Ethical uneasiness and the need for open-ended reflexivity: the case of research into older people with a wish to die

This article focuses on research ethics in highly intimate research with possible impact on life and death. In order to stimulate an open-ended dialogue about research ethics, we reflect on four ethical challenges that came up during our research into older people with a wish to die. Drawing on our experiences, we discuss (1) the possibly confirming influence of our research on the death wish (moral experience of whether or not to disregard responsibility); (2) the suggested duty to intervene (moral experience of whether or not to compromise the person’s autonomy); (3) the researcher’s authority and power over the data (moral experience of threatening a person’s self-narrative) and (4) the dilemma of intimacy (moral experience of encountering the tragic). For guidance in addressing these challenges, we draw upon work on research ethics from phenomenological and care ethics scholars, as well as from those writing about relational ethics in health research. We suggest that being open about ethical uneasiness is important, because in most cases of a grey area, there are only open-ended answers needing an enquiring mind, rather than clear and fixed guidelines. Acknowledgement of ethical uneasiness and open-ended reflexivity are indispensable to constitute a morally good research practice.     

Grass-roots reflections on substance abuse. A community dialogue approach

The Greater Cleveland Dialogue brings together people from all walks of life to express their sufferings and opinions. Professional ethicists have a role to play in this process, but chiefly as listeners and interpreters rather than as theoreticians. The ethics that arises from this process is at least as useful as the conclusions that descend deductively from the many rival "first principles" of a more theory-driven approach. If community dialogues provide a partial answer to questions of ethics and health care, they do so because they include the public. Policies related to health care affect the public and must be in tune with public sentiment if they are to be effective. Moreover, a different style of health care ethics emerges from the dialogue process. My view is that a truly public bioethics is ultimately necessary, since the policies our society develops in the area of health care can be meaningful only if they are grounded in the general will. We need to work harder at widening the umbrella of bioethics to include the public, for the sake of the community and for our own education as professionals. Certainly major questions for the future surround the nature of consensus and the process of achieving it.     

Financial literacy and anxiety about life in old age: evidence from the USA

This study examines whether financial literacy can help to reduce anxiety about life in old age. We hypothesized that financially literate people are more able to earn income and accumulate assets, leading them to have a less anxious life in old age. On the other hand, less financially literate people rely more on social security to secure themselves in the old age as they are not able to accumulate sufficient assets. By using US survey data, we provide evidence that assets significantly reduce anxiety about life in old age only for people who are more financially literate. For less financially literate people, social security plays an important role in reducing anxiety about life in old age. Besides these, having a child and doing regular exercise also reduced anxiety for all respondents but marital status reduced anxiety in respondents over 40 years of age. The results of our study are robust to measurement of financial literacy and endogeneity problems.     

Personal construct psychology methods for qualitative research

In this paper we discuss the unique influences of ethics assessment procedures on comparative qualitative research. These influences are particularly pronounced when researchers are from different disciplines and in different countries. Focusing on our experience conducting a study on the perceptions of young people regarding HIV/AIDS in two countries (Italy and Canada), we describe the impact of the ethics assessment procedures in our respective countries on recruitment, sampling and comparability of findings. We also raise issues related to differences in ethics assessment processes from a disciplinary perspective. We conclude by suggesting that our theory of technique approach, which focuses on studying how the choices made in research implementation influence the study findings, should be extended to include the impact of ethics assessment procedures.     

Responsibility and redistribution: The case of first best taxation

It is not straightforward to define the ethics of responsibility in cases where the consequences of changes in factors within our control are partly determined by factors beyond our control. In this paper, we suggest that one plausible view is to keep us responsible for the parts of the consequences that are independent of the factors beyond our control. Within the framework of a first best taxation problem, we present and characterise a redistributive mechanism that both satisfies this interpretation of the ethics of responsibility and the ethics of compensation within a broad class of economic environments. However, on a general basis, even this weaker version of the ethics of responsibility is not compatible with the ethics of compensation, and we report an impossibility result that clarifies the source of this conflict.Thanks to Alexander Cappelen, Walter Bossert, Marc Fleurbaey, Aanund Hylland, Peter Vallentyne, an associate editor and two anonymous referees for valuable comments. The author of course remains responsible for all remaining shortcomings.     

