for your service. Well no more. -/- No more is the need to sacrifice your career or professional aspirations. You can peacefully leave to work, entrusting your lovely children in the hands of the baby caretaker. Majority of the time that your child will be spending is with the caretaker and it is therefore absolutely necessary that a baby caretaker possess all the qualities of a good parent. Benevolence, patience, care and attention, all these qualities can be found in the baby caretaker provided by us. Our caretaker ensures the welfare of the child, creating the environment for sound mental, emotional and health development of the children. -/- We need to guarantee that the caretaker has the child's best interest at heart and looks at the security of our child with the same eye as we do. We select the baby caretakers that view this profession as means of contentment and satisfaction in their lives and not just another menial job to earn their livelihood. Children have the inherent need to have somebody always around them in oder to feel secure and wanted, avoiding loneliness and boredom. A Caretaker for baby in Noida not only provides this companion but also ensures that the natural curiosity of a child is kept alive even in the absence of their parents. -/- Big cities with the diverse kind of population, mostly coming to work from various parts of the country, have had some history of violent cases. And that’s why precaution should be taken while hiring Best caretaker in Noida . With thorough background check and verified references, all such apprehensions can be laid to rest.+ . (shrink)

Background: This study sought to understand the ethical issues encountered by medical residents during their residencies, evaluate the solutions proffered by them, and present their suggestions. Material/Methods: A survey consisting of 32 questions, including demographic information, was developed and distributed to Intensive Care Unit (ICU) residents from December 2020 to January 2021. A total of 53 completed questionnaires were submitted to the researchers. The data were analyzed using SPSS software version 26.0. Results: Of the participating residents who returned completed (...) forms, 50.9% were male and 49.1% were female, with an overall mean age of 30.5±4.4 years. Most residents’ views on ethical issues concerned themselves, the clinic, and patients/patient relatives. Responses showed a number of commonalities with the views of ICU physicians in other countries. Suggestions for resolving ethical issues solutions included instruction in medical ethics for all staff, increasing and strengthening pathways of communication both inside and outside of the clinics, regular inventory of medical supplies and assessment of equipment to prevent a shortage of resources, and the establishment of a hospital ethics committee. Conclusions: As numerous and varied ethical issues were encountered in the participating ICUs, we propose the following: preparation of an ICU-specific guide for resolving ethical problems, clarification of rules based on legal regulations, determining a hierarchy of responsibilities, and ethics courses for all ICU staff. In addition, hospital managers should support ICU services from both a legal and ethical standpoint. (shrink)

The world population is aging rapidly. Fear of falling among the elderly constitute a significant problem in health care. Among community-dwelling elderly, fear of falling is frequent, with prevalence ranging from 3% to 85% % in community-based epidemiologic studies. The aim of this review is to reveal the prevalence and risk factors of fear of falling (FOF) among elderly. The review has identified that age, sex, physical performance, comorbidity, a history of falls, hearing impairment, poor self-related (...) health and depressive symptoms affect fear of falling. The consequences that develop as a result of a fear of falling can include: loss of confidence, decreased quality of life, mobility or activity restriction and the development of deconditioning, leading to loneliness, depression, and anxiety, subsequent falls and physical, psychological and mental function declines. Maintenance of physical function and pain management might be important for older adults with fear of falling. (shrink)

This chapter offers a plea for the media to reframe its coverage of campus controversies from free expression to academic freedom. These freedoms are entwined, but distinct. Freedom of expression is extended to all persons with no expectation of quality control, apart from legal prohibitions against defamation, threats, etc. By contrast, academic freedom is a cluster of freedoms afforded to scholarly personnel for a particular purpose – namely, the pursuit of universities’ academic mission to seek truth and advance understanding in (...) the service of society. An academic freedom framing better reflects the distinctive social purpose around which universities are organized, as well as universities’ duty of care to employees and students. While universities have a legal and moral duty of care to all employees and students, the unjust, exclusionary past and present of higher education arguably makes that duty particularly acute in the case of equity-deserving (e.g., racialized, Indigenous, disabled or 2SLGBTQ+) people. Finally, academic freedom framing for campus media stories is less monolithic than free expression framing, allowing for a more nuanced understanding of campus controversies while keeping universities accountable to the public they serve. In this chapter, I survey three very different campus controversies at a single Canadian university, and the media response each received. I show how an academic freedom frame for those stories would have produced better reportage while reducing opportunities for bad actors to manipulate both universities and the media. At the end of the day, the real crisis at universities isn’t the cancellation of ill-judged events that were never a part of the academic mission; it is the ongoing erosion of academic freedom. (shrink)

