Ageing well is the elephant in the room when it comes to aged care
I recently came across a quote from philosopher Jean Jacques Rousseau, talking about what it means to live well:
“To live is not to breathe but to act. It is to make use of our organs, our senses, our faculties, of all the parts of ourselves which give us the sentiment of our existence. The man who has lived the most is not he who has counted the most years but he who has most felt life. Men have been buried at one hundred who have died at their birth.”
Perhaps unsurprisingly, I found myself nodding sagely along as I read. Because life isn’t something we have, it’s something we do. It is a set of activities that we can fuse with meaning. There doesn’t seem much value to living if all we do with it is exist. More is demanded of us.
Rousseau’s quote isn’t just sage; it’s inspiring. It makes us want to live better – more fully. It captures an idea that moral philosophers have been exploring for thousands of years: what it means to ‘live well’ – to have a life worth living.
Unfortunately, it also illustrates a bigger problem. Because in our current reality, not everyone is able to live the way Rousseau outlines as being the gold standard for Really Good LivingTM.
This is a reality that professionals working in the aged care sector should know all too well. They work directly with people who don’t have full use of their organs, their faculties or their senses. And yet when I presented Rousseau’s thought to a room full of aged care professionals recently, they felt the same inspiration and agreement that I’d felt.
That’s a problem.
If the good life looks like a robust, activity-filled life, what does that tell us about the possibility for the elderly to live well? And if we don’t believe that the elderly can live well, what does that mean for aged care?
If you have been following the testimony around the Aged Care Royal Commission, you’ll be aware of the galling evidence of misconduct, negligence and at times outright abuse. The most vulnerable members of our communities, and our families, have been subject to mistreatment due in part to a commercial drive to increase the profitability of aged care facilities at the expense of person-centred care .
Absent from the discussion thus far has been the question of ‘the good life’. That’s understandable given the range of much more immediate and serious concerns facing the aged care sector, but it is one that cannot be ignored.
In 2015, celebrity chef and aged care advocate Maggie Beer told The Ethics Centre that she wanted “to create a sense of outrage about [elderly people] who are merely existing”. Since then she has gone on to provide evidence to the Royal Commission, because she believes that food is about so much more than nutrition. It’s about memory, community, pleasure and taking care and pride in your work.
Consider the evidence given around food standards in aged care. There have been suggestions that uneaten food is being collected and reused in the kitchens for the next meal; that there is a “race to the bottom” to cut costs of meals at the expense of quality, and that the retailers selling to aged care facilities wildly inflate their prices. The result? Bad food for premium prices.
We should be disturbed by this. This food doesn’t even permit people to exist, let alone flourish. It leaves them wasting away, undernourished. It’s abhorrent. But what should be the appropriate standard for food within aged care? How should we determine what’s acceptable? Do we need food that is merely nutritious and of an acceptable standard, or does it need to do more than that?
Answering that question requires us to confront an underlying question:
Do we believe aged care is simply about providing people’s basic needs until they eventually die?
Or is it much more than that? Is it about ensuring that every remaining moment of life provides the “sentiment of existence” that Rousseau was concerned with?
When you look at the approximately 190,000 words of testimony that’s been given to the Royal Commission thus far, a clear answer begins to emerge. Alongside terms like ‘rights’, ‘harms’ and ‘fairness’ –which capture the bare minimum of ethical treatment for other people – appear words such as ‘empathy’, ‘love’ and ‘connection’. These words capture more than basic respect for persons, they capture a higher standard of how we should relate to other people. They’re compassionate words. People are expressing a demand not just for the elderly to be cared for, but to be cared about.
Counsel assisting the Royal Commission, Peter Gray QC, recently told the commission that “a philosophical shift is required, placing the people receiving care at the centre of quality and safety regulation. This means a new system, empowering them and respecting their rights.”
It’s clear that a philosophical shift is necessary. However, I would argue that what’s not clear is if ‘person-centred care’ is enough. Because unless we are able to confront the underlying social belief that at a certain age, all that remains for you in life is to die, we won’t be able to provide the kind of empowerment you felt reading Rousseau at the start of this article.
There is an ageist belief embedded within our society that all of the things that make life worth living are unavailable to the elderly. As long as we accept that to be true, we’ll be satisfied providing a level of care that simply avoids harm, rather than one that provides for a rich, meaningful and satisfying life.
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BY Matthew Beard
Matt is a moral philosopher with a background in applied and military ethics. In 2016, Matt won the Australasian Association of Philosophy prize for media engagement. Formerly a fellow at The Ethics Centre, Matt is currently host on ABC’s Short & Curly podcast and the Vincent Fairfax Fellowship Program Director.
Look at this: the power of women taking nude selfies
The continuing moral panic over women’s naked selfies is fundamentally misframed. By emphasising the potential for women to be made victims, we ignore the ways a woman’s body can be an expression of power.
According to the prevailing moral panic of the day, young women take naked selfies in order to please others and not themselves. This, we’re told, leaves them vulnerable to exploitation because women must always be vulnerable.
It’s as though the only mystery afforded to women is not their thoughts or talents but what lies underneath their clothes. Go no deeper than the skin. Deny any complexity that might present her as a human with needs separate from what men may want.
This seems to be a narrative we teach teenagers. My daughter was taught that not only was there no legal recourse for photos shared without consent (untrue) but that the effects on women were so catastrophic that they should never send a naked photo (also, untrue). This happened on International Women’s Day, as if to remind us of our to-do list.
Inevitably, they learn what we teach. When I worked with teens on a short film, they told me how boys pestered every girl in their class for naked selfies. The girls didn’t even think it was sexual; more of a competitive collection like Pokemon Go but for undeveloped breasts. The requests were thought of as frustrating but normal, because “that’s just how they are”. Yet despite the mundanity of such a frequent request, the same teens sincerely believed leaked selfies would hound a woman to her grave.
