Aims and objectives.  To explore nursing home staff members’ experiences of what dignity in end of life care means to older people and to themselves.

Background.  Dignity is a concept often used in end-of-life care, but its meaning is rarely clarified.

Design.  Qualitative descriptive study.

Methods.  Content analysis. This study is based on interviews with 21 staff members in four different nursing homes in Sweden.

Findings.  The results show that staff members balanced between providing for the older person’s physical needs while wishing to be able to deliver a ‘deeper’ level of care. The older people’s dignity is presented in the main theme: Feeling trust – Showing respect. The staff members’ dignity is presented in the main theme: Maintaining self-respect – Being shown respect. Threats to dignity are presented in the main theme: conflicts between the ideal and the reality.

Conclusions.  The results reveal that nursing home staff members deal with a moral conflict between what they are able to deliver and what they would like to provide in the care of older people.

Relevance to clinical practice.  To promote older people’s dignity, there is a need to take account of staff members’ work situation. Supervision and continuous education could be one way of achieving this.

This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in two nursing homes in Sweden. A secondary analysis was carried out on data obtained from three of the primary participants interviewed over a period of time (18-24 months), with a total of 12 interviews carried out using an inductive hermeneutic approach. The study reveals that sources of meaning were created by having a sense of: physical capability, cognitive capability, being needed, and belonging. Meaning was created through inner dialogue, communication and relationships with others. A second finding is that the experience of meaning can sometimes be hard to realize. © 2008 SAGE Publications.

Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body, (2) fragility and dependency, and (3) inner strength and a sense of coherence. © 2006 Edward Arnold (Publishers) Ltd.

People with dementia have previously not been active participants in research, with ethical difficulties often being cited as the reason for this. A wider inclusion of people with dementia in research raises several ethical and methodological challenges. This article adds to the emerging debate by reflecting on the ethical and methodological issues raised during an interview study involving people with dementia and their spouses. The study sought to explore the impact of living with dementia. We argue that there is support for the inclusion of people with dementia in research and that the benefits of participation usually far outweigh the risks, particularly when a ;safe context' has been created. The role of gatekeepers as potentially responsible for excluding people with dementia needs further consideration, with particular reference to the appropriateness of viewing consent as a primarily cognitive, universalistic and exclusionary event as opposed to a more particularistic, inclusive and context relevant process.

[No abstract available]

As policy makers and funders have become more concerned with allocating scarce resources effectively, attention to the sustainability of health intervention programs has increased. However, the empirical knowledge base about factors facilitating or working against sustainability remains at an early stage. The aim of this study was to contribute to improved understanding of the conditions under which community-based injury prevention programs are most likely to attain sustainability. Ten Swedish community-based injury prevention programs were analysed with respect to factors that contribute to or detract from program sustainability. All the programs are integrated within existing municipality structures. Data were collected by means of semi-structured telephone interviews with key informants.

The results suggested that different factors are interrelated, with no one factor being either primary or by itself sufficient for program sustainability. Financial, human, and relational resources lay the groundwork for the long-term operation of a program. The “integrated” program model appears to facilitate sustainability, but program intensity is vulnerable to changes in the financial status of the municipality and the priority-setting by municipality political decision makers. Sustainability may be compromised if a program becomes too dependent on a few key individuals. In contrast to financial, human, and relational resources, structural resources (e.g., injury surveillance and goals) appeared to have limited influence on sustainability. The programs were sustained with little evidence of effectiveness, resulting in limited feedback about how to improve a program in order to achieve and maintain long-term effectiveness.

There are several causes and reasons to why a person lack the ability to take a job or to perform his or her tasks at the work place. Even though nearly all these causes and reasons are well-known, we lack a way of systematicly analysing them. There is a need to understand how they are empirically and logically related to each other. As a reslut of such an analysis we can classify the conditions of work ability and thereby more easily distinguish between different types of reduced work ability. This article is an attempt to contribute to such an analysis.

This project draws together the diverse strands of the debate regarding disability in a way never before combined in a single volume. After providing a representative sampling of competing philosophical approaches to the conceptualization of disability as such, the volume goes on to address such themes as the complex interplay between disability and quality of life, questions of social justice as it relates to disability, and the personal dimensions of the disability experience. By explicitly locating the discussion of various applied ethical questions within the broader theoretical context of how disability is best conceptualized, the volume seeks to bridge the gap between abstract philosophical musings about the nature of disease, illness and disability found in much of the philosophy of medicine literature, on the one hand, and the comparatively concrete but less philosophical discourse frequently encountered in much of the disability studies literature. It also critically examines various claims advanced by disability advocates, as well as those of their critics. In bringing together leading scholars in the fields of moral theory, bioethics, and disability studies, this volume makes a unique contribution to the scholarly literature, while also offering a valuable resource to instructors and students interested in a text that critically examines and assesses various approaches to some of the most vexing problems in contemporary social and political philosophy.