Since the subsidised economy was substituted by privatisation in 1986, family became the main source of support for the majority of Vietnamese elderly. Traditionally, old aged parents live under the same roof with their adult children, so that they can be looked after. Recently, the process of modernisation of its economy with the focus on urban areas in Vietnam has pushed young rural generations away from home and torn rural families apart. Scholars and experts have tried to understand if (...) that movement is having any impact on the left-behind parents. However, the majority of the existing studies used secondary data, and quantitatively tested only the economic aspects. Other aspects of life of the left-behind elders attracted a limited amount of research. The voice of those left-behind elderly parents was also underestimated, and often not heard. This study utilised a qualitative approach and drew on the voice of those insiders, whose children had migrated to urban areas for employment. It explores the wellbeing of rural elderly individuals, not only the material aspects, but also emotional and physical care. (shrink)

The Disabilities Act of 1990 and the Developmental Disabilities Assistance and Bill of Rights Act of 2000 of United States in act to prevent social exclusion of people with intellectual and developmental disabilities (IDDs) and to cut back on unneeded expenditures to society. However, despite the protective legislation, the rights of adults with neurodevelopmental disorders have not yet been fully realised. There are several obstacles to overcome the neurological development related health care services, including health care usage, educational (...) and career pathways, family and social lives, self-fulfilment, and quality of life. There are significant gaps in the transition process that affect the health care systems. Lack of transition and transfer planning, neurodevelopmental disorder health care pathway services have lack of experience, education, and expertise which result the inadequate growth of the health care quality and create communication gap in between service providers and service users. The aim of this short communication is to mention and clarify the ethical concerns of neurodevelopmental service evaluation. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities approach (...) to characterize person-centered care as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of Molnupiravir through the large-scale PANORAMIC randomised control trial. By analysing the ways in which the authorisation and clinical use of Molnupiravir complicate standard approaches to clinical equipoise, standard of care, and participant consent in the PANORAMIC randomised control trial we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

Abstract: In this article, we explore what are ethical forms of holding service users responsible in mental health care contexts. Hanna Pickard has provided an account of how service users should be held responsible for morally wrong or seriously harmful conduct within contexts of mental health care, called the clinical stance. From a clinical stance one holds a person responsible for harm, but refrains from emotionally blaming the person and only considers the person responsible for this (...) conduct in a detached sense. Her account is based on what are considered best practices in the treatment of people with borderline personality disorder and addiction. We ask if this account generalizes across different diagnostic criteria and different clinical contexts. To begin to answer this question, we compare the clinical stance to an account of what are considered best practices in the treatment of service users at a specialized clinic for people with autism spectrum disorder in the Netherlands. We refer to this alternative account as the nurturing stance and highlight relevant similarities and differences between the clinical stance and the nurturing stance. We conclude with suggestions for further research and theorizing. (shrink)

Palliative care seeks to provide holistic care to improve the quality of life for the sick, especially as they approach the end of their lives. Addressing the spiritual dimension of the human person is useful because it provides answers to the meaning of life. Spiritual care has been shown to be of great benefit to patients. Therefore, this paper explores the importance of the spiritual dimension in palliative care; highlight the act of listening as a key (...) part of spiritual care, showing that physician burnout is the main obstacle to improving listening as an appropriate service that is both comforting and healing. -/- Los cuidados paliativos buscan ofrecer una atención holística para brindar una mejor calidad de vida a los enfermos, especialmente cuando se aproximan al fin de su existencia. Profundizar en la dimensión espiritual de la persona humana resulta útil puesto que ofrece respuestas al sentido de la vida. Se ha constatado que la atención espiritual aporta grandes beneficios para el paciente. Es por eso que en este trabajo hemos querido profundizar en la importancia de la dimensión espiritual en los cuidados paliativos; se destaca la actitud de la escucha como pieza clave de dicha atención espiritual, lo que evidencia que el burnout de los médicos es el principal obstáculo para potenciar la escucha como una adecuada disposición que resulte consoladora y sanadora. (shrink)

