Tag: residential facilities

Bioethics Blogs

A Good Death: Towards Alternative Dementia Personhoods

By Melissa Liu
Melissa is a Medical Anthropology PhD student at the U. of Washington, Seattle. Her nascent research circles the intersection of neuroscience, dementia, and design. Melissa is also a Neuroethics Fellow with the Center for Sensorimotor Neural Engineering, an NSF ERC.  
Something is amiss. Why is there a neighborhood of houses within this assisted living facility? Why do all the houses in the neighborhood have the same 1950s design? Am I standing on carpet? It looks like a garden path. The ceiling feels like a sunset in real time. [1] Where am I? When is this? The questions above are inspired by Lantern, one of several memory care facilities in Ohio based on a patent-pending memory care program created by Jean Makesh where rehabilitation is the goal [2] [3]. However, many more models around the world are based on Reminiscence therapy, a type of therapy which technically has “[no] single definition” but generally “[involves] the recalling of early life events and interaction between individuals” [4]. Research shows that “Reminiscence therapy is used extensively in dementia care and evidence shows when used effectively it helps individuals retain a sense of self-worth, identity and individuality” [4].

Reminiscence therapy serves as the foundation of many types of dementia village (DV) iterations. DV and similarly designed places are based on various models of caregiving and therapies. DV are memory care communities designed with the goal of caring for residents with dementia who live in their personal memories. The communities are designed to provide spaces for a high degree of reminiscence that allows freedom for residents to live their realities.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Ethical Dilemmas In Prison And Jail Health Care

Editor’s note: This post is published in conjunction with the March issue of Health Affairs, which features a cluster of articles on jails and health.

Prison and jail health care, despite occasional pockets of inspiration, provided by programs affiliated with academic institutions, is an arena of endless ethical conflict in which health care providers must negotiate relentlessly with prison officials to provide necessary and decent care.  The “right to health care” articulated by the Supreme Court pre-ordained these ongoing tensions.  The court reasoned that to place persons in prison or jail, where they could not secure their own care, and then to fail to provide that care, could result in precisely the pain and suffering prohibited by the Eighth Amendment to the Constitution.

Good reasoning was followed by a deeply flawed articulation of the “right” that defines the medical care entitlement as care provided to inmates without “deliberate indifference to their serious medical needs.” By forging a standard which was, and remains, unique in medicine and health care delivery — designed to avoid intruding on state malpractice litigation regarding adequacy of practice and standards of care — the court guaranteed that dispute would surround delivery.  That first framing, which did not establish a right to “standard of care” or to care delivered according to a “community standard,” set the stage for endless ethical and legal conflict.

The Eighth Amendment’s deliberate indifference standard, forbidding cruel and unusual punishment, presents a relatively demanding standard for proving liabil­ity.  The Eighth Amendment, as interpreted by the federal courts, does not render prison officials or staff liable in federal cases for malpractice or accidents, nor does it resolve inter-professional disputes — or patient-professional disputes — about the best choice of treatment.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.