Contributes to the general philosophy of action and the philosophy of welfare. This book explores and substantiates the idea of a strong interdependence between the concept of action and some of the central concepts of welfare, in particular health and illness and related concepts.

Purpose: The purpose of this paper is to make a critical analysis of the conceptual platform of the recently introduced International Classification of Functioning, Disability and Health (ICF). Special attention is paid to the suggested definitions of the concepts of activity and participation. My argument intends to show that these definitions are not coherent.Method: The theoretical platform of this paper is philosophical action theory. My argument makes particular use of the distinction between capacity and opportunity and shows that both concepts are applicable to all actions. Capacity and opportunity are distinguished from the actual performance of actions. The latter presupposes the existence of a will. On this conceptual basis follows an analysis of the distinction between activity and participation as conceived by the WHO in ICF.Conclusions: The main conclusion of my reasoning is that the notions of activity and participation in ICF partly rest on confusion between capacity for action and the actual performance of an action. If my conclusion is sound this has far-reaching consequences for the application of the ICF in the practice of rehabilitation. My diagnosis therefore is that the conceptual framework of ICF is in great need of a strict action - theoretic reconstruction.

När samhällets mest brännande frågor diskuteras talas det idag ofta om delaktighet. Men vad står det för? I den här boken framgår att delaktighet har olika betydelser i det politiska språkbruket och i vetenskapligt språk. Fjorton forskare analyserar delaktighetens olika språk och sammanfattar aktuella undersökningar av funktionshindrades delaktighet.En semantisk analys visar att delaktighet bland annat kan betyda inflytande, tillhörighet, engagemang och makt. Världshälsoorganisationens nya klassifikation (ICF) av människors delaktighet diskuteras och i andra kapitel presenteras forskning om barns delaktighet i skolan och i mer informella leksammanhang. Vidare diskuteras om delaktighet förutsätter likvärdiga levnadsvillkor, hur man kan förstå föräldrars inflytande i barnhabilitering och om det går att skapa delaktighet.Boken vänder sig till alla som har intresse för handikappolitik samt till ett brett spektrum av utbildningar som berör funktionshinder.Bokserien "Handikapp och samhälle" syftar till att tematiskt presentera aktuella socialvetenskapliga perspektiv på funktionshinder och handikapp för såväl universitets- och högskolestuderande som andra intresserade.

For many years scientists within human and animal science have extensively discussed the philosophy of medicine, but never have both sides communicated on their concepts of health, quality of life and welfare, with each other. This book helps clarify the difficult but central notions of health and welfare by comparing the human and animal variants of these concepts. Split into three parts this book starts by presenting a background of some of the major theories of human health and welfare, among these are the bio-statistical theory, classical theories such as Aristotle and Bentham, as well as objectivist and subjectivist contemporary theories. This is followed by a detailed discussion of theories on animal welfare and health; these include coping, feeling and preference theories. The final part of the book tests a comprehensive conceptual framework of a holistic kind, which focuses on the individual's ability to achieve it's vital goals

Värdighet anses vara ett grundläggande värde som en människa kan äga. Dessutom är det ett värde som bör respekteras både av personen själv och av andra människor. Många nutida etiker hävdar att det av yttersta vikt att sådan respekt ska vara en grundbult i hälso- och sjukvården och i vården av äldre.

[No abstract available]

This article is a reply to Venkatapuram's critique in his article Health, Vital Goals, Capabilities, this volume. I take issue mainly with three critical points put forward by Venkatapuram with regard to my theory of health. (1) I deny that the contents of my vital goals are relative to each community or context, as Venkatapuram claims. There is no conceptual connection at all between standard circumstances and vital goals, as I understand these concepts. (2) Venkatapuram notes that I stop short of filling the framework of vital goals with any content and thereby make my concept of health less concrete. I reply that some vital goals are indeed universal, viz. the ones which are necessary conditions for survival. Many other vital goals are individual and cannot therefore be included in a universal list. (3) Venkatapuram claims that my definition of vital goals is too broad, since it entails that some persons without any disease can be regarded as ill. However, in my understanding health is a relational concept from a state of complete health to a state of maximal illness. In this framework, a minor reduction of a state of complete health does not entail illness. This article also contains a comparison between my theory of health and Martha Nussbaum's theory of capabilities for dignity.