Some bioethicists argue that conscientious objectors in health care should have to justify themselves, just as objectors in the military do. They should have to provide reasons that explain why they should be exempt from offering the services that they find offensive. There are two versions of this view in the literature, each giving different standards of justification. We show these views are each either too permissive (i.e. would result in problematic exemptions based on conscience) or too restrictive (i.e. (...) would produce problematic denials of exemption). We then develop a middle ground position that we believe better combines respect for the conscience of healthcare professionals with concern for the duties that they owe to patients. Our claim, in short, is that insofar as objectors should have to justify themselves, they should have to do it according to the standard that we defend rather than according to the standards that others have developed. (shrink)

Resumen Ésta es la primera traducción al español de las guías “Atención después de la investigación: un marco para los comités de ética de investigación del National Health Service (NHS) (borrador versión 8.0)”. El documento afirma que existe una fuerte obligación moral de garantizar que los participantes enfermos de un estudio clínico hagan una transición después del estudio hacia una atención de la salud apropiada. Con “atención de la salud apropiada” se hace referencia al acceso para los participantes a (...) la atención de la salud, proporcionada principalmente por el National Health Service (en adelante NHS), el sistema de salud del Reino Unido, y/o a la intervención en estudio, también llamada producto o tratamiento en investigación. Las guías “Atención después de la investigación” están dirigidas principalmente a los miembros de los 79 comités de ética de investigación del NHS y a quienes presentan sus estudios de investigación ante estos comités. Se trata de un documento borrador muy avanzado, trabajado en numerosas reuniones, durante más de 3 años, que ha sido discutido por participantes de estudios y miembros de la comunidad, miembros y presidentes de comités de ética de investigación del Reino Unido, especialistas internacionales en ética de la investigación, representantes de la industria y otras partes interesadas. La redacción de las guías es producto de la colaboración de Neema Sofaer y Penney Lewis, ambas investigadoras del King’s College London, en el Centre of Medical Law and Ethics del Dickson Poon School of Law, y Hugh Davies, Asesor en Ética de la Investigación de la Health Research Authority (HRA) del NHS. El traductor del presente documento, Ignacio Mastroleo, participó del workshop en la Fundación Brocher (Ginebra, Suiza, diciembre de 2011) donde se revisó el borrador versión 7.0 y contribuyó en la revisión del borrador de la versión 8.0 durante el 2012. -/- Abstract This is the first Spanish translation of the guidelines “Care after research: a framework for NHS RECs (8th draft)”. The document states that there is a strong moral obligation to ensure that participants in a clinical study who are ill transition after the study to appropriate healthcare. The terms "appropriate healthcare" refer to participants’ access to health care, mainly provided by the National Health Service (NHS), the health system in the UK, and/or to the intervention study also named investigational treatment or product. The guides "Care after research" are mainly directed to members of the 79 NHS committees of research ethics (RECs) and to those who submit their research to these committees. This is a very advanced draft document, worked in several meetings, for more than three years, that has been discussed with study participants and community members, members and chairs of RECs in the UK, international specialists in research ethics, industry representatives and other stakeholders. The drafting of the guidelines is the result of the collaboration of Neema Sofaer and Penney Lewis, both researchers at King's College London, at the Centre of Medical Law and Ethics of Dickson Poon School of Law, and Hugh Davies, Research Ethics Advisor of the Health Research Authority (HRA) of the NHS. The translator of this document, Ignacio Mastroleo, attended the workshop at the Brocher Foundation (Geneva, Switzerland, December 2011) where draft version 7.0 was revised and contributed in the revision of draft version 8.0 during 2012. (shrink)

BACKGROUND: Little is known about how hospitalized patients share decisions with physicians. METHODS: We conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis. RESULTS: Most patients were white (61%) and half were female. (...) Most physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed. CONCLUSIONS: Shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict. PRACTICE IMPLICATIONS: Some hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy. (shrink)