Naked selfies carry many gendered clashes. I’ve always gasped at the difference between gendered aesthetics: I’ll rush to clean my room, groom and put on makeup before getting into an appropriate outfit of sorts before painstakingly composing shots; men just send a close-up photo of their cock jutting from a thicket of pubes.
It’s an effective example of the differences between the male and female gaze. A woman prepares because she is conditioned to know what men find attractive and that she is expected to deliver that. Men, conditioned to expect immediate access regardless of merit, put almost zero thought into their selfies. In the rare case they do, they project an image of themselves they want to see, rather than women who mirror what men want to see.
This positioning reinforces the power dynamic in heterosexual sexting. Men expect entertainment and women entertain at threat of exposure (also expected).
But why does the power lie with men?
On image sharing site Imgur, men enthusiastically share photos of naked women, even creating themed days for certain ‘types’ of women. But the images presented reflect the male gaze – photos taken of women, not by women.
Generally, whenever women posted selfies on Imgur, sexualised or not, she was immediately inundated with caustic remarks to stop being an exhibitionist (a polite euphemism for attention whore). That these are the same men who think nothing of going into a woman’s DMs to ask for naked photos is just another layer to it all. There is a clear mode of production, where women are the object and men remain in control of when and how they are seen. This is where the phrase “tits or get the fuck out” shows its intent: give us the body parts, not the entire body.
Perhaps this is because it is easier to sexually appreciate an object that has not been humanised or seen as an individual. When things are anonymised or presented in such a volume that they lose all semblance of individuality, they become an object that can be appreciated or abused without shame.
The power balance still rests with men – naked women are objects men readily expect, and demand to be presented in anticipated service of them. In this position of power, men expect women to arouse them, yet rarely consider whether women are aroused. Amazingly, we rarely discuss whether women find joy or pleasure in taking naked selfies, whether for themselves or others because we can’t move past women’s seemingly inevitable victimhood.
I’ve taken naked selfies for well over a decade. I first worried if photos might leak but, somewhat ironically, this concern has disappeared as I do more work in public. In Doing It: Women Tell the Truth About Great Sex, an anthology about sex, I wrote of how selfies can become graphic storytelling that not only builds intimacy but also an understanding of my sexuality and my sexual aesthetic pleasure. It is a power I never want to give up, so the book also contains a naked photo of me I had taken for a lover. It is a deliberate attempt to interrupt the means of production and also claim space within my sexuality, one that is defined by myself, not others.
When the photo was republished (with consent) by SBS, I wrote that “this is not some wishy-washy Stockholm syndrome masquerading as empowerment – there is ferocity in my choice”. It remains true today. By claiming my agency as an individual who feels pleasure and expression, I realise that confidence is not only crucial for my personal survival under patriarchy framed solely for men, but it is also a political act I can define as I choose. It makes me aware that my body, choices and actions are decided by me without reference to others’ expectations and that I contain greater complexity the roles of servant or victim that society allows.
Around this time, Mia Freedman wrote an article entitled ‘The conversation we have to have: Stop taking nude selfies’. Promoting the article on Twitter, Freedman wrote “taking nude selfies is your absolute right. So is smoking. Both come with massive risks.” In response, I took another naked selfie, but this time with a cigarette draped from my mouth and ‘fuck off’ written on my chest in black lipstick. I posted it everywhere without care because – again – my body, choices and actions are decided by me. I made the choice that and every day is that I will not have victims presented as complicit in their abuse. Because the fault will always be with the abuser, not the abused.
An act of power
Despite their conflicting emotions, publishing naked selfies taken in either arousal or anger are fearsome in their power. They are as much a rejection of victimhood as they are an opportunity for retribution. People can try to weaponise my body against me, but I will do it first and use it against them because I know its power.
This is why patriarchal structures and men condition women into submissive disempowerment. Women’s bodies are defined narrowly as vessels for pleasures and service for others, not ourselves. Such narrow and compliant definitions intentionally belie the power and complexity we contain.
Stories abound throughout history of the malevolent power of women’s bodies, so profound was male unease surrounding bloods and births. Women were told their vaginas ruined ship rope or their menstruation damned success. This was an admission women’s bodies were terrifying in their otherness but was also an excuse to contain them to the home rather than out in the community where they might gain power or control.
But history tells us many women believed in the power of their bodies. Balkan women would stand out in the fields, flashing their vaginas to the sky to quell thunderstorms. The Finnish believed in the magic of harakointi, using their exposed bodies to bless or curse on whim. Sheela-na-gigs (carvings of women often found in European architecture) embraced their power by spreading their labia, not to please or welcome men, but scare off evil. Women would lift their skirts to make others laugh in feasts for Roman gods and goddesses or lure lovers. More recently, women have exposed their bodies to protest petroleum in Nigeria or civil war in Liberia in acts of political, angry anasyrma.
Reframing the dialogue
The continuing moral panic over women’s naked selfies is fundamentally misframed. Women are presented as passively-defensive vessels in a state of perpetual victimhood. We are tasked with hiding our shameful-yet-coveted nakedness from people who expect to see us but only under their strict conditions.
A truer representation is that power exerts in all manners of life, including how we sexually communicate as equal, consenting partners. The moral panic should focus on when power corrupts that balance and how to correct it, not how to maintain the same corruption.
Join us as on 18 September for an an intimate conversation with Sexologist, Nikki Goldstein and art curator Jackie Dunn to unwrap the ethical dimensions of being nude. Get your ticket to The Ethics of Nudity here.
