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Safe I. From female warriors in the rainforest to infectious disease specialists: COVID-19 in the Amazon. Lancet Respir Med 2021; 9:566-567. [PMID: 33684357 DOI: 10.1016/s2213-2600(21)00033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Izabella Safe
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil; Universidade do Estado do Amazonas, Manaus, Amazonas, 69065-001, Brazil.
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Glasdam S, Ekstrand F, Rosberg M, van der Schaaf AM. A gap between the philosophy and the practice of palliative healthcare: sociological perspectives on the practice of nurses in specialised palliative homecare. Med Health Care Philos 2020; 23:141-152. [PMID: 31385188 PMCID: PMC7039838 DOI: 10.1007/s11019-019-09918-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values that configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients' drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses' profession in the palliative field and help them implement palliative care philosophy in practice.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Faculty of Medicine, Lund University, Baravägen 3, 222 41 Lund, Sweden
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3
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Locher D, Clark K, George A. Home Healthcare Fraud Enforcement: An Interagency Affair. Home Healthc Now 2019; 37:122-123. [PMID: 30829793 DOI: 10.1097/nhh.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- David Locher
- David Locher, JD, is an Associate, Baker Botts LLP, Washington, DC. Kyle Clark, JD, is a Partner, Baker Botts LLP, Washington, DC. Andrew George, JD, is a Special Counsel, Baker Botts LLP, Washington, DC
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4
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van Malenstein MM, Heerema NC, van Leeuwen PW, Westermann EJA, Kampelmacher MJ. [Withdrawal of chronic mechanical ventilation at home: coordination, organisation and implementation]. Ned Tijdschr Geneeskd 2018; 162:D2767. [PMID: 30570935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In the Netherlands, an increasing number of patients are dependent on domiciliary ventilation. General practitioners and elderly care physicians caring for these patients are increasingly confronted with problems related to chronic ventilation. Most patients die due to progression of respiratory failure, however, patients may ask their physician to electively withdraw their assisted ventilation. According to the Dutch Medical Treatment Contracts Act, withdrawal of domiciliary ventilation at the request of a patient constitutes normal medical care and concerns neither the assessment of, nor the compliance with, a request for euthanasia. Currently, there is no Dutch guidance or guideline containing practical advice regarding the medical, ethical, organisational and supportive aspects of withdrawal of domiciliary ventilation. This paper addresses the planning necessary for the patient and between treating professionals, for the organisation and implementation of withdrawal of domiciliary ventilation at the patient's home, a nursing home or hospice.
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5
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Affiliation(s)
- Kyle Clark
- Kyle Clark, JD, is Partner, Baker Botts L.L.P., Washington, DC. Andrew George, JD, is a Senior Associate, Baker Botts L.L.P., Washington, DC
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6
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Harris M, Gorski LA. Words You Never Want to Hear! Home Healthc Now 2017; 35:462-463. [PMID: 28857876 DOI: 10.1097/nhh.0000000000000581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Marilyn Harris
- Marilyn Harris, MSN, RN, NEA-BC, FAAN, is Retired Executive Director, current author and editor, Abington Memorial Hospital Home Care & Hospice, Willow Grove, Pennsylvania. Lisa A. Gorski, MS, RN, HHCNS-BC, CRNI®, FAAN, is a Clinical Nurse Specialist, Wheaton Franciscan Home Health & Hospice, Milwaukee, Wisconsin
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Abstract
Respecting the autonomy and will of people has legitimately led to strictly control the use of constraint in care activities, and promote a care ethics centred around people's needs and wills. But constraint is underlying in any action aiming at making people do something, even with their consent, especially when their ability to evaluate what is best for them may be altered. Ceaselessly present in care, this ordinary, silent constraint should not be only deemed as a necessary evil to be prevented. In contrast with this legally-based view, the paper adopts a pragmatic perspective. Leaning on minute case studies carried out at disable people's homes, the empirical section takes up some key troubling moments between caregivers and patients as trials capable of revealing 'constraint in practice': a situation of uncertainty, doubt, hesitations on the appraisal of what is happening and how to deal with it, banning any clear-cut distinction between technical gestures and moral values. Having outlined the characters of such a 'situational ethics', the authors argue in conclusion that, provided caregivers are never quits with its use, constraint is compatible with care, and assume that care theories could fruitfully support this advocacy to 'maintaining the trouble' in care practices.