How can we allocate scarce health care resources justly? In particular, are markets the most efficient way to deliver health services? Much blood, sweat and ink has been shed over this issue, but rarely has either faction challenged the unspoken assumption behind the claim made by advocates of markets: that efficiency advances the interests of both individuals and society. Whether markets actually do increase efficiency is arguably a matter for economists, but the deeper ethical question is whether efficiency is (...) the correct criterion, in terms of social justice and individual needs. (shrink)

Lately, more and more authors have asserted their belief that one of the criteria which, together with the medical ones, can and should be applied in the policy of selecting and/or prioritizing the patients in need for the allocation of medical resources with limited availability, is the principle of individual responsibility for illness. My intention in this study is to highlight some very serious obstacles looming against the attempt to apply this principle in the distribution of the medical services with (...) limited availability. Although there are numerous such obstacles, I shall only discuss five of them (the most important, in my opinion). These are: 1) the impossibility to establish with certainty whether a patient got ill due to his lifestyle; 2) the lack of a feasible and reliable method of establishing an individual’s responsibility for his lifestyle; 3) a patient’s right to privacy; 4) some moral requirements and principles and, last but not least, 5) the ethics of the medical profession. (shrink)

Healthcare systems across the globe are struggling with increasing costs and worsening outcomes. This presents those responsible for overseeing healthcare with a challenge. Increasingly, policymakers, politicians, clinical entrepreneurs and computer and data scientists argue that a key part of the solution will be ‘Artificial Intelligence’ (AI) – particularly Machine Learning (ML). This argument stems not from the belief that all healthcare needs will soon be taken care of by “robot doctors.” Instead, it is an argument that rests on the (...) classic counterfactual definition of AI as an umbrella term for a range of techniques that can be used to make machines complete tasks in a way that would be considered intelligent were they to be completed by a human. Automation of this nature could offer great opportunities for the improvement of healthcare services and ultimately patients’ health by significantly improving human clinical capabilities in diagnosis, drug discovery, epidemiology, personalised medicine, and operational efficiency. However, if these AI solutions are to be embedded in clinical practice, then at least three issues need to be considered: the technical possibilities and limitations; the ethical, regulatory and legal framework; and the governance framework. In this article, we report on the results of a systematic analysis designed to provide a clear overview of the second of these elements: the ethical, regulatory and legal framework. We find that ethical issues arise at six levels of abstraction (individual, interpersonal, group, institutional, sectoral, and societal) and can be categorised as epistemic, normative, or overarching. We conclude by stressing how important it is that the ethical challenges raised by implementing AI in healthcare settings are tackled proactively rather than reactively and map the key considerations for policymakers to each of the ethical concerns highlighted. (shrink)

The study aimed to identify the delegation of authority for the performance of the medical staff and its relationship to improving the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. Administrators, and technicians) with a total of 2150 employees, and the questionnaire was distributed to a stratified random sample of 330 employees, and 302 questionnaires were retrieved, with a rate of 91.5%. One of the most important results of the study was the existence of (...) a statistically significant relationship between delegation of authority and the quality of health care. One of the most important recommendations of the study was to strengthen the direction of senior management towards excellence in patient service, because the patient represents a fundamental focus in health services. (shrink)

Owing to its grappling with a motley of intricate socioeconomic, as well as medico-legal, crises, Haiti has found itself bereft of some of its people, many of whom have had to leave the Caribbean country in search of improved lives elsewhere. Receiving some of the Haitian refugees fleeing abject poverty, unemployment, and other harms and barriers has been the United States, one of Haiti's northern neighbors and a country that has played an outcome-determinative, if not outsized, role in steering the (...) country toward its presently hobbled state. Drawing on the U.S.’s recent treatment of Haitian refugees, this paper argues that U.S. reception of Haitian immigrants rubs salt in the wound of a long history of dehumanizing and oppressive abuses endured by Haitians. Furthermore, and more importantly, this paper posits that U.S. failure to wholly embrace its legal obligation to accept Haitian refugees under international law needs to be understood in the light of the specific horrors inflicted by science, in pre-independence Haiti, on non-consenting, Afro-Haitian experimental subjects. And by extension, such a contextually-nuanced understanding is crucial in shaping the delivery of healthcare services to Haitian refugees fortunate enough to remain in the U.S. —as an awareness and appreciation of the socio-historical context of patients' lived experiences, i.e., their complete social history, can furnish important clues vis-à-vis the presence and etiologies of disease, influence the foci of physical exams, and generally pave the way for the provision of cost-efficient and evidence-based care. (shrink)