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BY Amy Gray
Amy Gray is a Melbourne-based writer interested in feminism, popular and digital culture and parenting. follow her on twitter @_AmyGray_
Ethical concerns in sport: How to solve the crisis
The Ethics Centre (TEC) has often been called upon to assist sporting organisations with ethical crisis.
The Ethics Centre recently took advantage of an opportunity to discuss two recent cases regarding ethical sport dilemmas with a group of HR Sport Executives. It was an enlightening experience and we’d like to share it with you.
As a reminder, TEC undertook two high-profile reviews of sporting organisations over the last 18 months, the Australian Olympic Committee (AOC) and Cricket Australia (CA).
The first of these explored the comparison between sportsmanship and the ‘pragmatic’ or even gamesmanship* approach to its administration. Bringing the two approaches was problematic and culminated in disenchantment, frustration and an organisational culture that neither represented the best of sport or organisational administration.
The Centre delivered a warts-and-all report with 17 recommendations, all of which were accepted. Recent discussions with AOC reveal a major shift in the culture of the organisation over the last 12 months, under the leadership of CEO Matt Carroll and the Head of People and Culture, Amie Wallis. AOC staff need to be congratulated for what they have achieved.
The other engagement was with Cricket Australia, a culture and governance review in response to the ball-tampering incident at the Newlands Ground in South Africa during an international test match in March 2018. It was clearly against the rules.
The initial attempts of the players to conceal what they were doing is testament to this. But it wasn’t as clean-cut as that. The incident seemed to represent an attack on something sacred to Australians. Many fans reacted as if they were personally afflicted.
Our interviews and surveys of CA staff, players, cricket officials, sponsors and members of the public often explored the difference between sportsmanship and gamesmanship. Comparisons were drawn between ball-tampering, sledging and the underarm bowling incident in 1981 during a One Day International cricket match between Australia and New Zealand.
We recently had the good fortunate of being invited to a discussion about such issues with a group of HR executives, representing some of the major professional sporting organisations in Australia, from Horse Racing to Rugby, organised by Mercer Australia.
And of course we accepted.
We put to them the observation that when there is fraud in government, the actions are often labelled corruption, as they signify a greater social betrayal than a breach of the law. Fraud in the private sector doesn’t attract the same moral outrage and avoids the ‘corruption’ label, with one exception: sport. Sport also uses the word ‘corruption’ to describe fraudulent behaviour. We asked why.
The group started with the suggestion that people take sport personally, as we all feel part of it and we all feel like we own it. We play it to pursue the best in us, we barrack for our team, we involve our children in it and we use it as a tool to teach our children about values, about what is important in life.
We all feel obliged to have an opinion about it, perhaps as Australians. This is probably why people feel fraud in sport is a moral issue that goes beyond compliance with the law, a social ‘evil’ that the word ‘corruption’ better conveys. There was also the feeling that corruption is used because it reveals the interconnected network that comes with fraud in sport.
When asked about the dilemmas in sport more broadly, many spoke about the challenge players experience balancing their need to win and earn income, with their long-term wellbeing.
Players often hide their injuries to avoid being dropped from teams. These injuries are often physical, but sometimes they are mental. The period where an athlete is most successful financially is narrow. The pressure to sacrifice their long-term health as a result is real.
As HR professionals they also spoke of their dilemmas, when they need to balance advocacy for the individual player with the best interests of the company or business side of the sport. They spoke of this also in relation to the management of the team, when the coach feels the need to let someone play because their family is present, even though it may not be in the best interest of a win.
They spoke about how officials are tempted to overlook bad leadership of team leaders when the characters themselves raise the winning morale of the team. Some spoke about the challenges of being considerate of a person’s background, but also being clear that it did not excuse bad behaviour such as sexual harassment.
We see related dilemmas in other sectors currently under the public spotlight. It is accepted that the unique relationship between sport and ethics has been neglected by philosophers.
There may be much to be learnt by our experience of sport, and how its values are brought to the wider theatre of life. These discussions help us reach a better understanding about these relationships.
* Gamesmanship is built on the principle that winning is everything. Athletes and coaches are encouraged to bend the rules wherever possible in order to gain a competitive advantage over an opponent.
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BY David Burfoot
David has worked in the not-for-profit, public and private sectors domestically and internationally for organisations as diverse as the United Nations Development Program, Deloitte, the NSW Independent Commission Against Corruption and Sydney University. He has been an anti-corruption specialist with a number of government agencies and held senior positions responsible for corporate planning, change and internal communications.
People with dementia need to be heard – not bound and drugged
It began in Oakden. Or, it began with the implosion of one of the most monstrously run aged care facilities in Australia, as tales of abuse and neglect finally came to light.
That was May 2017. Two years on, we are in the midst of the first Royal Commission into Aged Care Quality and Safety, announced following a recommendation by the Scott Morrison government.
The first hearings began this year in Oakland’s city of Adelaide. They have seen countless brave witnesses come forward to share their experiences of what it’s like to live within the aged care system or see a loved one deteriorate or die – sometimes peacefully, sometimes painfully – within it.
In May, the third hearing round will take place in Sydney. This round will hear from people in residential aged care, with a focus on people living with dementia – who make up over 50 percent of residents in these facilities.
With our burgeoning ageing population, the number of people being diagnosed with dementia is expected to increase to 318 people per day by 2025 and more than 650 people by 2056.
Encompassing a range of different illnesses, including Alzheimer’s disease, vascular dementia and Lewy body disease, its symptoms are particularly cruel, dissolving intellect, memory and identity. In essence, dementia describes the gradual estrangement of a person from themselves – and from everyone who knew them.
It is one of the most prevalent health problems affecting developed nations today – and one of the most feared. Contrary to widespread belief, one in 15 sufferers are in their thirties, forties and fifties.
Physical restraints
How do you manage these incurable conditions? How can you humanely care for the remnants of a person who becomes more and more unrecognisable?
