Challenges Related to Safety and Independence.

Advancing age is associated with increasing risk of activities important for independence, such as driving and living alone. Cognitive impairment is more common with older age; financial resources and social support may dwindle. Risk, cognitive impairment, and decisional capacity each change over time. Transparent decision making and harm reduction help balance risk and safety. When a patient lacks decisional capacity, an option that considers the patient's preferences and shows respect for the person is favored. Vulnerable patients making choices that are high risk, and patients for whom others are making such choices, may require state intervention.

Grounding the right to live in the community (CRPD Article 19) in the capabilities approach to social justice.

For advocates of the rights of persons with disabilities, particularly persons with mental disabilities, the human right to live in the community as an equal member is seen to be central and, often, even as the basis for all other human rights. Yet, despite its articulation in human rights law in the Convention on the Rights of People with Disabilities (CRPD), foundational issues about the right remain undertheorized and unclear. This paper brings to bear the capabilities approach, a normative framework about human well-being, social development and social justice, to this central concern in disability rights, mental health ethics, and international human rights law: protecting and respecting a person's right to live in a community as an equal. We argue that this human and moral right is best conceptualized as a capability to live in the community as an equal member. The capabilities approach provides this capability with a strong ethical framework and conceptual resources to guide reasoning and its practical realization.

The Ethics of Socially Assistive Robots in Aged Care. A Focus Group Study With Older Adults in Flanders, Belgium.

OBJECTIVES: Socially assistive robots (SARs) need to be studied from older adults' perspective, given their predicted future ubiquity in aged-care settings. Current ethical discourses on SARs in aged care are uninformed by primary stakeholders' ethical perceptions. This study reports on what community-dwelling older adults in Flanders, Belgium, perceive as ethical issues of SARs in aged care. METHODS: Constructivist grounded theory guided the study of 9 focus groups of 59 community-dwelling older adults (70+ years) in Flanders, Belgium. An open-ended topic guide and a modified Alice Cares documentary focused discussions. The Qualitative Analysis Guide of Leuven (QUAGOL) guided data analysis. RESULTS: Data revealed older adults' multidimensional perceptions on the ethics of SARs which were structured along three sections: (a) SARs as components of a techno-societal evolution, (b) SARs' embeddedness in aged-care dynamics, (c) SARs as embodiments of ethical considerations. DISCUSSION: Perceptions sociohistorically contextualize the ethics of SAR use by older adults' views on societal, organizational, and relational contexts in which aged care takes place. These contexts need to inform the ethical criteria for the design, development, and use of SARs. Focusing on older adults' ethical perceptions creates "normativity in place," viewing participants as moral subjects.

Ethical Considerations Regarding the Use of Smart Home Technologies for Older Adults: An Integrative Review.

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.

Ethicted (evaluation process model to improve personalised ICT services for independent living and active ageing)--future scenario.

ICT innovations are constantly developed, and there is no lack of elderly customers, as the number of the elderly is dramatically increasing. Elderly are willing to use ICT to increase their own safety and social activity, but they need trust on the reliability, accessibility and other ethical aspects of ICT including the maintenance of privacy and self-determination. Ethical standards for ICT are usually not considered. "Ethicted" characterizes an ICT service or product as ethically evaluated. As a standardized procedure, it will not only increase the acceptability of ICT, but also provide services for ICT developers. In the future scenario, ICT under development should be evaluated by using a process model that is specifically built to find the lacks in ethical aspects. The model would then be tested by end-users, the formal and informal care givers, to receive direct feedback for redeveloping solutions. As final outcomes, there should be standards for ICT in elderly care and a service for ICT developers to utilize the evaluation model. This future scenario work included partners from 6 EU member countries. The combination of academic research and industrial/commercial interest of ICT developers should and can bring new value to assistive ICT for elderly care.

Human rights and intellectual disabilities in an era of 'choice'.

BACKGROUND: Efforts to uphold and promote the human rights of people with intellectual disabilities (ID) are being affected by the increasing emphasis on 'choice' in the delivery of social care services. While rights presume subjects or selves to whom they apply, there is a disconnect between the subjects presumed within human rights frameworks and the variable capacities of a heterogeneous ID population. This disconnect is amplified by choice discourses which characterise current service provision based upon neoliberal ideologies. METHOD: Conceptual assumptions and theoretical positions associated with human rights in relation to people with ID are critically examined. RESULTS: The analysis results in an argument that current conceptualisations of personhood in relation to human rights exclude people with ID. The adverse effects of this exclusion are exacerbated within services which emphasise the permissive rights associated with a neoliberal agenda of 'choice' over protective rights. CONCLUSIONS: In order to ensure that the human rights of people with ID are upheld, neoliberal emphases on choice need to be tempered and a more nuanced and inclusive notion of personhood in relation to universal human rights needs to be adopted.

Ethical perspectives on self-neglect among older adults.

Self-neglect is a serious and growing problem among older adults. A 2004 survey from Adult Protective Services (APS) showed that adults age 60 or older were named in 85,000 reports of self-neglect from 21 states (Naik, Lai, Kunik, & Dyer, 2008; Teaster, Dugar, Mendiondo, Abner, & Cecil, 2006). Although rehabilitation nurses are obligated to uphold the autonomy of older adults and strengthen their independence, dilemmas result when people's poor health behaviors put them or others at risk for negative consequences. When making decisions about nursing actions related to self-neglecting elderly people, the basic principles of autonomy, beneficence, nonmaleficence, and capacity must be considered. The purpose of this article is to discuss major ethical perspectives related to self-neglect among older adults.

Environments for ageing, assistive technology and self-determination: ethical perspectives.

The development of information and communication technologies for design of environments for ageing is of great importance considering demographic trends in the future. There is a realistic hope for the preservation of self-determination and independence in the long term. However, some risks like a gradual loss of privacy should not be underestimated. The article discusses some ethical problems within this context. At the same time, the article demonstrates that the development and implementation of these technologies might be discussed for instance under some ethical assumptions of personal self-responsibility as well as social responsibility for the widest independence in advanced age.