Squashed dreams and rare breeds: ableism and the arbiters of life and death

The week beginning 29 June 2015 is not just historic for the closure of the Independent Living Fund in the United Kingdom, but for me was the week they decided that my life is not worth investing in; they being NHS England, NICE and, with them, the Department of Health. They chose not to support the enzyme replacement therapy that has been not only keeping me alive, but giving me a quality of life – enabling me to return to finish my Disability Studies PhD exploring how Christian leaders explain disability, where ethics have become the main topic, and to rebuild my career – or so I thought.     

Spirituality and Ethics in Long-Term Care

Abstract

The issues of spirituality and ethics are evoked in a case of an 89-year-old woman resident in a nursing home who refused nutrition and hydration. Clergy representing Catholicism, Protestantism, Judaism, Hinduism and Islam were asked to respond to questions regarding the choice to end life and spiritual resources to help the patient. The clergy agreed that the patient is in a spiritual crisis but her autonomy should be respected, and spiritual resources should be expended to enhance meaning. The ethical dilemma for the social worker, as for the clergy, is whether to support the patient's freedom to end her life or persuade her to continue to live. The dilemma is based on conflicting social work values of self-determination and the preservation of life. Three ethical principles are in conflict: respect for autonomy, the duty to prevent harm, and beneficence. At the end of the process of ethical deliberation, the social worker must be prepared to accept the patient's decision.     

Ethical Decision-Making in the Helping Profession

Abstract

First, we examine several of the more prominent theoretical approaches in ethics (the utilitarian, absolute rule, principle based, and ethics of care approaches) and find the principle-based, common morality approach, and the ethics of care approach to be the two approaches that are most relevant to the types of ethical decisions practitioners characteristically are confronted with in a social work setting. We then propose combining these two approaches, taking into consideration the advantages and drawbacks of each, such that in application these two approaches can be seen to complement one another. We show in two brief hypothetical cases how the combined approach can be used to guide practitioners' ethical decision-making in real life situations.     

Care and community revalued during the COVID‐19 pandemic: A feminist couple perspective

The COVID‐19 pandemic led us to understand and revalue care ethics within our daily lives and communities based on the feminist theory of care ethics. This article is a personal reflection of an academic couple living in Japan as we reflect on our experiences and the challenges encountered in caring for ourselves and our community. We discuss the ideas of care theory mainly: caring‐about and caring‐for, interchangeably in our discussion across the three‐stage categories: Home — A Commonplace; Care Ethics in Community; and Care Ethics for Self. Through these personal narratives, we strive to recognize the struggles of living through the pandemic in a virtually connected world that often disconnects us from self. We foster the idea of embracing care ethics as a starting point at an individual level.     

ARE TRUSTWORTHINESS AND FAIRNESS ENOUGH? CONTEXTUAL FAMILY THERAPY AND THE GOOD FAMILY

The moral dimension of family therapy theory and practice has received increasing attention in recent years. Boszormenyi-Nagy was among the first to see that family therapy and moral questions are inseparable. His focus on relational ethics has helped us to reappropriate individual responsibility and accountability within a systemic context. Although contextual therapy has clearly enriched the field, we argue that its emphasis on trustworthiness and fairness provides a limited view of the good in family life and leads to three related problems. First, Boszormenyi-Nagy offers a compelling ethical vision of the family and then denies that he has done so, which undermines some of his key moral claims. Second, because fairness is defined subjectively, contextual therapy may not have the resources to deal with legitimate differences in family ideals. Third, the reliance on self-interest as the primary motive for trustworthy relating appears to be self-defeating. We offer a hermeneutic perspective that takes a broader approach to the good. It places greater emphasis on the social and historical context, deals squarely with different understandings of the good in family life, and recommends an approach to resolving these differences.     

高职院校学生顶岗实习之浅见

高职院校学生顶岗实习是一项新的教学环节,也是培养面向第一线需要的,实践能力强,具有良好职业道德的高技能、高素质人才的实践性教学环节。通过实践,取得了一些经验,为高职院校学生顶岗实习打下了基础。     

大学生职业道德教育途径探讨

近年来,在我国高等教育大众化的推动下,高校招生扩大,大学生就业难的问题非常突出,而大学生在就业过程中严重存在一些普遍性的职业道德素质问题:诚实守信素质缺失,吃苦耐劳素质的欠缺,责任意识缺乏等。随着社会分工的精细化和专业化,市场竞争激烈化,社会对从业人员的职业道德素质要求越来越高。服务社会的需要,高校应重视对大学生职业道德教育,积极探索大学生职业道德教育的有效途径。     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.     