One thing the Royal Commission has made clear: you don’t do it by defaulting to dehumanising mechanisms of restraint.
Unlike in the UK or the US, there are currently no regulations around use of restraints in aged care facilities. It is commonly resorted to by aged care workers if a patient displays physical aggression, or is a danger to themselves or others.
Yet it is also used in order to manage patients perceived as unruly in chronically understaffed facilities, when the risk of leaving them unsupervised is seen to be greater than the cost of depriving them their free movement and self-esteem. The problem of how to minimise harm in these conditions is an ongoing and high-pressure dilemma for staff.
Readers may remember the distressing footage from January’s 7.30 Report, in which dementia patients were seen sedated and strapped to chairs. One of them was the 72-year-old Terry Reeves. Following acts of aggression towards a male nurse, he was restrained for a total of 14 hours in a single day. His wife, however, had authorised that her husband be restrained with a lap belt if he was “a danger to himself or others”.
Maree McCabe, director of Dementia Australia, is vocal about why physical restraints should only be used as a last resort.
“We know from the research that physical restraint overall shows that it does not prevent falls,” she says. “In fact it may cause injury, and it may cause death.”
While there are circumstances where restraint may be appropriate McCabe says, “it is not there as a prolonged intervention”. Doing so, she says, “is an infringement of their human rights”.
After the 7.30program aired and one day before the Royal Commission hearings began, the federal government committed to stronger regulations around restraint, including that homes must document the alternatives they tried first.
Restraint by drugging
Another kind of restraint which has come into focus through the Royal Commission is chemical restraint. Psychotropic medication is currently prescribed to 80 percent of people with dementia in residential care – but it is only effective 10 percent of the time.
“We need to look at other interventions,” says McCabe. “The first to look at is: why is the person behaving in the way that they are? Why are they responding that way? It could be that they’re in pain. It could be something in the environment that is distressing them.”
She notes people with dementia often have “perceptual disturbances” – “things in the environment that look completely fine to us might not to someone living with dementia”. Wouldn’t you act out of character if your blue floor suddenly became a miniature sea, or a coat hanging on the door turned into the Babadook?
“It’s about people understanding of what it’s like to stand in the world of people living with dementia and simulate that experience for them,” says McCabe.
Whether through physical force or prescription, a dependence on restraint shows the extent to which dementia is misunderstood at the detriment of the autonomy and dignity of the sufferers. This misunderstanding is compounded by the fact that dementia is often present among other complex health problems.
Yet, and as the media may sensationally suggest, the aged care sector isn’t staffed by the callous or malicious. It is filled with good people, who are often overstretched, emotionally taxed and exhausted.
Dementia Australia is advocating for mandatory training on dementia for all people who work in aged care. This covers residential aged care, but could also extend to hospitals. Crucially, it encompasses community workers, too.
“Of the 447,000 Australians living with dementia, 70 percent live in the community and 30 percent live alone,” notes McCabe. “It’s harder to monitor community care, it’s less visible and less transparent. We have to make sure that the standards are across the board.”
It is only through listening to people living with dementia – recognising that while yes, they have a degenerative cognitive disease, they deserve to participate in the decision-making around their life and wellbeing – that our approach to it has evolved. Previously, people believed that it was dangerous to allow sufferers to cook, even to go out unaccompanied.
Likewise, it is crucial that we continue to afford people with dementia the full rights of personhood, however unfamiliar they may become. Only then can meaningful reform be made possible.
Besides, if for no other reason (and there are many other reasons), action is in our own selfish interest. The chances, after all, that you or someone you love will develop dementia are high.
BY Kate Prendergast
Kate Prendergast is a writer, reviewer and artist based in Sydney. She's worked at the Festival of Dangerous Ideas, Broad Encounters and Giramondo Publishing. She's not terrible at marketing, but it makes her think of a famous bit by standup legend Bill Hicks.
Corruption in sport: From the playing field to the field of ethics
Play fair or play to win. The interests of an individual player versus the team. Bad leaders who get good results.
These are just some of the common ethical tensions occurring throughout elite Australian sport. And they lead to corruption.
The Ethics Centre undertook two high profile reviews of sporting organisations over the past 18 months, the Australian Olympic Committee (AOC) and Cricket Australia (CA).
Australian Olympic Committee
Our AOC review explored the comparison between sportsmanship and gamesmanship. Sportsmanship is the fair, honest and decent treatment of others in competition. Gamesmanship, on the other hand, is built on the principle that winning is everything. Athletes and coaches are encouraged to plot, ploy and bend the rules wherever possible in order to gain a competitive advantage over opponents.
Bridging the two approaches was problematic. It culminated in disenchantment, frustration and an organisational culture within AOC that neither represented the best of sport or organisational administration.
The Ethics Centre delivered a warts-and-all report with 17 recommendations, all of which were accepted.
Recent discussions with AOC reveal a major shift in the culture of the organisation over the last 12 months, under the leadership of CEO Matt Carroll and the head of people and culture, Amie Wallis. AOC staff need to be congratulated for their achievements.
Ball tampering and Cricket Australia
The other engagement was with Cricket Australia – a culture and governance review in response to the ball tampering incident in South Africa in March 2018, something that was clearly against the rules.
Initial attempts by players to conceal what they were doing was testament to this, but it wasn’t as clean cut as that. The incident seemed to represent an attack on something sacred to Australians. Many fans reacted as if they were personally afflicted.
Our subsequent interviews and surveys with CA staff, players, officials, sponsors and members of the public often explored the difference between sportsmanship and gamesmanship.
Comparisons were drawn between ball tampering, sledging and the underarm bowling incident in 1981 during a One Day International cricket match between Australia and New Zealand.