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Affiliation(s)
- Antoine Hennion
- Mines ParisTech, PSL Research University, CSI - Centre for the Sociology of Innovation, i3 UMR CNRS 7185, Paris, France
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8
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Affiliation(s)
- Joy Mishell Cameron
- Joy Mishell Cameron, MPP, is the Vice President, Policy and Innovation, Visiting Nurse Associations of America, Arlington, Virginia
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9
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Abstract
Aim To explore caregivers' perspectives on ethics in older people's residential and domiciliary social care. Method Seventeen staff working in domiciliary and residential care were divided into four focus groups and invited to share their perspectives on 'ethical' or 'good' care, the ethical issues that arise in their care practice, and barriers and enablers for ethical care. Findings A thematic analysis identified four themes: negotiating relationships, boundaries and the management of emotions, the effects of negative portrayals of care, and becoming a good carer. Conclusion Providing ethical social care is complex, and involves managing emotional boundaries and relational issues. The authors suggest that caregivers provide skilled companionship to those in their care.
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Abstract
Little is known about older persons’ expectancies (or anticipations) about the possible actions of home-care professionals, although such data have implications for the ethics of home care and home-care policies. From a longitudinal study of older women’s experience of home care, findings are reported concerning their expectancies of professional home-care providers. A descriptive phenomenological method was used to detail the structure of the experience and its context. Data were analyzed from a series of interviews with 13 women aged 82 to 96 years. Among the five key structures of experience were ‘finding that someone has the job of helping me here’ and ‘determining where the helper’s field lies’. Two subsets within a category of expectancies were differentiated: speculations about helpers’ possible actions and expectancies about outcomes of helpers’ actions. As parameters of relational ethics, clients’ speculations and expectancies are appropriate bases for dialogue about older widows’ relationships with home-care professionals and the foci of home-care policies.
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Affiliation(s)
- Eileen J Porter
- MU Sinclair School of Nursing, University of Missouri-Columbia, Columbia, MO 65211, USA.
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Abstract
Elderly people are a particularly vulnerable group in society and have special health problems. The world population of older people is increasing. People who are 65 years or older constitute 6% of the Turkish population, 90% of whom have chronic health problems. In Turkey, there is a high possibility that elderly people’s requirements are not met by today’s health care system in the way they would wish. They prefer not to be hospitalized when they have health problems. From a wider perspective, various countries are still seeking how to provide the best care for elderly people. Our goal was to characterize home-based care for elderly people using an ethical approach as an area of interest for nurses and other health care professionals now and in the future, both for Turkey specifically and from a global perspective. We studied four case histories and then prepared a composite scenario and a short questionnaire for elderly people living in a specific district of Istanbul to evaluate their expectations from the health care system. We compared our findings with situations in other countries and have proposed some practical solutions. The results showed that these older people preferred to receive nursing care at home instead of in hospital in Turkey, and also in many other countries. In this article we discuss our findings, comparing them with those in the literature, and suggest that there should be nursing care at home with insurance coverage while using a proper ethical approach.
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12
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Brauer M. [Ethical questioning with an elderly couple losing their autonomy at home]. Soins 2016; 61:20-22. [PMID: 27393981 DOI: 10.1016/j.soin.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The complexity of the situation of certain patients living at home can place health professionals in a difficult position. Inter-professional collaboration, in consultation with the patient and their relatives, is essential to ensure a patient can remain at home and to adopt an ethical approach in all circumstances.
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Affiliation(s)
- Monique Brauer
- 7 bis, rue Serge Voyer, 94290 Villeneuve-Le-Roi, France.
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Marziali E, Serafini JMD, McCleary L. A Systematic Review of Practice Standards and Research Ethics in Technology-Based Home Health Care Intervention Programs for Older Adults. J Aging Health 2016; 17:679-96. [PMID: 16377767 DOI: 10.1177/0898264305281100] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The purpose of the review is to assess frequencies of reporting adherence to professional practice standards and research ethics in studies of technology-based home health care programs. Methods: Key databases were searched to yield 2,866 abstracts that were independently rated by two reviewers using inclusion-exclusion criteria, resulting in 107 articles that were then reviewed for reports of practice standards and research ethics. Results: Issues related to professional practice standards and research ethics were not well reported. When reported, adherence to practice standards included preintervention training, use of intervention protocols, supervision, and mechanisms for risk management. Research ethics most commonly reported were informed consent, REB/IRB approval, and protection of privacy. Discussion: The results raise questions as to whether practice standards and research ethics are addressed sufficiently when health service delivery occurs in technology-based environments. Guidelines for professional accountability in e-health service delivery are needed.
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Affiliation(s)
- Elsa Marziali
- Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, University of Toronto, Ontario, Canada.
