Search Results

This chapter focuses on caring about that is positive and disinterested, and only as it is directed at other persons. It distinguishes impersonal from personal care, and within the latter, between caring that does and caring that does not involve certain desires whose content essentially refers back to the one with the desires. Love of particular others and friendships are instances of personal care, and it is often critical to the agent to extend personal care to a friend or loved one.

The factors outside the traditional health care system—or straddling the boundary between health care and other sectors—can often have huge implications for persons' health and well being. This chapter briefly explores four such topics: assistive technology, personal care assistance, accessible public transportation, and accessible housing. It looks at controversies about health insurance coverage of these items and services.

This chapter begins by exploring the contours of that stage of illness where ‘a claim for comfort rather than curative or even palliative procedures’ has been reached. It stresses the difficulties of distinguishing between the prolongation of living and the prolongation of dying and asserts that requests for euthanasia in this context can be avoided by the provision of appropriate care. The paper gives more attention than previously to the grief of relatives and even touches on the subject of organ donation. It also summarizes research on the incidence of pain in terminal cancer and a discussion of the control of physical distress includes reference to the value of palliative surgery. Drugs may have their place in easing mental distress, but the paper places a strong emphasis on the importance of personal care. Religious faith may also be important here.

This chapter examines fundamental changes that have developed in the delivery of some parts of social care to individuals, aimed at both increasing their choice over service providers, but more recently their control over that choice. It argues that for such policies to succeed requires four elements: a range of services that offers meaningful diversity; accessible and understandable information for service users to make choices between options; empowerment of users and carers to select between services; and control — in some cases with support and monitoring — over those selections. It traces the development of first ‘direct payments’ to people entitled to support for personal care of different kinds since 1996, and more recently the pilot experiments with ‘individual budgets’, where service users are using combined resources from a variety of funding streams within what becomes a real, rather than a ‘quasi’-market.

Grounded in ethnographic field research in Tanzania, this chapter asks what happens when older people become restricted in their movements. It shows that for old, ill and disabled people in coastal Tanzania the home becomes a place of particular importance. However, as the chapter illustrates with detailed case studies, the home should not just be considered in its material sense, as an enclosed and demarcated space, but rather as a lived space interacting with the broader lived spaces of care. Introducing the term ‘carescapes,’ the chapter argues that lived spaces of care are created at the intersections of the home in its material sense, embodied people, and the broader society. The everyday care of frail and disabled older people occurs at these shifting intersections, but only close kin – in a social rather than a geographical sense – are involved in the provision of intimate, personal care and livelihood.

This chapter recommends that assisted suicide should be limited to people who are terminally ill. Although people who are competent should not be involuntarily committed because they are suicidal, assisted suicide should not be expanded to those with chronic, incurable conditions. If it is expanded in this way, it must include people with psychiatric disabilities. However, there are many ways to provide assistance and support to people with chronic and intractable medical and emotional conditions. Our society generally refuses to provide this support, even when it is less expensive, for a variety of reasons. For some people who are suicidal, government nonintervention suffices, but for others, neither radical autonomy nor coercive beneficence serves their needs.

To a great extent the underlying purposes of informed consent in research settings resemble those in the treatment situation. Informed consent promotes individuals’ autonomy by allowing subjects to make meaningful decisions about participation in research projects. Informed consent is also a means of reducing inequalities of knowledge and power in the researcher-subject relationship and thus increases the cooperation and compliance of subjects. Increased knowledge also enhances patients’ abilities to make decisions that will protect them from unwanted and undesirable intrusions on bodily integrity, perhaps of even greater importance here than in treatment settings, because of the sorry history of abuses inflicted on research subjects. As great as the similarities are between consent to treatment and consent to research, the differences are equally great. In treatment settings, as already noted, clinicians and patients are presumed to share the same goal: promoting patients’ health. They may disagree over the means, but a general coincidence of interests is ordinarily the rule. Charles Fried calls this confluence of interests the principle of personal care. “The traditional concept of the physician’s relation to his patient is one of unqualified fidelity to that patient’s health. He may certainly not do anything that would impair the patient’s health and he must do everything in his ability to further it”. The essence of this principle is that physicians will not allow any other considerations to impinge on their decisions as to what measures are in their patients’ best interests. Since the goal of scientific investigation is the production of generalizable knowledge, not primarily the promotion of individual health, the interests of subjects and researchers are not identical. Clinician-researchers who are providing treatment to subjects in their research studies may feel this clash of interests most acutely as steps taken to protect the generalizability of the data may conflict with the maximization of benefit to individual subjects (2). The need to take this conflict into account in the decisionmaking process is largely responsible for the differences between consent to research and consent to treatment.

Household production is an important non-market activity and the empirical literature has developed different methods towards valuing household production without, however, providing a rigorous theoretical foundation for the various approaches. We follow the literature initiated by Becker and Lancaster and we develop a model of the household as producer and consumer that provides a theoretical justification for the two main approaches towards valuing labour in household production: the replacement cost approach and the opportunity cost approach. We provide a justification for the replacement cost approach as a way of valuing labour input into own-account production of households but show also that in general this is an incomplete measure of full consumption. We further develop a cost-of-living index for full consumption and full household income. The consequences of the theoretical model are illustrated by a cross-country comparison, using the data by Ahmad and Koh.