Sporting HR executives
We recently had the good fortunate of being invited to a discussion about such issues with a group of HR executives, representing some of the major professional sporting organisations in Australia, from Horse Racing to Rugby, organised by Mercer Australia.
We put to them the observation that when there is fraud in government, the actions are often labelled corruption, as they signify a greater social betrayal than a breach of the law. Fraud in the private sector doesn’t attract the same moral outrage and avoids the label of corruption. But there is one exception. Sport also uses the word corruption to describe fraudulent behaviour. We asked why.
The group started with the suggestion people take sport personally, as we all feel part of it and like we own it. We play it to pursue the best in us, we barrack for our team, our kids play it, and we use it as a tool to teach our children about values and what is important in life. We feel obliged to have an opinion about it, perhaps as Australians.
This is probably why people feel fraud in sport is a moral issue that goes beyond compliance with the law, a social ‘evil’ that the word ‘corruption’ better conveys. There was also the feeling that corruption is used because it reveals the interconnected network that comes with fraud in sport.
When asked about the dilemmas in sport more broadly, many spoke about the challenge players experience balancing their need to win and earn income, with their long-term wellbeing. Players often hide injuries to avoid being dropped from teams. These injuries are often physical, and sometimes mental. The period where an athlete is most successful financially is narrow. This creates pressure to sacrifice long-term health.
As HR professionals they also spoke of their dilemmas, when they need to balance advocacy for the individual player with the best interests of the company or business side of the sport. They spoke of this also in relation to the management of the team, when the coach feels the need to let someone play because their family is present, even though it may not be in the best interest of a win.
They spoke about how officials can overlook bad leadership when the characters themselves raise the winning morale of teams. Some spoke about the challenges of being considerate of a person’s background, but also being clear that it did not excuse bad behaviour such as sexual harassment.
We see related dilemmas in other sectors currently under the public spotlight. It is accepted that the unique relationship between sport and ethics has been neglected by philosophers.
There may be much to be learned by our experience of sport, and how its values are brought to the wider theatre of life. These discussions help us reach a better understanding about these relationships.
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
BY David Burfoot
David has worked in the not-for-profit, public and private sectors domestically and internationally for organisations as diverse as the United Nations Development Program, Deloitte, the NSW Independent Commission Against Corruption and Sydney University. He has been an anti-corruption specialist with a number of government agencies and held senior positions responsible for corporate planning, change and internal communications.
Can robots solve our aged care crisis?
Would you trust a robot to look after the people who brought you into this world?
While most of us would want our parents and grandparents to have the attention of a kindly human when they need assistance, we may have to make do with technology.
The reason is: there are just not enough flesh-and-blood carers around. We have more seniors entering aged care than ever before, living longer and with complex needs, and we cannot adequately staff our aged care facilities.
The percentage of the Australian population aged over 85 is expected to double by 2066 and the aged care workforce would need to increase between two and three times before 2050 to provide care.
The looming dilemma
With aged care workers among the worst-paid in our society, there is no hope of filling that kind of demand. The Royal Commission into aged care quality and safety is now underway and we are facing a year of revelations about the impacts of understaffing, underfunding and inadequate training.
Some of the complaints already aired in the commission include unacceptably high rates of malnutrition among residents, lack of individualised care and cost-cutting that results in rationing necessities such as incontinence pads.
While the development of “assistance robots” promises to help improve services and the quality of life for those in aged care facilities, there are concerns that technology should not be used as a substitute for human contact.
Connection and interactivity
Human interaction is a critical source of intangible value for the development of human beings, according to Dr Costantino Grasso, Assistant Professor in Law at Coventry University and Global Module Leader for Corporate Governance and Ethics at the University of London.
“Such form of interaction is enjoyed by patients on every occasion in which a nurse interacts with them. The very presence of a human entails the patient value recognising him or her as a unique individual rather than an impersonal entity.
“This cannot be replaced by a robot because of its ‘mechanical’, ‘pre-programmed’ and thus ‘neutral’ way to interact with patients,” Grasso writes in The Corporate Social Responsibility And Business Ethics Blog.
The loss of privacy and autonomy?
An overview of research into this area by Canada’s McMaster University shows older adults worry the use of socially assistive robots may lead to a dehumanised society and a decrease in human contact.
“Also, despite their preference for a robot capable of interacting as a real person, they perceived the relationship with a humanoid robot as counterfeit, a deception,” according to the university.
Older adults also perceived the surveillance function of socially assistive robots as a threat to their autonomy and privacy.
A potential solution to the crisis
The ElliQ, a “home robot” now on the market, is a device that looks like a lamp (with a head that nods and moves) that is voice activated and can be the interface between the owner and their computer or mobile phone.
It can be used to remind people to take their medication or go for a walk, it can read out emails and texts, make phone calls and video calls and its video surveillance camera can trigger calls for assistance if the resident falls or has a medical problem.
The manufacturer, Intuition Robotics, says issues of privacy are sorted out “well in advance”, so that the resident decides whether family or anyone else should be notified about medical matters, such as erratic behaviour.
Despite having a “personality” of a helpful friend (who willingly shoulders the blame for any misunderstandings, such as unclear instructions from the user), it is not humanoid in appearance.
While ElliQ does not pretend to be anything but “technology”, other assistance robots are humanoid in appearance or may take the form of a cuddly animal. There are particular concerns about the use of assistance robots for people who are cognitively impaired, affected by dementia, for instance.
While it is a guiding principle in the artificial intelligence community that the robots should not be deceptive, some have argued that it should not matter if someone with dementia believes their cuddly assistance robot is alive, if it brings them comfort.
Ten tech developments in Aged Care
1. Robotic transport trolleys:
The Lamson RoboCart delivers meals, medication, laundry, waste and supplies.