The Encyclopedia of Applied Ethics, Second Edition addresses both the physiological and the psychological aspects of human behavior.  Carefully crafted, well written, and thoroughly indexed, the encyclopedia helps users-whether they are students just beginning formal study of the broad field or specialists in a branch of psychology-understand the field and how and why humans behave as we do.

The work is an all-encompassing reference providing a comprehensive and definitive review of the field. A broad and inclusive table of contents ensures detailed investigation of historical and theoretical material as well as in-depth analysis of current issues. Several disciplines may be involved in applied ethics: one branch of applied ethics, for example, bioethics, is commonly explicated in terms of ethical, legal, social, and philosophical issues.  Editor-in-Chief Ruth Chadwick has put together a group of leading contributors ranging from philosophers to practitioners in the particular fields in question, to academics from disciplines such as law and economics.

The 376 chapters are divided into 4 volumes, each chapter falling into a subject category including Applied Ethics;  Bioethics; Computers and Information Management; Economics/Business; Environmental Ethics; Ethics and Politics; Legal; Medical Ethics; Philosophy/Theories;  Social; and Social/Media.

• Concise entries (ten pages on average) provide foundational knowledge of the field
• Each article will features suggested readings pointing readers to additional sources for more information, a list of related websites, a 5-10 word glossary and a definition paragraph, and cross-references to related articles in the encyclopedia
• Newly expanded editorial board and a host of international contributors from the US, Australia, Belgium, Canada, France, Germany, Ireland, Israel, Japan, Sweden, and the United Kingdom
• The 376 chapters are divided into 4 volumes, each chapter falling into a subject category including Applied Ethics; Bioethics; Computers and Information Management; Economics/Business; Environmental Ethics; Ethics and Politics; Legal; Medical Ethics; Philosophy/Theories; Social; and Social/Media

The results of the empirical studies in the two projects focuses upon in this book, the Home project and the DOE project (Dignity and Older Europeans) are very rich. The country teams have collected an impressive volume of material which it will take a long time to analyse thoroughly. As will have become evident already, it is easy to give examples of quality of life, autonomy, integrity and dignity from the various studies in the two projects. This holds in particular for quality of life and autonomy in the Home project and for dignity in the DOE project. Dignity was the target concept in the DOE project, whereas good care in a broad sense was the target concept in the Home project.

The notion of quality of life has for several decades been well-established in ethical debate about health care and the care of older people. Dignity in Care for Older People highlights the notion of dignity within the care of the elderly, focusing on the importance of theoretical concepts. Primarily based on a Research Project, Dignity and Older Europeans, funded by the European Commission, this book provides a thorough investigation of the concept of dignity and related concepts such as quality of life and autonomy. It includes a chapter devoted to the dignity of human embodiment, emphasizing the importance of the notion of the lived body in the context of elderly care. As a result of the conceptual study a model of dignity emerges in which four variants of dignity stand out: dignity of merit, dignity as moral status, dignity of identity and Menschenwurde (the specifically human value). From this follows a discussion of how these variants of dignity can be used in characterizing the care of the elderly. The notions of dignity and dignified care are discussed particularly in relation to demented persons and dying persons. The book also contains a chapter on the dignity of the dead person. International in focus, Dignity in Care for Older People provides a contemporary discussion of the care of older people, and will be of use to qualified nurses and social care practitioners working with older people, as well as those on ethics and gerontology courses

In this article I respond to Bjorn Hofmanns criticism of some elements in my theory of health. Hofmanns main objective is to question "Nordenfelts basic premise that you can be ill without having negative first-person experiences, and to investigate the consequences of abandoning the premise." One of Hofmanns critical points is that my theory of health does not lend voice to the individual. My response is essentially conducted in four steps: (1) I question the aim of conceptual analysis that Hofmann proposes for the analysis of the notion of health. (2) I maintain that my analysis, in spite of Hofmanns contention, lends voice to the individual. It does so via my notion of subjective illness but also via my notion of vital goal. (3) I argue that conditions, such as coma, paralysis and mania are salient instances of ill health and that these may become neglected if the use of the terms "ill" and "illness" is restricted to instances where negative subjective experiences are present. (4) I rehearse my main arguments for selecting disability as the core element of ill health and respond to Hofmanns contention that persons who are in great pain can sometimes nevertheless perform perfectly.