That a standard of medical care must outline services that benefit the patient is relatively uncontroversial. However, one must determine how the practices outlined in a medical standard of care should benefit the patient. I will argue that practices outlined in a standard of medical care must not detract from the patient’s well-functioning and that clinicians can refuse to provide services that do. This paper, therefore, will advance the following two claims: (1) a standard of medical (...) class='Hi'>care must not cause dysfunction, and (2) if a physician is medically rational to not provide some service which fails to meet the above condition (i.e. fails to be a standard of medical care), then she may refuse to do so. I then apply my thesis to the prescription of puberty blockers to children with gender dysphoria. (shrink)

The study aimed to identify the sharing of information and its impact on the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. The study adopted the descriptive analytical approach. The number is 2150 employees, and the questionnaire was distributed to a stratified random sample of 330 employees, and 302 questionnaires were retrieved, with a rate of 91.5%. One of the most important results of the study was that there is a statistically significant effect at (...) the level (α≤0.05) of information sharing for the performance of the medical staff in the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. The axis of participation in information came with a relative weight (69.6%) and a high degree. The level of health care quality was high with a relative weight of (69.0%). One of the most important recommendations of the study was the need to pay attention to measuring patients' satisfaction levels, and to set up a box for complaints and suggestions for patients, and what are their suggestions and point of view for the service provided to them. (shrink)

AI, in the form of artificial carers, provides a possible solution to the problem of a growing elderly population Yet, concerns remain that artificial carers ( such as care-or chat-bots) could not emphathize with patients to the extent that humans can. Utilising the concept of empathy perception,we propose a Turing-type test that could check whether artificial carers could do many of the menial tasks human carers currently undertake, and in the process, free up more time for doctors to (...) offer empathy. -/- . (shrink)

A significant proportion of child protection cases involve care-experienced mothers, which reveals a continuous cycle of mothers who lose their children to social services after having been in state care themselves as children. While the importance of protecting children requires little explanation and forms the justificatory basis for child protection interventions, it is important to remember that care-experienced mothers were once children entrusted to the state’s care, and who arguably have been failed by the state in (...) that their parenting opportunities are significantly reduced. This paper aims to address this underexplored dilemma between protecting children and safeguarding mothering opportunities for care-experienced mothers. Appealing to the concept of solidarity, I argue that the state has an obligation to increase its compensatory efforts to secure the right of care-experienced women to not only become parents but to be able to be parents, with the aim of breaking the cycle of care experience. (shrink)

The study aimed to identify the delegation of authority for the performance of the medical staff and its relationship to improving the quality of health care in Al-Shifa Medical Complex in the southern Palestinian governorates. Administrators, and technicians) with a total of 2150 employees, and the questionnaire was distributed to a stratified random sample of 330 employees, and 302 questionnaires were retrieved, with a rate of 91.5%. One of the most important results of the study was the existence of (...) a statistically significant relationship between delegation of authority and the quality of health care. One of the most important recommendations of the study was to strengthen the direction of senior management towards excellence in patient service, because the patient represents a fundamental focus in health services. (shrink)

I defend social media’s potential to support Aristotelian virtue friendship against a variety of objections. I begin with Aristotle’s claim that the foundation of the best friendships is a shared life. Friends share the distinctively human and valuable components of their lives, especially reasoning together by sharing conversation and thoughts, and communal engagement in valued activities. Although some have charged that shared living is not possible between friends who interact through digital social media, I argue that social media preserves the (...) relevantly human and valuable portions of life, especially reasoning, play, and exchange of ideas. I then consider several criticisms of social media’s potential to host friendships, and refute or weaken the force of these objections, using this conception of a distinctively human shared life. I conclude that we should use the shared life to evaluate features of specific social media and norms for users’ conduct. (shrink)