2. Humanoid companions:
AvatarMind’s iPal is a constant companion that supplements personal care services and provides security with alerts for many medical emergencies such as falling down. Zora, a robot the size of a big doll, is overseen by a nurse with a laptop. Researchers in Australia found that it improved the mood of some patients, and got them more involved in activities, but required significant technical support.
3. Emotional support:
Paro is an interactive robotic baby seal that responds to touch, noise, light and temperature by moving its head and legs or making sounds. The robot has helped to improve the mood of its users, as well as offers some relief from the strains of anxiety and depression. It is used in Australia by RSL LifeCare.
4. Memory recovery:
Dthera Sciences has built a therapy that uses music and images to help patients recover memories. It analyses facial expressions to monitor the emotional impact on patients.
5. Korongee village:
This is a $25 million Tasmania facility for people with dementia, comprising 15 homes set within a small town context, with streets, a supermarket, cinema, café, beauty salon and gardens. Inspired by the dementia village of De Hogeweyk in the Netherlands, where residents have been found to live longer, eat better, and take fewer medications.
6. Pub for people with dementia:
Derwen Ward, part of Cefn Coed Hospital in Wales, opened the Derwen Arms last year to provide residents with a safe, but familiar, environment. The pub serves (non-alcoholic) beer, and has a pool table, and a dart board.
7. Pain detection:
PainChek is a facial recognition software that can detect pain in the elderly and people living with dementia. The tool has provided a significant improvement in data handling and simplification of reporting.
8. Providing sight:
IrisVision involves a Samsung smartphone and a virtual reality (VR) headset to help people with vision impairment see more clearly.
9. Holographic doctors:
Community health provider Silver Chain has been working on technology that uses “holographic doctors” to visit patients in their homes, creating a virtual clinic where healthcare professionals can have access to data and doctors.
10. Robotic suit:
A battery-powered soft exoskeleton helps people walk to restore mobility and independence.
BY Fiona Smith
Fiona Smith is a freelance journalist who writes about people, workplaces and social equity. Follow her on Twitter @fionaatwork
What ethics should athletes live by?
Athletes are bound by multiple codes – including the formal rules of the games they play and the informal conventions that define what is deemed to be acceptable conduct.
Professional athletes are often bound by a more stringent code that governs many aspects of their public and private lives. In an era of social media and phone cameras, lucrative sponsorships and media rights, online sports betting and performance enhancing drugs, there is very little that isn’t regulated, measured or scrutinised.
The culture of sport
The formal rules of any game establish the minimum standards that bind players and officials equally in order to ensure a fair contest. Not surprisingly, the formal rules are relative to the sports that they define: you can tackle someone to the ground in a rugby match (provided they’re holding the ball), but it would be deemed unacceptable in tennis.
But there are also conventions and informal obligations that define the culture of sport. For example, most sports establish informal boundaries that seek to capture a spirit of good sportsmanship. The cricketer who refuses to “walk” after losing their wicket – or who delivers a ball under-arm – may not be breaking any formal rule, but they’ll be offending the so-called spirit of cricket.
The sanctions for such an offence may be informal, but may blight that player’s career.
A question of trust
In sport, the bottom line is trust. Sportspeople are stewards for the games they play – with an obligation not to destroy the integrity of the sports in which they participate. Athletes tend to be intensely competitive, seeking victory for themselves, for their team or sometimes their nation.
Professional sports sell themselves to the public on the basis that the contests are real and, hopefully, fair. Every time two teams or competitors walk out onto the field of play, they place so much at stake – far more than just the result of one game.
That is why evidence of match fixing, doping or cheating is so destructive – it destroys public trust in the veracity of the competition that people pay to watch. It damages the reputation of the sport. And it is ultimately self-defeating – always leaving doubt in the dishonest victor’s mind, denying forever the satisfaction of a honest win.
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BY The Ethics Centre
The Ethics Centre is a not-for-profit organisation developing innovative programs, services and experiences, designed to bring ethics to the centre of professional and personal life.
Want your kids to make good decisions? Here’s what they need to learn
Ask just about any parent what they want for their children and they’ll give you roughly the same answers: we want our kids to be happy, healthy and – perhaps most importantly – good.
For many parents, the goal is to raise children who are better than they are, contribute positively to the world around them, challenge cruelty, injustice and ignorance in the world and make a positive difference in other people’s lives.
Basically, what they’re wanting is that their kids grow up to be ethical people. So, if that’s what so many of us want, it’s worth understanding exactly what ethics is and how we might light the ethical spark in the next generation.
Ethics is a branch of philosophy – it asks questions about the nature of goodness, what makes something right and wrong, and what makes life worth living. As a branch of philosophy, it also leaves no stone unturned. It interrogates any and every claim about what’s right, what’s wrong and what’s ‘normal’.
Whenever we make a choice, we change the world in some small way. Before us are a whole bunch of different possible worlds – it’s up to us to decide which one we’ll turn into reality. Ethics helps us make sure we’re choosing the best of those possible worlds, but it takes practice to do it well.
That means if we’re going to help our kids be ethical people, we need to model ethical thinking in our homes and classrooms, on sports fields and video games and wherever kids are making decisions.
But how do we do it? Here are a few tried and true techniques the ABC’s Short & Curly team have used over the last few years.
1. Don’t be afraid to say ‘I don’t know’
It can be scary to say “I don’t know” – especially when we’re having a conversation with kids. As adults, we’re supposed to have all the answers, right? The problem is, sometimes we don’t. And neither do the young people we’re talking to.
The more we pretend we know it all, the more self-conscious others feel about engaging us in a real conversation, or worse – disagreeing with us! Philosophers use discussions and debate as a team activity – we use disagreement and criticism as a way to work together to find out what’s true.