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Smebye KL, Kirkevold M, Engedal K. Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study. BMC Health Serv Res 2016; 16:21. [PMID: 26787190 PMCID: PMC4717656 DOI: 10.1186/s12913-015-1217-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 12/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for people with dementia living in their own homes is a challenging care issue that raises ethical dilemmas of how to balance autonomy with their safety and well-being. The theoretical framework for this study consisted of the concepts of autonomy, beneficence, non-maleficence, paternalism and from the ethics of care. The aim of this study was to explore ethical dilemmas concerning autonomy that were identified when persons with dementia wished to live at home. METHODS This Norwegian study had a qualitative, hermeneutic design and was based on nine cases. Each case consisted of of a triad: the person with dementia, the family carer and the professional caregiver. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2 i.e. dementia of moderate degree (4) able to communicate verbally and (5) expressed a wish to live at home. The family carers and professional caregivers registered in the patients' records were included in the study. An interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day care centre. By means of deductive analysis, autonomy-related ethical dilemmas were identified. The final interpretation was based on perspectives from the theoretical framework. RESULTS The analysis revealed three main ethical dilemmas: When the autonomy of the person with dementia conflicted with (1) the family carer's and professional caregiver's need to prevent harm (non-maleficence) (2) the beneficence of family carers and professional caregivers (3) the autonomy of the family carer. CONCLUSIONS In order to remain living in their own homes, people with dementia accepted their dependence on others in order to uphold their actual autonomy and live in accordance with their identified values. Paternalism could be justified in light of beneficence and non-maleficence and within an ethics of care.
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Affiliation(s)
| | - Marit Kirkevold
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Blindern, P.B. 1130, 0318 Oslo, Norway
- Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Knut Engedal
- Norwegian Centre for Aging and Health, Vestfold Health Trust, 3130 Tønsberg, Norway
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Chung J, Demiris G, Thompson HJ. Ethical Considerations Regarding the Use of Smart Home Technologies for Older Adults: An Integrative Review. Annu Rev Nurs Res 2016; 34:155-181. [PMID: 26673381 DOI: 10.1891/0739-6686.34.155] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PROBLEM With the wide adoption and use of smart home applications, there is a need for examining ethical issues regarding smart home use at the intersection of aging, technology, and home environment. PURPOSE The purpose of this review is to provide an overview of ethical considerations and the evidence on these ethical issues based on an integrative literature review with regard to the utilization of smart home technologies by older adults and their family members. REVIEW DESIGN AND METHODS: We conducted an integrative literature review of the scientific literature from indexed databases (e. g., MEDLINE, CINAHL, and PsycINFO). The framework guiding this review is derived from previous work on ethical considerations related to telehealth use for older adults and smart homes for palliative care. Key ethical issues of the framework include privacy, informed consent, autonomy, obtrusiveness, equal access, reduction in human touch, and usability. RESULTS Six hundred and thirty-five candidate articles were identified between the years 1990 and 2014. Sixteen articles were included in the review. Privacy and obtrusiveness issues appear to be the most important factors that can affect smart home technology adoption. In addition, this article recommends that stigmatization and reliability and maintenance of the system are additional factors to consider. IMPLICATIONS When smart home technology is used appropriately, it has the potential to improve quality of life and maintain safety among older adults, ultimately supporting the desire of older adults for aging in place. The ability to respond to potential ethical concerns will be critical to the future development and application of smart home technologies that aim to enhance safety and independence.
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Waycott J, Morgans A, Pedell S, Ozanne E, Vetere F, Kulik L, Davis H. Ethics in Evaluating a Sociotechnical Intervention With Socially Isolated Older Adults. Qual Health Res 2015; 25:1518-1528. [PMID: 25646003 DOI: 10.1177/1049732315570136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this article is to consider how ethical principles can inform the effective design and implementation of technology-based interventions that aim to promote the well-being of socially isolated older adults. We evaluated a new iPad application with small groups of older adults. In this article, we reflect on the ethical issues encountered at each stage of the research process. Drawing on the ethical principles of beneficence, research merit and integrity, justice, and respect, we identify key issues to consider in the future design and implementation of social isolation interventions that use new technologies. Key issues include (a) providing sufficient support to facilitate ongoing social interactions, (b) managing older adults' expectations, (c) providing encouragement without coercion, and (d) responding to individual needs. We conclude that it is important to report on ethical challenges incurred when evaluating social isolation interventions to inform future research in this important area.