Images of ageing in a 50+ magazine

The aim of this paper is to study what kind of ageing identity is constructed and what kinds of roles in old age are available for the readers of magazines aimed at readers over 50 years of age. The data comprise the back issues for the years 1996 and 2006 of the most popular 50+ magazine in Finland.There were three dominant patterns of talk. Talk of freedom included freedom from work and from predetermined roles, but also possibilities for new identities. Talk of activity emphasized physical activity, but also being mentally active and curious even in old age. Looking good in old age was always important, but in the more recent data, there was also praise of the charisma of older people associated with their life experiences. The magazine builds self-confidence among older people and encourages them to re-shape their lives.     

COHORT DIFFERENCES IN THE TRANSITION TO MOTHERHOOD:

Although research has found that educational attainment is a major predictor of age at first childbirth, this association may not be consistent across cohorts. In this article, we examine the adult transitions of four cohorts of married white women (N = 306), born between 1907 and 1933, including in our life course model not only education but also employment before marriage. As hypothesized, employment before marriage is the best predictor of the age at first childbirth among women entering adulthood prior to the end of World War II. In contrast, women in the early postwar years were moderately more likely to postpone childbearing due to educational pursuits.     

Mental health of the oldest-old

As more individuals live past age 100, it is important for health professionals to better understand characteristics important to the mental health of the oldest-old in our society. Few studies have been conducted on mental health in this group, but current literature suggests these individuals are very resilient with respect to mental health and life satisfaction, despite their health disadvantages. In interviews in a variety of studies, participants talked of the importance of both inner and outer resources for empowerment. Greater understanding of mental health in aging can inform policy makers as they draft new legislation and programs to enhance quality of life for the oldest-old.     

Finding Hope in the Life of Young Part-timers

The objective of this article is to link the structural factor (employment structure) and subjective factor (notion of labor) concerned with the generation process of young part-timers (freeters) by considering their life histories in terms of hope. Based on the ongoing research conducted over a period of 5 years on three male freeters, the following facts have come to light. Freeters are located on the lower strata of full-time and part-time jobs. They cannot envision a future career path in either employment style. Due to current labor ethics, they cannot form a subgroup that acknowledges their employment style and present-time orientation. Under pressure from labor ethics, which insist that they do “decent” work, they cannot help but hope to escape from this double-bind. To put it briefly, present Japanese society needs flexible workers, on the one hand, but cannot permit them to be flexible on the other. This kind of structural tension drives the young workers to hope. But hope does not dissolve the structural tension. On the contrary, it works to prolong this structural tension itself.     

The Relationship Between Work-Life Policies and Practices and Employee Loyalty:A Life Course Perspective

Using a representative sample of 3,381 American workers, this study investigates relationships among work/life policies, informal support, and employee loyalty over the life course (defined by age and parental status and age of youngest child). The central thesis is that our understanding of the impact of work/life policies on employee loyalty will be enriched by consideration of the non-work and work contexts that influence employee attitudes and behavior. The relationship between employee child care policies and loyalty varies for women and men at different stages of parenthood. Flexible-time policies have a consistent, positive association with employee loyalty with some variation based on life stage. Informal support (via supervisors and co-workers) has the greatest positive relationship with employee loyalty.     

Act Your Age

With the aim of contributing to a sociology of age, this essay develops a framework for understanding age as accomplished, i.e., as something that is both a process and the outcome of ongoing interactional work. The common expression act your age provides the useful metaphor of performance. We perform our own age constantly, but we also give meaning to other ages and to age more generally in our actions and interactions, our beliefs and words and feelings, our social policies. This essay offers two routes to the conclusion that age is accomplished. The first involves drawing parallels between the study of age and the study of gender. The second route uses existing scholarship, which recognizes that age is far more social than chronological. I draw on work in the social constructionist, symbolic interactionist, and life course traditions to develop the framework of age-as-accomplished and to show its potential to organize much of what we already have learned about age and aging.     

Ethical dimensions of nonprofit administration

This article explains why ethics is a necessary and powerful aspect of organizational life and why the managerial ethics of executive responsibility is arguably the most important part of management. While ethical considerations in management are largely the same regardless of organizational type, there are some unique characteristics of nonprofit organizations that create a special ethical context for the nonprofit administrative role. This uniqueness, the immensity and organizational complexity of the American nonprofit sector, and the importance of ethical considerations in an increasingly amoral society, are grounds for giving more attention to this topic.