What’s more, our beliefs about how the world works are often conditioned on what we’ve learned or been told is normal. What we know about fairness, honesty or whatever the topic is might not be the final answer – it could be conditioned by norms and beliefs we’ve been conditioned to believe, even if they don’t hold up to close analysis.
2. Be imaginative
Martha Nussbaum, one of the world’s pre-eminent philosophers, says “you can’t really change the heart without telling a story.” We’re narrative creatures – we’ve always used parables, fables, literature and film as ways of understanding the world around us.
Philosophers have tested their ideas through thought experiments and hypotheticals throughout time. They’re super weird, but they make for great road-trip fodder or dinner table debates.
Ethical reflection demands imagination. It requires us to be able to understand experiences we haven’t lived through and to empathise with people who might be radically different to us.
The next time you’re reading a book or watching a movie with your young one, that’s a moment for reflection. Did those characters do the right thing? How do you think that person felt? Would it have been OK if they’d broken that promise?
3. Don’t shut down a question
Some of our favourite one liners are actually really good ways of undermining ethical conversations. “Everybody does it”, “because I said so” and “you’ll understand when you’re older” are good examples. They rely on authority, tradition or experience as ways to cut off what might be a more productive conversation.
Sometimes, there’s not time for an ethical discussion, but rather than shutting it off with a one-liner, make a commitment to talk about it in more detail later, when you’ve got more time to explain yourself.
4. Question your assumptions
Our minds love telling stories – and we hate plot holes. If we don’t have the full story, we’ll often fill in the gaps with assumptions or inferences that don’t capture the full picture. Ethical conversations work best when they start by questioning what we think we know for sure. Are we starting our discussion on a good foundation?
5. Be curious and research
As well as checking our assumptions, ethics requires us to be curious and informed about the world around us. As much as many philosophers would beg to differ, we can’t understand the world from an armchair.
We need to do some research and uncover relevant facts. Bonus – while you’re doing some research together, you might be able to work together to understand the difference between a fact and an opinion, spot dodgy sources or filter out fake news.
6. Listen to and test your emotional responses
Our emotions are an important part of the way we make judgements, but they can sometimes run wild and lead us astray. Just because we find something disgusting, offensive or hurtful, doesn’t make it wrong. And just because we find something pleasant, fun or funny doesn’t mean it’s OK.
Add “yuck” and “yum” to your list of banned arguments – just because something makes you feel squeamish doesn’t make it bad. Listen to your emotions, but get curious about them – they need to be tested like everything else.
One final note: these tips won’t guarantee a kid won’t do the wrong thing sometimes – like all of us. But it will help you have a shared language for communicating, in a meaningful way, why what they did was wrong.
We all make judgements – it’s part of who we are – ethics helps us build the skills and character to ensure we’re making those judgements in ways that are alive to the world around us and the people within it. And like any skill, it’s easier to master if you start young.
The Short & Curly Guide to Life
What makes something good or bad?
Why are things the way they are? How come it’s so hard to work out the right thing to do? The Short & Curly Guide to Life is an imaginative look at some of life’s biggest and trickiest questions. Figuring out what’s right is way more fun than you think!
Short & Curly Guide to Life is on sale at book stores around Australia and via major online retailers. You can also tune into the ABC Radio podcast, Short & Curly, here.
Matt Beard is the resident philosopher on the ABC Podcast Short & Curly, and the author of The Short & Curly Guide to Life (Penguin Random House). Find him on Twitter @matthewtbeard
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BY Matthew Beard
Matt is a moral philosopher with a background in applied and military ethics. In 2016, Matt won the Australasian Association of Philosophy prize for media engagement. Formerly a fellow at The Ethics Centre, Matt is currently host on ABC’s Short & Curly podcast and the Vincent Fairfax Fellowship Program Director.
Big Thinker: Temple Grandin
Turning a perceived disability into a new way of solving problems, Temple Grandin (1947—present) has revolutionised the meat-processing industry and changed the way the world views autism.
Temple Grandin is an autism advocate and animal scientist who works to improve animal treatment in the livestock industry. Grandin has also changed public perceptions of autism, helping educators to maximise the strengths of those with autism, rather than focusing only on deficiencies.
An animal lover and meat eater, Grandin has used her autistic trait of “thinking in pictures” to design livestock facilities and educate meat produces on how to minimise animal suffering. As a result, she says there’s been ‘light years of improvement’ in an industry where half of all cattle in the United States are handled in facilities she designed.
This isn’t enough for some animal rights activists though, who accuse her of trying to soften the image of a ‘violent’ sector.
Thinking like a cow
Temple Grandin did not talk until she was three and a half years old. She struggled to communicate throughout her childhood, and other students bullied her at school.But there was one high school teacher, Mr Carlock, who saw something special in her. He mentored the troubled girl and encouraged her to study science.
Shocked by the cruelty she saw in abattoirs, Grandin combined her love for science and animals by fixating on designs to improve animal welfare in these facilities. Grandin knew she learned better by visualising, rather than reading and hearing long strings of words. In this respect, her thinking pattern was similar to animals, who don’t ‘speak’ a language.
She observed cattle in slaughterhouses, seeing how they responded to fear, senses, smells and visual memories. When cows can see they’re about to be killed, they panic, fall and injure themselves. To combat this, Grandin invented the curved loading chutes, which block their vision of what’s ahead, keeping them calm.
This not only improves animal welfare, it saves producers the cost of cattle death, injury and bruising – which also reduces the quality of meat. Grandin has spent her career designing livestock facilities to improve the way animals are treated.
In 1997, she worked with McDonalds after activists exposed animal torture on their production plants. She helped the fast food chain clean up cruel practices and restore its public image.
In 2010, Time Magazine named her one of the 100 most influential people in the world for her work in animal welfare.