The objective of the paper is to explore the issue that despite the absence of adequate formal and systematic ways for the poor and disadvantaged people to get access to health benefit like in a rich liberal society, there are active social customs, feelings and individual and collective responsibilities among the people that help the disadvantaged and poor people to have access to the minimum health care facility in both liberal and non-liberal poor countries. In order to explain the (...) importance and functional contribution of the social norms in this respect, some examples will be illustrated from Bangladesh which is a poor liberal country. There will be two sections of the paper. In the first section, it will be exhibited how the naturally and socially disadvantaged people in a liberal society get benefit following Rawls‟ theory of distributive justice. In the second section, it will be showed that in a poor country where there are less resources of the government to provide enough services to the poor and disadvantaged people, the communal feelings and the informal social institutions play a vital role that helps the disadvantaged and poor people to get access to the health benefit. The traditional social norms impose indirect sanction on its people to come forward to help the worse off people of the country. It is depicted that Rawlsian theory of distribution does not work properly in these countries, rather the communitarian feelings is more welcomed for the benefit of the overall welfare of the society and this will be shown in the conclusion of the paper. (shrink)

There is considerable enthusiasm about the prospect that artificial intelligence (AI) will help to improve the safety and efficacy of health services and the efficiency of health systems. To realize this potential, however, AI systems will have to overcome structural problems in the culture and practice of medicine and the organization of health systems that impact the data from which AI models are built, the environments into which they will be deployed, and the practices and incentives that structure their development. (...) This perspective elaborates on some of these structural challenges and provides recommendations to address potential shortcomings. (shrink)

Objectives: This study aimed to fill the gap between Vietnamese diabetic patients' needs and care through a qualitative study asking about their experiences with diabetes and quality of care. -/- Methods: Interviews with five diabetic patients were conducted at a tertiary general hospital located in southern Vietnam. The transcribed data were first subjected to quantitative text analysis using KH Coder to identify major categories of frequently used words, followed by a qualitative analysis of selected cases using the Steps (...) for Coding and Theorization (SCAT) method. -/- Results: The major categories of frequently used words were chronic health conditions, services, facilities, insurance, patient-doctor communication, and medication. SCAT analysis of three selected cases identified six themes: “Disregarding the disease at the early stage,” “Fear of complications,” “Satisfaction with hospital services and medical staff,” “Insurance-related problems,” “Long waiting times,” and “Communication barriers between patients and doctors.” Patients were satisfied with improved hospital facilities and services; however, the overloading of one hospital led to long waiting times and communication difficulties with doctors. Difficulties with health insurance were also observed, and patients were rather passive in disease management and needed to be empowered through improved communication with doctors and other care providers. -/- Conclusion: These findings from our trial of introducing a qualitative study into service evaluation suggest that listening to patients can help health providers learn their perspectives and be more responsive to their needs. (shrink)

The status and functioning of shame is contested in moral psychology. In much of anglophone philosophy and psychology, it is presumed to be largely destructive, while in Confucian philosophy and many East Asian communities, it is positively associated with moral development. Recent work in human-robot interaction offers a unique opportunity to investigate how shame functions while controlling for confounding variables of interpersonal interaction. One research program suggests a Confucian strategy for using robots to rebuke participants, but results from experiments with (...) educational technologies imply a different and potentially opposing account of shame’s role in personal development. By digging deeper into the details of Confucian theorizing about shame, I identify a unifying explanation for these apparently conflicting results. I conclude by offering suggestions for future empirical research in human-robot interactions to further investigate shame’s role in moral development. (shrink)

Digital records, from chat transcripts to social media posts, are being used to create chatbots that recreate the conversational style of deceased individuals. Some maintain that this is merely a new form of digital memorial, while others argue that they pose a variety of moral hazards. To resolve this, I turn to classical Chinese philosophy to make use of a debate over the ethics of funerals and mourning. This ancient argument includes much of interest for the contemporary issue at hand, (...) including the use of impersonators of the dead to help the bereaved to deal well with their grief. I connect this historical discussion with a modern trend in clinical psychology that reframes therapeutic interventions with bereaved individuals. The trend directs practitioners away from facilitating detachment and toward affirming continuing bonds. I conclude that these chatbots can offer an important source of support to mourners, but also discuss parameters and features of social context that will be important to avoid the moral hazards identified by sceptics. (shrink)

Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search.In sum, teaching in all three subjects combined (...) comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics. (shrink)