The relationship between individual and population health is partially built on the broad dichotomization of medicine into clinical medicine and public health. Potential drawbacks of current views include seeing both individual and population health as absolute and independent concepts. I will argue that the relationship between individual and population health is largely relative and dynamic. Their interrelated dynamism derives from a causally defined life course perspective on health determination starting from an individual’s conception through growth, development and participation in the collective till death, all seen within the context of an adaptive society. Indeed, it will become clear that neither individual nor population health is identifiable or even definable without informative contextualization within the other. For instance, a person’s health cannot be seen in isolation but must be placed in the rich contextual web such as the socioeconomic circumstances and other health determinants of where they were conceived, born, bred, and how they shaped and were shaped by their environment and communities, especially given the prevailing population health exposures over their lifetime. We cannot discuss the “what” and “how much” of individual and population health until we know the cumulative trajectories of both, using appropriate causal language.

The essays presented in this collection were written over a long period. The first two : "On the Classification of Verbs and Actions" and "On von Wright's Theory of Action" constitute steps in my preparation for the book Events, Actions, and Ordinary Language, Lund 1977. Much of the contents of the former paper was carried over to the book, whereas the analyses in the latter paper were more or less completely left out. These papers have not been published before .

"On Various Forms of Interaction" is a development of soroe ideas in Events, Actions, and Ordinary Language. This paper was previously published in Swedish in Henschen-Dahlqvist A-M ed. Filosofiska smulor, Festskrift tillägnad Kon rad Marc- Wogau på hans 75-årsdag, Uppsala 1977.

"Action- Explanations Reconsidered" was wri t ten in 1981 and has not been previously published . It is a short presentation of a basic idea in my dissertation Explanation of Human Actions, Uppsala 1974, as well as a commentary on sorne criticisrns that could be (and partly have been) directed against it .

"On Not Being Able To Act", finally, is a slightly modified version of a paper previously published in Pauli T. ed <320311>, Philosophical essays dedicated to Lennart Åqvist on his fiftieth birthday, Uppsala 1982. The analysis sketched in this paper has been more fully developed in my Disabilities and Their Classification, Linköping 1983.

SAGE Reference is proud to announce the five-volume Encyclopedia of Disability. This encyclopedia represents the first attempt to bring an authoritative reference resource to the many faces of disability. More than 500 world-renowned scholars have written over 1,000 entries -in a clear, accessible style-with the desire to bring all students, researchers, and interested readers closer to the daily experience of disability. Volumes 1 - 4 cover disability A to Z, including a reader's guide, comprehensive bibliography, and index. Volume 5 contains a wealth of primary source documents in the field of disability. The Encyclopedia of Disability is a must-have reference for all academic libraries, large public libraries, and any social science, medical, legal, or governmental reference collections. Non-governmental organizations, charitable foundations, and law firms will also want to add this set to their collections.

This paper contains a brief comparative analysis of some philosophical and scientific discourses on human and animal health and welfare, focusing mainly on the welfare of sentient animals. The paper sets forth two kinds of proposals for the analysis of animal welfare which do not appear in the contemporary philosophical discussion of human welfare, viz. the coping theory of welfare and the theory of welfare in terms of natural behaviour. These proposals are scrutinized in the light of some similar theories dealing with human health and quality of life. My conclusion is that the coping theory and the natural behaviour theory are not in themselves adequate for the characterization of welfare, either for humans or for sentient animals. I contend, finally, that, in the light of the previous discussion, there are good arguments for a particular set of analyses of both animal and human welfare, viz. the ones that are based on the notions of preference satisfaction and positive subjective experiences.

In this first chapter a number of basic concepts related to health care and the care of older people are analysed. The analysis focuses particulary on the concepts of quality of life and dignity. These two concepts however, are not the only ones to be considered in a situation of care. There are other values with which we are perhaps better acqainted and which must play an important role. Among these are health, autonomy and integrity. In this chapter i present some of these values and analyse them to a certain extent. This should make it easier to comprehend the more complicated concepts of quality of life and dignity. The discussion of quality of life is included in this first chapter since it is so closely related to health, which is the first concept to be studied. The discussion of dignity is helt over to the next chapter, where it can be explored in greater detail; this is necessary because the analysis is largely original and som of the ideas are presented here for the first time.