We need autistic minds
Grandin has also changed public perceptions of autism, a condition relatively unknown when she grew up. She argues people on the autism spectrum – who tend to struggle with verbal communication but think in pictures – can provide more insight in certain fields than those who think in a more conventional mathematical way.
“Visual thinking is an asset for an equipment designer. I am able to ‘see’ how all parts of a project will fit together and see potential problems.”
Grandin encourages teachers to develop the strengths of autistic children, and has devised clever ways to combat perceived flaws.Like many on the spectrum, she is oversensitive to touch. “I always hated to be hugged”, she says.
So at age 18, she built a ‘squeeze machine’ – two hinged wooden boards lined with foam rubber, which allows users to control the amount and duration of pressure applied. Therapy programs across the United States continue to utilise squeeze machines, with research showing they help relieve stress in users.
Hero or villain?
While considered a hero in the autism community, Grandin’s work divides animal welfare activists. People for the Ethical Treatment of Animals (PETA), the world’s largest animal rights group, appreciate and publish her work. Others, like biologist Marc Bekoff, hold that no animal in captivity can enjoy a pleasant life. Bekoff would rather see Grandin encourage people not to consume factory farmed animals; to him, “‘slightly better’ isn’t good enough”.
“No animal who winds up in the factory farm production line has a good or even moderately good life.” – Marc Bekoff
Grandin’s retort is that without meat eaters, farm animals would have no life at all. She argues if animals are going to die anyway, it’s important to minimise their suffering.
Does this apply to humans too?
The New York Times once asked her if she’d consider helping to make capital punishment more humane. Her response was blunt.
“I have read things about the malfunctions of the electric chair… I know how to fix it, but I will not use my knowledge to have any involvement in that. I will not cross the species barrier to help kill people. Period.”
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The moral life is more than carrots and sticks
Almost everywhere I go to talk about ethics, I face some variation of the question: ‘Why be ethical?’ The question flummoxes and depresses me.
That’s partly because I can’t help but feel the question is basically ‘What’s in it for me?’ dressed up with a bit of academic, devil’s advocate flavour. But it’s also because to ask that question at all, you’ve got to have a pretty bleak sense of who people, at their core, really are.
But all the same, there are lots of people who have set out to answer precisely this question. Most of them are somehow connected to the world of institutions — government, business, non-profits and so on. You know, all the groups who studies suggest are haemorrhaging trust.
There’s nothing wrong with answering this question per se — in fact, it’s an interesting and challenging project that’s challenged philosophers since more or less the time the disciplined divorced from theology. But the answers are leaving me more-or-less equally disheartened as the questions themselves.
One common answer has to do with trust. And the thinking fits pretty well into the carrot/stick dialectic. The carrot approach goes a bit like this: data tells us ethical organisations are more trusted by other stakeholders, recruit and retain better staff and might even make more money.
The stick approach goes like this: unethical behaviour leads to a decline in trust, which leads to increased regulation, reporting and accountability. It stifles innovation, restricts opportunities and costs money.
The second answer is alluded to in the discussion of trust: regulation. The reason you should be ethical is because if you don’t we’ll catch you and hold you accountable for what you’ve done. People can’t be trusted to do the right thing, so we introduce safeguards to stop them from doing the wrong thing.
These two arguments boil down to self-interest on one hand and fear on the other. They respond to the part of humanity that is self-interested, petty and manipulative. That’s not necessarily a problem — failing to manage this aspect of humanity usually leaves the most vulnerable to suffer — but it’s an incomplete picture of who we are.
“The more we conflate ethics with trust, regulatory standards or “enlightened self-interest”, the less space we allow for morality to play a salvific role — not just to stop bad, but to make good.”
About 250 years ago, the German philosopher Immanuel Kant wrote The Groundwork to the Metaphysics of Morals. Kant, in his brilliant but not-very-pithy way, argued that the only thing that has true moral worth is what he called ‘the good will’. The good will is the desire to do good for its own sake — regardless of the effects. Here’s Kant at his most poetic:
‘Even if by some particular disfavour of fate, or by the scanty endowment of a stepmotherly nature, this will should entirely lack the capacity to carry through its purpose; if despite its greatest striving it should still accomplish nothing, and only the good will were to remain … then, like a jewel, it would still shine by itself, as something that has full worth in itself.’
I worry that the way we talk about ethics today makes the formation of a good will, or some variation on it, impossible. This is because for regulatory and trust-based approaches to ethics, there’s always something outside morality that serves as motivation. It’s Santa Claus for grown-ups: we behave so we get presents instead of coal. And I’m not certain it works — I’m not inclined to trust someone who has ulterior motives for gaining my trust.
What’s more, it’s not clear how this approach to trust applies to groups who don’t need trust — think ‘too big to fail’ — and don’t have to fear regulation (perhaps they’re the ones who make the law). What reasons do they have for doing the right thing? And how might they define the right thing in a more morally sensitive way than pointing to their clean hands in the eyes of the law?
What is missing from this picture is anything that might generate a deep understanding — and love — of what’s good. The more we conflate ethics with trust, regulatory standards or “enlightened self-interest”, the less space we allow for morality to play a salvific role — not just to stop bad, but to make good.
I wholly understand the desire to minimise harm, prevent wrongdoing and serve justice. I also acknowledge the utility value in speaking the language of people’s desires — if people have been taught to think in terms of outcomes and self-interest, we may as well turn it to our advantage. But the more we do it, the more we entrench a mode of thinking that is at best narrow and at worst antithetical to the moral life itself.
It might still be that in the great moral trade-offs of life, protecting the vulnerable is more important that my high-minded philosophy. But we should at least know what we’re turning our back on — because in stopping people from doing bad, we might be preventing them from ever being good.
This article was originally written for Eureka St. Republished with permission.
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