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Affiliation(s)
- Jenny Waycott
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Amee Morgans
- Benetas Aged Care Services, Melbourne, Victoria, Australia
| | - Sonja Pedell
- Swinburne University of Technology, Melbourne, Victoria, Australia
| | | | - Frank Vetere
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Lars Kulik
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Hilary Davis
- The University of Melbourne, Melbourne, Victoria, Australia
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Mort M, Roberts C, Pols J, Domenech M, Moser I. Ethical implications of home telecare for older people: a framework derived from a multisited participative study. Health Expect 2015; 18:438-49. [PMID: 23914810 PMCID: PMC5060789 DOI: 10.1111/hex.12109] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 10/26/2022] Open
Abstract
CONTEXT Telecare and telehealth developments have recently attracted much attention in research and service development contexts, where their evaluation has predominantly concerned effectiveness and efficiency. Their social and ethical implications, in contrast, have received little scrutiny. OBJECTIVE To develop an ethical framework for telecare systems based on analysis of observations of telecare-in-use and citizens' panel deliberations. DESIGN Ethnographic study (observation, work shadowing), interviews, older citizens' panels and a participative conference. SETTING Participants' homes, workplaces and familiar community venues in England, Spain, the Netherlands and Norway 2008-2011. RESULTS Older respondents expressed concerns that telecare might be used to replace face-to-face/hands-on care to cut costs. Citizens' panels strongly advocated ethical and social questions being considered in tandem with technical and policy developments. Older people are too often excluded from telecare system design, and installation is often wrongly seen as a one-off event. Some systems enhance self-care by increasing self-awareness, while others shift agency away from the older person, introducing new forms of dependency. CONCLUSIONS Telecare has care limitations; it is not a solution, but a shift in networks of relations and responsibilities. Telecare cannot be meaningfully evaluated as an entity, but rather in the situated relations people and technologies create together. Characteristics of ethical telecare include on-going user/carer engagement in decision making about systems: in-home system evolution with feedback opportunities built into implementation. System design should be horizontal, 'two-way'/interactive rather than vertical or 'one-way'. An ethical framework for telecare has been developed from these conclusions (Table 1).
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Affiliation(s)
- Maggie Mort
- Department of Sociology and Division of MedicineLancaster UniversityLancasterUK
| | - Celia Roberts
- Department of SociologyLancaster UniversityLancasterUK
| | - Jeannette Pols
- Section of Medical Ethics, Department of General PracticeAcademic Medical CentreAmsterdamThe Netherlands
| | - Miquel Domenech
- Department of Social PsychologyAutonomous University of BarcelonaBarcelonaSpain
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18
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Council apologises for neglect that contributed to patient's death. Nurs Stand 2014; 29:12. [PMID: 25227352 DOI: 10.7748/ns.29.3.12.s13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Surrey County Council said it 'should have done more' for a woman with dementia, who died after being left in her home without care for nine days.
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19
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Berlinger N, Kaebnick R. Whose hands? Global migration, elder care, and the mothers of others. Virtual Mentor 2013; 15:761-766. [PMID: 24021104 DOI: 10.1001/virtualmentor.2013.15.9.jdsc1-1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Nancy Berlinger
- Research scholar at The Hastings Center in Garrison, New York
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20
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Lehoux P, Hivon M, Williams-Jones B, Miller FA, Urbach DR. How do medical device manufacturers' websites frame the value of health innovation? An empirical ethics analysis of five Canadian innovations. Med Health Care Philos 2012; 15:61-77. [PMID: 21290189 DOI: 10.1007/s11019-011-9312-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology's promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate "value proposition" of their innovation and seek to respond to what they consider the key expectations of their customers. Our analysis shows that the manufacturers' framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians' and patients' expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others.
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Affiliation(s)
- P Lehoux
- Department of Health Administration, University of Montreal, and Institute of Public Health Research of the University of Montreal (IRSPUM), C.P. 6128, Succursale Centre-ville, Montreal, QC, H3C 3J7, Canada.
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21
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Daydé MC. [Home care day to day and ethical reflection]. Soins 2011:52. [PMID: 21574318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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22
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Germanier F, Loew F, Ummel M, Zumwald C. [Ethical considerations. Boundary limits in the home]. Krankenpfl Soins Infirm 2011; 104:44-47. [PMID: 21404506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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23
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Kosta E, Pitkänen O, Niemelä M, Kaasinen E. Mobile-centric ambient intelligence in health- and homecare-anticipating ethical and legal challenges. Sci Eng Ethics 2010; 16:303-323. [PMID: 19597967 DOI: 10.1007/s11948-009-9150-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 06/19/2009] [Indexed: 05/28/2023]
Abstract
Ambient Intelligence provides the potential for vast and varied applications, bringing with it both promise and peril. The development of Ambient Intelligence applications poses a number of ethical and legal concerns. Mobile devices are increasingly evolving into tools to orientate in and interact with the environment, thus introducing a user-centric approach to Ambient Intelligence. The MINAmI (Micro-Nano integrated platform for transverse Ambient Intelligence applications) FP6 research project aims at creating core technologies for mobile device based Ambient Intelligence services. In this paper we assess five scenarios that demonstrate forthcoming MINAmI-based applications focusing on healthcare, assistive technology, homecare, and everyday life in general. A legal and ethical analysis of the scenarios is conducted, which reveals various conflicting interests. The paper concludes with some thoughts on drafting ethical guidelines for Ambient Intelligence applications.
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Affiliation(s)
- Eleni Kosta
- Interdisciplinary Centre for Law & ICT (ICRI), KU Leuven, IBBT, Sint-Michielsstraat 6, 3000 Leuven, Belgium.
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Abstract
Telecare, the provision of care through remote interaction enabled by information and communication technology, is quickly developing. Integration with other technological developments is to be expected and will create systems that enable more intense, continuous and unobtrusive monitoring of health, and more personalized feedback and instructions. One of the goals of telecare is enhancing the independence and self-management of patients. In this article three degrees of self-management are described and a distinction is made between compliant and concordant forms of self-management. It is argued that telecare merely promotes forms of self-management in which compliance to medical instructions is central. Technological developments and normative policy considerations may enforce this trend to implement an interpretation of self-management in which compliance to a strict medical regime is prominent. Against this, a plea is made for developing telecare systems that incorporate concordant and collaborative forms of self-management, in which the patient's own perspective is empowered.
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Affiliation(s)
- M Schermer
- Medical Ethics and Philosophy of Medicine, Room AE 340, Erasmus MC, Rotterdam, The Netherlands.
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25
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Ponte C. [Nurses, patients and families. 5/8--Money or objects of value, what protections for the elderly person in the institution?]. Soins Gerontol 2009:43-44. [PMID: 19366027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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26
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Chaturvedi SK. Ethical dilemmas in palliative care in traditional developing societies, with special reference to the Indian setting. J Med Ethics 2008; 34:611-615. [PMID: 18667651 DOI: 10.1136/jme.2006.018887] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND There are intriguing and challenging ethical dilemmas in the practice of palliative care in a traditional developing society. OBJECTIVE To review the different ethical issues involved in cancer and palliative care in developing countries, with special reference to India. METHODS Published literature on pain relief and palliative care in the developing countries was reviewed to identify ethical issues and dilemmas related to these, and ways in which ethical principles could be observed in delivery of palliative care in such countries are discussed. RESULTS The literature review revealed a number of ethical dilemmas and challenges that professionals, cancer patients and their families encountered during palliative care. It was noted that patients' preferences and decisions are influenced by family members. Dilemmas leave the professionals and families confused about how ethical their actions have been. Specific ethical issues were noted in relation to the availability and use of oral morphine for pain relief, spiritual care, lack of adequate palliative care services, and palliative care education. CONCLUSIONS The four principles of ethics posed difficulties in understanding the complex ethical issues in a developing country with a traditional background. Ethical issues need to be handled delicately and sensitively in palliative care settings, within the framework of the traditions and culture of the society and financial constraints. The possible role of ethics committees in palliative care settings to help decision-making needs to be studied and discussed.
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Affiliation(s)
- S K Chaturvedi
- National Institute of Mental Health & Neurosciences, Bangalore 560029, India.
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DeWolf Bosek MS, Cashman GS. But I want to go home: ethical obligations and concerns when trying to achieve a patient's wishes: the case. JONAS Healthc Law Ethics Regul 2008; 10:75. [PMID: 18776748 DOI: 10.1097/01.nhl.0000300789.82391.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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McClure M, DeWolf Bosek MS. Ethical obligations and concerns when trying to achieve a patient's wishes: palliative care clinical nurse specialist. JONAS Healthc Law Ethics Regul 2008; 10:77-79. [PMID: 18776750 DOI: 10.1097/01.nhl.0000300791.67143.d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Maura McClure
- Palliative Care Service, Fletcher Allen Health Care, Burlington, Vermont, USA
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Smith-Stoner M, Veitz AL. The role of home healthcare nurses in high-risk cancer screening. Home Healthc Nurse 2008; 26:96-101. [PMID: 18301112 DOI: 10.1097/01.nhh.0000311027.33894.c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Marilyn Smith-Stoner
- California State University-San Bernardino, Beaumont, California 92223-1543, USA.
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Bendiane MK, Galinier A, Favre R, Ribiere C, Lapiana JM, Obadia Y, Peretti-Watel P. French district nurses' opinions towards euthanasia, involvement in end-of-life care and nurse patient relationship: a national phone survey. J Med Ethics 2007; 33:708-711. [PMID: 18055901 PMCID: PMC2598217 DOI: 10.1136/jme.2006.018374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 10/15/2006] [Accepted: 10/16/2006] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To assess French district nurses' opinions towards euthanasia and to study factors associated with these opinions, with emphasis on attitudes towards terminal patients. DESIGN AND SETTING An anonymous telephone survey carried out in 2005 among a national random sample of French district nurses. PARTICIPANTS District nurses currently delivering home care who have at least 1 year of professional experience. Of 803 district nurses contacted, 602 agreed to participate (response rate 75%). MAIN OUTCOME MEASURES Opinion towards the legalisation of euthanasia (on a five-point Likert scale from "strongly agree" to "strongly disagree"), attitudes towards terminal patients (discussing end-of-life issues with them, considering they should be told their prognosis, valuing the role of advance directives and surrogates). RESULTS Overall, 65% of the 602 nurses favoured legalising euthanasia. Regarding associated factors, this proportion was higher among those who discuss end-of-life issues with terminal patients (70%), who consider competent patients should always be told their prognosis (81%) and who value the role of advance directives and surrogates in end-of-life decision-making for incompetent patients (68% and 77% respectively). Women and older nurses were less likely to favour legalising euthanasia, as were those who believed in a god who masters their destiny. CONCLUSIONS French nurses are more in favour of legalising euthanasia than French physicians; these two populations contrast greatly in the factors associated with this support. Further research is needed to investigate how and to what extent such attitudes may affect nursing practice and emotional well-being in the specific context of end-of-life home care.
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Affiliation(s)
- M-K Bendiane
- Southeastern Health Regional Observatory (ORS-PACA), Marseilles, France
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van Bruchem-van de Scheur GG, van der Arend AJG, Spreeuwenberg C, Abu-Saad HH, ter Meulen RHJ. Euthanasia and physician-assisted suicide in the Dutch homecare sector: the role of the district nurse. J Adv Nurs 2007; 58:44-52. [PMID: 17394615 DOI: 10.1111/j.1365-2648.2007.04224.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of the findings of a study into the role of district nurses in euthanasia and physician-assisted suicide in homecare organizations, conducted as part of a study into the role of nurses in medical end-of-life decisions. BACKGROUND Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Minister for Health reason to commission a study into the role of nurses in medical end-of-life decisions in hospitals, nursing homes and homecare organizations. This is the first quantitative study from the perspective of nurses. Previous quantitative studies were conducted under physicians and information on the role of nurses was obtained indirectly. METHOD A questionnaire was sent in 2003 to 500 district nurses employed in 55 homecare organizations. The absolute response rate was 86.0% and 81.6% (408) could be used for analysis. RESULTS In 22.3% of 278 cases, the district nurse was the first with whom patients discussed their request for euthanasia or physician-assisted suicide. In about half (49.8%) of 267 cases nurses were not involved in the general practitioner's decision-making process, and in only 13.3% of 264 cases, did they attend the administration of the lethal drugs. District nurses had provided some degree of aftercare to the surviving relatives in 80.3% of 264 cases. CONCLUSION Collaboration between general practitioners and district nurses needs improvement, particularly in relation to decision-making. Our Dutch data could help nurses in other countries to define their (future) role in euthanasia and physician-assisted suicide.
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Bendiane MK, Bouhnik AD, Favre R, Galinier A, Obadia Y, Moatti JP, Peretti-Watel P. Morphine prescription in end-of-life care and euthanasia: French home nurses' opinions. J Opioid Manag 2007; 3:21-6. [PMID: 17367091 DOI: 10.5055/jom.2007.0035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aimed to investigate factors that might lead French homecare nurses to consider the prescription of high-dose morphine to terminally ill patients to be euthanasia. METHODS The researchers conducted an anonymous telephone survey among a random sample of 602 French homecare nurses (response rate = 75 percent) in 2005. RESULTS Overall, 27 percent of responding home nurses considered prescribing high-dose morphine to terminally ill patients to be euthanasia. Such an opinion was more frequently held by older nurses, those who had not followed terminally ill patients during the previous three years, and those with less knowledge about pain management involving opioid analgesics. CONCLUSION There is an urgent need to strengthen pain management education among French homecare nurses--especially regarding the use of morphine--in order to both improve their technical skills and correct some misconceptions about opioid analgesics.
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Abstract
Noncompliance of family caregivers can present home hospice nurses with difficult ethical choices and powerful feelings about those choices. This is particularly so when family members do not adequately palliate their loved ones, resulting in treatable symptom distress during the dying process. This article presents a case study, moral analysis, and an evidence-based, practical plan of action for engaging family members of palliative care patients on a home hospice service.
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Affiliation(s)
- Timothy W Kirk
- Department of Philosophy, Villanova University, Villanova, Pennsylvania 19087, USA.
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Abstract
Changes in public policy have led to increasing numbers of children with disabilities and complex medical needs being cared for in the homes of Canadians. Little work, however, has explored the ethical implications of these policies. This paper focuses on some of the shortcomings of current policy and describes a developing method for policy analysis with an explicit focus on ethics that could be adopted in other nations. Three forms of analyses - descriptive, conceptual and normative - conducted on Canadian homecare policy documents describe various dimensions of Canadian homecare policy. The descriptive analysis demonstrated that the jurisdiction of homecare services is dispersed across numerous programs and ministries with no single structure for policy implementation and accountability. The needs of children and youth are rarely mentioned in home healthcare policies, but instead are addressed under broader social policies that are focused upon children and family. The conceptual analysis revealed four over-arching themes that represent the predominant elements of a value-structure that underlie homecare policy. They include: (1) home and community care as ideal; (2) the importance of independence and self-care of citizens; (3) family as primary care provider; and (4) citizenship as entitlement to rights and justice. Overall, these themes tend to reflect a neoliberal ideology that shifts the responsibility of care from the state to the individual and his/her family. A normative framework based on critical healthcare ethics is used in the paper to make recommendations to redress the current imbalance between state and family support. For example, including homecare services within the Canada Health Act (CHA) or the development of separate legislation consistent with the principles of the CHA would make it possible to ensure that the principles of universality, accessibility, portability and public administration, as opposed to principles that reinforce competitive individualism, direct the provision of homecare services in Canada.
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Affiliation(s)
- Elizabeth Peter
- University of Toronto, 155 College Street, Toronto, Ont., Canada M5T 1P8.
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Wells JK. Ethical dilemma and resolution:a case scenario. Indian J Med Ethics 2007; 4:31-34. [PMID: 18630218 DOI: 10.20529/ijme.2007.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article illustrates an ethical dilemma that I faced while treating an 86-year-old woman at her home. The ethical dilemma was caused due to several factors such as the expectations of the client (client/consumer rights), organisational expectations (employer, governmental and payer-source regulations) and my own personal values (one's moral philosophies, perceived social responsibilities, sense of professional duty) and how they all interact with each other. The case is a classic example of a seemingly simple yet frequent dilemma encountered by occupational and physical therapists in the United States serving clients who are covered by Medicare (the government's health insurance) for home health. The article is aimed at highlighting the various ethical principles involved in clinical decision-making, and it suggests methods for resolution of ethical dilemmas. Although the article is based against the backdrop of the US health care system, students and health care practitioners globally can relate to it.
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Lüthi U. [Creating dignity anew in every process]. Krankenpfl Soins Infirm 2007; 100:24-6. [PMID: 17427854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Wright LD. Professional boundaries in home care. Home Healthc Nurse 2006; 24:672-5. [PMID: 17135847 DOI: 10.1097/00004045-200611000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Busquet Duran X. Bioética y atención domiciliaria. Aten Primaria 2006; 38:523-5. [PMID: 17194360 PMCID: PMC7679945 DOI: 10.1157/13095060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Xavier Busquet Duran
- PADES-Manresa (ICS), Comité de Etica Asistencial, Fundación Jordi Col i Gurina, Barcelona, Spain
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Affiliation(s)
- Kathleen Cranley Glass
- Department of Human Genetics, McGill University, 3647 Peel Street, Montreal, Quebec, Canada.
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Collins TL. The therapy threshold within the Medicare prospective payment system: associated ethical dilemmas and influence of therapy practice patterns and quality of patient care. Home Healthc Nurse 2006; 24:581-9. [PMID: 17252965 DOI: 10.1097/00004045-200610000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Tracey L Collins
- University of Scranton, Department of Physical Therapy, Pennsylvania 18510, USA.
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Abstract
Home care, including hospice care, is a growing component of the current healthcare system and pertains to care services that are provided to individuals, their family members, and caregivers in their own residence. Both domains face funding limitations as life expectancy and the segment of the population older than 65 years increase. Tele-health, defined as the use of advanced telecommunication technologies to enable communication between patients and healthcare providers separated by geographic distance, is perceived as a concept that can enhance both home and hospice care and address some of the current challenges. This article discusses ethical challenges associated with the utilization of tele-health technologies by the nursing profession in the home setting. These factors form a framework for the ethical considerations that result from the introduction of these technologies in nursing practice. Specifically, the article discusses the issue of privacy and confidentiality of patient data, informed consent, equity of access, promoting dependency versus independence, the lack of human touch and the impact of technology on the nurse-patient relationship, and the medicalization of the home environment. These issues constitute a road map both for nursing practitioners who are aiming to provide an efficient delivery of services in the home and for nursing administrators who are asked to make judgments about the use of tele-health technology as a supplement to traditional care and as a cost-saving tool.
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Affiliation(s)
- George Demiris
- Department of Health Management & Informatics, School of Medicine, School of Social Work, and Sinclair School of Nursing, University of Missouri - Columbia, Columbia, Mo 65211, USA.
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Abstract
Many more people are reaching old age than ever before, and older people are increasingly living longer. As the nation experiences this unprecedented growth of older Americans, geriatric case managers are likely to encounter many clients at very advanced ages. Concomitantly, practitioners will confront elders with questionable decision-making capacity, as dementia and other cognitive impairments are more common among the older age groups. These clients pose potential safety and well-being concerns and may be vulnerable to exploitation, neglect, and abuse in their homes. Case managers' responses to such client scenarios may range from little involvement, by acquiescing to the client's right to make autonomous decisions, to resorting to legal action, which may lead to a substantial loss of rights for the elder. This article provides considerations for practice with elders presenting with questionable decision-making capacity and precarious living situations. The distinction between capacity and competency is presented and factors affecting decision making are discussed. Ethical aspects are addressed and the process of assessing capacity is reviewed to enhance case managers' practices in this area.
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Affiliation(s)
- Kathy Black
- School of Social Work, University of South Florida at Sarasota/Manatee, FL 34243, USA.
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Blass DM, Rye RM, Robbins BM, Miner MM, Handel S, Carroll JL, Rabins PV. Ethical Issues in Mobile Psychiatric Treatment with Homebound Elderly Patients: The Psychogeriatric Assessment and Treatment in City Housing Experience. J Am Geriatr Soc 2006; 54:843-8. [PMID: 16696753 DOI: 10.1111/j.1532-5415.2006.00706.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Unique and challenging ethical difficulties arise during mobile psychiatric treatment of elderly patients. This article outlines and analyzes five of these challenges that have been encountered during nearly 20 years of experience with the Psychogeriatric Assessment and Treatment in City Housing Program in Baltimore, Maryland. The ethical challenges reviewed are: establishing the treatment contract versus the right to refuse treatment, protecting confidentiality versus patient protection, protecting autonomy versus asserting beneficence, treatment termination versus open-ended treatment, and cost versus benefit of care. Ethical challenges with homebound elderly patients are unique because of patient characteristics as well as features of the treatment environment.
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Affiliation(s)
- David M Blass
- Department of Psychiatry and Behavioral Sciences, Phoebe R. Berman Bioethics Institute, Johns Hopkins Hospital, 60 North Wolfe Street, Baltimore, MD 21287, USA.
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Badzek LA, Leslie N, Schwertfeger RU, Deiriggi P, Glover J, Friend L. Advanced care planning: A study on home health nurses. Appl Nurs Res 2006; 19:56-62. [PMID: 16728288 DOI: 10.1016/j.apnr.2005.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2002] [Accepted: 04/25/2005] [Indexed: 11/17/2022]
Abstract
The purpose of this research was to assess home health nurses' (HHNs) knowledge, comfort levels, barriers, and personal participation in advanced care planning (ACP), a practice that recognizes patient preferences for health care treatment. Licensed nurses who identified home care as their primary area of practice (N = 519) were surveyed about their knowledge of laws governing ACP and their perceptions of patients' preferences for ACP. Most respondents were women (97%), and the average age of the respondents was 54 years. Most nurses felt knowledgeable and capable of educating patients on advance directives (ADs), although the nurses' knowledge of laws governing ACP was limited and often inaccurate. Generally, nurses felt comfortable during ACP discussions with patients and families. HHNs perceived patient or family reluctance as the greatest barrier hindering discussions of ACP. No association was found between level of education and whether a nurse had a personal AD. Twenty percent of the nurses had their valid personal AD. A greater knowledge base concerning ACP would facilitate HHN discussions with patients and families. Recognition of patient preferences can be enhanced by understanding and overcoming barriers that hinder discussions of ACP. Educational opportunities focusing on ACP are encouraged for all health care providers.
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Affiliation(s)
- Laurie A Badzek
- School of Nursing, West Virginia University, Morgantown, WV 26506, USA.
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Eckenwiler LA. A missed opportunity: the President's Council on Bioethics report on ethical caregiving. Am J Bioeth 2006; 6:W20-3. [PMID: 16500830 DOI: 10.1080/15265160500506431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Abstract
Most motor neurone disease (MND) patients die of respiratory system complications. When patients have advanced disease with symptoms of respiratory failure, management issues can become complicated by the introduction of assisted ventilatory devices. Therefore, care provision by a multidisciplinary team must be structured and co-ordinated in order to ensure that patients and their carers receive the optimal level of care. The objective of this article is to review the literature and explore the complex issues surrounding the use of non-invasive positive pressure ventilation (NIPPV) in home care MND patients as a justification for the development of a management guideline for medical practitioners. A guideline for multidisciplinary care of home ventilated MND patients will be proposed.
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Affiliation(s)
- Derek Eng
- Palliative Care Unit, Hollywood Private Hospital, Western Australia.
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Halamandaris VJ. A message to the missionaries. Caring 2005; 24:96. [PMID: 16358545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Bellome JA, Cummings S. Adult day services: the missing link in home care. Caring 2005; 24:12-8. [PMID: 16124217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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